Speaking of books...

Because I was speaking of books earlier, to wit, "Baby Led Weaning," a resource I'd like to refer to a skeptical friend to so that she can understand it a little bit better. But it's not stocked by any of the local libraries, including Super Big County (Fairfax, VA) library system, where I have a card because I work in this county.

It made me realize that I would happily buy this book for all the local libraries if I knew for certain they would add it to their collection as opposed to shifting it over to the book sale pile.

Most libraries, however, do accept requests for books, and it occurs to me that we crunchy-inclined mamas could do ourselves a great favor by making sure our favorite books on pregnancy, birthing, and parenting are stocked by the local library. Fairfax has the books by Ina Mae Gaskin, but not the one by Henci Goer, for instance.

(Although I just found The Thinking Woman's Guide to a Better Birth on Google Books, available as a limited preview. Tell your friends!)

So my question for you, dear readers, is...

What books would you recommend for your dream library collection? What books should every library have on hand and feature more prominently than, say, What to Expect on the pregnancy/birth/parenthood display rack?

Fighting Intervention Harassment

Desirre Andrews made a fascinating post over at PrepForBirth that itemizes interventions that often aren't necessary but are often pushed, subtly or not so much. Because I've now dubbed what I went through during my second labor "intervention harassment," I'm going to encourage you to read her post and then come back here to see how many of these things I either endured (in bold) or refused (in italics).

* The uniform
* Who’s on first?
* On a short leash. (I was on a medium one, actually, only confined to bed 20 minutes out of every 2 hours.)
* The big drag around – I was browbeaten for refusing the IV and finally consented to a heplock just to shut the frackin' nurse up.
* Staying put
* Ice chips and Jello I didn't even get jello.
* The marketing tool – Nah, I didn't feel like getting into the shower, honestly.
* One is enough They would have let me have a second person, but what they had in place was frustrating. Absolutely no one but those two people, and no one under 18 for our entire stay, which put the kaibosh on the kids meeting their baby brother.
* I know more than you– I got this, but in a defensive way, not an offensive way. I had come up swinging as soon as she ordered pit the first time, and she felt like she had to remind me that she had gone to school for this.
* If you don’t… – I can't count the number of times she came up with excuses to intervene. The most absurd was her combing through the monitor print-out, and pointing to an instance where the baby had moved away from the transducer as evidence that the baby was in distress. I actually laughed at her. "If it happens again," she said, "you're getting the pit." I spent the next two sessions on the monitor panicking over what she might do every time his heart beat slowed down even a little.
* Attitude and atmosphere – My day nurse seemed almost terrified of me, and because I was getting a rap as an uncooperative patient, I spent most of the day miserable--and progressing slowly. When the natural-birth-fluent night nurse came on, the energy changed, and I opened right up.
* Only if you ask – Kind of. There were things I should have asked for, but it wasn't until the night nurse came on that I realized what I should have asked for.
* Bait and switch – Thank goodness, not for me. But I did notice something about the childbirth ed class: they talk about all this walking around you can do, and gloss over the fact that once you have an epidural, you're not leaving the bed. Considering that everyone in the class but me was planning an epidural, I felt it was irresponsible of the educator to be singing the praises of walking during labor--so I pointed out the incongruity for the benefit of my classmates.
* New with bells and whistles – I don't think they were pushing interventions for a better bottom line.
* Routine vaginal exams – I refused all vaginal exams after I got to 5 cm until I felt the urge to push, but getting to 5 was a battle because of the environment.
* Pushing the epidural – Didn't apply to me since I had refused the basics that were needed for an epidural. but omg, the pit-pushing! That I refused it four times still blows my mind, and I'm starting to feel like the pressure to accede to these procedures constitutes intervention harassment. And while I'm sure there are folks that say, hey, at least you fought it and won.. there was this horrible hour between 6 and 7 when I began to doubt myself.

In other words, that harassment almost worked, and if it hadn't been for the night nurse, it might have.

The doctor isn't always right

Not long ago, I wrote my birth story up, and I got a lot of web traffic from it because I turned down pitocin four times, believing it to be an intervention that wasn't indicated for my labor and that having my labor medically managed would increase the bottom line cost of my birth and increase the chances that I would have a cesarean section.

A couple of weeks ago, I had my 6-week followup with the woman who _should_ have delivered my baby. She often shares anonymized birth stories with me, almost like case studies that help me better understand what is rapidly becoming my vocation. She told me about a recent night on call, when she had a woman with a scheduled cesarean successfully VBAC because she arrived at the hospital fully dilated and ready to push, and a woman having her fourth vaginal delivery go wrong because she had insisted on getting the epidural at two centimeters, well before the baby was engaged; when the baby finally did descend, it did so in a brow presentation, and got hung up, and she wound up having a c-section.

