People often ask me why I blog about the risks of homebirth and other birth choices. This email from a reader, along with her baby’s story, is one of the many reasons why.
The baby’s mother wrote:
This is the birth story of my sweet baby boy…
Thank you for steering women to make the right choices. Because of you I decided to attempt my VBAC in a hospital and for that I am very grateful.
Here is her story:
This story starts off with the reason I had my first cesarean. With our daughter I suffered a ruptured brain aneurysm. In order for me to receive the medication to prevent me from having a stroke the doctors decided to perform a cesarean section at 34 weeks. I was under general anesthesia and my brain was swelling so I do not remember meeting her until she was two weeks old.
Fast forward to just before I became pregnant with S, I had to be cleared not only by my obstetrician but also my neurosurgeon. All was clear and I was given the doctor’s blessing to try for another child.
With this current pregnancy I sought to have a vaginal birth after cesarean (VBAC) because of the horrible experience I had with my daughter. I wanted to experience labor and be present for his birth. I narrowed it down to a hospital that performed VBAC and I had all of my prenatal care there.
I was considered the perfect candidate.
- I had waited 22 months in between pregnancies.
- I had double suturing on my old incision
- My cesarean was not due to a labor problem (stalling, not descending, etc)
- I was young, 25
- I was healthy, thin and active.
My pregnancy was uneventful. At my 40 week appointment I had the doctor strip my membranes and it sent me into labor. Overnight I kept cramping so I decided to go to the hospital. (I was told to go in early and I did). When I got there my contractions stopped. I thought to myself “Let’s just have this baby!”
I was checked and was dilated 2 cm, and then an hour later I was 3. They decided to admit me because I was attempting a VBAC. When I got to my room, I asked that the doctor break my water and after that I got the epidural. (I had pitocin at a level 4, then a 2 and the doctor decided to turn it off because I was progressing beautifully. I don’t know if this affected my rupture or not). An hour later I was checked at a 5, and an hour after that I was complete. A lot of people rushed into my room to prepare for delivery.
The doctors told me to push but I couldn’t. I was in such pain in my upper abdomen but no one seemed to notice. The anesthesiologist told me that not all epidurals get rid of the pain.
Meanwhile my baby was having rapid heart decels. They tried turning me on my side and placing an internal monitor. Immediately after placing the internal monitor, the attending physician checked me (residents did deliveries) and called a cesarean. I was also experiencing reverse dilation. My babies heart rate was in the 30s.
They wheeled my immediately into the operating room. The doctor started to cut me open before the sheet was even up and I was not anesthetized properly. Decision to incision was less than 5 minutes. All I remember was the doctor saying “uterine rupture”. My old incision opened up and my baby was in my abdomen.
I screamed as they pulled my baby out, it was very painful. My baby was not crying.
Baby S was born at 8lbs 7.7oz and 22 inches long.
By then the anesthesiologist gave me so much medicine that I couldn’t move or talk. I just lay there. I was in surgery for over an hour and a half, and the doctors were working to save my uterus. I had suffered a placental abruption as well as the uterine rupture. The doctors believe that because my uterus ruptured I had the placental abruption.
My baby was not breathing. Because he needed a complicated procedure that the hospital was not prepared for they took him to Texas Children’s Hospital.
I was in recovery experiencing shock from blood loss and I got transfusions. I was shaking for hours after the surgery. The worst was yet to come, and I had to go to postpartum alone while I heard other babies crying and I did not have mine. My husband was at Texas Children’s Hospital.
In the middle of the night the doctors at Texas Children’s called me for permission to do a blood transfusion for S. I agreed and just wanted to see my son. At the time I did not fully understand what was wrong with him. The hospital released me after just 2 days so I could go see him.
When I got to the S’s hospital the doctors there were asking for consent to perform surgery. They already had him “cooling” on a pad that dropped his temperature very low. My baby felt dead. He was not conscious. The surgery was for an ECMO machine, a last resort machine that is used for life support. They told me our son would die without it so we agreed.
He ended up on life support for 10 days until they felt he would survive on his own. Another week passed and we finally heard his first cry. We stayed at the Ronald McDonald house for most of the time but we also had another child to take care of so we didn’t get to see him every day. That was very hard on our family and week later he came home with us.
While at the hospital he had an MRI done and told us that he had brain damage but they don’t know how extensive it will be until he gets older. That is the hardest part, not knowing. Right now he is a healthy growing boy and we love him. He seems to not have any effects from his birth and is meeting his milestones on time.
I’m writing this to let all women know of the risks of VBAC, because uterine rupture does happen. It’s not talked about very much and it should. Women should be totally aware of the risks before they attempt a VBAC. Please attempt your VBAC in a hospital equipped to do immediate surgery like mine was. While I was aware of the risks, I didn’t think it could happen to me. I was wrong.
I’m so thankful to both hospitals and the doctors that provided me with such great care. I’m just lucky my baby survived.
I’m not sure why it’s being ignored here that this woman’s was given pitocin. I had a c section with my first and am leaning towards a repeat c section with my second, so I’m certainly not against rcs, and I’m very pro hospital, but when I was weighing the options, both obs said that they generally do not give any pitocin during a vbac (and thus don’t recommend an epidural at least not an early one due to potential stalling of labor). I was told that pitocin increases the risk of uterine rupture during a vbac. Correct me if I’m not reading this properly, but she did have pitocin during her TOLAC and she did experience a uterine rupture depsite her being low risk. Isn’t it possible, therefore, that she could have had an Unmedicated natural vbac outside of the hospital without pitocin and delivered vaginally no complications? Obviously there’s no way of knowing pitocin caused her UR, but in light of the added risk factor, isn’t this a poor example of vbacs being safer in a hospital?
