A friend sent me a link to a new blog post on Fearless Parenting.
Once I stopped laughing after reading it, I was struck by the fact that, as is often the case, no sooner do I write a post then a homebirth advocate rushes to illustrate it. Yesterday I wrote about 10 things that homebirth and anti-vaccine advocacy have in common and immediately Attorney Valerie Borek steps up to prove my points. It’s almost as if she read my piece!
Borek, a member of the Birth Rights Bar, would like you to know why she chose homebirth (Top Ten Reasons Why This Attorney Chose a Home Birth).
What are Borek’s qualifications to write this piece? According to her LinkedIn profile, her skills include:
- Wills
- Legal Writing
- Legal Research
- Litigation
- Research
- Trials
- Estate Planning
- Bankruptcy
- Personal Injury
Do you see obstetrics anywhere in there? Me, neither.
But homebirth advocates imagine that having a baby makes them experts on childbirth … kind of like the fact that I filed a lawsuit makes me qualified to be a lawyer. Oh, wait, it doesn’t.
Borek disingenuously claims:
So this post isn’t a debate about safety. It’s a declaration of liberty and freedom of choice. (links and strike-through in the original)
Borek sprinkles her piece with citations, proving that homebirth advocates love bibliography salad of cherry picked and misleading citations. (it’s almost as if she read my piece!!) Moreover, she cites Midwifery Today, an immediate signal of extreme gullibility.
What are her reasons?
1. She wanted to be sure she would know who would be at the baby’s birth.
So did lots of homebirth mothers whose midwives didn’t show up in time or didn’t show up at all. The idea that your homebirth midwives will be there to catch your baby is one of the many myths of homebirth advocacy.
2. Pregnancy is not a disease.
Neither is a gunshot wound but that’s cared for in a hospital, too, Ms. Borek. What’s your point?
3. She is capable of maximizing the health of her baby!
That would be the magical thinking I noted yesterday. (It’s almost as if she read my piece!!)
4. Money
Ms. Borek, having a homebirth to save money is like defending your capital murder charge pro se. It is foolish in the extreme and dramatically increases the risk that someone is going to end up dead.
5. “My Man Doesn’t Belong in the Waiting Room… It was such a joy to have him attend appointments with the midwife.”
Maybe you should have a seat, Ms. Borek, because I have news that will leave you stupified: husbands attend obstetricians appointments, too.
6. She wanted to be heard.
An obstetrician would have heard her loud and clear, so that was not the problem. She wanted to be validated and petted, told that she was educated, empowered and a warrior mama. Only a homebirth midwife would do that.
7. She wanted to feel the pain because she credulously believed the made up crap about hormones, pain relief and bonding.
Clearly she received her information from echo chamber websites that delete non-conforming scientific data and ban commentors with actual expertise.
8. “I Assume My Baby Wouldn’t Like the Polar Plunge.”
I bet her baby wouldn’t have liked suffocating to death, either, but she seems to have had no problem exposing her/him to that much more serious risk. In addition, Borek believes that peace on earth begins with birth. Certainly worked that way for Hitler, Torquemada, Henry VIII, and Attila the Hun, right?
9. “A Momma Is Being Born Too.”
And that doesn’t happen in the hospital?
10. “Because I Can.”
That would be the libertarian streak that invokes rights and ignores responsibilities that I wrote about yesterday. (It’s almost as if she read my piece!!)
All that to say that Ms. Borek chose homebirth for the same reasons that most homebirth advocates do so; she knows nothing about obstetrics, believes nonsense made up by homebirth midwives and other laypeople, is impressed by the sloganeering that manages to be simultaneously inane and meaningless (“Pregnancy is not a disease.”), and was clueless that she was putting her baby at substantially increased risk of death.
She had every right to do so, but that doesn’t change the fact that she risked her baby’s life even more than if she had driven around with her baby unbuckled in the back seatof her car. The fact that the baby survived is due to luck, not magical thinking, and certainly not an accurate assessment of the risks.
Let me see if I can come up with an analogy that Ms. Borek might understand:
Ms. Borek, would you take legal advice (sprinkled with citations from outdated, irrelevant and reversed legal cases) from an obstetrician?
Me, neither
#3: I Can Maximize Health for Me and My Baby
“I know this isn’t good for my baby, but…”—SAID NO MOTHER EVER!
The irony of that statement. Lady, HOME BIRTH WAS BAD FOR YOUR BABY!
I birthed in a hospital with an independent in charge. To her points (since I’m as ‘highly’ qualified as she is to talk birth:
1) I knew exactly who was at my birth: Me, husband, midwife, midwifery student who had been to my antenatal appointments the entire third trimester and who asked very respectfully if she could attend. That’s it. An ob came in when all was done because I tore badly but she was lovely and took all of 5 minutes.
2) We’re not talking pregnancy. We’re talking labour. Labour is one of the most dangerous days in a woman’s and in a child’s life.
3) Child perfectly healthy (what? does she think that maternity rooms have ebola patients coming through?)
4) Completely covered by the state. And I’ve actually seen some insurances that charge a higher premium for homebirths so stick that in her pipe.
5) See point #1. Husband was there. Nobody said a thing.
6) At no point did I feel unheard. I didn’t want pethidine, I wasn’t given any. I wanted gas, I got. I wanted an epidural, the anesthetic guy was busy in an op and arrived too late 😛 I was heard though
7) I felt the pain. Meh. Pain is pain. You’re that desperate for pain go and bang your thumb with a hammer. Labour pain is nothing special.
8) The *hospital* room I was in was a good temperature. Not too hot and certainly not polar (now you want polar, come visit my office!). I was wearing damn close to nothing and wasn’t sweating like a pig and I’m incredibly sensitive to cold and I wasn’t shivering either.
9) Pretty damn sure I became a mom at the hospital!!! If not… things just got awkward O.O
10) Yes you can. You can also jump off a bridge. Don’t see that advice being given!
What a silly lady.
There’s quite a whopper on the EBB FB page right now, with a judge’s quote about how a low-intervention CNM-attended hospital birth “can’t compare” to a freestanding birth center, and that’s an argument FOR birth centers!
I thought the first line of her story was so ridiculous. “For those of you wondering what happens in the brain of an attorney when she becomes a mother…” Maybe it’s just me but that thought has never crossed my mind, ever. If the point is wanting to know what an intelligent, educated person thinks about birth, umm maybe you should be under the care of a doctor?
You know what? How being an attorney was related to being a mother TOTALLY went through my mind when my daughter was born. TOTALLY. I spent a lot of time thinking about how I could be BOTH an awe-inspiring attorney (what I really mean is that I’m already super special because I’m an attorney) and mother (because as soon as that kid came out, I became part of that special group of magical beings called “momma”). I wasn’t really sure I could reconcile the two… I mean, it’s pretty hard to be that freaking cool all the time.
What the hell is wrong with this woman???? She is why I freaking HATE being an attorney half the time. Attorneys are so damn pompous and self absorbed. Do attorneys have different things go through their minds when their children are born? I mean… seriously….? I rolled my eyes when I read that line….
Well, pregnancy is not a disease ITSELF but what about complications that can occur in delivery for mother and baby? I mean as an attoreny she must be familiar with things going wrong in all kind of “not-a- disease” scenarios… like, driving a car is fine most of the times but sometimes it does result in car accidents – so you’d better buckle your safety belt?
“Driving a car is not a car accident”?
Someone else has likely already said this, but I’ll chime in to add credence to the idea: You are allowed to feel pain in a hospital birth. No one will MAKE you take drugs. It’s very unlikely that anyone will even pressure you! At my first (planned) hospital birth, I went all-natural, and the nurse left me completely alone unless I paged her or my monitor slipped. With my second, I opted for an epidural, and I had to call the anesthesiologist to come see me. He wasn’t trolling the halls trying to pressure unsuspecting warrior mamas into padding his wallet, contrary to what NCB advocates cautioned.
Also, in spite of getting the epidural, I still had the same euphoric rush when my child was born as I did with my two previous unmedicated labors, and nearly three months later I still haven’t abandoned my infant in the wild, so I guess it’s fair to say we’ve bonded.
One of my former managers had a 100% intervention-free birth in a hospital (unless HRM counts). Nothing went wrong, so nothing was required…
I did as well.
They stopped my hemorrhage, but I was ok with that intervention.
I would be ok with that intervention as well! I forgot to mention that I did get my tears stitched. That was my 2nd.
For my first I did have a few besides monitoring: IV (I asked for myself as I was dehydrated from vomiting), episiotomy (baby went into distress and needed out), managed 3rd stage.
Yeah, that’s the thing that just makes _intuitive_ sense to me. If you want the all-natural birth, you can have it at the hospital if nothing goes wrong. If something goes wrong, they have the resources on hand to deal with it quickly – it’s the best of both worlds. Where, if you’re at home, you’re having an all-natural birth no matter what, and if something goes wrong, you either deal with the all-natural (yikes) consequences, or have an emergency rush to the hospital that may or may not be in time.
My mom never told me the details about my birth (I mean, other than the exact day and time, and how beautiful I was, which I take with a grain of salt but appreciate), but she often pointed out to me the hospital that I was born in when we drove by. I always assumed I was a typical boring fourth child, but she had me there, just in case, and had warm feelings about the place for the rest of her life (she died there).
She did a lot of things I appreciate in retrospect but took for granted at the time. Like vaccinating me to schedule.
And for most women who want a natural birth, that’s what they really want! All natural as long as things go well, with the ability to get immediate interventions if things go not-so well.
Makes sense to me too. The other thing I don’t get is why you would want a LESS trained provider in a setting with fewer resources. Wouldn’t you want someone MORE trained to compensate for the lack of resources? Their logic does not resemble our Earth logic.
We sometimes attend a breastfeeding group hosted at the hospital where I had my daughter who is now 3 1/2 (she is not still nursing, her little brother is). I’ve told her about how she was born there and now every time we go there she takes a minute to tell me that this is the hospital where she was born. We have also discussed how we have babies in hospitals so that there are doctors there to help us if there is a problem.
When my first was born (induction due to PROM @ 39 weeks), my nurse was *quite* pushy about the epidural, from the start, since I was a FTM. She also scolded me (no other word to describe it) for not sleeping in early labor, but the monitor kept beeping b/c it would lose baby’s heart rate, making it hard to sleep. My last 2 hospital experiences were much better, but I believe that sometimes hospitals can be pushy about epis. When it was time to push, it was shift change and a nurse I never met pushed that little handheld button to give me more epi medicine without asking about my pain. Which isn’t a big deal, but at the time it felt disrespectful.
Come on. Everyone knows that pain felt at home birth is way more sacred and pure than pain felt at the hospital.
I liked my short OB appointments. Then when it cames time for me to ask a hundred questions during an appointment he patiently answered them all. I have to work, I don’t have time to make buddy buddy for an hour. And my hubby went to a ton of my appointments.
My husband was at Every. Single. Appointment. with our first. With our second, I think he missed maybe 2 or 3 during the whole time (and I had more appointments than normal because during my 3rd trimester my doctors were concerned about my blood pressure and did extra monitoring – the horrible doctors who were concerned with my and my baby’s health)
And during my second pregnancy, I just didn’t have that many questions. I’d been through it before, read the books, etc.
