Letters from the Issue of April 1, 2004

Page 2 of 3

VBACs (vaginal births after cesarean) are done successfully all the time, and patients must sign extensive consents indicating they are aware of the risks, which include uterine rupture, placental abruption/hemorrhaging that may result in fetal and/or maternal death, and possible hysterectomy for uncontrolled bleeding. If Mrs. Wasserman was willing to accept these risks, then more power to her. I just happen to feel that most people would rather have a repeat cesarean section and a healthy mother and baby than accept the guilt and responsibility if anything were to go wrong, all so they could have the "birth experience."

In my experience, when labor and birth go smoothly (which the majority of them do), the outcome is a healthy mother and baby. But when things go wrong, they go very wrong very quickly, and can cause poor fetal outcome or death, or even maternal death in some instances. This is why it is critical for physicians, nurses, midwives, doulas, and families to work together to provide families with their "birth experience," allowing room for medical intervention when necessary.

What I feel the public also doesn't understand is that there is a difference between "lay midwives," who have minimal medical background and training, and "certified nurse midwives," who are RNs with graduate-level training in labor and birth. They are trained to recognize the early warning signs of things going wrong and defer care of the patient to their backup physician when necessary. I can't tell you how many cases I have seen where high-risk patients are laboring at home or in a birthing center with a lay midwife, and then come to the hospital at the last minute with obvious signs of prolonged fetal distress, and I have to tell you, the outcome is often very poor. But then who gets blamed? Not the midwife with no medical training or malpractice insurance.

Celeste quotes Cher Durham as saying, "Why would you want to be medicated if you don't have to? Why would you want a needle in your spine?" The answer is simple: You don't! Hospital nurses and physicians are there to make the experience what you want, within the policies of the facility. If you don't want an epidural or intravenous narcotics, nobody is going to hold you down and give them to you. It's all about informed decisions and choice, but sometimes the power is taken away from everyone involved in order to prevent a poor outcome. If a baby tells you it's in trouble, you'd better do something about it before it's too late.

With regard to "elective c-sections," you must consider the Hispanic culture here in South Florida. I can't tell you how many patients come in from South America wanting to "schedule my c-section," only to be horrified to be told that no, we do not just schedule c-sections for no reason and that they will be having a vaginal delivery. Sure, some doctors are willing to do this, but very few will promote unnecessary and risky surgical intervention.

The answer to all of this: education, education, education. Explore your options, know your rights, and go into the experience empowered with knowledge. But please, if things go wrong and you need a c-section, understand that it's not your fault and it's not our fault. Things happen. Look at your beautiful new baby and realize: This is what it's all about.

Just a final observation: Celeste states that during Cher Durham's delivery, "For a moment the baby is stuck, snagging her mother's insides with her left hand." Hmmm.... She must have x-ray vision! That would be really useful in hospitals so we could see what's going on inside the womb.

Samantha Roher, RN, labor and delivery


Home Is Where the Birth Is

At least it was in my case, without problems, two times: I would categorize myself as a very safety-conscious nerd. I am not a risk-taker, and I do not think of myself as brave. I also have several family members who are doctors, so before I became pregnant the first time, I did a fairly extensive review of the mainstream medical literature. (If I was going to go through nine months of pregnancy, I wanted to make sure my decision about where and how to give birth was the safest one for my child.)

After much reading, I chose to have a home birth (and have since had another) with trained and licensed midwives precisely because of the conclusion reached by the studies I read: Healthy, low-risk women who give birth at home have no increased risk either to themselves or to their babies. Since health outcomes are equivalent in home birth vs. hospital birth for women classified as having a low-risk pregnancy, the deciding factor should be where women feel most comfortable having their baby.

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