I would never recommend home birth, but this does seem to be a case where hospital-only interventions (epidural, pitocin) could have been the culprits in raising her risk of a uterine rupture. If I were to attempt a vbac, my discussion with my provider was quite clear that if possible we would want to avoid an epidural as well as pitocin. And that would still be in a hospital.
American College of Obstetricians and Gynecologists (ACOG). Vaginal birth after previous cesarean delivery:
“Epidural anesthesia for labor may be used as part of TOLAC.” Level A Evidence
Both ACOG and RCOG (UK) also discuss induction and augmentation of labor in their TOLAC guidelines.
My doctor never said that epidurals were contraindicated vbac. As I stated in my comment, she said that PITOCIN can increase the risk of UR. During our discussion she just mentioned that it would be best to avoid an early epidural so as to not run the risk of stalling labor and needing pitocin. Didn’t the woman in the story have pitocin?
I see your point about the pitocin; I have a friend who was recently told the same thing by her OB, that if she tried for a VBAC they could not give her pitocin, presumably because it increased the risks of uterine rupture.
I don’t think it’s true that epidurals can stall labor, though. Hasn’t that been disproven?
Any OB types want to weigh in on this? What do you guys do for patients who are doing VBAC, will you augment or induce them with pitocin?
“Hasn’t that been disproven?”
Yes. http://www.skepticalob.com/2014/10/cochrane-review-women-should-get-labor-epidurals-as-soon-as-they-want-them.html
“I would never recommend home birth, but this does seem to be a case
where hospital-only interventions (epidural, pitocin) could have been
the culprits in raising her risk of a uterine rupture.”
In your post, you brought up the idea that epidural analgesia possibly contributed towards the UR.
Why on earth would avoiding an epidural in a VBAC be advisable? If your uterus ruptures you will be facing an emergency C-section under general anesthesia, the absolute most dangerous scenario for you and your baby.
If your provider really say avoiding an epidural, you need to ask what the mechanism is by which an epidural increases the risk of uterine rupture and for documentation that this occurs.
My friend had a hospital VBAC in August. Her uterus ruptured, she had an emergency C under general, they initially didn’t think the baby would survive the night, she had to be life-flighted to a larger hospital, undergo cooling and still seizured for days. She is permanently brain-damaged. Catastophes can and do still happen in a hospital. You should be as prepared as possible. Continuous monitoring, epidural, etc.
Not sure if you misread my original comment or if it was just unclear to you, but my doctor did not say that epidurals increase the risk of UR. Again, I was told that pitocin can increase the risk of UR in a vbac. The woman in the story had pitocin, thus, I was questioning the reason for posting this experience — as it’s possible her risk for UR was elevated by having pitocin.
The epidural mentioning was part of my discussion with my doctor and she said that early epidurals can stall or slow labor, necessitating pitocin, so it could be better to avoid needing pitocin.
I had an emergency c section with my first child. I did not have an epidural in place prior to that, and they were able to place a spinal block very quickly and I did not have to undergo general anesthesia.
Epidurals do not slow early labor. See my links above about the Cochrane review from October 2014. Perhaps your doctor hasn’t seen this?
Actually that is not what the study says…it states, “The duration of second stage of labour showed no clinically meaningful difference between early initiation and late initiation of epidural analgesia…”. (please note..it said SECOND stage) And then goes on to say, “There was significant heterogeneity in the duration of first stage of labour and the data were not pooled.”
Now could that mean a shorter duration of the first stage of labor…sure..but my bet would be longer..but that’s just my opinion.
Not bashing women who want pain management. Just wanted to clear up that it did NOT say that epidurals do not slow early labor.
And a very recent large meta-analysis demonstrated that epidurals in early labor (<4cm) do not increase the risk of a C-section. That is a myth.
I never said epidurals increase the risk for c sections and I don’t see how that’s relevant to my comment or to Dr. Amy’s post….
“hospital-only interventions (epidural, pitocin) could have been the culprits in raising her risk of a uterine rupture”
Maybe it wasn’t your intended meaning…but it is what you said.
Your doctor is wrong. There was a Cochrane review in October 2014 showing that early epidurals do NOT increase the risk of C-sections.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007238.pub2/abstract;jsessionid=0A981B8CEC081C53F8FA20F91016EBE5.f03t04
http://www.skepticalob.com/2014/10/cochrane-review-women-should-get-labor-epidurals-as-soon-as-they-want-them.html
agreed
I feel frustrated by the pressure to do VBACs. Due to a pelvic injury and large baby despite the fact that I only gained 15 lbs while pregnant, my OB recommended I do repeat c-sections for any future pregnancies. My c-section with my son was a relief and very not traumatic. When I tell friends I’ll have c-sections for my next 2 kids, they get all horrified and act like I don’t “get” the supposed wonders of “natural childbirth.” I labored in unmedicated agony for 35 hours. If not for modern medicine I and my baby would be dead. VBAC is not always the right answer and the unequivocal support for them without realistic risk discussions really disturbs me.
bullshit. Of course you will end up cut open because of pitocin and other medical interventions the hospital did to you. I had a succesful VBAC with my second child because i resisted all those bullshits the hospital was offering me (pitocine, epidural, membrane rupture, elective CS) which can lead to complication like fetal distress, etc… I chose to give birth in a hospital because of security reasons (if anything goes wrong, IF) but i still let nature do its work and I delivered my baby beautifully. Why would a woman be designed to conceive a baby if they are not able to deliver them vaginally. It doesn’t make sense. Don’t let false information ruin your common sense.
