NIH panel on VBAC, or: Give me liberty

Recently the National Institutes of Health convened a panel to examine the "issue" of vaginal birth after Cesarean (VBAC). Evidence was reviewed, testimonies heard, and a consensus statement released.

While cautiously optimistic that the issue was being reviewed at all, birth advocates had reasons to be concerned.

First, in 2006, a similar panel convened regarding the issue of Cesarean delivery on maternal request (CDMR). What they found was that there was "inadequate evidence to recommend for or against." Which is ridiculous, really, given that the risks of Cesarean to mother and baby are well documented, and they become even clearer particularly when there's not a potential medical indication and therefore benefit (such as resolving fetal distress, interrupting an obstructed labor, etc). So basically, they treated a natural process as having no greater weight than a surgical one and so came out stating that the scales were balanced. The ridiculous presumptiousness of assuming that they know everything there is to know about human labor and birth, that its impact on mother and baby and family and society at the time of birth and forever after is able to be scientifically measured and accounted for--and that even if it were, that the choice is theirs to make-- is outweighed only by the fact that in the case of debating VBAC, vaginal birth (which will happen, come hell or high water, as the natural end of a full-term pregnancy) is treated as the "intervention," something to be "done" as that which needs to be justified, while surgical delivery is treated as the control--the status quo, the "innocent until proven guilty." You can read more on the limitations of that panel's decision here.

Anyway. Henci Goer very cogently articulated the concerns going into the VBAC panel here. The Unnecessarean takes up the other end by articulating the concerns coming out of it. Both are very much worth reading, as are the comments; they contain a good deal of backstory on the lengths that doctors and courts are willing to go to in order to maintain control over birthing women's choices (some particularly sickening facts of court-ordered Cesarean cases, in paritcular), and one commenter shares the following quote from Sheila Kitzinger:

No one would deny that each infant and particularly every maternal death is tragedy to be prevented if at all possible, nor that modern obstetric care, which has developed in the hospital setting, has been at least partly responsible for the dramatic decrease in both maternal and peri-natal mortality over the past half century. But it is not necessarily perverse to question whether our present priority should be to reach minimum figures for peri-natal mortality at any price when this includes giving up things which free human beings have often felt to be more important than their own survival- such as freedom to live their own lives their own way and to make individual choices in line with their own sense of values.

Living out here as we do, in Virginia--home of liberty and rebellion in two major wars, the Revolutionary and the Civil War (not to wander too off-topic, but we recently watched Gettysburg and I was amazed to realize that far from what I learned in history, the Civil War was not about "OMG The South is racist," because the north was, too; it was about whether or not the states had the right to withdraw from a federal government making decisions they didn't feel were in their best interest. I'm inclined to believe that the founders intended that they SHOULD have this right, and so the whole outcome, viewed through that light, feels completely different to me) --I'm struck by the fact that this is exactly what "Give me liberty or give me death" MEANS. It doesn't have to mean death at the hands of the British army--it might mean facing down the (albeit very small) risk of a uterine rupture. Or the right to refuse chemotherapy. Or drink raw milk, or refuse vaccination. People have chosen the risks of freedom over the "safety" of relative captivity here for a long time ("ships are safe in harbor, but that's not what ships are for"), and parents have long been accepted as the proxy decisionmakers for their children, able to elect for one or the other on behalf of those too young to make the decision themselves, but this right is quickly being eroded, now beginning before birth.

So basically, while a small battle or two was somewhat won (recommending that ACOG drop its strict recommendation that only facilities with "immediately available" operating room personnel "perform" VBAC), the war (having any power to compel them to do so, plus the greater--central-- issue of a pregnant woman's right to what essentially amounts to constitutional personhood and self-determination--ie, informed refusal of surgery without regard to whether her physician "feels she is a good candidate") was not.

So. Henci Goer's signature line contains the quote below, which sums up the reaction to this latest news:

“You are not required to complete the work, nor are you free to cease from it.”
Pirke Avot 3:18

Let the work go forward.

