C-sections and External Versions

This is a topic that I feel quite strongly about. I feel so lucky that with the birth of my daughter, that I was not pressured to have a c-section after I stalled for nine hours at 6 centimeters dilated. Without my amazing midwife and the team I had, I really don’t know what would have happened. Thankfully, it was never even mentioned. But for how many women is it? And how many of those women end up feeling pressured to have one? And lastly, how often is it really necessary?? This will always be one of those things that I will learn as I go. This, obviously, does not have anything to do with times in which a c-section would be appropriate.

The following link will take you to an article written by an OB regarding the top ten signs he/she may be planning a c-section. I agree with most of the points, however #6 regarding a breech baby and performing an external cephalic version (ECV) as the “remedy”. I work in a hospital and in my experience, these are not super successful. Seems that about half the time they work and the other half, they don’t. Then there is a small percentage of the babies who do flip from the ECV but then go back breech before labor begins. Then what? AND not to mention that every woman I have talked to has said that this is so incredibly painful. If you are under the care of a midwife, the on-call OB is the one to perform the ECV. You have to be hooked up to an IV for a number of reasons because it is risky. Placental abruption, cord twisting, and labor onset (which could be as early as 36 weeks) are just a few and really, these are not very common, but something to be aware of. My thoughts are: why not just deliver a breech baby? It seems that many facilities still shy away from allowing healthy moms and babies to deliver in the breech presentation. Transverse breech would be the only time in which I would see a c-section necessary. The hospital I work in and where I delivered both my babies does not yet allow breech or water births unless delivery is imminent (as in-within minutes of arrival). It does happen. I remember when a mother delivered a footling breech baby in front of the ER in her car. Then there was the mama who rode into the birth center backwards on a wheel chair with a tiny little foot ready to come out. There are risks with breech deliveries too. The baby who was born outside the ER did suffer a broken clavicle.

Anyway, this is not the most educationally driven post. I just wanted to write out some thoughts on the subject. Please share your experience with both breech and an ECV, especially if you are already a student or working midwife.

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Book Review: Get Me Out (Part 1-2)

(A note: I KNOW this is long. Please, if you have any interest in this subject, read through. I add several direct quotes from the book which I feel are important. Thank you for checking it out! If you’ve read this, please leave your thoughts in the comments and if you haven’t, well, you should!)

I have been so excited to share this book with you guys! It wasn’t even on my reading list (see tab above) and as I was checking books out over the weekend I found this little gem.

Get Me Out was written by Randi Hutter Epstein, MD and is a comical, factual, and historical account of the history of childbirth “from the Garden of Eden to the Sperm Bank” as the front cover reads. As most of you readers out there are childbirth guroos like myself, you may also know of Abby Epstein, co-author of Your Best Birth with Ricki Lake. I have yet to find any credible resource that these two are related somehow, however I would not be surprised if they were.

This post is only to summarize and discuss the first two parts of the book (I just couldn’t wait!) as I am still reading it. The book starts off with a lot of history in regards to how the concept of childbirth came about. Many believed that labor pains were “the curse of Eve” since she ate that damn apple. Regardless of your spiritual beliefs, the book does an excellent job of bringing forth history which most have never even heard of and most of which is rather comical. For example, many believed that “good sex made for good babies” but no one really defined what “good sex” was, just that if you had a “good baby” then you must have had “good sex” at conception.

Epstein goes on to discuss how childbirth tools came about, specifically forceps and the speculum. and how the inventors of those tools were mearly trying to prevent internal damage to the woman, specifically vesicovaginal fistulas (holes/tears) from childbirth. It’s disturbing to read that these doctors tested out their new inventions on slaves because if a woman was so damaged during childbirth, then she was useless to her owner and breeding more slaves was an important aspect to maintaining the plantation.

Homebirth was the only way women gave birth hundreds of years ago and historically, no man was allowed in the birthing room. Only midwives and her supporters (sisters, mother, etc). A male doctor once dressed as a woman and entered the birthing room. Once he was discovered he was killed. Seriously?! It’s this kind of history that has me hanging on every word in the book, to think that men were truly not allowed and today, thousands of male OBs practice and treat women. Wow.

Maternal and infant mortality is discussed quite a bit, mostly in regards to how the birth was handled as men seeped their way into the birthing room. Doctors never washed their hands before seeing patients, causing a huge rise in deaths to mothers from childbed fever. It was very common for a doctor to see a patient to her death and go into the next room to deliver another baby and passing on infection to both. Even in the early 1900s hand-washing was still not believed to prevent the spread of infections.

At the turn of the 20th century, the ideas of a Lying-In hospital began to open up across the country, the new birth place for women. Women were told that there was nothing safer than giving birth at the Laying -In hospital, despite the maternal mortality rate staying the same for several years due to lack of hand-washing, among other things (uneducated doctors, student-doctors, misuse of tools, hemorrhaging, etc).

Lastly, twilight sleep. I had never heard of this form of childbirth until now. Women were fighting for their rights in the early 1900s and one of those rights was to give birth without pain (which is ironic today, since natural, med-free childbirth is harder to push for). Two docs put an odd concoction of drugs together (morphine and scopolamine) and within a few hours the mother was not pain-free, but “awoke” hours later to find that she’d had her baby and had no recollection of the pain when in fact she was writhing in pain, being restrained to her bed and treated like a wild animal. Yeah, nuts I tell ya.