Why didn’t you deliver on your own at home?
“Why would a woman be designed to conceive a baby if they are not able to deliver them vaginally.”
Because evolution doesn’t design things perfectly, and nature finds high maternal, infant and child mortality rates to be perfectly acceptable.
You realize that you are essentially saying “women are designed to deliver vaginally” and “I was afraid of something going wrong so I went to the hospital” but “I still let nature do its work” are 100% completely contradictory statements.
YOU didn’t “trust” your body or nature and that’s why you went to the hospital. But it’s ok for you to sit on your high horse and condemn other women for making the same decision. Hypocrite.
Oh man. If a homebirth midwife had overseen this birth they would both be dead.
So glad your baby and you both survived this ordeal! It’s great that you made the best decision to ensure a good outcome. I guess I will never nderstand why, to some women, the process is more important than the outcome. Even at my most “crunchy granola” stage of life, when I had my first child back in the early eighties, I remember thinking how stupid it would be to do a home birth. Why take chances like that? We live in the first world, we have options, there are villagers in places like Guatemala who would give anything to be able to deliver in a clean, modern, well-staffed hospital.
I get a little tired of “white privilege” being evoked constantly, but I think this crazy notion of home birth is an example of white privilege run rampant. Just more one-upmanship amongst upper middle class mombies.
Oh, and I am the mom of three healthy, brilliant, successful young people, all of whom were delivered in hospitals and formula fed. Yay to hopitals, yay to formula, yay to living in modern times.
“Your risk of rupture (the norm, anyway) is less than 1%. Your risk of requiring a hysterectomy in subsequent CS’s is 3-7%.”
http://community.babycenter.com/post/a49964395/vbac_doctor_wants_baby_out_by_39_weeks_40_max.
Say wat.
Is that the misquoted statistic about accreta? That (approximately that number) of women who have prior c/s AND placenta previa wind up needing a hysterectomy, which anti-CS activists pull the conditionals out of?
Just sounds like a biased VBACer saying the “norm” rupture rate is less than 1%, but then implies the norm rate for hysterectomy with repeat CS is 3-7%. Talk about fear mongering and inaccuracy.
I did my residency at a busy hospital which did 8-10 thousand deliveries a year. I scrubbed on one C Hyst.
I have been in practice (private and hospitalist) for 27 years. I have scrubbed on one more in all that time.
So no, it’s not very common.
Dr. Amy – because of you, I also attempted my VBAC in a hospital. My first c-section was due to GD and suspected macrosomia (he was estimated at 10lbs, and came in at 9 and a half). Actually, that c-section was due to you, as well. I was devastated when I was told that I should have a scheduled c-section instead of attempting labor. Although I had been completely sucked in by the woo at that point, I still fortunately needed to be sure about my decision to skip the c-section and show up at the hospital pushing (as suggested by a homebirth midwife I had been talking to). I came across your blog, thought you were full of shit, researched further, and realized you weren’t. The statistics were very clear – with the risk factors I had, there was a chance of shoulder dystocia well into the double digits.
I went ahead with the scheduled c-section at 40 weeks exactly, but was still extremely upset about it. Additionally, breastfeeding did not work out (I produced a maximum of 4oz per day on a high dose of domperidone purchased from god knows where overseas that arrived in a package marked “gift” on the customs form. I’d like to think that had I not been suffering severe PPD and sleep deprivation from feeding/supplementing/pumping every two hours, I would have realized how ridiculous it all was, but who knows. Eventually, with some zoloft and shoving the breast pump and domperidone deep into storage, I got myself together. Around that time I rediscovered your blog with your “Ode to a C-section Mother” post. It was the first thing that made me feel like a good mother, instead of a failure. I kept reading.
Immediately after the c-section, I decided I would have a VBAC with the next one, at home. I didn’t think my doctors would give me a fair chance at one. My GD didn’t go away after birth – I remained pre-diabetic, and I think I had been having poor sugar control well before the official GD test with my first pregnancy, so I knew it would recur. I had a home birth midwife lined up and was just waiting for the right time to get pregnant. This time I would keep an eye on my sugar from the start, and it would all be different.
THANK GOD I started reading your blog. I realized that all the things I had been told, and believe, were lies. I pulled out my midwife’s information book, and realized she was not even a certified midwife – no letters after her name at all (not that the letters CPM would have made it better, but still)! I was horrified. HORRIFIED.
Last June I got pregnant again. At my first visit, my OB told me if the baby didn’t measure as big as my last one, and everything went well, I could try for a VBAC. She did not make any promises or get my hopes up. And you know what? I was perfectly okay with another scheduled c-section. I just wanted a healthy baby.
Although I declined the GD test this time, I was testing my sugar from the very beginning, four times a day, and stuck to a diabetic diet. By 12 weeks my sugar was already creeping up, but still within normal range. About four or five months in, it got uncontrollable and I started glyburide. Because of that, I had NSTs twice a week starting at 32 weeks. I passed all of them. An ultrasound estimated that the baby would be about 8lbs at term. I felt pretty good about that – the ultrasound of my first estimated him a pound more than he ended up being. To my surprise, my OB was fine with scheduling a c-section 5 days after my due date, and if i went into labor before then, we would attempt a VBAC.