In other words, it's not as important to have a birth plan as it is to be fully prepared. A birth _plan_, especially if you've never given birth before, quickly goes out the window when things don't go to plan--and they usually don't.

But by being prepared, you can spare yourself a lot of agony. One tip I don't hear mentioned much, but one that helped me when I was fighting the OB for a natural birth, is to talk to other women in your family, if possible, about their birth experiences. One of the objections my OB had to allowing me to progress naturally was that I was clearly carrying a big baby. My retort was to list off the birth weights of my aunts and uncles, my own and my brother's and several of my cousins. It hadn't helped that K had showed up at a funny angle and gotten his shoulder hung up on my pelvis back in 1992--but not seriously so. Another objection she had was that if something *did* go wrong, she wanted it to happen during daytime hours when there were "a lot more people here." Staffing issues on the late shift?

But as I continued to talk to my midwife at my 6-week checkup, she explained to me that the doctor--new to the practice--had never had a patient question her judgment. Remember her comment during my birth story, that she was accustomed to a certain process? During her medical school and internships in India, and her residency in an inner-city hospital, she had never faced a strong-willed, well-informed patient who was prepared to advocate on her own behalf.

So here's where my birth "plan" went wrong. Not only did I get a stranger delivering my baby--I got a stranger who had never encountered a birth she hadn't medically managed. Had I put blind trust in this woman, it was possible I'd have wound up with a c-section.

Now, for the post-script. It turned out that the OB called the senior doctor in the practice, the one that I thought would deliver me if my midwife wasn't available, and asked her what to do with this stubborn patient who kept refusing treatment. The senior doctor responded, "Get used to it." As my midwife explained, our community has a lot of intelligent, strong women who don't want to be treated under an assembly-line process. By fighting the new doctor, I taught her something new about the kind of doctor she could be--one that listens to her patients, one that resists a rote process, one that doesn't hunt down a pathology or use fear tactics to bully her patients into interventions they don't need.

What of all the doctors who never get this lesson?

Pregnancy Is Not a Pathology

Reading Pushed at the recommendation of my midwife last week has really made me regret my fickleness in 1995 that led me away from nursing school, which had been my intent until my first marriage fell apart. My goal back then was to pursue nursing through to the graduate level and become a certified nurse midwife, but as we fell apart and I immersed myself more and more into creative writing (and I failed organic chemistry), I second guessed myself. Then things between us really disintegrated between 1996 and 97, and I lost all interest in school.

So anyway, being pregnant again has totally renewed my energies in that direction. And the more I read, the more I see that things have actually gotten worse for women in the 17 years since I was last pregnant.

My midwife wants to write a book about childbirth, but she's a midwife who wants to be a writer. I am keenly interested in these issues too, and I am a writer who would have wanted to be a midwife.

I'm thinking she and I will be talking more.

Anyhow, you don't have to read the entire book to get an idea of what I'm on about. This L.A. Times article, which was published yesterday, addresses it more concisely:

Once reserved for cases in which the life of the baby or mother was in danger, the cesarean is now routine. The most common operation in the U.S., it is performed in 31% of births, up from 4.5% in 1965.

With that surge has come an explosion in medical bills, an increase in complications -- and a reconsideration of the cesarean as a sometimes unnecessary risk.

It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive U.S. brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.

....

The cesarean rate in the U.S. is higher than in most other developed nations. And in spite of a standing government goal of reducing such deliveries, the U.S. has set a new record every year for more than a decade.

The problem, experts say, is that the cesarean -- delivery via uterine incision -- exposes a woman to the risk of infection, blood clots and other serious problems. Cesareans also have been shown to increase premature births and the need for intensive care for newborns. Even without such complications, cesareans result in longer hospital stays.

Inducing childbirth -- bringing on or hastening labor with the drug oxytocin -- also is on the rise and is another source of growing concern. Experts say miscalculations often result in the delivery of infants who are too young to breathe on their own. Induction, studies show, also raises the risk of complications that lead to cesareans.

Despite all this intervention -- and, many believe, because of it -- childbirth in the U.S. doesn't measure up. The U.S. lags behind other developed nations on key performance indicators including infant mortality and birth weight.

And in at least two areas, the U.S. has lost ground after decades of improvement: The maternal death rate began to rise in 2002, and the typical American newborn is delivered at 39 weeks, down from the full 40. Public health experts view the trends with alarm.

I should add that I don't consider myself a radical. I'm not interested in a home birth, not crazy about seeing certain common sense things I did with my first son now being proselytized as "attachment parenting," and I tend to be moderate in most political arenas, mostly because being a journalist causes a person to be more circumspect in examining all sides of an issue. But I do believe that obstetrics is an important field that should support midwifery, not the other way around and not competing with one another.