"But Gwyneth did it"

[cdlamis]

I never thought that those words would come out of my mouth but yesterday someone was teasing me for wanting to try a vaginal birth with baby #2 when Julia was 9lbs 14oz.

I actually said "Gwyneth Paltrow did it (vaginal birth)". Her baby girl weighed 9 lbs 11oz! Out of someone so small. Must be all that yoga!


Daniella
Mom to Julia 6-13-02
And baby #2 EDD 12-30-04!!

[Rachels]

She did! If you can grow a big baby, chances are excellent that you can deliver a big baby. You just have to find a midwife or doctor that believes that, too.

-Rachel
Mom to Abigail Rose
5/18/02

[Marisa6826]

Ummm, but Daniella, she named her daughter Apple too ;) :P.

I thought this was her first, no?

Regardless. Go for it!

-m

[aliceinwonderland]

Was it a vaginal delivery for sure? I never read either way, just that the dad said it was a long labor.

I know, big baby out of someone so small!!

[cdlamis]

Oh- I forgot about her name! Apple????

Anyway, I meant that Gwyneth delivered a big baby, not that it was a VBAC.

Daniella
Mom to Julia 6-13-02
And baby #2 EDD 12-30-04!!

[jojo2324]

I know. My first thought was, "Apple??" But then that's the pot and kettle...Since my daughter is named after an herb. Maybe she did it in honor of Manhattan?

[StaceyKim]

rachel,
sorry but i disagree! it's all about you and your husbands genes that determine the size of the baby. there is NO WAY i could have delivered my 9lb 5oz baby EVER. his head didn't even get to the birth canal and this is after 12 hrs of labor (and NO pain, i might add with pitocin)! so, i think just because you *make* a big baby does not mean you can deliver a big baby. some people cannot even deliver relatively small babies.
also, it doesn't say how she delivered the baby. i wonder if it was a c/s!

[lisams]

She said "chances are excellent", not that it is 100%. I think when a woman is told her baby is large, a c-section or induction is the regular plan. Inducing leads to higher rates of c-sections, and therefore most larger babies are delivered c-section without an attempt at vaginal. It's nice to see women who have larger than normal babies deliver vaginally since it is not the norm.

Lisa

[kthomp]

I had my very large baby (9lbs 7 oz) vaginally without any problems (except for a small tear.) It can be done ladies! I was a big baby myself, so maybe I was "built" to have one.
I love to hear stories about LGA (large for gestational age) babies since they don't seem to be too common.

I spent around 45 minutes pushing with DD. Just curious- how long did all you other mommies spend pushing and how big was your baby?

[Rachels]

If you look at the research, you will see that chances are indeed excellent that even very small women can birth large babies vaginally. Some women do have true CPD, which makes it impossible, but the numbers are tiny. Our rates of c-section for because the baby was "too big" are totally medically unjustifiable. FWIW, pushing position has a lot to do with it, as does epidural use. Being upright, on hands and knees, or semi reclining increases the diameter of the birth canal up to 30%. The difference is so enormous that the WHO has specified that lying on one's back to give birth, as happens in most US hospitals, is a practice that is "clearly harmful and should be eliminated."

I personally know eight different women who birthed 10+ pound babies with midwives with virtually no intervention. Birth attendants make a difference, too.

-Rachel
Mom to Abigail Rose
5/18/02

[lizajane]

9lbs 9.5 ounces. 22 inches long. i did have pitocin, which i am sure contributed to my short 11 hour labor. but i only pushed for 30-45 minutes without any trouble at all. i did tear, but come on! something has to give when a 9 1/2 pound person is shooting out of a normal sized body!