My water ended up breaking six days before my due date, with light meconium. I went in right away since I was GBS positive and knew I would need to be on antibiotics. I was hooked up to an IV and a monitor and we waited for labor to start. It sucked being hooked up to everything – but since I actually understood why these things were important, I was completely fine with it. I honestly still expected to be wheeled off for a c-section at any moment.
Eight hours went by and although I was having contractions, they were irregular and not very strong. I was dilated to a 3 (when I arrived at the hospital, I was only at a 1, but she was able to stretch me to a 3 and I stayed that way). Eight hours, no progress. Again, I expected to be getting prepped for a c-section. But the baby looked great, so I was started on a low, slow dose of pitocin. I started at a 1, and they increased it by 1 every half hour. For a few hours I was convinced that something was wrong with the IV, because the pitocin didn’t seem to be doing anything… but apparently a dose of 1 doesn’t do much. Eventually I started feeling it. And OH MY GOD, the pain was incredible, more than I could have imagined. I was, thankfully, not attached to an unmedicated delivery like I had been with my first! I knew I would get the epidural when I needed it, and I did. While they were getting it inserted, a nurse was helping me get through the contractions, which were pretty much on top of each other. The fetal monitor slipped off, and I could see how anxious my OB was by the look on her face, because I was in so much pain and barely had a break between contractions. I actually said to her, “Don’t worry, I’m not rupturing, I just have a really low pain tolerance.” Still, she shut off the pitocin, to see if my labor had kicked in on it’s own. I was dilated to a 7 at that point.
My labor did not kick in on its own. Once the pitocin was shut off, it went right back to the weak, irregular contractions that I’d been having for my entire pregnancy. Two hours went by with no progress, and they restarted the pitocin (all the way back at 1!). Again, I thought “c-section, any minute” and started to get annoyed that I hadn’t just scheduled a c-section at 39 weeks. This was taking forever and I hadn’t slept or eaten the night before as I’d been sick (or so I’d thought – I guess it was just the baby telling me she was ready). But, after that, things progressed quickly. Before I knew it, I was completely dilated. We tried a few practice pushes and the OB decided to let me labor another hour for the baby to come down some more. And she did come down! Once I started pushing, it was only for maybe half an hour. I didn’t think she was moving down at all, but my OB and my husband assured me she was. Before I knew it, after a small episiotomy to prevent a tear that was looking to go badly (one more thing I would have been scared of before), her head was out. One more push and the rest of her was out. A neonatologist was in the room due to the meconium, but she ended up not being needed – my daughter was perfect, with apgars of 8 & 9. She weight 8lbs, 14oz – almost a pound BIGGER than the ultrasound estimate. But she was so different than my son, who clearly looked like a sugar baby. Looking at the difference between them I knew I’d made the right choice having a c-section with my first.
I got to hold her right away while I got stitched up. After a good long while I got to get up right away and have a shower. It was amazing.
From water breaking to delivery was just under 24 hours. What would have happened if I’d never discovered your blog? I would have tried to have her at home. I certainly wouldn’t have had a GBS test, or glyburide. How long would the uncertified direct-entry midwife have let me wait to let me go into labor after my water broke before we went to a hospital? Having read the horror stories, I don’t even want to know. Maybe it would have turned out fine. Maybe even better than in the hospital. Maybe the baby wouldn’t have gotten a horrible infection or GBS. But… maybe she would have. And that’s just one thing that could have gone wrong – what else would have gone wrong with inadequately treated GD? I can’t even think about it. All those risks I would have taken, for what? To avoid being attached to some wires for 20 long-at-the time but really very short hours of my life? Good god.
So, thank you. This blog may well have saved two of my babies.
Sorry this is so long, I don’t know how to write without using way too many words.
This was beautiful! I’m so glad that you ended up here, that your babies arrived safely, that you were brave enough to use formula despite how rude some people can be about it, you opted for pain relief, communicated well, and that you had a safe VBAC in the hospital. You are awesome.
No need to apologize for the length. I was very glad to read it. So happy that both you and your babies are fine. You’ve made my day!
Congratulations and so happy to read such a positive story!
“All those risks I would have taken, for what? To avoid being attached
to some wires for 20 long-at-the time but really very short hours of my
life?”
To me, that says it all. You are a great mother to give up what you thought you wanted for the safety of your babies.
I agree.
And, to be fair, I really think that her attitude absolutely reflects how most people feel. Given proper information, most would make good decisions like this. The problem is that those who wouldn’t cling to and promote the false information to justify themselves.
I’d love to know where this happened, if you feel comfortable sharing (I can give you more info about myself privately). Spreading the word about where women can get care that isn’t, as some of us like or have in the past liked to say, “knife-happy,” yet makes good use of truly helpful interventions, could really benefit women in that area who are genuinely in search of a healthy birth but probably wouldn’t be open to Dr. Amy’s own writings because of the reputation some supposed advocates of healthy birth have smeared her with. personwithemail@yahoo.com, if this lets me post an email.
Sure – this was in Novi, MI at Providence Park hospital. The practice is Metro Partners in Women’s Health, which consists of 6 OBs and some CNMs.
As I kept mentioning, I expected to be wheeled in for a C-section at any moment – not because anything was actually going wrong, but because apparently a part of me still believed in the “knife-happy” OB stereotype, even though at that point I would have been okay with it.
