Wednesday, August 26, 2009

What my chiropractor doesn't know about his daughter's birth (Dana, don't read this)

Dana is a good friend of mine who is 39 weeks pregnant, and doesn't need any negative birth stories floating around her psyche these days. [If you are still reading this Daen--come back after Wee3 is born and read it!]

My chiropractor is awesome. I have been going to see him since a few weeks after Ayden was born, and the man is AWESOME! He complains when I DON'T bring my rambunctious kids with me to my appointments, because he thinks they are cool. He has done adjustments on Ayden twice (he has special certification in pediatric and maternal chiropractic care). Once when Ayden was a few weeks old, and once when Ayden was kicked in the head by a horse a few years ago. After years of prodding, Brent is finally a convert, too. Our chiropractor's name is Dr. Bob.
Dr. Bob's wife got pregnant this year with their first baby. So exciting!! I tried to cautiously probe around for his views on natural childbirth, midwifery, and breastfeeding, without seeming too nosy. Natural childbirth, yes, midwifery, no, breastfeeding, big yes. Which can be a bad combination--GPs and OBs do cesareans on one in 3 or 4 women on average, which means natural childbirth as a goal is statistically reduced by choosing not to have a midwife. They also give drugs in labour more often, which means that more babies whose moms were attended by GPs and OBs have breastfeeding issues, because cesareans and drugs can interfere with the natural instinctive behaviours of newborns, making learning to breastfeed difficult or impossible. None of these things is the woman's FAULT, nor any individual nor doctor nor OB's failure; they are simply reflective of medical birth culture and statistical data. Anyways, I worried a bit that their hopes for the birth of their baby would be unmet, but I hoped for the best. Intervention and cesarean rates vary from practitioner to practitioner, but most still attend vaginal deliveries (most physician attended first time moms are given pain relieving drugs, however) so hopefully everything would work out for them.
Well, lo and behold, after 9 months of pregnancy, Dr. Bob's wife went into labour! We all wonder near the end if we might be that FIRST WOMAN EVER to stay pregnant FOREVER, but luckily nature knows what she's doing. Bob cancelled an appointment of mine, and we rescheduled for the following week.
"BIRTH STORY?!?!" I quizzed him, after I gave him a gift and learned the essentials: baby girl, her name, weight, and health status.
His wife went into labour, went to the hospital, was sent home, went back again a few hours later, toughed out the pain until about 5 cm, then was given an epidural. A few hours of being in the bed hooked up to IV pumps, a blood pressure cuff, and an external fetal monitor, her baby showed signs of distress. They rushed them to the ER, performed emergency surgery, resuscitated a limp baby, and told her parents she was born "not breathing" with "the cord wrapped around her neck," and indicated it was fortunate they were able to perform surgery quickly to save their baby.

I have a few issues with this.
#1, all babies are born "NOT BREATHING," and it is not unusual for it to take a while for a baby to start breathing, or even need some encouragement or resuscitation. From the sounds of things from Dr. Bob's story, his baby was very limp, unmoving, and non responsive, as well as not breathing. So she was quite critically non responsive at birth. If she was resuscitated (which she was) and narcotic drugs were used during labour (most epidurals contain Fentanyl, a narcotic, as well as an anaesthetic), she would likely be given the drug Narcan to reverse the effects of Fentanyl overdose. Fentanyl overdose is characterized by unconsciousness, depressed or absent breathing, depressed or absent heart rate, pinpoint pupils, cold, clammy, pale or bluish skin, and unresponsiveness to stimulation. Narcan is what we use at work to crash the highs of pimps, partiers, and ravers when their lives are at risk....far too dangerous a drug for a newborn, IMO, but a necessary one if a baby is overdosed.
Sure, it is possible that the cord around her neck was either compressed by a body part against her mother, or wrapped so tightly it was impeding blood flow to her brain, but;
#2, it is quite common for babies to be born with the cord wrapped around their neck. In the vast majority of cases, this is not threatening or dangerous. If in fact Dr Bob's wife had NOT had the epidural, she would have been able to move about during labour, which encourages the baby to move and turn, unravelling or loosening a tight cord wrap in many cases because bodies in water move the path of least resistance, away from cord tension and danger. And it would be exceedingly uncommon for a baby's cord to be wrapped so tightly that it is impeding blood flow to the baby's brain, which was the theory Bob seemed to attribute to his baby's distress.
#3, it is fairly common for epidural anasthesia to CAUSE distress in the unborn baby. All medical and obstetrical personnel will acknowledge this to be true. But do they ever, EVER point to it as the cause of fetal distress, to panicked parents during an emergency? Of course not. No one wants to blame anyone or anything in the heat of the moment, and afterwards no one wants to have been a part of the cause of an infant's distress or danger, or to face the inherent risks of such a common intervention as the epidural. Far better to blame an organic cause. Blame birth. Blame the woman's body, or the infant's cord, or the baby's position, or the precariousness of life, especially during birth, but never blame the epidural.
Bull. Crap.