[StaceyKim]

"chances are excellent"... not sure what the % is when you say that but i HAD to be induced because i was so late with no signs of a baby coming. so, i don't know what the big deal about getting induced is...MANY people NEED to be induced or the baby would be WAY overdue or never come on there own. my husband was a 10lb'r and i was a 6lb'r when i was born and i WAS never (i don't care how many freakn' techniques there are out there) delivering this baby vaginally. i don't happen to believe in midwives and all that...i want a doctor, a hospital, etc. MORE babies are living and MORE moms are living after childbirth and I am sure it is because of DOCTOR intervention. midwives have been around for a long time but they are not doctors.
i know PLENTY of good stories of people getting induced and NOT having a c/s because of it. i think c/s are up because more people are requesting it, people are getting induced early, and there are a lot of multiple births these days and those a lot of times need to be delivered c/s.
anyway, back to my point, i am a tiny petite person with small hips and i know i could not have delivered this baby without some kind of complication and all i care about is having a healthy baby in the end.
also, GP, is not a tiny girl. she happens to be quite tall, so it wouldn't surprise me that she could deliver the baby.
anyway, i just don't want people to feel badly if they have to have a c/s. there are situations you have no control over and a lot of c/s are best for both the baby and mother.

ETA: I pretty much knew I was having a big baby but I did try to deliver but couldn't. I don't know too many people who elect to have c/s without trying to deliver first.

[Bethann31]

I've had 4 babies, 7 lbs 15 oz, 8 lbs 8 oz, 8 lbs 6 oz and 9 lbs 12 oz. I've never had a c-section or a tear. I'm not a huge person, 5'4", and about 160lbs at 9 months pregnant (except this last time, don't want to go there.....) I was a large baby too. The longest I ever pushed was about 30 minutes I believe.


Beth

Josh 3/90
Mollie 4/92
Jeffrey 12/94
and Katherine 6/03

[llcoddington]

I had my 6lb 12 oz. baby after 2 hours of pushing! And, she barely made it out! My labor was short- maybe 8 hours. I did go to a midwife and prior to delivery was told that due to my pelvic structure I might or might not be able to deliver vaginally. I am very glad I could but my midwife also said that if Lauren had been any bigger she would not have been able to come out.

Lana
mommy to Lauren 12/5/03

[StaceyKim]

FWIW, I didn't even get to the pushing part. Didn't need the epidural because I was in no pain...probably due to the head not even being close to the birth canal. The doctors and nurses did a lot to try to get me to dilate etc. but it JUST WASN'T HAPPENING.
I think in my case, the baby was "too big".
Oh, and I wasn't on my back either.

[bluej]

I pushed for 3 hours with Alex, but she was posterior, so all of that pushing just got her good and stuck. She was pushed back up, turned, suctioned and forceped (hmmm, that's probably not a word) out in less than ten minutes...she was 8 lbs 10 oz. Caden was 9 lbs 8 oz and I pushed with him for about twenty minutes. Could have been less but we took it nice and slow because we knew he was big. There was very little pushing with Ryden, 8 lbs 11 oz, b/c we barely made it to the hospital in time. He was born less than five minutes after getting me on the bed. For what it's worth, I had the least amount of tearing with my biggest baby. He was also my easiest labor and he was induced (no drugs other than the pitocin).

[Rachels]

Okay, well, like I said and like another poster said, the chances are excellent. It doesn't mean EVERYBODY, without fail, will be problem-free. Reporting the statistical likelihood for this all to be fine for the OP is not in any way blaming you for anything. No need to be defensive, really.

-Rachel
Mom to Abigail Rose
5/18/02

[Rachels]

>"MANY people NEED to be induced or
>the baby would be WAY overdue or never come on there own.

Simply not true, statistically speaking. Many people ARE induced, but that is to be distinguished from medical need. Again, I'm not talking about individuals, I'm tralking about evidence-based maternity care, which the US does not practice.

i don't happen to
>believe in midwives and all that...i want a doctor, a
>hospital, etc. MORE babies are living and MORE moms are
>living after childbirth and I am sure it is because of DOCTOR
>intervention. midwives have been around for a long time but
>they are not doctors.

This is a pretty common misconception. If you take time to read any of the research, you'll see that it speaks for itself. I've never read such a convincing body of literature on any subject, ever. I started out believing what you do, but you simply can't read the last half century of research and still hold those convictions. And the several dozen countries with better mother / baby mortality rates than ours all have midwives providing at least 75% of maternity care.

You seem under the impression that I never think c-sections are necessary, and that's incorrect as well. I answered this post to support the OP. If you're happy with your birth, I think that's great.