First of all I’m very happy you did go to the hospital, in any case. It is the right decision even if you’re low-risk. I used to consider home birth too, and my husband is still dreaming of us having a baby in our tub, but I told him nah-uh, this ain’t never gonna happen! My reality slap was the tragic stillbirth in a family we know (the mother as low-risk as could be, with previous 4 vaginal births).
Second, I’m a little confused. I thought the general policy for VBACs was to give no pitocin at all, because of the extra strain it puts on the uterus, and if labor doesn’t progress on its own then it’s repeat Cesarean. Am I wrong?
It varies. My experience is that few docs are willing to induce labor in a previous cesarian, but many are willing to augment.
I keep reading about the risk of rupture with a VBAC, but there doesn’t seem to be much info out there about the risk of rupture without a previous c-section. I only ask as a friend of mine had a rupture during her third labour. Babies one and two were both born vaginally, fairly quick, straightforward and spontaneous labours. Baby number three was born via emergency c-section after a prolonged labour and heart decels. He’s healthy and thriving, and is a very cheeky two year old.
Off topic, sorry. I come here every now and then and have read some interesting things. I really wish that there was a place to post questions, though. For example, I’d love to hear some opinions on Michel Odent and Aviva Romm. Is anyone who regularly posts here familiar with them? If so, what are your thoughts on them and their work?
http://www.skepticalob.com/2014/02/aviva-romm-writes-things-that-arent-true.html
http://www.skepticalob.com/2014/02/aviva-romm-if-homebirth-is-so-safe-why-dont-you-attend-them.html
http://www.skepticalob.com/2014/02/aviva-romm-is-in-a-bind-over-the-hideous-mana-death-rates.html
I work in a hospital which has been supportive of VBACs. We had one come in Monday in early labor at 38.2 weeks. Her previous section was due to breech, so she was a good candidate. Got to complete without Pitocin (or any interventions, hah!) and began pushing. 3 pushes and baby’s heart rate fell and didn’t come back up. We rushed to the back, made the incision, and baby’s head popped right out. Complete uterine rupture. Apgars 5/7/9 and Mom is fine. This outcome could ONLY have happened in a hospital.
Good work to the whole team!
This baby was mine. When I had my follow up visit with the doctors that delivered my son, the kept telling me, “I’m so glad you weren’t at home”. There was a brief moment in the beginning of my pregnancy where I considered home birth, but because of this blog I decided against it. I have now learned about lay midwives’ “credentials” and I’m so happy that I came to that decision. Even an OB in the situation I was in could not save us from death that day.
I wonder If I didn’t heal the best from my cesarean because I was healing my head and brain at the same time, but I will never know.
***An OB if I was at home
I am so glad you were on the hospital, too! What a scary thing to go through. Wishing you the absolute best for your son, your recovery and your family!
Thank you for sharing your story. I’m so glad you were in a hospital and that you were close to Texas Children’s. The dedication of the doctors, nurses and staff at Texas Children’s is amazing.
Your family will be in my prayers. I hope your little one continues to grow strong and heathy.
Texas Children’s is truly a world-class facility, I love them and they do such great work.
Thank you for sharing your story. I am glad your son is alive! I hope he stays healthy.
I am glad your son is fine. I hope he keeps meeting his milestones. Thanks for sharing your story.
Congratulations, Emily, on the birth of your son. What a harrowing couple of births you’ve had with frankly amazing outcomes (ruptured cerebral aneurysm with impending herniation, stat section, both survived; extensive HIE necessitating ECMO, survived). Texas Children’s is a phenomenal hospital and he is receiving world-class care.
No one wants to make your experience into some kind of object lesson but wow it is alarming to think of the alternatives.
Congratulations on your baby boy! I’m also glad that you weren’t at home. I really hope that he has no ill-effects from the brain damage and that he continues on doing wonderful things.
Much love to you and your family. I hope that your boy is doing well. Thank you for sharing your story!
Thank you so much for sharing your story. I am so glad that you and your son survived! Congratulations on your baby!
I am so glad that you and your son both survived and thrived after such a near-miss!
Wonder if there’s a connective tissue disorder of some sort there.
I don’t know. It’s obvious that connective tissue disorders could cause complications, but I don’t know that anyone has the issue properly.
Actually — there are some studies out there. I know with Ehlers-Danlos type 1/2 Classical there is a risk of PROM as well as pre-term labor due to incompetent cervix. We’ve been doing a lot of reading on this lately — I have this disorder as do my adult children (19 yo twin girls).
That’s very interesting. Sounds plausible, also.
OT, but I would love to see Dr. Amy’s response to this: https://www.facebook.com/events/1413017898965170/
The WHO code has been used to justify giving crap health care to moms and babies in the developed world. Why anyone would celebrate that is beyond me.
Formula marketing to women without access to clean water or proper bottle preparation or the ongoing ability to pay for it is pretty disastrous. However, the long term goal should be to improve access to clean water and proper sanitation, so that everyone gets to make the choice for themselves.
Lots of progress being made in that realm but a long, long way to go. Formula marketing to less developed countries is reprehensible and will be for many years to come. http://www.who.int/mediacentre/news/notes/2014/jmp-report/en/
Sure…but many of those women are decrying formula marketing in first world hospitals. That’s entirely different. If they (the women involved in the campaign) want to make a difference, I agree with Trixie…work on improving the conditions for those people without so they have choices. Obviously clean water and proper sanitation will bring them so much more than just a choice of breast v. formula anyway.