I love how they frame themselves as Freedom Riders flying in the face of a heaping dose of wrong side of history. Like with everything going on in America right now, the people needing their rights protected are mommies and daddies deluding themselves into thinking that their hospital phobias and control freakiness are good excuses for giving birth in bacteria-infested private homes.
Very nice description!
Good point. If they were concerned about actual birth rights, they’d be after better maternity care for indigent populations, rights for labor management of pregnant inmates, etc.
Can I ask why there’s a comma in “me, neither”?
You’ve done it a bunch of times so it’s clearly not a typo.
https://answers.yahoo.com/question/index?qid=20081222203704AAWTQ6o
Either would be a valid stylistic choice, provided the meaning is equally clear with or without the comma. [See: http://www.chicagomanualofstyle.org/qanda/data/faq/topics/Commas.html%5D
Fair enough, although I can’t recall ever seeing or hearing it that way before.
Might be one of those blue-black / white-gold things.
See, again we part ways with “She had every right to do so”. Did she, really? What is the difference between allowing a baby to die at birth because of your stubborn insistence on turning you back on all reason and tossing a baby who has just been born into a dumpster? Someone please tell me, because I really would like to know. When do we cross the line from informed consent to negligence to gross negligence to criminal negligence to manslaughter to murder, in its varying degrees?
But what if it isn’t ‘stubborn insistence’? Time and again women tell of believing their midwives and doulas are competent to deal with any variation of normal that happens, and that other carers will not have their best interests at heart, and that their babies and they will be safer with homebirth.
Millions of dollars are lost every year when people believe the gorgeous young thing they met on the internet is a real person who really loves them and needs all that money for their mother’s hip operation and to send their brothers and sisters to school.
It’s easy to be wise in retrospect in both cases, though the realisation process is agonising.
And what if a pregnant woman just doesn’t want the c/s? For whatever
reason? It can’t be right to cut into a mentally competent woman who
has made a choice we don’t agree with. That way lies all kind of
horrors no one wants a piece of.
Throwing a living child on a dumpster is more likely a sign of mental illness than any kind of criminal culpability.
Life’s complicated.
Yeah, that’s what I ran into. I didn’t love hospitals to begin with, I thought a drug-free birth was better by my gut feelings, then I watched business of being born, which led to reading nothing but NCB stuff and deciding that a freestanding birth center was the way to go, especially since our health insurance covered it. Baby came out safe, but still, my husband reported things to the insurance company that led to that group being dropped from the plan. Now that I’ve read up on everything HERE, I understand the risks that I took, and would NEVER do that again. Furthermore *gasp* I get that epidurals don’t hurt babies, and I’ll be asking for one ASAP! And, I don’t want to sit and let baby cook, either – I’ll be asking about inducing in the 39th week, if they’re up for it! Sea change in thoughts on this, given accurate information…
“And what if a pregnant woman just doesn’t want the c/s?”
That’s problematic for me because the dominant narrative in this society about CS–not just among NCB types, but in the mainstream media–is “C-sections ‘r’ bad ‘n’ scary! Doctors do them unnecessarily all the time, and try to convince women who don’t need them that they actually do!!!!! Of course in rare cases they are necessary to save lives but you REALLY don’t want one otherwise because they’re so bad ‘n’ scary ‘n’ they take much longer to recover from ‘n’ it’s MAAAAJOR SURGERY!!!”
Most women don’t want the thing described in that narrative, but the thing described in that narrative is not actual real-life c-sections. And when you add to that the additional NCB narrative of “c-sections are unnatural and could harm your baby and interfere with bonding and basically mean you didn’t really give birth to your baby, plus Mother Nature designed women to birth vaginally with no complications, and childbirth is inherently safe”… basically there are a bunch of deluded bullshit reasons that many women genuinely believe and are basing their decisions on.
And because this dominant narrative includes the concept of “unnecessareans” that doctors do just to line their pockets or get to a golf game on time, women are less likely to trust that their doctor is telling the truth when she says that due to XYZ problem in labor she recommends a c-section to ensure that the baby is ok.
Obviously everyone has the right to make decisions based on bullshit, but it’s incredibly sad when a woman who passionately loves and wants her baby makes a decision, based on total bullshit, that she THINKS is good for the baby but which is actually harmful or fatal.
Or to put it another way, I think that these false narratives about c-section make a lot of women say “I don’t want a c-section” who would say the opposite if they knew the truth.
When the baby is outside of her body, that’s when.
So long as baby is inside mom, MOM gets to decide what happens. Its a matter of bodily autonomy, and getting rid of this and letting someone be charged with a crime over birth choices is an idea that can be dangerous to all females.
If you want to argue that its unethical, fine. But making it illegal? That’s a no go, and a horrible idea. Please don’t give lawmakers any more control over womans bodies. This would penalize so many just to punish a few, as most moms choose what they believe is best. The courts are already pushing back womens hard fought rights to control our own bodies, they do not need any more supporters.
The care provider knowingly practicing beyond their scope is negligent, and it should be criminal negligence. Deliberately misinforming the patient is also unacceptable, and shedding light on this issue and trying to rectify the legal situation to recognize these issues is kind of the point.
The pregnant woman is practicing bodily autonomy. The implications of violating her bodily autonomy are wide ranging and horrific.
After birth, the baby’s rights are no longer superseded by the mother’s bodily autonomy and failure to provide care is criminal, regardless of who it is that fails the baby.
From #6 “My midwife answered every question I had during our hour-long
appointments. When I asked the OB about nutrition, I was told I could
buy some books. When I asked how it made sense to fast then shock my system with glucose while growing a human, I was told “well don’t do it if you don’t want to.” ”
It sounds like she’s more interested in arguing than learning anything. If she was so concerned about nutrition and the glucose tolerance test, why not do her own research, instead of interrogating the OB? Aren’t homebirthers all about doing their research?
It actually sounds like she’s angry at the OB for not pretending to be a nutritionist. Now the midwife *will* pretend to be a nutritionist. So that’s worth paying for.
An OB or CNM is competent to talk prenatal nutrition. If she wanted to talk about it for an hour, though, yeah, eventually I’d say, “Go read ___ book (because I’ve got a waiting room full of people with real problems)”.
OBs and CNMs usually refer special dietary needs to an RD. If she didn’t need a dietary referral, that’s a good sign.
Is there anything you can’t or don’t eat? If your diet is very restricted you need to see a dietician.
Are you aware of the guidelines about foods to avoid in pregnancy and recommended weight gain and calorie intake?
Have a leaflet.
Babies will grow perfectly well even if you eat rubbish. If you’re asking about good choices, you’re already invested in doing the right thing, and you’re ahead of the curve.
Your OB should not have to waste time telling you that your already healthy diet is healthy, and discussing the relative merits of kale over broccoli.
It’s green- you’re winning!
You, Dr Kitty, more than anyone, know that the first question is, ‘What can you keep down?”
Doesn’t a lot of medicine come down to that? “If you care enough to ask, there is nothing I need to tell you”
True.
Today was not a good day.
Puking in the car park of your daughter’s daycare in front of multiple other parents is super fun.
Exactly. At that point, kale vs broccoli seems like a meaningless discussion
Yup. My OB explained the actual important parts of eating while pregnant in just a few minutes at my first appointment. It’s one particular natural-health fallacy, that there exists a perfect diet that will result in much better health than the many reasonably good diet choices.
Anybody can be a nutritionist, it’s an unregulated term. The actual doctors are called “dietitians”.
She sounds like she needs a new OB. I have probably spend hours in various conversations with my OB and the NPs are her practice discussing diet and nutrition options to help me deal with my morning sickness and gallbladder problems. They have talked to me in depth about my food triggers and how to make sure I’m getting properly fed.
She also sounds like she is mad the doctor didn’t praise her for any things she was doing diet wise because she read about it. She might have been going gluten free, paleo, eating lots of kale and the doctor didn’t praise her and tell her she was the best mama ever for doing that. Also, the way her question about the gtt was worded, you know she was just being obnoxious.
Yep. I’m guessing the OB was sick of her arguing with every single thing that they said, and decided to pick their battles. The phrasing she uses there implies that she did not bring that up in a spirit of genuinely wanting to learn more about the rationale behind the test. (Full disclosure, I didn’t do the GTT, either time, for reasons that seemed like a pretty good idea at the time, and if I could do it all over I’d make the same decision again, both times, but it’s not because I hold some illusions about how OMG AWFUL the test is.)
I suspect you are right there, Elaine. When someone comes to you for your expertise but then argues with everything you advise, you can remain polite and patient for a certain length of time, before you resort to “OK, THEN, DO WHATEVER YOU LIKE!”
I had the most mind-bendingly frustrating conversation with a 40+year old primip at 41+ weeks, trying to persuade her (and her doula of course) to stay at the hospital after a NST and be induced. Borderline AFI too. And oh you bet I’d been talking induction for quite some time- I was being the most pain in the butt MEDwife, I was not her favorite. We go around and around about cord accidents and big babies and shoulder dystocia and risks of induction and c/s and finally I’m like, “It sounds like you’re ready to go home.”
…
“Well, as long as it’s safe for the baby!”
Facepalm
Did you respond, “nope, that’s what I’m saying, IT’S NOT!!!”?
Yes. She had a private moment with her doula and went home, and I documented the heck out of it.
She accosted me in public, while I was dealing with a tantruming toddler no less, a few months later and told me proudly about going into labor 4 days after that, pushing for hours, vacuum at the end, shoulder dystocia, third degree tear, emphasis on “went into labor naturally” and “vagina”. She showed me!
I typically compare that to the drunk driver who, despite all his friends’ protests, makes it home safely. He only ran over some garbage cans at the end of the driveway.
“I told you I could drive”
Boy, you sure showed us, didn’t you?
Exactly this. “Other than some crumpled fenders, which were repaired to almost-as-good-as-new, everything turned out fine! I’m going to tell all my friends about my empowering drunk driving experience.”
Freaking thing is, if you were a homebirth midwife, you would have wanted to bury this woman under the bottom of the clients you use for references. A midwife who doesn’t trust birth! You would have been chased out of ranks faster than you can say, shoulder dys…
Lucky you, being a medwife, huh?
I was seriously just very, very glad that she didn’t show up the next day in labor with a dead baby. I know myself and I would have beaten myself up for it, because surely I could have said SOMEthing to get her to stay. That type of thing is not easy to live with and really, you can’t even use the anecdote to persuade other patients, because HIPAA.
It would have been terrible if she had shown up the next day in labour with a dead baby. And I can easily imagine you beating yourself up. That’s a pretty normal human reaction. That’s why I’m not sure how I feel about obstetricians telling homebirth mothers, “It would have happened at the hospital, too!” Of course, that’s just reinforcing the standard homebirth tropes but… the coward that I am, I know I won’t be able to say, “Hell, no, it would not have happened here!”