As I like to do with all my reviews, here are my favorite notations so far (chronological from the beginning of the book through part two):

(Middle Ages) One guide-book told women that getting pregnant was the same as catching a serious disease-an opportunity to die.

When do you call for extra measures and when do you let nature take its course? It’s a debate that began in the late sixteenth century but resonates loudly and clearly into the twenty-first.

Sims was not the first person to do vaginal-tear experiments on slaves. But he was the first one to do it successfully and the first one to turn his procedure into global fame and fortune. Fifteen years before Sims did his trails, Dr. John Peter Mettauer tried the same kind of thing on several slaves, but he used lead sutures instead of silver.

There was no such thing as informed consent-or any kind of consent, informed or otherwise.

Sims used his newest invention, the speculum, made from two large spoons he picked up at the local hardware store.

He created the so-called Sims position: placing a woman in a fetal position to make it easier to look inside.

Sometimes doctors went from autopsy to delivery, back and forth-death to birth, birth to death, chaffering germs with them. Long before doctors eyed bacteria or knew anything about them, a few scientists suspected contagion. They did not know what was spreading but had a hunch something awful was passing from one sick new mother to the next.

The hand that is relied upon for succor in the painful and perilous hour of childbirth becomes the innocent cause of her destruction.

Then Semmelweis reasoned that doctors who perform autopsies before delivering babies carried something deadly from the morgue to the delivery room. He was proposing a sort of germ theory without knowing anything about germs. His colleagues saw otherwise. They saw a young arrogant doctor claiming that doctors were murderers.

The germ theory provided one reason for illness, but it was at odds with several other well-rooted theories.

Joseph Lister discovered that carbolic acid destroyed germs lurking in wounds; he named his cleaning technique antisepsis. And Rober Kock devised a four-step program to prove, without a shadow of a doubt, that germs triggered illness.

Kochk’s four steps: 1) The bacteria must be present in every case of the disease, 2) the bacteria must be isolated from the host with the disease and grown in pure culture, 3) the specific disease must be reproduced when a pure culture of the bacteria is inoculated into a healthy susceptible host and 4) the bacteria must be recoverable from the experimentally infected host.

Events during the turn of the twentieth century proved that germs caused the disease; that doctors passed the infection to patients; and that antiseptic technique (scrubbing between patients) prevented infections.

About 8 mothers died for every 1,000 births.

By the turn of the twentieth century, doctors accepted the idea that germs caused childbed fever. But for the next few decades, many of them could not accept the idea that they carried the germs.

They promoted an autoinfection theory, insisting that new mothers got sick by ‘infecting or by the spread of an inherently bacteriologically fertile reproductive organs’, aka endotoxin theory (a toxin growing from within).

Eventually, other studies would make it crystal clear that pregnant women may be more susceptible to colds and flu, but the pregnant womb does not grow its own garden of bacteria. The endotoxin theory died. The only way a women got childbed fever was by having a contaminated band or instrument inserted during delivery.

They (doctors) believed they were saving lives by luring women away from midwives and into the hospital, where doctors could control the business of babies. Ironically, what they thought was the best medical care was sometimes the deadliest.

They (doctors) hoped the buzz about the reopening of the Laying-In hospital would dissuade women from going to midwives.

In 1900, 5 percent of women gave birth in hospitals. By the 1930s, about half of all women and 75 percent of women in cities delivered in hospitals. And by the 1960s, nearly every pregnant woman chose a hospital birth over a home birth.

The feeling among most women was that if you wanted to survive childbirth, you were better off at home and far away from maternity wards.

It was not only a move from home to hospital, it was a move from one culture to another, from the familiar to the strange. It meant you were on doctor’s turf.

In 1900, a baby was born in New York City every 10 minutes.

Doctors believed that women needed to be in the hospital to get the best care in the cleanest surroundings. They also knew that a hospital birth spared them from running from house to house.

Dammerschlaf, or twilight sleep, as it would become known in America, provided women with drugs during labor that lulled them into a woozy forgetfulness during the birth of the baby.

The added amnesia meant that women felt pain but forgot about it-which makes you wonder if anything is painful if there is no memory.

Sheppard-Tower Maternity and Infancy Protection Act, a federal program that gave grants to states for prenatal and child health clinics. The act also provided funding for nutrition and hygiene education, midwifery training, ad home visits by nurses to check on pregnant women.

The Twilight Sleep Association illustrates, perhaps more than any other turn-of-the-centurey organization, the zeal of the early feminists; the simmering anger toward male doctors; and the power of the media to shape public opinion.

Yet there were plenty of doctors who thought that women who could not bear the discomfort of childbirth could not withstand the selflessness of motherhood.

Drug advocates convinced women that taking medicine was not a sign of weakness but was healthier for themselves and their newborn.

Childbirth drugs diminished uterine contractions and caused hallucinations. It also impared newborn breathing. Doctors  called it newborn oligopnea, halted breathing. The doctors reassuringly added that while some twilight babies stop breathing for a bit, they never turn blue.

A Long Island doctor wrote a letter to the editor of the New York Times calling its twilight-sleep stories an ‘unprofessional and dangerous way of misinforming the public’.

Forgetting the moment of birth should not make any difference whatsoever on the kind of mothers these women would become. Epidurals, which remove pain but allow women to be alert, were a long way away.