-Rachel
Mom to Abigail Rose
5/18/02

[StaceyKim]

sorry but it annoys me when there is so much negativity on the site about c/s and you seem to have a strong opinion against them. some of us probably wouldn't be alive if it wasn't for a c/s! that's all. if you were in my shoes, maybe you would understand.
i do agree that there are a lot more c/s performed, some necessary, some maybe not. i don't know. there are a lot of contributing factors to having a c/s. i certainly did everything to prevent one. i had another friend whose baby was breech, another friend with twins and they were breech...all resulting in c/s. also, i think the malpractice insurance for ob's has skyrocketed and probably has influenced the frequency of c/s too.
i am not in any way pro c/s but it is good to know that it is available to those who need it.

[Rachels]

I couldn't agree more with your last sentence. My strong opinions about the fact that the US totally ignores overwhelming medical evidence in the way we practice maternity care is in no way a strike against the technology itself. It's a strike against its misuse and over-application. Necessary cesareans are necessary. Thank heavens we have them. But most cesareans are not medically necessary, statistically speaking. It really sounds like yours was, and I'm really so glad you had that available to you. I would sign right up myself if it would protect my baby's life.

But after writing my dissertation, where I studied birthing literature to the exclusion of just about anything else for several years, I had no choice but to really change my thinking about it. Honestly, I sounded just like you before I read all of that. But I could not continue to hold the views that doctors are handling normal birth appropriately in the face of those many hundreds of studies, spanning decades, all saying the same thing.

I think it's VERY hard to go against the wishes of one's doctor. I'd never fault ANY woman for the kind of birth she had, nor do I think we need to all be birthing in the same ways. My absolute conviction is that women need to birth in the ways and places and with the people with whom they feel safest. But I have an equal conviction that we should expect our healthcare providers to actually practice in accordance with the research, and with the recommendations of such organizations as the W.H.O. And right now we don't-- at ALL. I also think that we as women ought to have easier access to this kind of information. You shouldn't have to write a dissertation about birth to learn about what's safe and what isn't, KWIM?

But again, I in no way fault you for your birth, or anyone else for theirs.


-Rachel
Mom to Abigail Rose
5/18/02

[StaceyKim]

I guess we are on the same page here. We can end this discussion...no hard feelings here at all! :-)

[Rachels]

Nor here!

-Rachel
Mom to Abigail Rose
5/18/02

[starrynight]

I think it depends more on the size of your pelvis and the way the baby is positioned then the actual size of you in relation to height and weight. My mom is only 5'3" and my brother was 9lbs 1oz and 23 inches long, she had him vaginally in one push I think she said.

I'm 5'4 and am average weight now, was tiny when I got pregnant with ds, he was 8lbs 11oz and had the biggest head/shoulders I have ever seen on a kid in my life and he came out just fine, I pushed for 10-15 minutes I think it was 3 pushes.

And sometimes the second baby gets smaller, not always bigger so it may not even be an issue. Ds was my biggest and the girls each got a pound smaller and an inch shorter than him. So my youngest was my smallest when I figured she would have been my biggest on the each baby gets bigger theory!

And just to throw this one out there, my neice was 5lbs 4 or 5oz and my sil was in labor with her for almost 2 days and she pushed forever before my neice would come out, so again I really think it's pelvis shape and baby position that determine how long you push before the baby comes out or even if the baby will come out vaginally.

Daniella, good luck going for a vaginal birth!

[lisams]

From reading Rachel's posts, I think she has a strong opinion about women being educated, empowered and in charge of the decisions made about HER own body. Many women are told they cannot birth a "large" child vaginally when it is very much doable. Many women don't even know the risks of a c/s when going into one and that is very scary, especially when they are not emergency situations and a woman should be given the chance to make an educated decision for herself. Whether a baby is born vaginally or c/s does not make one birth better than the other - either way a beuatiful child has entered the world, it's just that with a c/s there tend to be more complications post op. I would do everything I could to avoid a c/s but if I had to have one then thank God it's available.


Lisa

[Sarah1]

Joanne, I don't think there's ANY comparison between Sorrel and Apple. I personally cannot imagine saying, "Good morning, Apple!" or "I'd like you to meet my friend, Apple." Sorrel is much more a name than Apple, IMO...not to steer anyone else away from naming their kid Apple...

