At Least..

A picture I love:

It's all in the way you look at it.

I was just reading more on the puke forum (OBGYN.net). And I thought of something.

Why do the not use the correct terminology? Here is my logic.

Woman goes to hospital, labor no where ready to go (either scheduled induction or someone who jumps at the first couple of contractions) but the clock is started, the OB's start the induction pathway... Pit, AROM, more PIT, etc...

And then the "labor stalls"

Here is the part that kills me. This is labeled failure to progress. But is it really? Should it not be labeled what it really is? Failure to induce to delivery?

The OB's make us feel like it is our bodies that fail us.. Yet you can turn that around and say it is their intervention that failed to work. THEY FAILED! I can just see the "no, not me, not Dr. GOD. Oh no, I did everything by the book"


Just my grumbling on how it is all how you look at it. Did my body fail, or did Medicine fail?

Just Cut.

This is a response to a thread on an interesting forum. A forum of OB's from around the world who sit around and share "war stories" or ask for opinions from eachother.

So this is what riled my hair today...

This first part is from one OB asking about a case, and what her esteemed peers would do:

I have a good one for y'all to ponder. 23 y.o. primigravida, currently> >at 34 weeks gestational age with twins. Currently weighs 399. EFW at> >31 weeks on both twins was 5 pounds. Cephalic/cephalic presentation.> >During a visit to L&D for false labor, monitoring was essentially> >impossible.> >> >Route of delivery?

So here is one OB, telling the list that she has a 400lb woman with twins, what should she do... (ok, and here is my thing? She do? Do what? Why does she get to choose this person's route of birth? When birth is not even going to happen right now?)

And a response from another esteemed OB:

I would rec. C/S at 36 weeks. If not you will end up doing her at 3 in the morning after a 34 hour labor wit 28 hours of ruptured membranes and get out 2 sick kids. Again, IMHO. This old dog learned one new trick over the years, Vaginal Bypass before labor is the answer. I doesn't matter what the question is. (TIC, at least a little bit)

Alright. So lets look at this....

C/S at 36 weeks: Why? Does she have pre-e? The babies will not even be considered term then!

Doing her at 3 in the morning: Is this implied to prophylactic cut during 9-5 just in case it might be a late night?

After a..... get out 2 sick kids: Can you say ASSUMPTIONS? How does this one man know how this woman's labor will go? Do they hand out crystal balls in med school these days? He has not a single bit of data on this woman, her heath or anything besides her weight. And what grantees that the kids will be sick?

34 hour labor: NOT that uncommon in first time births!

28 hours of ruptured membranes: Why? Are you implying to artificially rupture the membranes? Or assuming that they will rupture on their own.. based on what?

Vaginal bypass: Great term is it not. Is the vagina broken? Does she need permission to use this part of her body?

It does not matter what the question is: ? Too short? cut Too tall? cut Fat? cut Old? cut Too many babies? cut.


Sigh.... This is not the only time I have seen such callous attitudes that if you ask me represent a decent proportion of our obstetrical community. This one person is using his "professional opinion" not based one bit on any hard data about this woman to decide her fate for her.

So when people ask me about my bandwagon. About my cause.... Read the above, you tell me, Why? What is wrong with this woman besides two things that are not even rare, obese and twins.

If you are so interested in such wonderful wisdom of how our bodies are incapable of birth, wonder on over to the board of Gods and Surgeons at OBGYN.net.

Why I have a "bandwagon"

Sigh.

I was recently informed I have a bandwagon, a soapbox... And I started thinking about this. Ya know, what is wrong with having a platform?

What is part of my platform? Well, I use a word climate to describe a whole host of factors that contribute to one physical event. Birth.

Sex, Pregnancy, and Birth all happen. On the pure scientific level, procreation, continuation of the species. A biological process. A physical chain of events that occur in mammalian animals driven by hormones, etc.

Procreation happens, all mammals reproduce. And I guess enter here my ~evil agenda, twisted view, etc~... All mammals have the inate, physical ability to reproduce unassisted. there I said it. Rabbits do it, cats do it, cows do it, even if you believe it, our closest relative, primates birth without assistance. Yet humans are the ONLY mamal that cannot procreate without assistance? Most people will bluster "perposterous, what are you talking about, we don't need assistance!". Do we?

Alright. Then why do we use assitance (MW, OB, Hosptial, etc)? Now the popular response would be multi facited... 1) We have the technology to make it safer. 2) We have the technology so women can be saved from the pains of labor. 3) We need help in case something goes wrong!

Ok.. I can see that, I can see the logic to that. But what I cannot see is that our society has completely embrased the technical form of Birth and shunned other options. That if you were to ask a woman on the street if they "needed a Dr., a hospital to birth a baby" the answer would be yes. Why?

Sort of off on the side, but the mind wanders you know... One fellow listmember once wrote, that if we feel birth is so inherently dangerous that we must do it in a hospital, is it a leap to next mandate the beginning of the process "intercourse" to also be done in the hospital? Jokingly staing that something might go wrong, all those sperms may be lost, there may be a physical injury during the act.

Is it a "feel good" need? To feel that I have surrounded myself with everything, (including the machine that goes ping) and so now if something goes astray, I will be saved....

I just do not know... Somehow we arrived at this point. Now what?

