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Wednesday
Sep092009

The Birth of The Unnecesarean

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I was recently asked to write up my birth story—specifically, how I used the Internet to make informed decisions and how I now use the Internet to help other women find access to the information or experts they need to make informed decisions about their care.

The following is the rough draft I submitted. I’m posting it here for those of you who are wondering how TheUnnecesarean.com came to be, which is something I’ve wanted to do for nearly one year. Writing in third person allowed me to write it in 20 minutes over a cup of coffee and without excessive verbosity. The edited, pared-down version turned out great, but I’m posting this off-the-top-of-the-head version anyway.

Someone commented recently that they were grateful that their doctor made such off-the-wall, unscientific remarks to them during prenatal visits or they would have never even considered seeking out better and more appropriate care for them. I agree. If the doctors and midwives had given me better information, cited sources and not told me about their personal tragic experiences coupled with inaccurate information, I would have had a cesarean in a heartbeat. I put the burden of proof on them because I didn’t hear anything better than Level C evidence or personal experience and they failed to convince me.

I was scared, disappointed, embarrassed for them and the lies they were trying to pass off as fact, stressed, felt defeated by a system of questionable ethics much bigger than me and all the while very kind and understanding of what they were saying, trying my best to negotiate the very best health care for me and my baby.

Later, I got pissed off.

 

***

 

Jill was a 31 year old pregnant for the first time. Her pregnancy was uneventful, which made her not worry as much about the lack of continuity of care at the large Southern California hospital. At her 37 week prenatal visit, the midwife measured her fundal height at 47 centimeters—about 10 centimeters more than pregnancy books said it should be. Concerned, Jill called that midwife the next day and requested a late-term ultrasound. The midwife reluctantly agreed and, on August 14, the sonographer estimated fetal weight at 10 lbs., 2 oz. and the due date at August 11, which would have been 37* weeks gestation. At 5’11” with a long family history of large babies, Jill was excited about her possibly big arrival.

Several days later, she received a call from a different midwife who had just returned from vacation who said, “Sweetie, you need a c-section.” She told her she was at risk for shoulder dystocia, ended their prenatal relationship and scheduled an appointment with an obstetrician for Jill later that week. At the insistence of a friend, Jill met for hours with a home birth midwife prior to the appointment with the doctors, who informed her of the inaccuracy of ultrasound estimates of fetal weight, the rampant overuse of cesarean section, the unpredictability of shoulder dystocia and effectiveness of having a doula at an institutional birth. In comparison, the doctor and midwife she met with the next day shared only horror stories in response to Jill’s many requests for the scientific rationale behind their decision.

Confused, Jill used the internet to access to medical journals at the university at which she worked. After days of research, Jill concluded that the home birth midwife’s information was evidence-based and correct down to the statistics she cited, while the doctor and midwife shared purely anecdotal information and were also not following ACOG’s Practice Bulletin No. 22, which outlines guidelines for management of fetal macrosomia, also available online.

At 38.5 weeks pregnant, Jill went into labor spontaneously, stayed home as long as possible and, with the support of a doula, gave birth to a healthy 10 lb., 3 oz. girl with no incident. While the five hours spend giving birth in the hospital was traumatic due to unknown staff entering the room to talk about fetal demise, cerebral palsy and other ways that Jill’s pelvis would kill or harm her baby, Jill remains extremely grateful that she found evidence-based information online and exercised her right to refuse unnecessary surgery. Two years later and supported again by a doula, Jill gave birth to an even bigger baby in a freestanding birth center with midwives and maintained concurrent care with a home birth midwife—all of whom she found on the Internet.

Concerned about the unnecessary stress and unscientific recommendations imposed upon women by their medical care providers, Jill started a web site to make the information that she spent a week compiling at 38 weeks pregnant available to other women being bullied into a cesarean based on ultrasound fetal weight estimates, personal experience of their physician, fear of litigation and other unscientific reasons in defiance of established practice standards. Her desire was to help at least one woman protect herself from the aggressive tactics of defensive medicine and in the eleven months that the site has been live, Jill has discovered a generation of American women disgusted and exhausted with having to fight to give birth vaginally in a hospital.

 

 

Addendum sent to person compiling stories:

If relevant, I didn’t set out to become and do not consider myself an expert. I have a few evidence-based take-home messages that are obvious, along with a personal endorsement of home birth midwifery. My goal has always been to encourage women to ask questions and think critically about the messages they are receiving, either directly or culturally, and assume responsibility for their bodies. I hope that when I and other women share their experiences, other women will get a clearer picture of what is possible to use in making their own decisions.

 

 

*NB: After learning more about my cycles, I discovered that I ovulate one week earlier than the textbook two week standard. While the charts say my daughter was born at 38 5/7, she was actually 39 5/7 weeks. Also noteworthy is that if someone had told me a few years ago that I would be announcing to thousands of people the precise schedule of my ovulation, I would have thought they were nutty.

 

 

Thank you to all of you who regularly read this blog and pass posts on to your friends.

 

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Reader Comments (23)

Thank you for sharing your birth. I am amazed every time I read something on here I didn't know. Thank you for empowering me to ask WHY and WHY NOT? I will never turn over the power of my body to someone else again.

September 9, 2009 | Unregistered CommenterJaimey

In fighting for my right to labour with my first (breech presentation) baby, I recall those nights at the computer researching. I wonder how many mothers end up in this situation? How many of them (like me) still end up with an unnecesearan because there aren't enough care providers who believe in women and birth out there.

Keep fighting sisters.

I did!

I am working with the Coalition for Breech Birth in Canada. We have managed to get the Society of Ob's and Gyn's of Canada to change their breech policy and are now hosting an international conference for careproviders and consumers: www.breechbirth.ca

September 9, 2009 | Unregistered Commentermcshelf

I'm so glad that you posted your story. I always assumed that you had had an unnecesarean. I didn't realize you had fended one off so valiantly! Inspirational.

September 9, 2009 | Unregistered CommenterLeigh

Thanks for sharing your story. I too thought you had an unnecessary cesarean. How cool that you educated yourself and fought to prevent one!

That whole Big Baby Bull really gets my blood pressure rising!

BTW, I just bought an Enjoy Birth shirt off your Zazzle site. It is perfect for me! :)

September 9, 2009 | Unregistered CommenterEnjoy Birth

Thanks Jill. Very interesting. i'm happy but susprised you avoided the knife!

September 9, 2009 | Unregistered CommenterNaomi

Thank you! I love your blog.

September 9, 2009 | Unregistered CommenterMychelle

You are 5'11"? In my head, you are still 4'1".

September 9, 2009 | Unregistered CommenterAlison Green

I had also assumed that you'd had an unnecesarean.

Way to go with the big babies! And with the rockin blog :)

September 9, 2009 | Unregistered CommenterMolly

Excellent post! I am glad you started this blog. I also did a lot of internet research before the birth of my first. Even staying home as long as possible in labor (with a kickass doula) did not save me from ridiculous hospital protocol (I showed up with my baby crowning and a nurse decided to try to start an IV?! My 100% perfect healthy baby was hijacked to the nursery for 2 hours because...?) But at least I avoided the knife. I know too many women who were badgered, bullied, or tricked into c-sections. Some of them don't even know they were hoodwinked. That makes me sad, that they have so little faith in their bodies, and so much faith in a care provider who is just as human and fallible as the rest of us.

Way to go on your births! Keep up the great work with this site!

September 9, 2009 | Unregistered CommenterLori

Alison, I think I was 4'1" at birth. Let me check with my mom.

September 9, 2009 | Registered CommenterJill
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