Of course, that’s about doctors who, in their heart of hearts are cowards like me. I imagine there are many obstetricians trying to be tactful without lying – but distraught people would take it to mean what they want it to mean. I remember a homebirth advocate here wondering how being in the hospital would have prevented rupture or shoulder dystocia. I replied that no, it wouldn’t have but a hospital would have been able to influence the OUTCOME once it happened. I suppose it’s the same with doctors – they say “the rupture could not have been prevented”, leaving out that a team and an OR might have prevented the OUTCOME. The mother hears, “the death would have still happened.”
Surely you could use the anecdote to persuade other patients, as long as you left out identifying info? I mean calling her “40+” rather than her exact age, not mentioning the baby’s sex or when it was born (“last year” instead of “right before last Thanksgiving”), etc.
She could have had her vaginal birth without all the trauma. What a moron.
Lol, and I’m someone who did the GTT last time and would like to avoid it at all expense if I get pregnant again. Not because of the effect on a fetus, but rather because I hate the taste and have resigned myself to the fact that I’ll have GD this time as well. Just would rather do the daily finger pricks.
I’m pretty sure a brief glucose test of 2 hours is overall harmless compared to the dangers of undiagnosed gestational diabetes, but that’s just my opinion and I’m a lawyer (gasp!), not an obstetrician. All I know is my (university educated and licenced) midwife recommended it.
“When I asked how it made sense to fast then shock my system with glucose while growing a human”
Because of course nobody else ever thought of that before.
“Because it gives us the most accurate way of diagnosing GDM. Your body’s homeostatic mechanisms are designed to ensure your serum glucose remains between tightly controlled levels which won’t affect your baby, regardless of what you eat or don’t eat…unless you have diabetes. This test isn’t doing anything that a lie-in and a breakfast of orange juice and pancakes isn’t doing anyway”.
But, but, but I only drink filtered water, and I never eat pancakes (unless they are made of non-GMO sprouted quinoa, and I’m sure non-GMO spouted quinoa has a low qlycemic index)! As for that lie-in? No way! I am doing yoga even in my sleep. This GDM you are testing for sounds nasty and unhealthy, and what you need to understand is that OTHER women are nasty and unhealthy, not special me. I unequivocally intend to stay low risk by reading a lot about diet and keeping my head stuck firmly in the sand.
Yeah, my response only works with people who are still capable of logical thought.
Oh my god. Laughing
Dr. Kitty (or other docs here) – a question for you regarding GD. Like a lot of moms, I think the glucola tastes pretty lousy. Are there any legitimate options around it, that would still enable a mom to complete the test but using something like orange juice or bananas or something?
I’d love to have another kid, but knowing that I had GD last time, I’m pretty sure I’ll face the test nice and early the next time.
Not a doctor, but the thing with the glucola is that the doctor knows exactly how much glucose is in there. It would be very difficult to match that with food, and there would be more variability.
That would be the challenge. My OB let me drink a can of Dr. Pepper for my postpartum GD test – it contains 45 g of sugar instead of the 50 g of glucola. My sugars were quite low (I think around 90?) an hour after the test, so there was no need to follow up with the glucola. However, it would have been different if
I know someone who was proud to have her midwives approve orange juice and bananas for her GTT test for her second pregnancy; she’d had GD in her earlier one. However, my guess is that it failed to work correctly in diagnosing GD. Without knowing all of the details, I did hear that her second baby was absolutely huge (and she’s a tiny gal). That’s something that would scare the s*** out of me.
How would the midwife know how much glucose was in the bananas/orange juice? If the next woman had an extra banana, it would be different. That’s ridiculous, you can’t run an assay if you keep changing the standards or have no baselines. If you don’t know what went in, the numbers are meaningless on the other end.
If you don’t have GD, your pancreas should produce enough insulin to clear the 50g of sugar in X amount of time, so they take blood I think right before the glucola, shortly after, and then after whatever amount of time it should have been cleared. The first and 3rd numbers should be pretty close. (at least that’s how I’ve run GTT on mice) How many blood samples did this stellar midwife even take? If she only took one, an hour after the bananas and oj, that’s not a valid test.
It’s even more complicated as the fruits have other types of sugar in addition to glucose. You’d have to account for the sucrose and fructose metabolic pathways as well as the fiber content’s effect on timing. Far more straightforward just to test with glucose.
I agree. I have no idea what actually happened, but am guessing that she passed the GTT test on the basis of her orange/banana blood sugar. Her kid was then unmonitored at the end of pregnancy, causing her to have a 9-lb baby. (For a mom who _might_ weigh almost 100 lbs soaking wet, he was huge.)
Interesting that the 1st and 3rd GTT numbers should be similar. My fasting and 3rd number were both hypoglycaemic, and the 1st and 2nd hour numbers were borderline GD. I hated having GD, especially w/ the hypoglycaemic numbers to deal with as well.
Here you go: Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening. http://www.ncbi.nlm.nih.gov/pubmed/10561636
NB: I am an attorney with a jelly bean fetish, not a trained medical professional!
Ooooh, I do like the sound of jelly beans. Love your disclaimer!
ETA: I feel bad for the women recruited for the study for having to undergo the GTT twice!
*raises hand* My first one-hour test was borderline, so I got the GTT a second time, and that over a three-hour period. Had to go in fasting, but I had other non-missable things to do that morning, so I didn’t get to eat anything, or drink anything except water, until about 2 PM when I got to chug that…lovely…glucola. Then I had to kill three hours while waiting to get my blood drawn at the one, two, and three hour marks, so I didn’t get out of there until 5.
You know, I generally ate pretty healthily during that pregnancy: massive quantities of fruits and veggies, lean protein, and so forth. Leaving there, however, my first stop was for a cheeseburger, fries, and a shake, and God have mercy on the soul of any idiot who dared stand in my way.
(For the record, I didn’t have GD.)
Failed my one hour (non fasting and I ate, sigh, waffles and syrup beforehand). Vomited at hour 2 in my 3 hr GTT. Passed the repeat with low average results. Lessons learned: even if you don’t have to fast before a glucose test, probably don’t binge on simple carbohydrates; and if you are a pukey pregnant lady, take Zofran before the GTT. It was horrible.
I stupidly did the same thing and then went to go visit a friend an hour away. I almost passed out and barely made it. I learned a lesson from that one.
Something weird about those data. They claim a similar blood sugar response to both but GD was diagnosed by both tests in only one out of 5 cases of GD. I want a larger test, possibly in a higher risk population, to validate the jelly bean alternative.
I loved the taste of tje 50 g. it was like a fizzy drink without the fizz. Plus I was starving. At my hospital they let you lick a small slice of lemon in order to get rid of the taste. It is such a small amount (just a few drops) that it does not impair the results but it really changes the taste in your mouth. I used it with the 4 hours test, 100 g of glucose instead of the 50 g of the screening one that I really loved.
I’m not sure why she was convinced that this would be a problem. I mean, people are evolved to deal with fasting then eating lots of sugary foods. That’s what insulin is for. The question is whether your body can do that the way it’s supposed to in the presence of the stresses and temptations of modern life and the additional stressor of the fetus. If you can’t stand the “shock” of 100 cc of glucose after fasting overnight, how are you going to deal with breakfast tomorrow? Fast all night and then get your system shocked by (admittedly icky) glucose solution or fast all night and get your system shocked by (tastier but still high glycemic index) fruit juice and sweetened museli? It’s not that different to the fetus. You need to know whether that daily “shock” is doing harm or not. Hence, the test under controlled conditions.
It sounds more like she just had an OB that wasn’t capable or willing to answer her questions. Maybe she needed to find another OB if she didn’t like the one she had (if it was possible, of course, since it’s not always possible). Why is that so hard for people – if you don’t like your doctor and you can go somewhere else, go somewhere else and find a doctor who answers your questions the way you want and who you ‘mesh with.’
It’s certainly possible, but I’d add the caveat that the OB wasn’t able or willing to answer he questions _to her satisfaction_. And that is important, because that last qualifier leaves a lot of things up for question. Maybe the OB did answer the questions and she wasn’t satisfied with the answers and expected (or hoped), maybe even based on “education” she got from woo-peddlers, that there would be more to it?
See the answers provided by the doctors here. In terms of “nutrition” there are a couple of basics to consider, but once those are taken in to account, the answer is “meh.” It’s not a huge issue.
The problem is, this does not go over with some people, who want to hear that they have to be eating this and that and need to avoid that and this. And if they don’t hear that, they don’t feel they have been given a satisfactory answer.
That’s why in this story, I’m hesitant to conclude that the OB didn’t or wouldn’t answer the question, because given the source of the story, it is absolutely a case where this person might not be satisfied with the actual answer.
I could understand #4 if Ms. Borek was poor, uninsured, and truly unable to afford a hospital birth. However, she’s an attorney. That doesn’t make her wealthy, but she’s not a Wal*Mart cashier or a home health aide.
#6 might also apply in those circumstances, especially if she was a woman of color. But again , what she really wanted to be heard (and be parroted back to her) was that she was making the superior, “educated” choice of a homebirth, not the hospital birth that lesser educated women choose.
Eh, I wouldn’t bet on that. Nowadays, young law graduates who don’t become junior partners can be very poor indeed, with a lawyer’s student loans and a cashier’s salary.
She lists birth plans as part of her practice, wonder who can afford to have a lawyer help write a birth plan? And how much does that cost? http://www.vboreklaw.com/meet-the-attorney.html
Oh jeeze. Writing a birth plan with a lawyer is like bringing your doctor to help you make a business contract. Completely useless.
It’s one step up from having it notarized, I guess.
Co-sign on the fact that attorney doesn’t mean rich. Especially if someone is working as a solo practitioner, they are very likely only just keeping their head above water. A few people I graduated with had to take part-time jobs to pay the rent after law school (one delivered Pizza, and one currently works at a grocery store).
But what the law degree would have gotten her was the ability to know how to navigate the system of state benefits and how to negotiate a payment plan with the hospital if she had wanted that route. Cost was not a reason for the decision, but something she could point to once the decision was made.
Homebirth isn’t cheaper than hospital birth unless you are uninsured.
The financial argument does make sense for a subset of people, and since much of the time HB does go well, it can be a valid consideration, once you have decided it’s safe enough. One one side, you have $2,500-5k for a HB. On the other, a *best case scenario* of $12k (pre negotiated, pre paid in part, covering basics).
If it goes well, you have saved a lot of money.
If you transfer, but it still ends well with a VB, you eat much of that MW fee (since some was for prenatal), and add a hospital stay. So you lose a few K to the MW, and a few K for not pre paying/pre negotiating (you can always negotiate after the fact too), and (possibly, but not always) for the EMS.
If it goes poorly, odds are you would be looking at an increased hospital bill, regardless of where you started out. An emergency CS or NICU wouldn’t be covered in that basic fee of $12k. The cost might be less if you started in a hospital (got the CS instead of needing cooling cap), but when looking at a bill that can bankrupt an average family, it hardly matters. Once it’s past a certain threshold, it’s not getting paid, at all or in full, anyway. (A very high bill might end up being an overall savings, because a bankruptcy may also clear other high, financially destructive debts.)