I also wanted to add that while Gwyneth Paltrow is really thin (OK, not that I've seen her in person!), she does appear to have a tall frame and wide enough hips. Not that there is an ounce of fat on her hips...but I think they are definitely wide enough to allow for a vaginal birth!

Do we know for sure that she delivered vaginally?

[Rachels]

I can find out. My husband is vaguely related to her. We don't know her, but she is very close with DH's aunt, who is one of her father's immediate relatives. I forget the connection, exactly.

I'll also try to get the scoop on Apple. :) As much as I try never to criticize somebody's name choice for her child, Apple Blythe Alison Martin strikes me as rife for problems. Apple Blight, Apple Martini... those sprang instantly to mind.

But I'm glad mom and baby are doing okay. From all reports from DH's relative, Gwyneth is an incredibly lovely person.

-Rachel
Mom to Abigail Rose
5/18/02

[Calmegja2]

Maybe it's short for "apple of my eye"?

Which starts Stevie Wonder songs playing in my head.

***conspiracy, based on nothing theory below***

Wasn't Gwyneth extremely close to her father? And didn't they both love Motown music (hence the film "Duets")? A case could be made that perhaps that song had meaning to her because of her relationship with her father, and there goes the name Apple.

[ddmarsh]

Yes I have to agree that Apple tops the list of bizarre Hollywood names in my book :).

Did anyone read the article about Charlie Sheen and wife having a baby a few weeks ago in People? It just struck me as so funny b/c they made a point of saying they did not like bizarre Hollywood names and thus named their daughter Sam - not short for anything, just Sam. It also discussed the fact that she had a first-time planned C-section for "scheduling" purposes, went into labor beforehand, rushed to the hospital and had the section anyway. Go figure.

[jk3]

Interesting theory! I don't think Apple has too much to worry about. She probably won't get teased due to the fact that her mom is a swanky actress + dad is a rock star. Plus celebs often go for unusual names so she probably won't be hanging out with too many friends named Emily, Sarah or the like!

Jenn
DS 6/3/03

[jojo2324]

Thanks Sarah!! :)

I pushed for two hours with #1, 8 lbs, 7 oz. With #2, pushed for 20 minutes, 7 lbs, 11 oz. I think. My goodness, I don't remember how much she weighed. I think it was 7.11. And all the nurses kept commenting that she was a big baby for a person my size, and I said, "Well, my first was nearly a pound bigger!"

[votre_ami03]

I was 9lbs 8 oz, my XH was 6lbs something, our son was 9lbs 2 oz. Looks like Nolan took after my side of the family. I had no complications delivering him, pushed less than an hour, c-sec was never mnetioned. I did break my tailbone, but others have done that w/far smaller babies.


Christy, mommy to Nolan 7/22/03

[MartiesMom2B]

Uhm Gwyneth had her baby? I guess I better go crawl back under my rock. . .

Sonia
Proud Mommy to Martie 4/6/03

[StaceyKim]

I don't know any women that are NOT educated about the choices they have in regards to giving birth. Maybe I am missing something here...we have almost 10 months to prepare for birth! most c/s that i know of occur because of different reasons than being too large. I know I asked not only my doctor about c/s and vaginal births but read many books and did my own research. i asked my doctor MANY questions about c/s not even knowing i would end up having one. i had friends who had "issues" when they gave birth vaginally too. it is quite rough on our bodies in general. basically, when you are giving birth there are many surprises...you just don't know what is going to happen.
i don't feel as though i didn't have a choice in the birth of my ds. no one told me you cannot deliver a large baby before i went into labor. i can't imagine being told that. we knew the baby would be big and we knew i was small. but i trusted my doctor when she said we needed to end up to doing a c/s.

[Rachels]

LOTS of women are not educated about the choices they have in regards to giving birth. This is no reflection on women themselves-- the information that is widely available is often incomplete or simply false. And a doctor who is not practicing in compliance with recommended standards and scientific evidence is maybe not going to be giving the full story, either. What I learned when I went digging for birth research was absolutely shocking. I thought I knew plenty about it, and I was wrong on just so many fronts. It truly was amazing. It really shook up my perception that we are empowered to make our own decisions. If all we know is the status-quo, mainstream stuff that's out there about birth, we are NOT.

