AZ Woman Threatened With A Court Ordered Cesarean

This morning I saw this article on Facebook that was posted by Jill at the Unecessarean. It is originally from the Lake Powell Chronicle and it caught my eye, as I was born in Page at this same hospital. It is the ONLY hospital within 120 mile radius.

*I highlighted a few parts.

Hospital policy pains expectant mom

Posted: Wednesday, Sep 30th, 2009BY: Mary Forney — Lake Powell Chronicle

PAGE – A pregnant woman’s pleas not to have an unnecessary caesarean are being ignored by Page Hospital administrators.

Joy Szabo, 32, said she is upset with Page Hospital’s general ruling in June prohibiting vaginal births after cesareans (VBAC). The mother of three children, she has given birth to all of her children at Page Hospital, the only hospital in the immediate area. A placenta eruption caused her to have an emergency cesarean delivering her second child, but the hospital allowed her third child to be delivered naturally two years ago.Now pregnant with her fourth child, she is being forced to have a caesarean due to lack of hospital staffing.

“Page Hospital is, as many small communities are, challenged with resources,” said Chief Executive Officer Sandy Haryasz. “Page simply does not have the physician resources to respond to an emergency. Currently, we have two physicians who are delivering babies and a third physician will be joining us next week.

“Three physicians cannot provide the coverage recommended by ACOG (American College of Obstetrics and Gynecology). The physicians must be immediately available because of the risks of a VBAC and we cannot provide that in Page. In addition, we cannot provide an anesthesiologist to be readily available because we only have one anesthesiologist.”

Joy thinks it is against her legal rights to force her to have unnecessary surgery that might place her and her baby at greater risk of harm than delivering naturally. Her only option to having natural birth is to travel to a women’s care clinic in Phoenix or have unassisted home delivery.

While the hospital’s new policy not to do VBACs is unwritten, Haryasz said the decision is not based on money, but on there not being enough “volume” to warrant hiring another physician or emergency anesthesiologist.

“This is about providing quality safe care to all our patients,” Haryasz said. “The hospital would have to cancel surgeries or any other procedure because that doctor or anesthesiologist would have to be available to her while she’s in labor, which could take hours or days.”

Joy’s husband, Jeff, 44, is supporting what he thinks is his wife’s right to choose.

“I have talked with Banner Health officials who have said it’s just their policy,” Jeff said. “It’s a legal decision – not a medical decision. My wife’s plight is indicative of the health-care system in the U.S. They make money off of people’s suffering.

“Consequently, medical care is dictated by cost and insurance companies and not by what’s best for the patient.”Joy said she voiced her concerns at a board of directors meeting and has met twice with Haryasz.“I asked Sandy what would happen if I just showed up refusing a c-section and she said they would obtain a court order,” Joy said.

“They don’t want to allow VBACs because she said they aren’t equipped for emergency c-sections, but if they can’t do emergency c-sections, they shouldn’t be having labor and delivery at all. That’s why women go to the hospital to have their babies – in case there is an emergency.“I wish her luck explaining to a judge that she is insisting I have a medically unnecessary surgery.”

ACOG currently supports VBAC deliveries, citing on their Web site at www.acog.org, that the benefits include the avoidance of abdominal surgery, shorter hospital stay, lower risk of infection, less blood loss, and less need for blood transfusions.The risks include a rupture of the previous cesarean scar during delivery, or in rare circumstances, rupture of the uterus.

Haryasz said that despite ACOG’s recommendations and the favorability of success with VBACs, Page Hospital is sticking by its decision to no longer perform natural deliveries after cesareans.“We respect our patient’s wishes should they choose VBAC, however the medical staff and administration have determined that deviating from national standards and performing this procedure here is a risk that is unwarranted and too great for our mothers and babies,” Haryasz said.The Szabos think that lack of staffing is not sufficient cause for Joy to be forced to undergo unwanted, unnecessary surgery.

“My doctor doesn’t have a problem with me having natural delivery, but said that the hospital does,” Joy said. “The fact that I successfully had a VBAC two years ago lowers my risk for rupture, but that doesn’t matter since the hospital has decided that all VBACs have to have an ‘elective c-section.’ I think my definition of ‘elective’ differs from theirs because I don’t want this.”