This also shows why the same people may wait on transfer, way past the point it’s prudent.
Also-
Had she been truly poor, working at Wal Mart, she would have qualified for Mediciad. In my state, this even pays for HB and stand alone BCs.
The people that get truly screwed are those right at the edge of the working poor, and those in the lower middle class, because they cannot afford insurance, but don’t qualify for Mediciad. Also, if you do qualify financially for Mediciad, but have even the smallest retirement account, or a decent car that you own, you may also find yourself locked out of Medicaid, even if taking the cash out means losing so much you can’t pay for a birth anyway.
It has gotten better for all woman now that pregnancy coverage is mandated, but if you can’t pay the copayment or monthy bill for insurance, its still irrelevant whether it’s covered or not.
TLDR: its not outrageous to look at the cost as consideration. if it was your sole consideration, IMO that’s a bad reason, because it’s a huge compromise in safety. But for a HBer that thinks its safe/safe enough, it does make sense.
There is also Medicaid step down–for those who make just a little more than the limit for qualifying for Medicaid. You have to pay a certain amount out of pocket but then after that, Medicaid pays. For some people it’s 5 thousand, which is already what a home birth costs. My experience with it was before Obamacare, I hope that the step down program has a lower out of pocket amount now. Either way, getting approved for Medicaid can be a lengthy process and some programs take so long that a woman is into her second trimester before she gets her card and can get prenatal care.
If you can’t afford insurance but are too “rich” for Medicaid, wouldn’t you just give birth at a hospital and then not pay the bills they send you? Can’t do that with an HM midwife, since they’re prepaid…
Ignoring the bill entirely might result in collections, damage to credit rating, etc. However, if you talk to the hospital billing department, generally something can be worked out, a payment plan or discount of some kind. They get that uninsured people don’t have a spare $30,000 lying around, and they’d rather get something than nothing.
https://www.youtube.com/watch?v=Rot7qfitLL0
(In the version from TAL, he does go into his payment plan…)
True. And either way, you pay way less than you were billed for. And either way, those options are not typically available for a home birth.
If she’s an attorney that believes in that stuff maybe she should get in touch with the “Kelly” lady who was having problems putting in her complaint against her on to the police.
OT but interesting: Bariatric surgery may improve pregnancy outcomes for obese women
The numbers have been looked good for pregnancy outcomes s/p bariatric surgery for years, which is awesome, but it seems like I see more women who have eaten their way back to obesity (like, right back to where they started and up), and now they’re obese plus they have nutritional deficiencies. It’s no magic bullet.
For a second I read that as “barbaric surgery.”
Do you have a place to report technical problems? Every time I load skepticalob.com the most recent article is this one: http://www.skepticalob.com/2015/02/celebrities-say-take-this-medical-advice.html
Same
Did you see her bio? Founder of “Birth Rights Bar Association”? What kind of bullshit is that? Is she even a licensed attorney? What attorney makes their own bar association? Is this equivalent to MANA? They make up their own “professional” associations that truly mean nothing in order to be validated, or truly in this case, to drive business their way. Laughable.
i’m part of a bar association…it’s at the tavern down the street.
https://www.youtube.com/watch?v=zH3BBFXaBTU
I must be part of the JAG (judge advocate general) association since I like to drink at the legion : )
Eh, other than the aba and official state bars they’re all just social groups. So her bar assn isn’t any more made up than any other.
http://www.birthrightsbar.org/membership.html
Heh, it reminds me of one of the paediatricians who came recommended to us before our son was born. We liked the guy’s bedside manner, but it turns out that he’d left the AAP and was president of a fringe religious-based/conservative paediatric group, the American College of Pediatricians.
We ended up going with someone else.
“Birth Rights Bar Association” just reminded me of Python’s Life of Brian and The Right to Give Birth.
Neat analogy. I’m a solicitor, with seven years experience in the field. 4 years PQE, and I’m accredited as a senior caseworker in my field by the Law Society of England and Wales as well. I’ve also had two babies. But I still know bugger all about obstetrics, or indeed midwifery.
I’m an attorney with 17 years experience in finance and commercial property development. I wouldn’t even take my own legal advice in a field too far removed from my own (eg divorce law).
1) “Oh, new SOB post.”
2) Scroll down page, past new post.
3) Stop at post just below it, give heavy sigh, get dreamy smile on face
4) Snap out of it and read new post.
yup. that about sums it up for my daily morning ritual..
Three Cheers for Lady Valerie Borek! How full of foresight, to have just the right genes at play. Yes lucky smarty pants she must be…so much better and enlightened than us commoners . Her child’s birth is the event of the century and we can all learn from the example she set. Imagine! A lawyer who picks and chooses which aspects of modernity mesh with her personal narrative. She is so cutting edge and quirky. Why if she can do it, then we all can!
You put a smile on my face, yentavegan.
All this talk about husbands being present has gotten me thinking. My great grandmother had all her babies at home (lived in the middle of nowhere on a farm) and my husband ‘s grandmother did the same. Their husbands would go out to the barn or sit in the kitchen (sipping something stronger than tea) during births. They were not there in the room. There is a lot of talk about giving birth “like our great grandmothers did” but I think there is a lot of glossing over the fact that pregnancy and birth was considered women’s business and husbands were not expected to be involved or present for the births.
One of my great grandmothers had 11 children with what sounds like 3rd or 4th degree tears with every single pregnancy. I do not wish to emulate. Plus my great grandfather was reputedly a jerk who helped her not at all. Again, do not wish to have the “good old days” back.
Completely agree. They also tend to gloss over the fact that the maternal death rate was ridiculously high back then.
My father can not stand seeing blood or people in pain. He once passed out when I came in with a scraped knee as a child. So the agreement was to keep him out of the room when I was born for the benefit of everyone.
Well apparently the nurses thought that he specifically wanted to be brought in for the birth (a more common request at the time) so he walked in to the middle of the action. And promptly passed out. My Mom had to deliver me with a nurse while the doctor and everyone else in the room took care of him.
Haha – My dad passed out too and my mom asked the nurses to do something with him. I think in my Dad’s case they just moved him out of the way and continued on.
I was born right at the beginning of the era when fathers were expected to be in the delivery room, but not my father – he was in the waiting area just outside, watching a football game on TV. (and he still remembers what the score was when he heard me crying, which is when he went into the room.)
I understand that some women are frustrated by the group practice model for OBs, but it’s not the only model out there. My OB and his partners provide back up coverage, but they deliver 95% of their patients. He checked on me a couple of times during labor, and was there for the entire second stage. My husband (who came to as many prenatal visits as we mutually wanted) and I both really liked the care model.
I’m OK with the group practice model. The OB-only practices (there are a few familiy practice that have family practice w/ OB docs) have a call rotation so it’s assured that there will be no schedule conflicts and a physician is available.
Me too! I’d rather be dealing with the OB on call, who’s rested and refreshed and able to think clearly, than the midwife who’s just done a delivery yesterday and possibly has more than one going on at the same time. (I know that’s happened). I agree with the above poster: by the time the OB became involved in the delivery, I didn’t really care who was in the room any more.
I can’t really say they’ll be rested, as you don’t know how long they’ve been on call from when they see you (12hrs, 24, 36hrs?) but they are there!
They at least have nurses and other personnel to help watch for problems.
Yeah, I do 24 hr shifts and definitely am not feeling great by hr 18, but I’m in house, and adrenalin helps, too.
Okay, maybe not “rested.” But present and accounted for. 🙂
Exactly. SOMEONE will be there who knows what they are doing and has slept in the last 24 hours.
And I felt quite differently – I did not like my nurse at the hospital, but my husband and I both very much liked my OB, and we were both reassured by his presence. It may sound strange, but the second stage very much felt like a pas de deux between the doctor and me. I trusted him and his advice and how he had managed my high-risk pregnancy, and I was glad he was there to deliver my son.
Amen – my first was under the care of two midwives in a freestanding birth center and it never occurred to me that they ran a brutal schedule. When i went into labor, I called them at 11:30pm, and they had just closed up shop after being up with other laborees for a day and a half or so – fortunately for them, my labor was very fast, but still, in retrospect, not good to have sleep deprived people presiding over a birth. After my daughter was born, her assistant was filling out paperwork and apologizing for the difficulty she was having doing so because she had taken a Tylenol 3 when she got home, before I called them, to help her get some solid sleep…so wait…the midwife herself is terribly sleep deprived, and the lone assistant is too, plus fighting a Tylenol 3?!? wowzers
She took a Tylenol 3 while she was on call? I would call that extraordinarily unwise. No. Stupid. Just stupid will do. You can’t do that!!
That may have been one of the things that got them dropped from the insurance plan after review. We were not thrilled when she said that!
I love the group practice model. They share info and I rotated appointments. I felt like I was getting 100s of years of experience among them.
I *love* group practices. Maybe because I’m a teacher in a school where we all work really well together, and I see all the students, not just those enrolled in my classes, as “my” kids. I love the fact that when our GP is out on maternity leave, or booked solid on a day when one of my kids gets sick, I can still see someone I know at least casually. The CNM practice I used with my second was very open about how they operated, and they had a policy that you had to have at least 1 appointment (preferably more) with all four of their midwives so you’d get to know anyone who was on-call when you delivered.
The CNMs I saw had the same policy, it was really reassuring. (And funny/sweet, because they told me which days they were working, in the hope that I’d come in on their shift.)
With my first, I had the OB I had only seen once deliver my baby. With my second, I almost had an OB from another practice deliver my baby, but I ended up with an OB I had never met from my practice. I really did not matter to me. By the time they came in, I was so out of it, I wouldn’t have noticed if a monkey had come to deliver the baby. Plus, the nurses, who I had never met before, were the ones to help me and comfort me throughout the whole process.
A friend once told me that by the time she got to 10 cm, she didn’t care if the janitor delivered the baby. She just wanted the baby out, NOW! And that was with an epidural.
I do not remember the names of the OBs that performed my CS. I do remember my son’s neonatologists names. The OBs did a great job by the way. No problems at all, beautiful scar.
I got all of my GYN care at Planned Parenthood before I got pregnant, so I just wanted an OB/GYN who could do the job and took my insurance. When I chose my OB/GYN practice, it was explained on the first visit that I would see all 6 providers at some point, and one of them would deliver my baby (they discovered twins on the second visit). Of course, I ended up delivering in another city, with staff I’d never met before I arrived for delivery.
I chose an OB that was super awesome, knew me/my situation well, would be present, and respect my choices; my last OB was very paternalistic and ignored me. I also picked the hospital, loved my MFMs, etc.
Then ended up going into PTL and delivering in another city, knowing none of the staff.
Best laid plans….
This is what is meant by “over educated”. Obviously she’s highly educated in one field, but it ain’t medicine and ESPECIALLY not obstetrics, but she thinks her education in her field bleeds over into everything else. If only it worked that way. It would be awesome to just do a bit of googling and know enough to represent myself in court. You know, touch on the relevant statutes and procedures. I can write pretty well. Writing a motion isn’t that complicated, surely.
She’s so educated she should join NASA and build a spaceship and go in to orbit where her brain seems to be.