-Rachel
Mom to Abigail Rose
5/18/02

[JElaineB]

I think MANY women are not educated about their childbirth choices. I think this BBB community is unusual in that we have so many posters who ARE well-educated about their choices. And I'm sure in real life posters here gravitate towards the same well-educated types of people. Just that fact that we seek out a board like this for information and support would indicate that we go beyond what many women do. Many women simply listen to their doctors without researching options on their own. And many women I am sure receive little or inadequate prenatal care.

I too had a c-section (after induction) even though I really wanted a vaginal birth. I am ok with the way things turned out because the health of my baby was at risk. But I did research potential outcomes on my own and did not disagree with my doctor's reasoning. But I don't doubt there are doctors out there who tell a woman she is about to have a 10 lb. baby and needs a c-section and cannot attempt a vaginal birth. I don't doubt that it happens every day.

Jennifer
mom to Jacob 9/27/02

[Rachels]

If anyone's interested, the single best resource that I've found in terms of synthesizing the actual research is Henci Goer. She has two books that are just great. One is called The Thinking Woman's Guide to Better Birth, and it's a layperson's book. It explains and clarifies the research on childbirth. The other is Obstetric Myths versus Research Realities. That one actually lists the studies with brief abstracts about their findings and groups them all into categories. When I was doing my dissertation research, I read most of the studies themselves, and Goer's reports are accurate. Her work is incredibly comprehensive. It's a great place to start if you don't want to spend years tracking down studies and trying to make sense of them. :)


-Rachel
Mom to Abigail Rose
5/18/02

[wagner36]

Yeah, me too - I'm apparently living under a very big boulder these days...

[egoldber]

LOL! I was thinking the same thing! :)

[StaceyKim]

rachel, i am sure you will agree that scientific evidence is open to interpretation. facts can be skewed to back up any statement that you have. although, i agree that you should take an active role in any medical care that you have, you have to be very careful that you are not interpreting scientific evidence according to preconceived notions that you already had.
also scientific evidence is also influenced by studies done in different countries. these countries may not have the resources that we have.

[sugarsnappea]

I didn't even know she was pregnant. :)

[StaceyKim]

"If you're happy with your birth, I think that's great"
I think this statement right here is demeaning. What exactly do you mean by this?
Your interpretation of your research is JUST THAT, your interpretation, it does not make it an irrefutable fact.

what is "evidence-based maternity care" exactly?

[mommd]

OK, not Rachel, but I think all she means is that some people are not happy with how their births went because they felt like they were pressured into doing things by their docs that may not have been necessary, like induction or c-section. I also don't think Rachel ever said it was fact, just that research supports what she was saying.

Maybe people are still in defense mode from all the political discussions, but I don't understand how an innocent post about giving birth to a large baby can start an arguement?

[ddmarsh]

>"If you're happy with your birth, I think that's great"
>I think this statement right here is demeaning. What exactly do you mean >by this?

I'm sure she meant exactly what she said. That is, as long as you are happy with your experience, good for you. Many others, however, look for additional information and for those she and many other sources are readily available.

>Your interpretation of your research is JUST THAT, your interpretation, >it does not make it an irrefutable fact.

We've had these discussions before. WELL DESIGNED, APPROPRIATELY EXECUTED research is not open to myriad interpretations. Goodness if that were true think of all of the scientific ideas and advances we have that would be out the window. Rachel is not citing research on births that was done on the island of Wackama involving 2 women. She typcially cites bodies of reasearch that are well-founded, scientifically based form well respected sources. It is entirely up to you whether you wish to pursue that information or pay it any regard whatsoever, that does not however make it meaningless.