2 Years Later

It's been just over two years since my girls were born via c-section and I suddenly became a mother.

The night before their birthday I was busy decorating their cupcakes. As I glanced at the clock, I couldn't help but revisit what exactly was going on at that time two years ago. Although a lot of the events surrounding their birth aren't positive to look back on, I am so grateful for my girls and the wonderful blessing they are in my life. I am also grateful for all that I have learned from their birth and am still learning. I know that we are given challenges in life so that we can learn and grow, and I feel like I have been given the opportunity to do just that.

Why Your Due Date Isn't When You Think

Here's a great article I read recently about why most estimated due dates aren't accurate.

I highlighted some of the information that stuck out to me.

The Lie of the EDD: Why Your Due Date Isn't when You Think

This article can be found here.

We have it ingrained in our heads throughout our entire adult lives-pregnancy is 40 weeks. The "due date" we are given at that first prenatal visit is based upon that 40 weeks, and we look forward to it with great anticipation. When we are still pregnant after that magical date, we call
ourselves "overdue" and the days seem to drag on like years. The problem with this belief about the 40 week EDD is that it is not based in fact. It is one of many pregnancy and childbirth myths which has wormed its way into the standard of practice over the years-something that is still believed because "that's the way it's always been done".

The folly of Naegele's Rule

The 40 week due date is based upon Naegele's Rule. This theory was originated by Harmanni Boerhaave, a botanist who in 1744 came up with a method of calculating the EDD based upon evidence in the Bible that human gestation lasts approximately 10 lunar months. The formula was publicized around 1812 by German obstetrician Franz Naegele and since has become the accepted norm for calculating the due date. There is one glaring flaw in Naegele's rule. Strictly speaking, a lunar (or synodic - from new moon to new moon) month is actually 29.53 days, which makes 10 lunar months roughly 295 days, a full 15 days longer than the 280 days gestation we've been lead to believe is average. In fact, if left alone, 50-80% of mothers will gestate beyond 40 weeks.

Variants in cycle length

Aside from the gross miscalculation of the lunar due date, there is another common problem associated with formulating a woman's EDD: most methods of calculating gestational length are based upon a 28 day cycle. Not all women have a 28 day cycle; some are longer, some are shorter, and even those with a 28 day cycle do not always ovulate right on day 14. If a woman has a cycle which is significantly longer than 28 days and the baby is forced out too soon because her due date is calculated according to her LMP (last menstrual period), this can result in a premature baby with potential health problems at birth.

The inaccuracy of ultrasound

First trimester: 7 days

14 - 20 weeks: 10 days

21 - 30 weeks: 14 days

31 - 42 weeks: 21 days

Recent research offers a more accurate method of approximating gestational length. In 1990 Mittendorf et Al. undertook a study to calculate the average length of uncomplicated human pregnancy. They found that for first time mothers (nulliparas) pregnancy lasted an average of 288 days (41 weeks 1 day). For multiparas, mothers who had previously given birth, the average gestational length was 283 days or 40 weeks 3 days. To easily calculate this EDD formula, a nullipara would take the LMP, subtract 3 months, then add 15 days. Multiparas start with LMP, subtract 3 months and add 10 days. The best way to determine an accurate due date, no matter which method you use, is to chart your cycles so that you know what day you ovulate. There are online programs available for this purpose (refer to links in resources section). Complete classes on tracking your cycle are also available through the Couple to Couple League.

ACOG and postdates

One of the most vital pieces of information to know when you are expecting is that ACOG itself (American College of Obstetricians and Gynecologists) does not recommend interfering with a normal pregnancy before 42 completed weeks. This is why knowing your true conception date and EDD is very important; if you come under pressure from a care provider to deliver at a certain point, you can be armed with ACOG's official recommendations as well as your own exact due date. This can help you and your baby avoid much unnecessary trauma throughout the labor and delivery.

Remember, babies can't read calendars; they come on their own time and almost always without complication when left alone to be born when they are truly ready.