Being well educated, she could read Scientific American without much problem. I can! But then I don’t pretend to have more than a vague understanding of the topics covered.
I can read it. But I don’t have to read very far before I’m not doing a lot of comprehending. And the engineering and physics papers are very humbling experiences.
Indeed! Much like the ex-lawyer who lost a lot of weight and transformed into a Fructose-is-Poison expert on physiology – just by reading stuff!
10. Because I can!
Just because you can, doesn’t mean you should.
Just like the bacon wrapped pizza being advertised. The commercial says “it’s perfectly legal to have one”. That doesn’t make it healthy or even delicious.
Mmm, I don’t know, I love little caesar’s. Haven’t stooped as low as the bacon-wrapped…yet…
Hmm…
1. I wanted to ensure who was at my son’s birth, too. The person I wanted there was called an OB. And you can bet she was in attendance. For the entire delivery.
2. Pregnancy is not a disease.
She mentions that childbirth is so natural, it can almost be done in one’s sleep. Uhhh, no. Besides, there’s a lot of things I do in my sleep that I don’t do when conscious (drooling comes to mind).
3. She is capable of maximizing the health of her baby!
Love her assumption that she can control the outcome, and a big part of it is due to maintaining her healthy, low-risk pregnancy. Tell that to two of my cousins who nearly lost their lives in childbirth after low-risk pregnancies and unexpectedly high-risk deliveries.
4. Money
It’s called purchasing health insurance. In the U.S., it’s private insurance that *many* employers provide. Here in British Columbia, it’s public insurance that everyone above a certain income level pays into monthly. Either way, using money as an excuse to have a home birth is simply idiotic.
5. “My Man Doesn’t Belong in the Waiting Room… It was such a joy to have him attend appointments with the midwife.”
My husband doesn’t belong in the waiting room, either. He was with my at appointments and in the ultrasound room for every appointment his employer would allow him to attend. He was present throughout my son’s L&D (even though he slept happily through 5-10 cm!).
6. She wanted to be heard.
I had an OB hospital birth and was heard loud and clear. Ironically, the “evil” doctors who only “push medicine” had to be pushed into giving me an epidural. I had to confirm 3x that I wanted one before the anesthesiologist happily arrived.
7. She wanted to feel the pain because she credulously believed the made up crap about hormones, pain relief and bonding.
Ha. As a sufferer of endometriosis, all I have to say is that iIf pain creates bonding, I should be the world’s most awesome mother. If you want pain relief, take it and _enjoy_ it! Pain has zero to do with creating an awesome mother.
8. “I Assume My Baby Wouldn’t Like the Polar Plunge.”
She seems to think that a baby who comes into the world without crying is a healthy one. The last time I checked, a baby who comes into the world without crying at all is a medical concern. (But then again, I’m not a doctor at all…)
9. “A Momma Is Being Born Too.”
Proof that the birth had more to do with _her_ rebirth than her child’s birth.
10. “Because I Can.”
Well, gosh darn it. That’s a mature reason to deny your child good medical care.
Pain and bonding…
https://www.youtube.com/watch?v=qdFLPn30dvQ
The initiation to motherhood as she envisions it? 🙂
Of course. It’s the Fraternity of Motherhood. You need to pay your dues to join.
And I don’t think that is being facetious.
*Sorority
No, fraternity. Like Kevin Bacon.
No, sorority. Like with women.
You find a good sorority initiation scene that includes infliction of pain and post it and you can talk about sororities
You can’t adapt a quote? I’m standing within a mile of where that movie was filmed. It’s not a brotherhood of motherhood (although the rhyme is good). BedifrsBesides, sorority hazing is plenty painful, just goes for psychological/emotional pain.
But fraternity does not exclude women. The “Fraternal Order of Police” includes female officers.
ETA
I am a member of Alpha Chi Sigma, the “chemistry” fraternity. It is considered a fraternity, but has lots of women members.
Don’t be so obtuse with your pop culture.
I find crying in a fresh newborn to be very comforting. Something about knowing they have the strength and lung capacity to let out a good wail is instinctively reassuring.
Me too. My son took a few seconds to cry after he was born. Literally the first thing I said when they handed to me was “Why isn’t he crying?” They encouraged me to rub him vigorously, and it only took a few seconds of doing so for his precious newborn wail to start up.
Conversely you have the babies who try to start yelling before their bodies are even born. Those are kind of awesome. Little firecrackers!
My son was like that. I was wondering why I was hearing crying because from what I was feeling, there was still a baby in there! He was born at 35 weeks, so it was nice to hear that roar.
Oh gosh, I bet it was. It always feels good to send away a NICU resuscitation team.
The NICU nurse was so kind. She did help keep baby’s hat on his head, his first few minutes were devoted to pulling off his hat with both hands.
LOL! Sounds like my daughter. She pretty much did everything she could to get that hat off until we left the hospital. She’s always had pretty strong opinions, that one.
One of our nurses went to the hospital gift shop and bought a special hat for our daughter. So sweet!
She WOULD hat the baby! I bet she patted, too! Smh.
/s
She also was talking to him and telling him he was handsome : )
The trifecta! What a witch.
Yeah, he must be damaged for life now.
My last one cried en route, too. My OB did the snot sucker and such while just his head was out, and he responded quite vigorously. We had a preterm labor scare a month earlier, complete with the steroid shots for his lungs, and my husband said “those shots must have worked!”.
My daughter also did that and I was so confused! I think someone had to tell me it was her and not another baby in the room.
We have a picture of my daughter, half in/half out of my abdomen, pink and wriggling and clearly VERY unimpressed with the whole process of being born by CS.
She was so clearly (and noisily) ok that my OB just lifted her straight over the screen and onto my chest for immediate skin to skin.
My middle baby did that! She was NOT impressed about the whole birth thing and screamed at anything more than cuddles for the ‘Golden Hour’.
My eldest and last only peeped and then sneezed loudly. I joked that they’re safe from the Fae and then ended up explaining superstitions/folklore.
Yep–I couldn’t see the babies when they were born because the doctors/nurses immediately took them to be examined (pre-term), so I was listening for the crying and relaxed when I heard it.
My most recent baby didn’t cry for several minutes after he was born- not until the vitamin K shot. The nurses were definitely worried. Turns out that he is just a very laid-back little fellow who rarely cries, but we didn’t know that at the time.
Aw, mine was that way too. He was pinking up and moving air and all the good stuff that newborns are supposed to do, but he didn’t squawk until we gave his foot a good hard rub. He didn’t really “learn” to cry until he was about a week old. He’d make these short little protest yells instead 🙂
My son didn’t cry either but he was pink and alert and his eyes were wide open. He gave me epic stink face when they put him on my chest right after he was delivered.
I scared myself silly during a minute like that too because my second was so quiet compared to my first after birth. My eldest is still a huge drama queen while my youngest is a people-pleasing sweetheart.
Yes. I had an EMCS earlier this month, and the baby didn’t cry. Apgar 5 at birth. She’s fine now, and has certainly made up for it since, but it was very worrying at the time. Didn’t even cry at the vitamin k! Give me a good, loud pair of lungs every time.
Scary! Glad it all worked out well.
Thanks.
I’m glad you and baby are okay! I had a cs with DD, and my OB warned us that she might not cry at first, but not to be worried because she hadn’t had the fluid pushed out of her via the birth canal, and that was normal. As a matter of fact, though, she came out telling us all *exactly* what she though of being pulled from somewhere dark and comfy and warm into a bright OR. (I’m pretty sure if you could translate her shrieks, she was cussing out my OB nine ways from Sunday.) Most beautiful sound I ever heard.
Oh goodness! Glad she’s doing well now, and hope that you’re recovering well too.
Indeed. Back I was a teenager, I volunteered in the ER of the local hospital for a few years. A doc there always said that he liked it when infants came into the ER red-faced and screaming because if they’re red-faced and screaming, you don’t have to worry to much about the ABCs–i.e., airway, breathing, and circulation.
My grandson likes his solid food now, but at first he had to relearn the mechanics of swallowing at every meal, and his mothe would become hysterical as he seemed to choke:”he’s going to die!”
“”Nonsense, ” I would tell her” “his color is fine. Call me if he turns blue”. (He never did)
My husband used to give Baby Prof the pacifier between every two mouthfuls, to get him to swallow. Worked.
I love when calves start mooing before they’ve even managed to turn from their side after being born to their stomach. You know that’s a healthy little one.
Never seen it yet, but apparently some calves can start to moo during delivery after their thorax is delivered, but before their hips come out. My husband says it’s the funniest thing ever – in part because the dam will often start running in a circle to try and get to the baby. (Yeah, it’s probably not nice to laugh at them, but the cows are so darn funny….)
My daughter spent about that first hour crying her little lungs out… good to know that they were working well.
“He was present throughout my son’s L&D (even though he slept happily through 5-10 cm!).”
LOL, my husband was the same. First baby, he was bonding with the nurses over the early morning coffeepot and took a nap while I was in the shower for a couple of hours. Second baby, we hired a doula so he got to nap through almost the entire thing. I was starting to push and the CNM asked me if we should wake him up. I managed to get out a “Yes” and she called out to him, “Wake up D—, you’re having a baby!” I think he’ll never forget waking up that way.
Lol…love it!
My husband napped for all 3 and woke up for the deliveries too! It really made a difference for me because I was able to take advantage of the early discharge option to go back home and sleep in my own bed, where there were 2 or more rested adults waiting to look after the baby while I napped.
Mine stayed awake and *I* napped. (thank you meds 🙂 )
Quite envious! I watched the Weather Channel after my epi had kicked in.
“She mentions that childbirth is so natural, it can almost be done in one’s sleep. Uhhh, no. Besides, there’s a lot of things I do in my sleep that I don’t do when conscious (drooling comes to mind).”
Having done woo-ey drug-free NCB once – the fugue state from the pain blocked most memory of the THREE HOURS of pushing for me – is that like sleep, because I don’t remember any of it?
An attorney chose home birth to save money? Um… I don’t know a whole lot of practicing attorneys who don’t have health insurance. Wait, scratch that: I don’t know any.
And of course, home birth isn’t covered by insurance, so unless you chose high-deductible insurance, you’re going to be paying more for a home birth than you would for a hospital birth.
But as we attorneys often say, we became attorneys because we can’t do math. Although apparently I can do it better than Ms. Borek. And so can my husband, who of course went to every OB visit with me and was in the OR when I delivered.
Never in my life have I known a homebirth practice to cost less than any covered hospital birth, regardless of deductable. And I should know, because I have the crappiest, highest-deductable insurance around.
I had a home birth seeking friend have to abandon the idea for this very reason. She ended up with a CNM group that did only hospital births. She had wanted the midwife who did her homebirth (CNM) to attend her again and the midwife had stopped doing homebirths. She could not afford the insane CPM fee even with the bartering option that would have covered a third of the fee.
Even if you have no insurance at all, going to the hospital in the first place, especially if you call around and negotiate a payment plan in advance, is likely to cost a whole lot less than planning a home birth and then transferring. Remember than 20% of first time mothers and 10% of low-risk multips need emergency transfer!