[egoldber]

Evidence based maternity care is practicing maternity care based on the research. And my understanding is similar to Rachel's. Here is in the US, we do a shockingly poor job of aligning medical care in OB to research results. There are a lot of reasons for this, mainly driven by the way that hospitals and doctors are re-imbursed in this country and by the skyhigh cost of malpractice insurance for OBs. If you look at the maternal mortality data provided by the WHO, the United States isn't even in the top 20. We barely make the top 30. Virtually every other developed nation provides better maternal outcomes than we do.

http://www.who.int/reproductive-health/publications/maternal_mortality_2000/tables.html#Annex%20Table%20A

And I will offer myself up as someone who was woefully uneducated about birth and birthing options before having DD. I mean, I read all (and I mean ALL) the mainstream books about birth before having her, but when my labor didn't go by the book, I was at a loss as to how to respond. I trusted my OB, and in retrospect, I think my OB made choices that were easier for her rather than in my best interest. I truly wish I had read Henci Goer's book before having DD.

I ended up with a C-section. My DD did not descend into the birth canal after an induced labor. Short story is my water broke 3 weeks early, had no contractions on my own, no progress after several hours on pitocin, so OB recommended CS. (FYI, DD was 7 lbs, 5 oz) After doing extensive research afterwards, I know that several decisions my OB made did nothing to improve my chances of not having a C-section. Maybe I would have ended up with a CS anyway, but frankly, she didn't help me at all.

And I am not unhappy with my birth experience. I had a fine recovery with no complications. But it wasn't the birth that *I* wanted. And I realize now that the way OB works in this country is not always with the best interests of the mother and child in mind.

Just speaking to my experience,

[gisele]

For what it's worth, I have that book "Thinking Woman's Guide..."

In my case, my water broke, but after 8 hours I wasn't having any real contractions. So I went to the hospital and was induced. Even the book recommends induction if labor hasn't started after the water breaks. After another 6 hours, I had an epidural because I was in so much pain. After another 16 hours, I finally got to push - and spent 3 hours doing it with no progress. I was so incredibly exhausted. Then I had the C-section, and was so glad it was over. I did everything I could to have a vaginal birth, but it didn't happen that way. Other women I know who have had C-sections also just "didn't do it". They all had very good reasons.

We all know that the US has a higher C-section rate. But a lot of this comes from elective repeat C-sections. I did everything I could to have a vaginal delivery and it wound up being a C-section. Before birth everyone drilled into me about childbirth and natural methods, etc, avoid the C-section like it was an awful thing, etc. Now after the birth, I get people telling me "if you had done this or that you might have avoided it", like having my C-section was an evil thing or really wasn't necessary. And how terrible am I to have added to that US statistic. I know other C-section moms who have also encountered this. I don't think those who parrot the anti C-section party line realize how this make other moms feel.

A friend of mine delivered a 9lb 12oz baby via C-section. She tried hard to deliver vaginally and it just wasn't going to happen.

My grandmother couldn't deliver her first child - a girl - because the baby was too big. This was in the 1920's in a rural area in Asia, so C-sections were not available. She was in labor for a long long time, and finally they had to make a decision - to save the mother or the baby. They had to cut up the baby to get it out of the mother. Thankfully my father was smaller so he made it though later.

Although the stats say the rates are higher in the US, mothers shouldn't be made to feel guilty for having one. After all, if the outcome is a healthy mom and baby, then the birth should be deemed as successful.

[stella]

your poor grandmother! Can you imagine how horrible for her? And that's why we are SO lucky to have surgical births available! I have had 2 c-sections and I am NOT trying to open another debate, but each time I was delighted with the outcome and I would do it again.

I think people (like your well-meaning friends and acquaintances) should only offer advice on how to avoid a c-section when it has been asked for. Oh, your poor grandmother...

[cdlamis]

My original intent of this thread was just a joke that I said "Gwyneth did it" but it has turned into a good conversation.

I have to agree that many women are not aware of their choices and trust their doctors whole heartedly. MANY OBs turn to c-sections for convenience or fear of the worst scenario and patients trust them. My Ob/GYN suggested a C/S 3 weeks early when she estimted that Julia was going to be big. If I weren't educated about the risks and alternatives, I might have agreed.
*ETA- I did not trust my OB/GYN because she was always suggesting inductions and C/S for non- medical reasons or on her own "hunches". I want to be clear that I am not blaming or criticizing anyone for trusting their doctors. I would trust the recommendations made by my present OB/GYN- I would still do my research but I would trust her opinion as well.