The Shape of a Mother

{this picture is from The Shape of a Mother website}

I got my first stretch mark when I was around 30 weeks. I had been so proud of myself {up until that point} for maintaining a tight streak-free stomach, even though I was measuring around 40 weeks. My doctor even marveled at how nice it looked. Of course, it was only a few days later when I noticed a tiny silver firework that had secretly exploded above my protruding belly button. After that, it was all downhill {Palmer's butter promise my butt!} as my stomach turned into what I referred to as the "battle zone". I still loved being pregnant, but as my belly continued to grow and grow, my 22 year old mind worried itself as to how this skin would look after the fact.

I'd seen the moms that had their babies and were suddenly back into their jeans again, just like magic. But they all had one baby, not two, so I came to terms with the fact that my stomach would never look like theirs, and it would probably be a while before I got back into my jeans. In the OR during my c/s, I even told my OB to take off as much excess skin as he wanted before he stitched me back up. He laughed and replied, "What excess skin?". I might have been doped up on drugs but I wasn't stupid. I went home looking like I was 6 months pregnant, and I cried when I saw my stomach in the mirror weeks later.

It's been almost two years, and I'd like to say that I've regained most of my body, or at least as much as I could. I still have stretch marks and extra skin that I would love to donate to anyone who needs it {let me know}, and my belly button still refuses to smile. After nursing twins for 10 months, well let's just say that my ladies found retirement in Smallville. The truth is I don't regret any of it. It's only a testament to me of how strong and amazing my body is and how grateful I should be to God for blessing me with it. My body can grow and feed two babies, TWO BABIES! It can stretch and mold and could fulfill every task it was given even when it was twice the work. It took me a while to feel this way, but I'm glad that I do.

After reading a few posts on the Unecessarean, I noticed a link for "The Shape of A Mother."It is a compilation of mothers from different backgrounds and births sharing how their bodies have changed after pregnancy and birth. I like it because it's real, and there aren't any airbrushed pictures on this one. You won't see any Angelinas post-tummy tuck, or JLOs in their itty-bitty bikinis. Just real women with real bodies, that are striving to embrace the changes their bodies made to bring life into the world.

One Thing Leads To Another {interventions}

Cascade of Interventions

{For a larger diagram go here. I couldn't quite figure out how to make it bigger}

The leader of my ICAN chapter posted this on facebook a few days ago. I think it is amazing how one intervention {namely induction} can result in several others. How many times have you heard, "they gave me pitocin, and my contractions got strong so fast that I had to have an epidural " {and so forth}? I have to say that I haven't met very many women who weren't induced or given any type augmentation to speed up or start their labor. Many ended up needing even more interventions because of it. While induction is necessary in some situations, it seems to be the norm for any mom giving birth in the hospital whether they really need it or not.

Induction of Labor

(from the ICAN website)

The International Cesarean Awareness Network strongly advises women and health care practitioners to avoid induction of labor unless a true medical indication exists. Induction of labor frequently leads to further intervention in birth including the need for fetal monitoring, epidural anesthesia, instrumental delivery and cesarean section. Each of these interventions increases risks to babies and mothers.

First time mothers are especially vulnerable: Induction itself doubles a first-time mother’s risk of having a cesarean section.

A cesarean puts a woman’s entire reproductive life, including subsequent pregnancies, at higher risk.

For all women, induction of labor increases the use of forceps and vacuum extraction as well as rates of shoulder dystocia.

Women with a prior cesarean who are induced have a 33-75% risk of having another cesarean.

Induction of labor has been shown to increase the risk of uterine rupture for women with a prior cesarean scar.

Babies whose births are induced more often experience resuscitation, admission to the intensive care unit, and phototherapy to treat jaundice, which generally require separation from the mother.

*This is why it scares me to hear women going in to be induced in situations where it is not medically necessary.

At Your Cervix {a L&D Nurse} recently blogged on intervention refusal here. She also included situations that would warrant an induction.