Seriously. When I found this site (well, its predecessor) around 2006 or so, we were planning our second and looking into homebirth CPMs or hospital CNMs. I was still reading the ICAN mailing list which was saying, over and over, that having a homebirth was the solution to every birth and baby related problem under the sun. The homebirth CPMs were charging around $5000; the CNM practice I went with charged under $4000. And in the event of a “transfer” with the CNMs (needing an OB to perform a c-section), their fee went WAY down. Oh, and the CNMs were covered by insurance and the CPMs weren’t.
My sister didn’t have health insurance her first year as a lawyer. It was 2006, before Obamacare, so she couldn’t go on my father’s insurance. An alumnus of her school hired first year associates as independent contractors. It wasn’t the most ethical arrangement, but after a year of searching she had no other job offers, so she signed up to work for his firm. She found a new job as soon as she could.
Depending on the state, if she really couldn’t afford insurance and was pregnant, Medicaid would still allow her a homebirth.
Medicaid pays lay midwives?
Well, CPMs. In my state, home or birth center birth with a CPM is covered by Medicaid.
In my state, Medicaid pays for home births with non-nurse midwives. My state also requires private insurers to pay for home births with non-nurse midwives, even if they have no malpractice insurance.
My husband went to all my appointments. When I got referred to the ARNP who did the diabetes education, he went too so he could understand how to support me and help control the GD. He was there, holding my hand while I gave birth (such nice, freezing cold hands! Felt amazing on my face between contractions). There is no way that my OB practice and the hospitals I was in are unique in letting my husband be a part of things.
Mine went to most of my appts and was there throughout labor and delivery. This chick seems to think it’s 1959 in the hospital.
She must think twilight sleep a la “Mad Men” is EXACTLY like an epidural!
In NCB circles, this 50s-60s-esque point of view is downright encouraged. I can’t count the number of times I was told that my DH couldn’t come to my appointments (wrong, if anything the OB would ask where he was when he wasn’t there), couldn’t be with me when DD was born (wrong), couldn’t take pictures (before we went into the OR, my doc made sure that DH had his camera), that women in hospitals have to push flat on their backs and tied to the bed (what the hell?), that I’d only get to see my baby for a few hours at a time (I would have killed for a night nursery by day 2), etc. If you counter any of these claims with “I have literally never known anyone who had to deal with any of that, and most of my friends are pregnant/postpartum right now and have been for the last several years,” that’s discounted with “oh, that was just THEIR experience, most hospitals are still like this.” *sigh* It’s fearmongering at its best.
Isn’t it ironic that they think of hospitals as 50s/60s, and yet many of them want to return to a birthing time much older than that? A la Ina Mae Gaskin.
Indeed! Though there was plenty to dislike about 50s/60s-era hospitals, I’d still sure as heck rather deliver there than in a middle-of-bloody-nowhere hut with a care provider (I use the term in the loosest possible sense) whose motto of service is “survival of the fittest.”
The anesthesiologist took the camera from my DH in the OR because he wasn’t taking pictures. I love that Doctor!
My husband went to all my appointments and was in the delivery room, he got to hold our daughter first (my choice) because they were sewing me up and I was very shaky. My daughter was born in 1994.
This was a Catholic hospital and still had some of the sisters/nuns working on the ward.
#5 made me laugh because my husband has been to maybe a grand total of 6 or so appointments through three full term pregnancies. But when he *has* gone, he never once sat in the waiting room while I was seen. That’s utterly ridiculous.
My husband just came with me to an OB appointment no problem. If NCB people want to bag on hospital birth at least make sure it is accurate!
An Actual Wife rarely came. She has a job. I have a job. OB office near my job. She came a few times, if it was something big, like a scan. But other than that, I didn’t need her to hold my hand either.
Yeah, my husband didn’t go to most appointments, because our work schedules were different and the times that were convenient for me were not at all convenient for him.
He did go to the anatomy scan, and to the growth scan where Baby Prof was diagnosed with IUGR. Ironically, immediately after that ultrasound, he went to a meeting and learned that the wife of someone else at that meeting was about to be induced due to IUGR. They apparently had a pretty awesome conversation about life with heavily pregnant women.
There were two appointments with each pregnancy where my husband did have to wait outside, which is standard for the hospital I go to and I hope is standard elsewhere. The appointments involved a mental health quiz and a discussion on safe home environments. One at the start of the pregnancy for a baseline, one towards the end to see if anything had changed. I appreciated the gentleness and care of my CNMs because even though I have an awesome husband, not everyone has a safe home environment and I’m glad that the screening and support options are there.
I got asked those “Are you safe at home?” questions during triage when I was in labor with my second child. I thought it was weird they did *not* ask my husband to step out for that.
When my husband’s wedding ring got smooshed at 7 on a Saturday night and we had to go to the ER, they asked him “Do you feel safe at home?” with me there. He was hemming (probably thinking the bar across the street on St. Patrick’s Day [aka amateur drinkers day]) I said “She means do I beat you?” “Oh! Oh, no, no, no!” He’s such a ditz.
My husband came to every appointment except one with our first baby. He wasn’t with me at my initial appointment with my OB when we were making sure this pregnancy was viable (I had a miscarriage last summer). My OB commented on my husband not being there, which means to me that husbands are more than welcome at their wives’ prenatal exams. My husband had to be at work when I went in, otherwise he would have come.
Wow. I guess she would be surprised that my husband also went to every appointment with me, and was present during my son’s birth (sorry–his extraction), and had his own relationship with my OB–meaning that he was very comfortable asking questions or getting clarification on his own. My need for petting is very low, and I don’t require validation, so I can’t really address those from my own experience. I guess the difference is that, while I respected and trusted my OB, I didn’t need his friendship; I needed his expertise.
One thing we found to be true (for us) was that many times the things people assume aren’t “allowed” are things that people tend not to ask about–when I was getting my spinal, I asked if I would have staples or stitches. I preferred stitches. The nurses said that he used staples. When he came in, I asked if he would be willing to do stitches instead, and he was glad to; he said no one had ever expressed a preference before. Sometimes it’s a matter of saying “this is what I want; is that doable?” instead of feeding the “they won’t LET me” conspiracy.
It’s a conversation. What are you doing, and why are you doing it. If the difference between what they’re doing and what you like is minor, you can request it; if the difference is major, you can understand why they’re not doing what you like. I guess it’s the difference between seeing hospital staff as part of a team that includes you, vs as The Enemy.
I think NCB adversarial attitudes can make it a difficult conversation for other patients though. In some places NCB is so popular, and hospital teams so frequently attacked for not following the 10 page birth plan and trying to use actual medicine to prevent complications, that it impacts interactions with regular patients who just have questions.
Exactly, which is why it’s so important to pick a care provider whose experience you trust and who treats you with respect, too. I like to know why my doctor does what he does–not because I don’t trust him, but because I like to know what’s going on with my body. As a result, he explains to me what he’s doing and why he’s doing it, and I make informed decisions (read: what he suggests, but now I understand why) as a result. Because of this, if there were a genuine emergency while I was giving birth and he didn’t have time to explain everything (“push with everything you’ve got, we need this baby out NOW, I’m getting the vacuum extractor”), I’d trust him to be doing the right thing and to explain exactly what’s going on once things have calmed down. We’re a team, which means we have mutual respect, and that’s why we get on so well.
That is so true! I mean, there is a usual way to do things, because you just can’t reinvent the wheel every single time. But some people have this sense that they can’t speak up and ask about things like pushing positions, ambulating in labor, skin to skin time after c/s, and if think it’s because their sources set them up for combat with their care providers. I have to prove I’m not an enemy the minute I walk into the room.
Hey, let’s not let science ruin Empowering Experience! Don’t you know these women need this? They need to be able to put their babies at risk, because EMPOWERMENT!
Facepalm.
I looked at her Linedin in profile. She graduated from a third tier law school in 2008 and has never worked as a lawyer except as a solo practitioner?
I wouldn’t take her legal advice either.
Agreed! I’m not an attorney but I’m a bit of a tier snob because of my brother. 🙂
And as I posted above she’s the founder of “The Birth Rights Bar Association.” Any legit attorney will know that is so ridiculous. What are the bar dues? What pretend bar exam do you need to take to join this bar? Or is it a lets drink the kool-aid bar?
Ouch. But true.
Oh holy shit, it actually happened, we’re on the verge of lay lawyers with made up associations to represent lay midwives with made up credentials.
DOGS AND CATS LIVING TOGETHER! MASS HYSTERIA!
Eh she may be cuckoo and maybe a bad attorney (who knows? Even people eith crazy beliefs can be smart and talented lawyers–I mean, hobby lobby won, right? but don’t basebuton which law scool she attended. Geez law school snobbery even here.
Lawyers are competitive people, on the whole. Law school snobbery is neither the start nor any means the end of it. Like all rules of thumb, there are exceptions, and given the number of law graduates out there, there might even be a lot of exceptions.
Great lawyers come out of lower tier law schools, and follow their passion to achieve their goals. This one has a law degree and has done a bit of stuff, including starting a one issue bar association that has nothing much to do with law.
Not impressive from a lawyerly point of view.
Right. I’m an attorney. I’m not saying she’s impressive. But where she went to school is irrelevant.
I’d consider taking her legal advice if she was a medical malpractice lawyer, but she isn’t.
One thing that bothers me is that Borek is in Pennsylvania, where homebirth is connection to the Amish population. It just sits wrong with me that she is sort of exploiting the very real religious freedom considerations that might be present with Amish homebirth for her own purposes. And there’s also a kind of privilege/cultural appropriation at work here too if (as I suspect) she’s trying to piggyback on the Amish tradition of home birth, especially as it has developed in relation to state law. She might be freely choosing homebirth with a lay midwife; but maybe Amish women would actually prefer to have their birth choices expanded to include modern medical care.
I read a book a few years back by a college professor about his friendship with the Amish family who lives across the road in the N. Indiana area. He’d give them (the husband and wife) a ride to and from the hospital when she was in labor.
“It must have been stressful for my doctors to know their patient was a lawyer who was going to give birth at home. I was surprised they took me in to begin with.” — Hmmm. And yet those heartless, money-grubbing, golf-game-getting-to doctors did take you in. It’s like they felt they had a moral imperative to treat you without passion or prejudice, or something. Sheesh.
Ha. Crazy Lactivist is an attorney. She took advantage of her u-grad degree in microbiology when writing an op-ed piece condemning GMOs, however.
My mom’s favorite story of my birth in 1975 was when she asked the OB who was delivering me via C/S if my dad could be in the room and he said, “That’s like asking if he could be here if you were having open heart surgery. The answer is no.” Fast forward to 2009 when my son was born via emergency C/S and my OB shouts to my husband, “Get in there and scrub up dad! You’ll never hear the end of it if you miss your kid’s birth!”
Yeah my father wasn’t present at my birth or my sister’s (1977 and 1980 respectively). He was in the hospital, but not the delivery room. I don’t think “dad in the delivery room” was a thing until the late 80s/early 90s.