Yes, many C/S end up being necessary (like mine did eventually) but they are used way too much here in the U.S.

I appreciate all the words of wisdom and stories of mothers who have done it (birthed big babies). In the end, if I have a vaginal birth, I will be overjoyed and proud that I did my research. If I try and end up with another C/S, then I will know that I did all I could and I did my best. I think that is all we can hope for with all mothers here.

Daniella
Mom to Julia 6-13-02
And baby #2 EDD 12-30-04!!

[Sarah1]

Yeah, from what I've read, scheduled c-sections are almost the norm in Hollywood these days. They schedule everything else; why not the arrival of their baby?

Sheesh.

[Rachels]

That sounds awful! Listen, though, it's getting frustrating to be talking only about research and to have people responding defensively about their particular reasons for a section. Please reread my comments carefully, and note where I said repeatedly that I don't fault any woman for her birth, nor do I think that all women can or should have the same kinds of births.

As for Henci Goer, I'll have to recheck my copy of Thinking WOman's Guide, but I can tell you that the research does NOT show that a woman should be immediately induced if contractions don't start when her water breaks. After 18-24 hours, the risk of infection starts to increase, but before that, assuming nobody is doing vaginal exams, it's very minimal. And amniotic fluid keeps being produced; it totally repenishes itself every two hours. Again, not criticizing you or your birth in any way-- just clarifying a research point that was misstated.

-Rachel
Mom to Abigail Rose
5/18/02

[amp]

Daniella - As the other posters have said, educate yourself about your options and do what you feel is right for you!

That said, I find myself to be fairly educated about birth, but I didn't know much about CS's. I knew I was very afraid of having one and didn't want to know much more. But when my OB recommended a CS for my 10 lb 9 oz baby boy AND she told me I could try to labor if I wanted to, I asked her why she was recommending the CS instead. She told me that she did not think that it would end in a vaginal birth experience and could possibly be more traumatic and damaging to me if I tried and then had to have a CS, but she was more than willing to respect my options. I took her advice and while it may be true that she was looking out for herself, *I* was 100% convinced that she was also looking out for the best interest of me and my baby! And it turned out just fine and I feel pretty good about the experience now. I still don't like to hear that I was not educated enough (even if true) to have a vaginal birth, nor do I like to feel as if my experience is subpar to a vag. birth. I know that wasn't anyone's intent here, but it *is* hard not to take personally. I don't want to debate whether that was the intent or whether I didn't learn nearly enough before the doc cut me open. I simply wanted to say that the choice every woman makes for herself, with her DH and her OB is very personal decision and should be respected as such.

Just my humble 2 cents.

[Rachels]

>"If you're happy with your birth, I think that's great"
>I think this statement right here is demeaning. What exactly
>do you mean by this?

I meant that I think it's great if you're happy with your birth experience.


>Your interpretation of your research is JUST THAT, your
>interpretation, it does not make it an irrefutable fact.

Well, again, don't take my word for it. The research speaks for itself if you care to read it.


>
>what is "evidence-based maternity care" exactly?

It means practicing maternity care in accordance with the evidence for what is best and safest for mother and baby. The US does not do this. Every single country that does has lower mortality rates than we do-- there are literally more than two dozen.



-Rachel
Mom to Abigail Rose
5/18/02

[memedee]

I get people telling me "if you had done this or that you might have avoided it", like having my C-section was an evil thing or really wasn't necessary. And how terrible am I to have added to that US statistic. I know other C-section moms who have also encountered this. I don't think those who parrot the anti C-section party line realize how this make other moms feel.

I totally agree!!
Well said.

[Rachels]

I still don't like to hear that I was not educated enough (even if true) to have a
>vaginal birth, nor do I like to feel as if my experience is
>subpar to a vag. birth. I know that wasn't anyone's intent
>here, but it *is* hard not to take personally.

Good heavens. I don't think anyone has ever said that. I certainly haven't, nor do I think it. As for taking it personally, I can't help you. Talking about research and healthcare is not a personal attack in any way. The fact that most women can have vaginal births doesn't mean that all women can or should. I'm sounding like a broken record-- I've said this over and over, but it seems to be getting skipped by folks who are trying to justify their cesareans to me. I don't need anyone to do that. It's totally unnecessary. If you read what I wrote, you won't see any put-down of any woman for the birth that she had. I would never, ever do such a thing. It's counter to everything I actually AM saying.