Taking Charge of Your Fertility {book review}

To be able to take charge of your pregnancy and birth, you must do several things including educating yourself in regards to the process that your body naturally goes through. This is the same when it comes to taking charge of your fertility. Now you might be wondering how fertility ties into birth etc, but in my mind it truly does. It starts at the very beginning of what could lead to birth, and has everything to do with how a woman's body works.

I am sharing this with you because I think out of the many things that women aren't educated about (which could include pregnancy,birth, risks, interventions etc), fertility and knowledge of how a woman's body works throughout a cycle is right up there.

After experiencing a lot of negative side effects from my birth control pills, I began looking into different options. I contacted my OB/GYN and tried a few different brands that she recommended, but nothing seemed to help. Then a friend of mine mentioned what most people know as Natural Family Planning. After asking around for more information, a very kind lady mailed me a book called "Taking Charge of Your Fertility." I was immediately hooked. It is based off the the FAM method which stands for the Fertility Awareness Method. While similar to NFP, it has a few differences. This method takes you step by step through charting your temperature, and changes in cervical fluid, position etc which can potentially tell you everything about your fertility.

Once again, I am sharing this with you because I have to admit that I didn't understand a lot of things about my body, even after getting pregnant and having children. I had no clue that not every woman ovulates on day 14, as most OB's assume and that there are specific signs to show whether a woman is ovulating (fertile) or not. I didn't know there was such thing as cervical fluid and that a woman could check her own cervix (whoa!).

While I understand that charting isn't the birth control method for everyone, I think it is so beneficial for a woman to know her cycle, especially when attempting or avoiding conception. For those who aren't a fan of their birth control pills, IUDs, etc. it is nice to have another option, because honestly I felt I was at a dead end.

When TTC for the first time, I just figured I would ovulate on day 12-16, as most websites will tell you. Assuming this can be detrimental as not all women are fertile around these days. You might think something is wrong with you, when in reality you are TTC at an infertile time.This can also have a big effect on the estimated due date that your doctor will give you. Most OBs go off of the 14 day rule, which can be off for those who don't ovulate on that specific day. This could potentially push your due date forward or behind what it should be, and cause unnecessary inductions when it seems that your baby is "late". Boy was I surprised when after charting for one month, I didn't ovulate until Day 22. If I wouldn't have known this, and would have gotten pregnant at this time, my EDD could have been set for more than a week earlier then it should have been. For someone like me who is trying to avoid being induced or c/sectioned due to post dates, a week can make a world of difference!

The other benefit to charting and knowing your cycle is learning that you are pregnant without having to wait for a pregnancy test. After charting your waking temperature for an entire cycle, you should be able to tell whether you have achieved pregnancy by looking at how many high temperatures follow in the luteal phase (or final phase) of your cycle.

There are so many benefits to knowing this information and I would highly recommend this book. It has really been eye-opening to me and I am sure it would be to other women out there too.

{I should note that I am not at all bashing the use of birth control pills (or other contraceptives) as I used them for several years and found them to be extremely effective}

"Pit to Distress" {it's no joke}

I just read some shocking information on Birth At Home in AZ, about how some OBs are using a tactic called "pit to distress." Pit, which refers to Pitocin, is the drug commonly used to augment labor and increase contractions, making them stronger and more consistent. These doctors are ordering that their patients be given unsafe amounts of Pitocin intentionally, in order to "prove" whether the baby is going to be born vaginally or not, or better yet to get them home by dinner time {by way of a quick c-section}. Many of these situations end up in c-sections due to {can you guess?} fetal distress, which is brought on by the over usage of this drug.

This is a real problem that is going on right now. Jill at The Unnecesarean blogged about this a few days ago here, mentioning that it is also referred to {by RNs} as the “pit to distress, then cut” routine . This dangerous practice has been witnessed first hand by mothers, doulas and OB Nurses. One OB Nurse {NursingBirth} blogged about it here, and included details of one birth she attended where she was specifically asked to use this tactic. It's hard to think that this is actually happening to women, and that medical professionals are getting away with putting these women and their babies in danger, but it's true. This is yet another reason why women need to take charge of their births, and become more aware of the risks involved with these commonly used drugs.