And then the baby was resuscitated, and everyone is a hero, and relieved, and spends a long time recovering. Well, mom and baby spend a long time recovering. Baby loses several ounces of weight, and Bob describes himself stepping in, ordering the nurses to supplement her with formula despite plans to breastfeed, hoping to later phase out the formula when his wife's milk comes in. What he doesn't know will hurt his wife's breastfeeding, because weight loss within the normal range for a newborn is what prompts a baby to feed often, which is what stimulates a woman's milk supply to an adequate level for that particular baby. Formula fills baby up, she feeds less often, and her mom's body makes less milk. Do some babies lose too much? Absolutely. Is formula supplementation appropriate in those cases? Absolutely. It is a life saver sometimes, and should be used when appropriate. [weight loss over 10% is what is considered appropriate for initiating supplementation]. Dr Bob's baby did not lose 10% of her birth weight.
So, between infant distress at birth, separation of mom and baby during surgical recovery, and Dr. Bob's lack of knowledge of how breastfeeding works, breastfeeding "didn't work out as planned."

But he's grateful to have a healthy baby, and of course I'm happy he has one, too. I just think it unfair that he is grateful to the hospital staff for saving his baby from a distressed state that there is a good chance they created by using epidural anasthesia, but which hospital staff indicated was created by a too tight cord wrapped around the neck! Epidurals have their place in obstetrical medicine. They do. Hear me say this:
EPIDURALS HAVE THEIR PLACE! Epidurals are GOOD! Epidurals give women strength in prolonged labours, relax a woman through those last few centimeters when they are stalled, and help women cope with intense, unmanageable pain (often indicative of non optimal fetal position--not IMPOSSIBLE fetal position, but NON OPTIMAL--difficult, more painful, but absolutely possible), or to cope with the increased intensity of induced labour. BUT epidurals are not risk free, and they are overused. They are often considered by women and for women FIRST when pain becomes intense or overwhelming, instead of the long list of drug free labour coping methods available and proven to be effective. Instead of being saved for a last resort when all else fails, they are used first.

Was Dr Bob's baby in distress because of natural causes? Possibly. Was she in distress because of the depressant drugs or maternal immobility involved in epidural anasthesia? Possibly. Who knows? But either option should, ethically, be considered.

I have opinions. They are strong. They are biased. They challenge the status quo. They are founded on statistical evidence and knowledge of anatomy, physiology, and the effect of drugs on the body. They are also founded on my own life experience.
My greatest hope is that our society can revise our birth culture to a healthier, more positive, woman and child centred, woman empowering one, based on evidence based practice, an acknowledgment of the intuitive, mysterious, and spiritual aspects of birth, and centered around respect for nature's birth process. When we move in that direction, women and babies will be healthier as a result. Which is what everyone wants.

Nuff said.


Rachel Clear said...

Clap clap clap, Melissa!

This post hit me in the RIGHT SPOT today. Just yesterday I got into a "should midwives be legal in the U.S." debate with a friend's husband on facebook and it KILLED ME.He actually said, and I quote, "Rach, you're starting to sound like one of those La LACHE Nazis... breast milk is better than formula... BULLCRAP!" I about fell over and realized there was nothing I could say to convince a man who has never given birth and who has only seen ONE to understand the complicated issues. He described how his wife's labor was and I said, "You're sure it was natural at first... sounds like she had pitocin" and he said, "Oh yeah, she did." DUH. And all the rest made sense. He eventually conceded it should be LEGAL, but he still thinks it's stupid. Wanted. To. Punch. Bless you for writing this. I needed to agree with someone today. :)

Tania Grim said...

you rock!

Caryn Ouwehand said...

If I could have had a midwife's fee covered by provincial health care, I would have LOVED to have one... but we couldn't afford one 2 years ago.

Tonya said...

You are always willing to tackle some hard issues here. Thanks! You are able to back up your opinion with statistics. Good job!

lori lls said...

I know, I know.

It is very sad to me too, when I hear of problematic births and how happy the parents are that the brave hospital staff saved their baby's life. Yes, that does happen from time to time, and yay for hospitals and yay for well-trained staff! Yay, I say again.

BUT. Whenever I probe for how such births started, nearly every time the woman was induced or received some other invasive, non-natural procedure. You can't expect the body to know what the crap is going on if you try to override its processes from the get-go.

And what will this experience do but to further the notion (among the chiropractor's family and friends and whomever else hears the story) that they should all be thanking their lucky stars they had a hospital birth with a doctor? It's a very frustrating scenario.

Just this summer I heard a birth story about a man I grew up with whose wife's breast-feeding experience "didn't go as planned." And it was a very similar story to yours. The wife's body reacted poorly to an intervention, and she wasn't able to recover well enough to start the feeding in time. It just irks the fire out of me, because that woman's most basic right - TO FEED HER CHILD - was stolen out from under her. Not to mention the horrendous birth she endured.

Talking about this stuff though is good, because it may arise in someone's mind the tiniest notion that "Hey, there could be another way." Then if they don't want to take the other way, so be it. But options, people. OPTIONS.