What's Up With Modern Care?

Something has been very much on my mind lately, and I didn't know how exactly to word it, but I'm going to try now: people don't care about pregnancy and birth nearly as much as they should.

There, I said it.

Why is it that a woman's rights in childbirth are so overlooked? Why can't a mom refuse continuous fetal monitoring? Why can't a mom have more than one person present at her cesarean, planned or unplanned? Why can't a mom make all the calls in a hospital birth? Why must women be subject to hospital/insurance company's/care provider's policy? Why is home birth so frowned on? Why is she not holding the power in regards to her care, as a rule, across the board? Why is this not a bigger issue in the mainstream media?

Why is it that if a woman is told by her doctor that she needs, say, gallbladder surgery, she asks for time to think it over, or gets a second opinion or something like that, but if her OB says her baby might be "too big," etc., she doesn't even question it and goes along with the scheduled induction or cesarean? Why is it that prenatal testing isn't questioned? Why aren't things like dopplar heartbeat scans, or ultrasounds, or Gestational Diabetes testing, or anything pregnancy-related, questioned by moms? Why is it okay (and even encouraged) to do whatever your doctor suggests, even if you don't understand it, and the best explanation they can offer you is, "It's just how things are done?" What is it about pregnancy that turns otherwise independent women into mindless drones who think, "Well, they're the OB, so they must know best," even if they aren't comfortable or don't agree with their OB's advice?

Here are my biggest pet peeves:

1. The Due Date. Why do people put so much focus on due dates? Not every woman's cycles are the same length, and not every child develops at the same pace, so why do people still hold to the belief that every pregnancy should  last the same amount of time? Why is it okay for some women to go into spontaneous labor early, but going past the EDD is such a crime? Babies develop at different rates in the womb, just as the do after they're born. They're not all ready at the same time, and not all moms will gestate for the same amount of time. Some moms and babies are ready later. Some are ready sooner. It. Is. Just. An. Estimate. Don't rely on it solely. 40 weeks is merely the average time women give birth. only a small percentage (about 5%, I believe) of babies are born on their due date, and just as many give birth before then as after. If you induce or have a cesarean before at least 40 weeks, or at any time, really, you run the risk of baby not being ready (due to an incorrectly calculated due date, or our body or baby simply needing more time), and is that really worth it? Is your personal comfort (not being pregnant anymore) really worth risking your baby? ACOG states that postdates is not until after 42 weeks, not 40, and no interventions should happen until then without warning signs. Here's a good reference about this: http://www.theunnecesarean.com/blog/2009/10/3/postdates-separating-fact-from-fiction.html#sthash.ozx9GHMc.dpbs
2. Ultrasound Weight Estimates/Your Baby is Too Big. Not only can ultrasounds be off by as much as 3lbs as far as weight, but the margin of error is at least 50% or so. Also, even if your baby is big, that doesn't have nearly as much influence on whether they can be birthed vaginally as their position, the shape of mom's pelvis, and her active movement in labor and pushing do. I've heard of truly tiny women birthing 11+ pound babies, so size really isn't a big deal on its own. Ignore the weight estimates. Seriously. It is exceedingly rare for a woman's body to make a baby she can't birth.
3. Repeat Cesarean vs. VBAC Safety. In the majority of cases, VBAC is the safer option. Major abdominal surgery is almost never going to carry fewer risks. If you look at the list of possible complications for a repeat cesarean sections, compared to the list of possible VBAC complications, it's astounding. RCS is held up by most care providers as the "safer" option, when really, it carries far more risks, which are far more likely to happen, than VBAC. Don't believe me? Check this out (and this is only one small example of what I'm talking about):
   