Clean water changes everything. It is outrageous that, 150 years after the human race discovered this, STILL hundreds of millions of people don’t have it.
Yeah. And folklore and superstition about colostrum being bad for babies kills a lot of newborns, especially when they get dirty water in its place. So the Gates foundation advocating getting babies to nurse in the first hour after birth makes a lot of sense and is an almost costless way to save a lot of lives right now. But rich white ladies acting persecuted about formula marketing in the US is stupid by comparison. Get mad about what Nestle does in developing countries, but not here.
Their crusade is irrelevant to me and doesn’t change the fact that marketing formula to less developed countries is morally and ethically wrong. It’s possible to work for better conditions and in the short term, get formula companies to stop with their bullshit once and for all.
Oh I agree with you, I just think some of the women involved in this particular campaign are either intentionally or unintentionally misguided. They aren’t focusing on marketing to less developed countries, they are focusing on making formula as hard to get as possible, in the developed world.
Another way to look at this situation requires me to check my privilege.
A. Women in less developed nations are no less savvy then college educated women especially when it comes to infant feeding .
B. women in less developed nations know how to heat water so that it is safe to drink. They know how to use their locally available energy fuels to create a fire and boil water.
C. women in less developed nations suffer from the same breastfeeding issue as women in developed nations, poor infant latch, low milk supply, painful nipples, crying infants etc…. mother infant separation
And formula-feeding is essential when the mother is infected with HIV and her baby is HIV neg.
No, exclusive breastfeeding is preferred over formula in areas where safe formula preparation isn’t possible. That’s the WHO recommendation. The risk of death from diarrheal illness is higher than the risk of getting HIV from breastfeeding, especially exclusive breastfeeding.
Talk about a crappy choice, though… Especially if the HIV+ woman can’t have access to antiretroviral medications.
Yeah. With ARV treatment and exclusive breastfeeding to 6 months, the rates are low enough to make it the least bad choice.
Again a money issue because ARVT is expensive too
Isn’t the problem of formula in developing nations more a problem of resources than knowledge btw? Women who live there and can afford as much formula and energy to heat water as they need have healthy babies. But when poverty and lack of infrastructure combine, many women just don’t have good options if they can’t breastfeed.
Definitely, there have always been breastfeeding failures, and proper formula is miles better than makeshifts. However, keep in mind that for a woman living in urban poverty in many areas, formula powder isn’t much more expensive than extra food for Mom. For a subsistence farmer or villager, that much cash is tough to come by.
You know what might really be useful to women who have breastfeeding problems and live in rural poverty? 1950s-style formula made with modern technology. A powder designed to be mixed with whole milk and water, useful for anyone with the power to boil water and milk. Maybe one version for cow’s milk and one for goat’s milk. How expensive would it be to make something like that? What would you need to put in it?
My elderly neighbor is from India and she told me she has issues breast feeding and she mixed Karo syrup or something similar and goats milk to make formula because she did not have access to powdered formula consistently. She said her son thrived and she used this method with her daughter who was my math professor at the local college.
That’s basically what they fed my mom in the 50s.
Boiling water doesn’t solve all forms of contamination, particularly in urban slums.
At least boiling gets rid of microbes. If other pollutants like heavy metals or pesticides or industrial waste is in the environment the mother lives in (food, water, air…), it will likely be in her milk too, and sometimes at higher concentrations.
It’s one of the things that makes me think the WHO, the UNICEF or the Bill & Melinda Gates foundation’s campaigns to promote breastfeeding in developing countries are well intended and probably useful, but they run the risk of being oversold. Saying that breastfeeding is the most important thing one can do for babies? I’d say making breastfeeding available is the bare minimum. But women with low supply will still have low supply, those with HIV, hep B or other infectious disease potentially transmitted by breastmilk will still have that issue, and women who try to go to university or hold a job (and hence get up in the social ladder) risk to find it an added burden if they breastfeed too.
I may sound cynical, but while breastfeeding is well and good, it’s the kind of intervention that can get political traction because it doesn’t threaten the social status quo.
I am not understanding what the problem is with marketing formula in these countries? What if the mother is HIV+ or has another medical issue that requires formula use? Would it not be useful to have free samples and options to choose from? We all know breast is best, but not when mom has HIV or died during childbirth.
First, because formula is marketed as preferable and more high class than breastfeeding, which, when you’re trying to prevent diarrheal illness, it really isn’t.
Second, if safe water isn’t available, it’s actually preferable to breastfeed with HIV than to use formula.
One minor point: can we stop referring to developing countries as if they were some amorphous blob? There are working and middle class mothers in developing nations, too, who have access to water purification methods and money to buy formula but need to work and can’t be pumping/exclusively feeding. Yes, there is a percentage of extremely poor people in such countries that can’t access clean water/afford formula than in developed countries or read labels and should be encouraged ot breastfeed if possible. But there is also a large percentage of people who do need formula and benefit from it even in those countries and that choice should not be denied to them.
Other than water access, a lot of the problems associated with using formula is that the labels are in a foreign language and that people mix it innapropriately — issues that could be solved by better marketing and information instead of banning marketing.
Also, breastpumps? Are they adequately marketed in developing nations? Most of my relatives have those parts imported from the US at great cost. What are working mothers to do?
Thanks Mariana, that’s a good point! Not all situations are the same and it’s easy to take things for granted when talking about other countries.
I have an upper class friend in Pakistan who needed to use formula, and she pointed out to me that Nestle not only has a monopoly on formula there, but also a monopoly on the bottled water you have to buy to make the formula.
