Thursday, September 2, 2010

The Pendulum Swings

Can you feel it? The pendulum is beginning to swing the other way again. Last February I witnessed a doctor emotionally manipulating a woman, who was courageously working on pushing her baby out, into agreeing to a cesarean. I didn't know then that in that hospital room we were standing at the apogee of the pendulum's arc.

Apogee (Merriam Webster) Definition: 1. Farthest point on an orbit 2. final climactic stage, standing at the culmination

I only knew that in the past few years it had become a greater and greater struggle to keep my hospital doula clients out of the operating room. I didn't know that this was the final climatic stage in a hailstorm of surgeries.

Here is a simple physics lesson:
When a pendulum reaches it's apogee it holds its maximum potential energy. This energy is released as it begins to swing back the other way.

Can you feel it? In the past few months there has been a huge release of energy on a national and international scale against cesarean sections. On Tuesday I opened our local paper and saw more evidence of this phenomena; an article reprinted from the Los Angeles Times titled Study Finds Patience May Lower C-section Rates. That's right patience, not patients.

Here is a simple vocabulary lesson:
**Patient as a noun.
(Merriam Webster) Definition: individual awaiting or under medical care and treatment 2. one that is acted upon
**Patient as an adjective

(Merriam Webster) Definition: Patient 1.manifesting forbearance under provocation or strain 2. not hasty or impetuous 3. steadfast despite opposition, difficulty or adversity
**Patience is a singular noun
(Merriam Webster) Definition: the fact of being patient

Here is what this latest study done by the Eunice Kennedy Shriver National Institute of Child Health and Human Development said:

If doctors and their patients (women under their medical care) would have patience (forbearance under the strain of waiting out those last difficult weeks of pregnancy) and not go with an induction they have a much greater chance of not having a surgical birth. Of course for the woman remaining patient (steadfast) to the idea of waiting for spontaneous labor in spite of her doctors threats of placental disintegration, baby too large or blood pressure rising (opposition) can be a daunting (a great strain). In my experience getting a mom through these last prenatal visits is very difficult but well worth the effort. My own doula statistics bear this out with a 1% section rate for my first time moms who wait for labor to begin on its own.

If doctors would be patient (not hasty or impetuous) about the progress of their patients (women who they are acting upon) labors there could be many fewer c-sections. The authors of the study say doctors aren't acknowledging that labor takes time and doesn't follow a predictable pattern, especially in first time mothers. A high proportion of the surgical births reviewed were done after the patient (one who is acted upon) had been in active labor for only 2 to 3 hours! OMG!!! These women are being labeled as suffering from "failure to progress" which leaves them feeling defective the rest of their lives which leaves them much more open to being manipulated into repeat elective cesareans for all future babies. Most of the women I attend at births are in active labor for waaaaaaayyyy longer than that. I guide them, support them and explain that this is normal, babies take time and they are doing just fine. My cesarean rate even for mom's who agreed to an induction; 1%. The study showed that a major reason for having a cesarean was having had a cesarean. But my total cesarean rate with spontaneous labor, inductions and v-bac attempts is only 7%. There is no great mystery here. I am no wonder woman. Doulas and midwives support women whom they do not see as patients but instaed as healthy people in the process of a healthy physiologic act; like breathing or sex. Doulas and midwives having an abundance of patience is the key to good, safe, healthy births.

One final thought: Years ago I met the women who were spearheading our local International Cesarean Awareness Network at the time. One of them said, "There is no such thing as a 'failure to progress' only a 'failure to wait'. I have been calling it that ever since and now we are beginning to have the studies to prove who failed and what that failure has meant to women in america.

Can you feel it?

National Institute of Health panel strongly urges that steps be taken to reverse repeat cesarean sections.

Study in Journal of Obstetrics and Gynecology says v-bac is a reasonable and safe choice because the outcomes for repeat elective surgery and v-bac were basically the same.

New Guidelines from American College of Obstetricians and Gynecologists on repeat sections.

Study Finds Patience May Lower C-section Rates.

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