I was born in 1980 and from conversations with friends and their parents, all of our fathers were present at our births.
Huh. Maybe my dad was just unenlightened then. Oh, and my sister was born on Superbowl Sunday so I guess he was watching the game (somewhere in the hospital, I believe). He had no such excuse for me, but from the way my parents have told the stories, my mom didn’t seem to expect my dad to be in the delivery room and wasn’t especially upset about it.
Mine wasn’t in the delivery room either. I think my mom was glad. He was a handful, as they say.
Same; I was ’77 and my dad was right there for me and my younger siblings. I think the 70s was the turning of the tide for this. 🙂
I agree, I was born in ’78 and my Dad was given the choice but opted to wait just outside. By the ’80s I think it was pretty much expected, because my two uncles (who have six kids between the two of them, all born between 1980 and 1988) were in the delivery room for the births of my cousins.
My Dad was at my birth in 1978. They did Lamaze.
Were you c section birth? That’s why my dad wasn’t allowed. He wasn’t particularly upset by it anyway. Neither was I if memory serves correctly.
No, neither my sister nor I were Csections. Maybe he was just squeamish? I can ask. Oh well, I don’t mind or anything, I was just under the impression that that was still pretty standard at that point. And this was in NYC, so not exactly a backwater.
Hmm, that might depend on location. My older brother was born in 76 and my in 77 and he was with my mom, well, he was allowed to be anyway. He missed my birth because I came to fast while he was filling out paperwork, but he could have been there if things hadn’t worked out that way.
That was very bizarre. I don’t think this lady has a grip on reality. None of the things she feared happened in any of my hospital births. One of which was au naturale under the care of CNMs….. In a hospital.
Anyhow, being “validated” and “petted” struck me as probably a pretty true reason people choose homebirth. I had a different provider at each birth. The degree of validation and petting varied. Probably the most validation and petting was with the CNMs. So maybe just interview doctors or CNMs for your best fit, get the validation and petting you need, all the while taking advantage of the life saving qualities of the hospital and medical professionals who work there! Win win!
Another great post Dr. Amy! Thank you so much for what you do!
Did she give birth in the 1950’s? Hasn’t it been a really long time since men haven’t been allowed to attend appointments or be in the delivery room? My husband always came when he wasn’t working and my oldest will be 16 in 6 weeks. I don’t know when she had her homebirth, but my last hospital birth was 4 years ago and my husband was at appointments with me and the hospital too, even came with me to specialist ultrasounds. And he used to shoot the breeze with my OBGYN during appointments.
My father was in the delivery room with my mother and I was born in the early 70’s.
Oh, and he was in there for the birth of my sister as well two years later. I don’t think they even knew any of their contemporaries who weren’t there for “the big event” if they wanted to be. And this was over forty years ago (in the US and UK).
I was born in 1971 and my father was there. He was annoyed that he wasn’t allowed to smoke in the delivery room, because “if there was a time when I really needed a fag, it was then.”
The only bit they put my husband out of the room for during my recent antenatal appointment was when they weighed me, asked me about domestic violence, other partners and risks of STDs and questions about vaginal discharge, so really it was more about preserving my dignity and looking after my privacy than excluding him, and it took 5 minutes out of a 45 minute appointment (first appointment- full risk screening, scan, medical history and examination etc).
The midwife just said “would you mind leaving- we need to ask some personal questions, and we need some privacy, we’ll get you back in a minute”.
I was born in the 80s and my mother swears the OB and my Dad had a bad joke oneupmanship competition at each appointment. I was a planned repeat C Section so the appointments were apparently super chill.
Practising “Dad” jokes? That is very sweet 🙂
I was born in ’77. My dad went to appointments with my mom and was in the delivery room for me and both of my sisters. *I* went along to a few appointments with my mom when she was pregnant with each of my sisters as well, which was in 78-79 and 82.
All I have to say is that I hope the so-called “Birth Rights Bar” will go after the ludicrously bad informed consents that home birth midwives purport to give their clients. But I sort of doubt it.
Since I’ve represented women forced to give birth in shackles and women denied prenatal care, do you think I can join their “bar”?
Oh, they didn’t mean that kind of birth rights, did they?
OK, Ms. Borek, you have the legal right to give birth out of the hospital in all 50 states! You win!
You also have the legal right to eat bluegrass and oak leaves instead of nutritious vegetables. Now, feel free to argue for the actual merits of either choice.
Yep, another example of someone who doesn’t understand that rights are manifested in the ability to do things, not in the things we do.
The idea of getting medical advice from lawyers is not so funny, actually. I had a patient who’s a paralegal for a big PI firm in needing birth control. Because of her constellation of issues a drospirenone containing pill (in the Yasmin family) was perfect for her. The ensuing discussion about the merits of drospirenone and the fact that her law firm was interested in recruiting for a class action suit against those pills bordered on hilarious. Luckily she was very smart and got the concept that the class action suit was being driven by the realities of tort law (most popular pill in the world makes for big class of plaintiffs makes for big money) and not by drospirenone being more dangerous than other progestins. I’ve had other patients refuse the 3rd-generation progestins over this issue.
I thought there was actually good evidence of the 3rd generation progestins creating more risks and offering fewer (or no additional) benefits that the older ones?
EHHHH
No.
Nothing tells you about the unique patient response to medication like birth control pills.
No two women (even sisters) will react to birth control pills in the same way.
It is trial and error.
If someone has breakthrough bleeding, acne or severe PMS on one pill, but doesn’t on another, you’re not going to convince her to stick with pill number one because of a very slight increase in risk of DVT and stroke.
I have people who only find their “perfect” pill after 5 or 6 attempts.
Why aren’t you recommending the IUD for women having so many problems with hormonal BC?
We do. But it’s costly. And some women find it distasteful
Not to mention that some people have personal objections to the MOA of certain methods of birth control.
I *might* be able to persuade a religious Catholic to take a pill which works primarily by preventing ovulation, I’m extremely unlikely to be able to persuade her to opt for a method which works largely by preventing implantation.
I also have the option of prescribing Desogestrel progesterone only pills, which I don’t think you have in the USA. They are VERY popular among the contingent of women who are too high risk for combined hormonal pills because of their age or weight or smoking status, but who don’t like the idea of LARC.
Desogestrel, unlike other progesterone only pills, is over 95% effective with perfect use, suppresses ovulation, many women have no periods with it, and you have a 12 hr window if you miss a pill.
For people who like the idea of pills, but don’t suit combined pills, it is often Desogestel that they end up with.
“I also have the option of prescribing Desogestrel progesterone only pills, which I don’t think you have in the USA”
Correct, we only have the norethindrone ones. And they do not have a big window. I wonder why the US doesn’t have Desogestrel ones.
I had no idea they existed anywhere. I’m interested to know why we don’t have them as well. No FDA approval yet, maybe?
Yep, no FDA approval.
Meanwhile I have the choice of branded Cerazette, generic Desogestrel and several branded generic versions. I don’t prescribe noresthisterone POPs at all any more.
I also have the option of prescribing Co-Cyprindiol (Dianette) as a combined oral contraceptive for patients with moderate acne or hirsuitism. I think Canada has that (Diane 35?) but not the US. It is a good option for people who need contraception while on oral retinoids.
What contraceptive works primarily.by preventing implantation? None spring to mind immediately…(although that is true for many questions that consultants et al ask me :p )
IUS and IUCD
Mirena:
Many women still ovulate with it, and it largely works by thinning the endometrium to prevent implantation, with some barrier effect by increasing cervical mucus viscosity.
Copper coils:
Copper ions kill gametes, but also embryos, and again prevent implantation, (which is why they work so well as post coital contraception).
That is why those methods, when they do result in pregnancy, are much more likely to result in etopics.
I’ve had this conversation enough times to know that if I can’t show that a method will prevent ovulation in the majority of cycles, I’m likely to fail to convince a very religious person to go for it, because they won’t be certain how it is working.
Let’s not forget that some women actually desire “side effects” from birth control pills and are just trying to find one with the best mix.
Personally, I very much enjoyed the MASSIVE spike in my libido with the first few pills in each new pack of Qlaira… I’m not entirely sure if DH shared my enthusiasm.
The pill was good for us when we just needed some breathing space after pregnancy loss and for career reasons, but didn’t want to put anything on hold for longer than six months.
And I hated being a raging maniac with severe mood swings and no libido with all the hormonal birth controls I tried. Condom was the best before my sterilization.
Horses for courses, isn’t it!
Glad you got something that suited in the end.
Yup, the side-effect of amenorrhoea for the Mirena is exactly what I wanted
I do…
And here it is all free…
And some people still just don’t want to.
Maybe they want a baby in 6-18 months, but just not right now (which means IUS/IUCD/SDI is not really ideal).
Or they want something with a guaranteed predictable bleed pattern, but the ability to skip a period too if it is more convenient.
Maybe they are someone who has to take a valium just to have a gynae examination, and a coil insertion is her worst nightmare.
The point is that there is no one size fits all method of contraception.
I can tell people that coils and implants are more effective, have less side effects and will reduce their period pain and bleeding until I am blue in the face, and some people will still say “ewww…I just don’t like that idea”.
People like what they know. If they have a pill they remember to take, that suits them and which isn’t causing problems, there is no huge impetus to change.
Which is fine, as long as they are aware of all of their options and the risks and benefits involved.
Patient choice and autonomy FTW!
I tried the Mirena, but my periods didn’t calm down after a few months – just a continuous trickle of bleeding – and the fish line was poking my husband! I know that they can cut that closer, but I didn’t like the side effects. I also didn’t like the lack of control – having to have someone else remove. Frankly, I can’t wait till the nuva ring goes generic. That was my all-time favorite. I’m open to the arm implant, since that’s not going to interfere with my husband! But I worry about getting it, and then having the same issue with bleeding or just not liking the particular mix of side effects, and then that’s more wasted money to remove it. Plus, I can remember to take the Pill, so it’s usually just what I end up going with.
The “need a doctor for removal”, along with a year of bleeding on Depo shots scared me off IUDs for a long time. I have health insurance at unpredictable intervals and financial insecurity from decades of poverty. I was afraid I wouldn’t be able to get it out if I needed too (although I did keep the removal instructions- I wouldn’t actually take it out myself except under very dire circumstances but I feel better having them).
I did get an IUD after the littlest though, and bled for almost four months after insertion. Now it’s the easiest thing ever. Light monthly spotting, no other noticeable effects other than a lack of pregnancy. So much better than condoms!
I had two Mirenas, one before my first child, one after.
First inserted under GA at time of endometriosis surgery and removed easily 2 years later in my doctor’s office. No periods, no side effects. LOVED IT.
Second- failed insertion attempt 4months post- natal. Despite a cervical block (yes, needles in my cervix) my cervix failed to dilate enough for insertion.
So I had it put in under GA.
Once again, no periods, no side effects, loved it.
Then, when I tried to have it removed 3 years later it got stuck behind a big band of endometriosis scarring in my cervical canal.
Two failed attempts to remove it in my doctor’s office, the second with yet another cervical block (yay! More needles in my cervix) before finally having it removed under sedation in an OR.