Thanks for nursing

I casually joined the Facebook group "If breastfeeding offends you, put a blanket over YOUR head" some time ago. I only recently learned of the companion blog. They are currently featuring the above printable cards, which I think are completely awesome. I will probably print some out to have on hand, even though I think I have only seen someone else breastfeeding in public ONE TIME. Oh, well--it never hurts to be prepared.

What should you do if you come across a nursing mother and you don't have one of these at the ready? Make eye contact and smile at her. That's all. Don't: a) stare, b) grimace, c) say something rude, or d) hastily avoid eye contact and shield your children's/husband's eyes like you've just caught her urinating.

If all else fails--just ACT NORMAL. There's a crazy thought, huh?

Spring goals

One thing I meant to talk more about in my last post was cutting down not just on coffee, but on a variety of other substances that I find to be rather addictive. They're nothing earth-shattering; sugar is one, BAKED GOODS are another. Someone brought banana bread in to work the other weekend and I wound up polishing off half the loaf, knowing while I was doing so that it wasn't what I wanted to be doing. Even decaf coffee kind of functions that way--I find myself downing it mindlessly, then craving more. Whereas when I drink tea in the morning, it's more like "That was nice, now I'm done." There's a certain kind of reaction I have to particular things that keeps me from making level-headed decisions about them. Television and the internet are another. The kind of slothful, bloated, I-know-I-should-get-up-or-do-something-different-but-I-can't-make-myself feeling that I really don't care for. I love spontaneity, but there's something to be said for intentionality as well.

The antidotes? Again, nothing mind-blowing. Eating "decent food" that lacks such a strong binge potential. (Generally easy for me at home, where I plan the meals; much harder when I'm somewhere else with unlimited junk food!) Going to bed early (staying up late--another addictive practice) and even a little hungry now and then. Getting plenty of activity and exercise. Sticking to a routine and keeping the apartment as neat as I can. I'm happy to say that I'm back to my pre-pregnancy weight, but in a way, that's removed my impetus to exercise. I'm happiest and most energetic when I do, though, so I need to find a way to keep that up. I'm trying to spend less time on my computer in the evenings, since school means I spend a lot of time that way during the day.

Another way to engage in the real world in a mindful way is by reading actual BOOKS (and magazines). Even most of my course readings these days are online, and so actually holding a book and turning the pages are activities that have threatened to become obsolete for me. I've found this tends to make me rush, feel a little bit hyper, skimming to get through something versus reading it in order to know it or enjoy it. I see this tendency in myself and I don't like it. So I'm making an effort to check out books from the library, and I've actually changed two online subscriptions (great for reducing clutter and waste, but somehow not as satisfying or durable) to print (Mothering magazine and Midwifery Today).

Luckily, spring is coming and I'm also on break from school, so it should afford me some good chances to continue to energize my routine and myself. I've always liked doing seasonal rather than just new year's goals too, so in honor of the warmer weather, here are my spring goals:

1) Keep exercising 5 days a week
2) Go to bed before 10 and get up before 6:30
3) Keep tracking calories with The Daily Plate and avoiding addictive triggers like coffee, sugar, and baked goods
4) Stay off the computer in the evening
5) Read a book a month

Let's see how I do!

Slump lifted.

I'm pleased to say I pulled out of the slump I was in a few days ago. I let myself slump for the rest of that afternoon, then started strategizing about how to fix it.

One thing was setting a couple of concrete goals for the next day: I WOULD get up when my alarm went off, and go work out. I WOULD finish the chapter of notes I was working on. Taking "do I feel like it?" out of the equation seemed to help, and I did, in fact, do those things. And those successes gave me a boosts in other areas.

Another element was analyzing where my energy drains were coming from. One was getting lax about bedtime. For awhile I was pretty consistently going to bed before 10pm. Then I started picking up more evening shifts, staying up later, sleeping in later, then staying up later, etc. I'm working on that.