Yeah that’s not cool.
Is the monopoly government enforced? Otherwise, what prevents other companies from selling water and formula there? Bad publicity? Emerging market is still to small?
Why can’t she purify her own water? I’m surprised there is only one brand of bottled water, most developing nations I’ve been to have a wide array of bottled water companies since everyone drinks it.
In Peru where I’m from, it seems like Enfamil has a strong market share, although I’m sure Nestle also sells a good amount (Nido is also super popular).
I’m not sure what the alternative is, or what would be solved by Nestle *not* selling formula in that market.
At least when the brand sold is real, honest formula, it’s useful to those who can afford it. There was a scandal a few years ago in China with formula made by Chinese companies who used melamine to artificially boost the protein content of their product, and bribed officials to close their eyes to the fraud. (The people responsible, or at least some of them, were condemned to death when the scandal was brought to light.)
If I remember correctly, at least a couple babies actually died from drinking the melamine milk.
I think a couple officials got executed for that whole debacle.
Corruption is what prevents other companies from selling there.
Agree! Not all developing countries have unreliable access to clean water. Many women in developing countries choose formula for whatever reason. We can’t assume they are incapable of choosing what is best for them and their family.
Marketing breastpumps in developing countries is every bit as unethical as formula. After the milk has been pumped it must be fed in a bottle. Lack of clean water and a sanitary place to wash and sterilize that bottle is as dangerous as formula feeding. It’s straight from the tap or nothing under those circumstances.
Sterilizing pump parts and storing the milk is a giant pain if you have hot running water and a refrigerator. I can’t imagine trying to do it without that stuff.
Clean water and sanitary conditions are commonplace in many developing countries.
Ehhhhh
*Some* places for *some* women in *some* countries.
In 2005 at one of Jeevan’s organisation’s sister hospitals we had running water for 5/24 hrs: 5am-7am, 5pm-7pm and we never found the 5th hour.
That water was not remotely safe to drink.
We had a western style flush toilet that was connected to the sewerage system, but not the water mains. To flush it you hand filled the cistern with a bucket of water.
Our washing facilities were a tap, buckets and a heating element you could plug directly into the mains and put in the bucket if you wanted warm water. Since all the wiring was exposed and we could see what Indian electricians consider to be acceptable work, we decided not to take our lives in our hands, and just used cold water.
The hospital re-washed latex gloves
I used to live in a developing country. Sanitary conditions were similar to a developed country. Developing countries are a very large and diverse group–they aren’t all comparable to India.
For the purposes of this discussion, referring to less developed countries in this context is entirely appropriate. “A percentage of extremely poor” ? Don’t minimize the number of people suffering from extreme poverty and don’t assume it’s ONLY women suffering from extreme poverty who should be trying to breastfeed. 780M people lack access to clean water. But it’s not just access, either. It’s cultural issues, economic issues, geographical issues, gender issues — it’s not just about lack of access to water.
This discussion really makes my blood boil because invariably, the ethics formula marketing in developed countries gets conflated with the ethics of formula marketing in less developed countries. They are NOT the same thing. I really don’t give a rat’s ass about whether or not formula companies can market to affluent women or not — my concern, my life’s work is about helping mothers and children who for a plethora of reasons lack the same resources.
As for breastpumps, that issue has been covered by “alannah” below. What do working mothers do? In rural areas, we teach them to take their babies with them when they need to work or perform tasks that could otherwise take them away from their children. The alternative, which is to leave them behind, usually in the care of extended family, is often fatal. Real progress is being made here but the cultural barriers are not insignificant.
The other thing I hate about this discussion is that inevitably, two sides of realtive affluence come out to play — the women who are all “OMG formula should be locked up in hospitals/no goody bags/breast is best!” and the smaller contingent, voicing the “My body, my choice” argument. Again, I don’t care. I don’t care if Nestle throws a parade in the middle of Cedars Sinai L+D, complete with mascots and a formula pinata. I don’t care, just keep your shitty, unethical, amoral marketing and lobbying practices out of less developed countries, because it kills babies. And that’s why we’re all here, right? None of us like to see that happen.
Do these people think locking up formula, shaming mothers, doing away with formula advertising is going to make formula feeding go away? Formula feeding is a perfectly acceptable solution for Mother’s who do not want to breast feed. Mothers are making that choice on their own, not because they get a diaper bag with Similac written in it, or a sticker on a scale in the Ped’s office saying Carnation Good Start. Get real. Stop taking way mother’s right to bottle feed her baby.
If the WHO or the gov’t want American woman to breast feed and breast longer how about they start by paying mothers to stay home longer then 6-8 weeks? Or maybe paying them more then $200 in DBL in those 6-8 weeks. How about they enforce pumping rooms for nursing employees? How about granting more money for lactation support in the hospitals? How about not charging for nurses to get lactation certified? Until the gov’t wants to step up to the plate and offer their support in more then just words they need to back off.
I personally miss getting the free diaper bag….
AMEN! Support the heck of the women who want to breastfeed, real support like you suggested! And leave the other women alone. We’re big girls and can make our own decisions without locks and bans and what not.
Ignorance at its best! Did they ever consider the health status of the mother in regards to breast feeding? Maybe she had a double masectomy, is HIV+, has diabetes, or the other litany of issues that could affect the safety of the infant or mother? No, of course not they just assume that nobody will ever need formula because breast feeding worked for them and their baby. Personally, a coupon is not going to sway my decision to try and breastfeed again, but if it does not work I would like those samples and coupons please! 🙂
I can only imagine what they would have done to women like my grandmother who gave her first, born during the WWII baby bread soaked in wine when she couldn’t find goat or cow milk – well, any milk. How dare she have no milk!