I’d happily get a third one, but I suspect my gynaecologist and my husband would not be on board with that plan!
So there you go, despite pretty awful insertion/ removals, Mirena was my most favourite thing ever.
I have the NuvaRing (it’s covered by my insurance) and it’s awesome. I only take it to stop my periods because I have a pretty short cycle. I was just so DONE with buying tampons and boiling my cup.
This is so fascinating. I’m looking forward to this discussion once little bit has decided to stop kicking my kidneys every 20 minutes.
Hell, I am all for LARCs being as widely used as possible, but personally, I use pills. Granted, for non-contraceptive reasons, as I’m in a monogamous relationship with another cis woman (I joke that I double up on methods, as is recommended–mine are pills and homosexuality), so if I miss a pill, the worst thing that happens is breakthrough bleeding. But since I already have other pills to remember anyhow, that was the most convenient thing for me, especially since if the first formulation hadn’t cleared up my symptoms, it would have been no big deal to switch.
No. Quite the opposite. Have you been getting your medical information from legal journals?
No, this was based on what my own medical practice has to say about Nuvaring – an increased, though still small, risk of blood clots: http://www.onemedical.com/blog/newsworthy/nuvaring-blood-clot-risk/. Personally I think all OBs should be pushing IUDs now anyway as the safest & most effective (and cost effective) form of birth control.
Sorry, I mean the increased risk with Yaz, not Nuvaring. Although the Nuvaring website acknowledges that some studies also show an increased risk for Nuvaring: “Other studies have reported that the risk of blood clots was higher for
women who use combination birth control pills containing desogestrel (a
progestin similar to the progestin in NuvaRing) than for women who use
combination birth control pills that do not contain desogestrel”
http://www.nuvaring.com/consumer/faqs/
My gyny doc said the increased risk of using Yaz could be balanced by driving my car for three hours less per year, and I signed up. Love it.
No pre-menstrual dysphoria for the first time ever. I didn’t even know that not being able to park the car or choose anything, starting with lipstick shade for the day, had a name.
Will soon have to think about menopause things, since on paper I must be there, but am v hesitant to change.
I have to advise any woman seeing me for contraception about Long Acting reversible methods, at least annually.
There is a significant proportion of women who just don’t like the idea of foreign bodies in their uterus or arm, and nothing you can say will convince them to try a coil or Nexplanon.
Believe me, my pill users are still on the pill despite my best efforts to persuade them to try something else.
For me, I’m not interested in an alternate form of contraception like LARCs because I have not had a period for a few years because of continuous Nuvaring use. YAHOO!
I realize I’m one of the rare ones, though–I would think that most would have breakthrough bleeding obnoxious enough to not use continuously for that long.
Nuvaring has really not caught on here, and we’re not big diaphragm users either.
Menstrual cups are also not popular.
I think culturally Irish women are conditioned against touching their genitals, and so the squick factor works against them.
When all contraception is free, and you can choose whatever method you want, then things like that matter more.
Dr. Kitty, do you have a preference for the copper coil or the Mirena for a 43 year old woman who doesn’t want more kids, no health issues? Both are free, have to make the choice this week.
GuestII- I’ve used both, so I can describe my personal experience with each. Both have been effective in preventing unwanted pregnancies. The Mirena reduced my periods to almost nothing, which could be an advantage or a disadvantage- nice to not have to deal with periods, but not so good if you want to use information about your periods as a gauge for general health and whether or not menopause is about to kick in. Periods were heavier on the copper IUD, especially for the first year, but then they settled down to being about what they were before using any form of hormonal birth control. I had some mild sporadic abdominal pain with the second Mirena, but not with the first, and not with the copper one, so I think that potential side effect is due to the insertion process itself rather than being specifically due to one type or the other. Even then, it wasn’t annoying enough to have it removed. The copper one is good for 10 years, the Mirena for fewer (5 or 7, depending on which country’s guidelines you are looking at). Both are good choices.
Chiming in- it depends on a lot of individual factors. As a rule of thumb, if you don’t think you can tolerate up to 6 months of irregular bleeding, don’t get the Mirena. If you can get through that knowing the reward is likely very light to zero periods, get the Mirena.
I’d go for Mirena. Purely because over the next 5years you’re likely to experience peri menopausal period craziness, and a copper coil will not help matters… Also Mirena can provide the progesterone component of HRT if you start to get flushes and night sweats.
90% of women with Mirena have shorter, lighter periods, 20% have no periods at all. Three-six months of spotting and staining, knowing you can get it out at any time if you can’t cope… Small price to pay.
Thanks, Ainsley, Medwife, and Dr. Kitty. I had an early loss from an unplanned pregnancy recently (we were going to call it Shiraz, oops) and it really hit home that I don’t want any more children at this juncture, so I’ve been weighing my birth control options. I think I’m going to go with the Mirena. Your advice has been very helpful, and I thank you all.
I’m also curious. I’m 36, and when the current resident of my uterus is evicted, we’re closing up the baby-making shop. I had a horrible experience with hormonal birth control last year (severe depression and behavior change), after years of being mildly unhappy with NuvaRing, and my doc recommends an IUD. But my friend just had an ectopic on hers, which does scare me some.
IUS and IUCD have failure rates similar to tubal ligation, but any pregnancy that does happen is significantly more likely to be ectopic, because coils are effective at preventing uterine implantations and less so for preventing tubal ones. But ectopic pregnancies are still very rare.
If the shop is truly shutting down for good, is vasectomy an option? Failure rate is 10 times lower…
Like I said, hormonal BC is a crapshoot, so I wouldn’t write off one method just because another didn’t suit.
Personally, I’ve been on lots ( and lots) of different pills over the years, because it helped the endometriosis if I bicycled or tricycled packets, and it took a while to get anyone to agree to a Mirena.
From memory: Microgynon (increased appetite, acne),
Mercilon and Logynon (depression, breakthrough bleeding), Dianette, Yasmin and Cilest ( all fine), Cerazette while breastfeeding and waiting for Coil (no libido) and Qlaira (3 day bleeds, the libido of a teenage boy for two days a month).
I do best with high oestrogen, third generation preparations, Qlaira which is a weird quadriphasic prep and Mirena, which is low dose levonorgestrel.
I’ve tried more than half a dozen different kinds of pills, which made me crazy or have morning sickness like symptoms. I’m also not good at taking daily pills. I’ve tried the patch, which gave me a horrible rash. NuvaRing was the best of the HBCs but it killed my sex drive, although I used it for about 10 years. Then, after my first pregnancy, I coudln’t get it on my new insurance and it was prohibitively expensive. The OB office where I worked in my teens and twenties made it easy for me to switch around, but that was no longer an option, and I am so shaken by the pill I tried AFTER NR that I’m done with the whole HBC biz.
We may discuss vasectomy. But my cousin just had a vasectomy baby, so I think that makes hubs nervous.
If you’re absolutely sure you’re done having babies, is tubal ligation an option?
The problem with the diaphragm (for me, and I suspect others) is that sometimes, putting it in is rather interrupting. If you know what I mean. And I think that you do. Otherwise, it’s a fine method of contraception and it’s useful to catch blood too when you’re doing the deed at that time of the month.
I love my NuvaRing. I don’t know if I’m super lucky or what, but I’ve had it for 6 months and have only had breakthrough bleeding twice.
I had to talk my providers into giving me the implant. The fact that I am not sexually active didn’t help, but I don’t have moral problems with premarital sex. It could happen, you know.
Yep. IUDs are simply unsuitable for those of us who find internals problematic- a significant minority of women, I think.
I’m sorry, I’m late for a meeting about LARCs. Seriously. I’ll try and post later
I had a terrible time with an IUD. I can’t use hormonal birth control (makes me puffy and ill and I’ve tried different combos but no luck getting one I can live with) and the copper IUD caused horribly painful and heavy periods. Had to take it out after less than a year. Hubby finally went for the vasectomy and I’m so glad I don’t need to worry about it anymore.
A lot depends on your personal plans, though. My husband and I would like to conceive soon, but not right now. I don’t want to have to deal with implanting then removing anything. I’m quite good at taking daily pills – very compliant with medical treatment plans – so Monessa has worked well for me.
I had nearly constant light-menstrual-style bleeding while I had an Implanon; 58 days of bleeding in a row before I got it removed. Actually, that’s when I started taking Monessa – a last ditch effort to stop the bleeding. It didn’t work and I teased my OBGYN that I was glad she could get me in that week because otherwise I’d have picked up a fifth of vodka from the store and have my husband bring home some iodine dip and a scalpel from the farm and have our very own DIY Implanon removal.
After all, if you can give birth at home, why not remove your own BC devices? (No, we did not actually mean to do surgery on my arm at home. That would be insane…like giving birth at home.)
In two pregnancies, I attended every OB appt with my wife.
I asked the doctor more questions than my wife did.
My husband never came to a single one……errrr, my EX-husband….
My husband rarely came, but he came nearly daily when I was an inpatient on antepartum. I had such complicated patients, and was an MFM fellow at the time, my husband just didn’t want to hear any of it. The only time he came was when he wanted the OB to tell me to stop working, but I ended up getting admitted anyway. In subsequent pregnancies, I just booked my clinic appts into my schedule, so it wouldn’t have been convenient for my husband to come with the little ones. he figured I understood what was happening, her just wanted to come when the baby was coming. He did make it for all of the births, but didn’t stick around long for me – he followed the babies to NICU, then went home. He figured my colleagues were better at looking after me than anything he was going to offer. Plus, he is very frugal, and didn’t want to have the pay the babysitters any more than necessary. But he was right, I delivered where I worked and had an amazing built in support system. We eventually had to make a sign to keep people from visiting so I could rest.
Mine came to my ultrasound appointments and my CVS. He didn’t come to my regular appointments, though he would have had I asked. He was a star during labour and delivery, even the midwife commented on his level of awesomeness.
Mine came to some of the more important ones. Sometimes he had to work. There were times with our second where if he was available I preferred he stay home with our other child rather than coming, so I could go by myself and give a urine sample without a toddler commenting on it.
My husband was going through fellowship at the time. The only reason he made it to the 20 week anatomy scan was the doc who did it (also a fellow) did us a solid and basically did two.
I forgave him 😉
My husband came for a few with the first one because of schedules. The second one he came to both of the ultrasounds. For the third, he will only be coming for the 20 week ultrasound. Between schedules and kids, it is hard for him to come now.
Hubby doesn’t drive, he works an hour from home, and we had very different work schedules. He came to 3 of my appointments. The first was at 10 weeks, when I started bleeding at work and had to wait 90 minutes for relief to show up so I could leave. He met me at the office. I talked him into taking an unpaid personal day for the 21-week anatomy scan. It turned out to be a good thing, because he was there when our daughter’s heart problem was discovered. He was also there for my first appointments in Boston, waddling around 2 hospitals for a long day of back-to-back appointments.
What I want to know is how “nutrition, hydration, exercise, and lots of questions about what my body was doing” prevent the placenta from growing over the cervix or stop the baby getting the cord wrapped around his neck.