4. Inducing Carries Little to No Risk: No. Just no. Have you checked out the facts on pitocin? What about cytotec, or cervadil, or AROM (artificial rupture of membranes)? Do you really think that a medically induced labor, that the body is obviously not ready for since it hasn't triggered labor on its own, is going to behave the same way as a spontaneous labor? Medications carry risks and have side effects, and since the drugs most commonly used to induce labor are either not indicated for use in inducing labor, or are contraindicated by the manufacturer for use in non-medically necessitated induction, should that not give women pause? Why do doctors not disclose these risks? Medically necessitated inductions are not something a mother should feel ashamed of, but if it's not necessary, there's a lot to consider before putting your body and your baby through that.
5. Cesarean Sections, Whether Primary or Repeat, Carry Little To No Risk: Again, NO. Cesarean birth, while a blessing we should be grateful for as a lifesaving measure for mothers and babies who are truly at risk, is far too common these days (more than double what the WHO recommends as the maximum safe percentage of cesarean births). It is major abdominal surgery. It is not the way our bodies were designed to give birth, and therefore is not "the same" as vaginal birth. It should be maternal choice whether to have a cesarean or not, and all the real facts should be given to mothers so they can make their choice based on the best modern evidence. Look up the risks of abdominal surgery sometime, and see how risky is really is. After the second cesarean a woman has, her risk of hysterectomy rises to nearly 1%, whereas if a woman has a VBAC or two under her belt, that risk is only about 0.17%. You do the math.
6. The Birth Experience Isn't Important (as Long as You Have a Healthy Baby): This makes me so angry. The ultimate goal in childbirth is of course to have a healthy baby and mom, but why is mom's experience viewed as unimportant? This is the birth of her child, after all, something that alters not only her state of being (she's a mom now), but her body as well! Should she not have the right to have it happen in the way she wants, and feel respected and in control during the process? Things don't always go according to plan, but mom should be the one calling the shots, and she should feel content at the end, knowing that nothing was done against her will and that she had the power in her hands the entire time.
7. Medication in Pregnancy is BAD, but Medication in (or to Start) Labor is Okay: Just think about that for a second. Really think about it. Why should you avoid anything other than tylenol and antacids while pregnant, but pitocin/morphine/stadol/etc. are fine while you're in labor? Does labor magically stop medications from crossing the placenta and getting to baby? No, it doesn't. The hypocrisy drives me insane.
8. High/Low Amniotic Fluid: This is one of the latest scare tactics used to get moms to schedule an induction or cesarean. "Oh, it looks like you might have too much/too little amniotic fluid. We'd better induce/perform a cesarean immediately." Yeah, right. Do you know how rare it is for low fluid to actually be present? Do you know how rare it is for high fluid levels to actually be caused by a true problem with baby? Do you know what measures can be taken to check on baby's wellbeing before inducing? Yeah, it's really not (usually) as big a deal as it's made out to be, and often the measures doctors take to "save the baby" are counter-intuitive. Like, breaking mom's water to induce labor due to high levels of fluid, when breaking the water with baby high and not engaged in the birth canal can cause the umbilical cord to become trapped and compress oxygen supply to baby, necessitating a cesarean delivery. This is definitely one of those situations where mom should insist on a second opinion or more testing before jumping to delivering baby.
9. Multiples Can't Be Delivered Vaginally: Oh lord. Why not? Even if they're breech, why not allow a TOL (trial of labor)? WHY NOT? Twins, triplets, and even more multiples can be conceived naturally, and have been delivered naturally, since the dawn of time. Yes, cesareans are sometimes necessary, but why assume they will be and refuse to allow mom a TOL? Why jump to the worst possible conclusion? This makes absolutely no sense to me.
10. The Cord Was Around Baby's Neck/Baby Was Breech, it's a Good Thing We Did a Cesarean: Wow. Because no babies are ever born with the cord wrapped around them. It happens in about 1/3 or births, and is not an immediate complication. Breech babies are the same way. Babies are born, vaginally, with the cord around their neck or in a breech presentation, every day, and are perfectly fine. This is one of those "lack of training" issues, where care providers aren't taught how to deliver a baby with a nuchal cord/hand/breech presentation/etc., so they immediately jump to a cesarean delivery. Why is mom's choice not the first priority? This is a serious issue when it comes to lack of training or our care providers. There's no reason to assume these babies can't be born vaginally.
11. You Can Trust Everything Your Care Provider Says: Nope. Don't take anything at face value. If this statement were true, doulas wouldn't exist. If the people delivering babies were infallible, and never made a mistake or did anything against mom's wishes, people like me wouldn't exist. There wouldn't be sites like improvingbirth.org, or evidencebasedbirth.com, or any site like that. There wouldn't be rallies focused on bringing birthing womens' rights to the eyes of the public. There wouldn't be women seeking new care in subsequent pregnancies due to unhappiness with their first birth experience. I am not kidding when I say that you should never settle on a care provider if there's anything they say or do that makes you uncomfortable for any reason.
12. Our Modern Obstetrical Care is the Best in the World, and Has Women's Best Interests at Heart: Wrong. The USA ranks LAST as far as maternal and fetal outcomes/mortality of all developed nations in the world, yet we spend the most on obstetrical care. Why? Because medicated births and cesareans make a lot of money for hospitals and doctors, but they are not in the best interests (healthwise) of moms and babies. We are still employing practices from over 50 years ago, and obstetrics is just about the only field of healthcare to do so. You wouldn't want your general practitioner to practice outdated care from the early 1900's, so why would you want your OB to do so? That's exactly what's happening. So much of the care the modern OB's base their practices on is from around the 1950's. It is not modern, it is not evidence based, and it is not beneficial to moms or babies in any way. Every other medical field has advanced with the times, but obstetrics has not, and yet that is the one field people blindly trust.  We deserve better

These are the main reasons I get so angry and hurt for the sake of other moms out there. These are the reasons I'm wary of another hospital birth. These are the reasons I'm a doula. The lies that pervade the birth world, that come from your OB, your midwife, your mom, your aunt, your friend, etc. need to stop. The modern, evidence-based truth needs to get out there, because all moms deserve it.