I suppose she did it right in the end, though. Bread in wine is so much better than formula (non-existing then, I think.)
I seem to notice it’s only breastfeeding mothers up in arms about formula. Those of us who use it don’t have the same problems. Paternalistic much? So glad I have formula to use with my nonexistent supply and chronic health issues that require medication.
I support the right of a woman to attempt a VBAC – what I do not support is women being led to VBAC without a full appreciation of the risk of rupture (or any of the other myriad of risks of vaginal birth). We need information that clearly lays out the risks and benefits of the choices available, along with information on the likelihood of those risks materializing and what could happen should those risks materialize. Then we need to allow women to ask whatever questions they may have – and to make an informed choice about what best meets their needs and those of their family, without judgement. This is why I hate the use of cesarean rates as a metric of obstetric care – it provides an incentive to encourage a particular mode of delivery, even when that choice might not result in the best outcome for a particular mother/child. People bemoan cesareans against a mother’s wishes – but there are also women who undergo vaginal deliveries that are equally against the mother’s wishes.
I am so very glad you and your babies survived two dangerous medical problems!
I hope both of your babies continue to thrive!
I am really sorry that your VBAC attempt ended in such a way. I hope that your baby will be fine in the long term.
Thank you very much for sharing your story here.
I didn’t rupture, but I did experience reverse dilation as well as my baby moving in the wrong direction during my VBAC attempt. I was in a hospital with the crunchiest CNM I’ve ever worked with, and even she said we needed a cesarean. So glad I wasn’t at home!
I am so glad they both survived and I’m so glad she was in a hospital. I hope her baby suffers no long-term effects.
The crunchies will blame the pitocin and the membrane stripping and rupturing. We know how they think. This is all the hospital’s fault. In 3…2…
No doubt, but women who are on the fence will be much more likely to heed the lesson of this story.
It does show that even in a young, healthy woman, with uneventful pregnancy, something can go drastically wrong, very fast, and being in the hospital saved this woman and her child!
Why do they always state that the pregnancy was uneventful? What does that have to do with anything?
Lots – pre-eclampsia, placenta praevia, GDM and likely many others that aren’t springing to my tired mind immediately male the pregnancy higher risk, and therefore treated with more caution.
What do you mean? I had a partial placental abruption at 20 weeks, GD, incompetent cervix, preterm labor…my pregnancy had everything to do with how I ended up delivering.
My point was that in many, many horror stories, the person will be shocked that her delivery was complicated because she had no complications during the pregnancy. People apparently don’t realize that there is always room for things to go sideways.
True that.
I always thought pitocin wasn’t supposed to be used during VBAC’s? Is that not true?
More doctors are using Pitocin with VBACs these days. One of the Docs I work with brought in a research paper stating the cost benefit analysis of Pitting a VBAC.
I thought membrane stripping was one of the bits that the crunchies approved of. Don’t midwives do it?
Yes, but see, midwives do it correctly – with sensitivity to the divinity of the sacred yona.
I regret the membrane stripping in my last pregnancy pretty deeply & do think it could have contributed to PROM two days later (I found decent research that shows that it can increase PROM incidence) but the part I comfort myself with is that Midwives are every last bit as into membrane stripping as OBs, probably moreso! So it is something that could have happened in any setting.
I’m confused – stripping membranes is an attempt to induce labor. PROM is premature rupture of membranes, isn’t it? If it was premature, why were they stripped? Not snarky, genuinely confused.
PROM: Water breaking when labor hasn’t started yet, but at full term. Most of the time, it’s followed by the onset of labor, sometimes it isn’t, in which case intervention is necessary.
PPROM: (Preterm premature rupture of membranes) Water breaking before full-term and not in labor, sometimes followed by hospital time to try to delay the birth a little longer.
That confused me for a while, too.
Thank you!
PPROM is when the baby is actually premature. The extra P stands for ‘precipitous’. PROM is when membranes rupture prior to the onset of labor.
In my case the membrane stripping failed to put me into labor (not a surprise, not a particularly effective technique), and then my water broke prior to the onset of labor. I am not super sad about it because the baby had a double umbilical knot so if I had known that I would not have gone past 40 weeks anyway, but it did make labor harder on the baby & the diagnosis was cord compression. After the fact I looked at a study that said that in membrane stripping increases PROM incidence a bit.
My point was just that both midwives & OBs do this with equal frequency, even if it is problatic.
Docs do them too.
I’m curious about the choice to augment, though, which results in 10x the odds of rupture. It was stated explicitly to us in our ob/gyn rotation that this should not be done. Some ob’s are happy to induce with Pitocin only, some will not, but we were very clearly told no prostaglandin gel (i forget what the trade name is in the US), no augmentation. Reference is Dekker et al (2010), BJOG. 2010; 117:1358-1365.
Okay, yeah, I have always thought you don’t use pitocin during a VBAC. I’m confused by this part of her story. They always talk about pitocin being bad during VBACs on the VBAC support boards I read.
My OB was willing to use to attempt to start labor for me for a VBAC attempt. I didn’t like my odds of it working (didn’t do much for me with the first baby) so I went with a c-section..
So there are OBs that use it in VBAC.
How terrifying! I hope that both of her miracle babies continue to grow and go.