Blame and Accountability

Blame and Accountability


Are they polar opposites? Or do they swing an intricate dance around each other? Can you only have one and not the other? Does one negate the other? If you use blame, then are you not accountable? Or can you be accountable and still have blame?

This random thought pattern occurred to me as I tried to sleep last nights, a fall cold wracking my body with coughs that have sent my muscles into spasms.

The context that I was thinking was a comment that “Women should be accountable for their cesareans, not blaming Dr’s, nurses, etc. That women have walked out, etc..” And it angered me.

And then I thought about this… Can there not be blame and accountability at the same time? And also I think this is a harsh line to walk.. It was not too long ago that a woman was held accountable for being raped… That blaming the attacker was wrong…

And then I thought about the similarities between rape and coerced surgery.
Both “attackers” have blinders on, both are looking out for themselves and what they want, irrelevant of the other party. An attacker wants sexual gratification, domination. A coerced cesarean provider wants domination, control, limit of their liability. Both of these two individuals act on motives that are swayed to their desires, ignoring the desires of the victim.

A woman who was coerced into a cesarean is told lots of postmortem comments. Like “you could have found another OB”, “you could have walked in pushing”, “you could have refused” etc…”you were weak, you were ignorant”

A woman who was raped was told “you were asking for it, in your dress and behavior”, “what do you expect you were in the wrong place, wrong friends, etc”. “you could have fought harder, why didn’t you?” “your actions made you weak, vulnerable, a target”. “you should have known better than to be there, or with them”

So does this take the blame off of the attacker? The OB? Both who were the dominant party in the situation? And on this note, yes, in society it is noted that “men have more control, more power, more respect” “Dr’s are more intelligent, have the answers, are altruistic, {do no harm}, have your best interest in mind”. Can we say that this is 100% correct? No, there are exemptions. Are all men rapists? (and a woman can also be a rapist), Are all OB’s self centered, uncaring, control freaks?

Does the victim already blame themselves? Hold themselves painfully accountable for the events of that day? The time leading up to it? I think you will be hard pressed to find one that does not have guilt, remorse, over the decisions made.

So that leads me to this? Can you wrap blame and accountability up into responsibility? Who was responsible for those events that occurred? Obviously BOTH parties. Rape takes two, and well surgery takes many…

Is it wrong then to lay blame on others? OB’s, husbands, family, friends, strangers? Does by saying you blame them mean you are not accountable? Or can it be a mix of both? Were they not a factor, did they not contribute to the end result?

Can the victim then not express anger, hostility towards the other participant? Is that wrong? Are they to ignore that, to not blame anyone else and take the burden of responsibility solely onto themselves? To allow the other party to not be responsible for their actions?

Yet that is what we have done. We have legalized the coherced cesarean and placed the blame on ourselves, ignorant weak women. That it is ok in society for the all knowing, in control OB to “have done everything in his power that he could do”, irrelevant to the woman’s desires.

People always say you have options, choices.. But is this true? Is life like the endless possibilities of multiple outcomes? Are there not physical restraints placed upon us? Here are some examples… When people state… well you could have….

Find another OB… Alright, let’s look at this.. Is there an unlimited supply of OB’s to choose from in all areas? Can you just pick up the phone and talk directly to an OB? Ask them the questions to rule out their intentions? Finances are a question.. Not all OB’s may be covered by insurance.. So then should you go into debt, loose money (that maybe you physically just do not even have?)to find one? Drive endless miles to another area?

Have a home birth (or possibly unassisted) birth.. Let’s face it, for all this is NOT a wise idea for everyone. Yes it is an option, yes it can turn out well. And honestly I have nothing against this personally (and I am planning one in the future for myself), but there are some risks that make this an expensive gamble. OB’s and hospitals to exist for a reason. For example, If a woman may have a blood clotting (bleeding) disorder. This can make a home birth much more risky. So is this person not limited in their choices? Can we look at this woman and say “nahhh, the risk is not there, or it is soooo minimal”. Some may be ok with that, some may agree. Others may be afraid. Others may look for guidance and assistance. Does this make them fair game then for an unnecessary cesarean and then all the blame accountability crap aftwerwards? But we expect this woman with a limitation to be stronger, to face adversary, to take the gamble.

So this then leads me to conclude, time, location, finances, culture, family, physical health, etc are all real restraints placed upon us. Are some people in a better position to have less restraints upon them? Yes! While others have more restraints. Yet we paint the broad brush of “well you could have”. Could they?!? Is it right to say to everyone they could have?

So if the person holds a gun to the woman’s head, and threatens her, and no one is there to defend her. Should she have done a judo chop, kicked the gun away and ran? Is there not debilitating fear playing a role? what if she was physically incapable of overpowering her attacker? What is the difference between a physical gun and perceived threat, a ‘dead baby card’. So do we say to the woman who submitted to the gun, “well, you were weak”. Yet we say to a person who had the dead baby card shoved in their face multiple times “you should have been stronger, known better, whipped out all the statistics and medical facts”. That is just about as realistic as saying to the woman she should have pulled out HER gun on the attacker. Yes, some may carry a gun, and yes, some may be able to battle wits with an OB, but do we expect this of all? Yes unfortunately we do.

Let’s face it, this is what we are demanding of ourselves. To overpower all opposition, to steamroll through medicine, family, finances, miles… Some of us may be able to do this… and some not…

Ok, I am done having deep thoughts now… I hope you had a chance to look and think about these ponderings, and maybe looked and pondered on your own.