The other was caffeine. Matt and I switched back to caffeinated coffee around the time I went back to work, because I was up late working until 1 or 2am many evenings. One cup turned into two, turned into a couple of cups in the afternoon, until we were making a whole pot and drinking it every day (sometimes more). We figured out that at our peak, I was drinking around 6 cups a day and Matt was drinking closer to 10. I told him I remembered how after Eden was born, even though I wasn't sleeping much, I still had a ton of energy. I told him that I haven't felt like that for awhile.

The first day was hard. Talk about a slump. I oozed around the apartment with a throbbing headache and zero energy. Day 2 (yesterday) was better. Day 3 (today), I again have a headache, but my energy level is coming up again. I'm optimistic it will get even better.

So what do we drink in the morning? We started with tea (herbal or decaf), which is warm and tasty, but recently we stumbled onto Vanilla Steamers, and boy, are they good. A cup of warm milk, an egg yolk, a splash of vanilla, a sprinkling of cinnamon, and just a little maple syrup. It's like hot chocolate, but vanilla. Kind of like warm eggnog. Creamy, dreamy, nourishing, and filling, I think they're better than coffee. Even better still? We can also drink them before bed. Eden is a big fan, too!

Visit from Grandma Mary

We had a great time with Matt's mom this past weekend. The hardest thing about living out here is being so far from our families, but we're always so excited when they come to visit, and we were happy to see that Eden had no trouble remembering who she was and having a great time with her!

The last few days have found it really hard for me to concentrate on schoolwork. I don't know why. Remarkably, I have felt able to get things done around the house (which is a blessing, since one of our cats has been throwing up on the carpet after each feeding, and today while I cleaned that up, Eden found my full cup of coffee and "sent it sailing," as my mother would say, further adorning our cream-colored living room rug). It's just when I try to sit and get work done that I feel antsy. Probably some senioritis, since this is my last term of only classes; probably some spring fever; and probably some of the inertia that comes with being just past the middle of the term.

So I'm set to start clinicals in May. Here in Virginia. Our plans have changed about this so many times that I don't even know where to start. At the beginning of this year, we thought we felt the call to move back to Iowa, stay with my parents, and do my clinicals there. While part of me was brokenhearted to leave Virginia, part of me was thrilled to move back closer to our families, and almost all of me was thrilled to finally have things settled. A few weeks into it, however, one of my sites dried up and the other became...less than enthusiastic. The logistics of melding our household (two adults, a baby, and two cats) with my parents' (three adults, two to three dogs, and a business) started to seem increasingly difficult. Jobs did not appear promising. Finances began to look daunting. The final straw was finding out that despite the fact that I'm scheduled to attend Frontier's weeklong clinical preparation session (known as Clinical Bound) in April, if I didn't start clinicals within 16 weeks, I'd be required to repeat it (not easy or cheap). Getting started--and, of course, also finished--sooner started to seem like an imperative.

Making phone calls to find a preceptor around here didn't go much better this time than it had the first, but I did find a place doing office visits with a women's health nurse practitioner (allowed for certain elements of clinicals if a CNM can't be found) I know, and I'm thrilled about that. A close friend has agreed to watch Eden one day a week, so I'll know she's in good hands, not have to be away from her too much (other sites I'd talked to wanted me there full time), and still be able to work. Matt will be able to keep his job into the summer and so our finances should be all right. I've found a hospital in Maryland where I can start doing births starting in September, and from what I can tell, I should be able to finish up around December. That's a nice idea.

It's frustrating not to know what we'll be up to after that, but we're trying to resign ourselves to it. Every time we've tried to plan ahead, we've been brought back firmly in check by a change in circumstances. Evidently we're meant to live one day at a time, quite literally. This has put a strain on us, and our families and friends, but we're doing our best to deal with it.

I've been thinking lately about our diet. While overall it's quite good, I daresay better than most, it isn't perfect. We each have our own chronic health concerns that are not entirely resolved, and having Eden start eating table foods versus just effortlessly receiving perfect nutrition we don't have to think about has made me want to give her the very best start I can. Things like the GAPS program or the Maker's Diet seem to make intuitive sense to me, but we haven't figured out anything definitive yet. More on that journey yet to come.