-Rachel
Mom to Abigail Rose
5/18/02

[stella]

One thing I think is interesting is how you said "she may have been looking out for herself" and then "looking out for the best interest of me and my baby" because if she's smart (and I'm sure she is) liability-wise, she is trying to ensure a good result - FOR EVERYONE'S SAKE. The interests align in terms of her not being sued. She is less likely to be sued if you deliver a healthy baby and if you are not injured in the process.

And that's what you want as well. And that's what's best for baby. (and what a BIG baby, by the way!!!)

[Rachels]

ARRRRRRRRRGH!!!!!!!!!!!! I am not, nor is anyone else I've seen post here, anti c-section. The medical FACT is that at least half of the sections done in this country are medically unnecessary. THAT is what I have a problem with, because it risks the safety of mothers and babies, and I as I've said, I don't blame any woman for it. Labor is not a good time to try to rectify a systemically flawed model of care, KWIM?

You're arguing your right to your section, or the necessity of your section, and I'm saying, RIGHT! I agree! AND I think that women should be told the truth about the vast differences between what science says and what the US model of maternity care actually does. That's all.

If anyone on this board disagrees that women should have access to evidence about safe maternity care, regardless of the kind of birth she had, well, okay. We disagree.

Good grief.

-Rachel
Mom to Abigail Rose
5/18/02

[Rachels]

Yes, but (sigh) the point I'm making here-- and this is NOT about any one birth-- is that the risk of everything NOT turning out well for the baby is higher in a surgical birth. It just is. Surgical birth does not insure the good results we're hoping for all the time. The rate at which it causes major complications is much higher than the rate at which complications follow vaginal birth. There are absolutely good, solid, evidence-based reasons for cesarean birth, and I'm profoundly grateful that the technology exists. But the rate at which it is used here cannot be reconciled with doing what's best for every mom and baby. It just can't.

-Rachel
Mom to Abigail Rose
5/18/02

[Rachels]

I think this post illustrates perfectly what I believe. In the end, I knew that if I had a cesarean, it would be because it was absolutely medically necessary for our safety. And I wouldn't have regretted it at all if it had happened. Daniella, you seem to be going about this wonderfully! :)

-Rachel
Mom to Abigail Rose
5/18/02

[memedee]

"If you can grow a big baby, chances are excellent that you can deliver a big baby"
I am a big fan of all kinds of research:scientific,anecdotal,historical and I think everyone should participate and be their own advocate to ensure the best medical care.

When a statement is made and being represented as the "TRUTH", it sure do sound like a judgement to me if perhaps ones experience does not represent the "TRUTH"

[Rachels]

I do and I don't agree that evidence is open to interpretation. To a degree, it is, of course. But facts cannot be skewed to back up any statement. And when every single study over a half century points to the same conclusion, as happens all the time in the birthing literature, you have to begin to take it seriously. The W.H.O. has, and every country with better outcomes than ours has. The US hasn't, and that's my complaint.

As for preconceived notions, I already spoke to that. When I started my research, none of this had crossed my mind. I thought midwifery was crazy, and I was planning a hospital birth with an epidural and thought that c-sections were pretty often necessary. I sounded like you, as I've said. But then I studied. And doing that forced me to reevaluate, to change both my views and my own approach to healthcare. If you think it was easy, you're mistaken. I had to confront and challenge everything I'd ever thought about birth, a subject on which I considered myself pretty well-informed. My family had to come along with me, which meant challenging all of their preconceptions, too. It was tough. I understand how tough it is to be confronted with solid evidence that what you think isn't actually backed up by any basis in fact. I've been there. But my choice in that experience was to then modify my thinking. It was hard, but I couldn't in good conscience continue to hold to my original convictions, because they had simply and completely been disproven.

If I had said, instead of actually being willing to take a look at my own culture-bound expectations, that all research was faulty and suspect and basically crap, as is happening here, I would have felt ridiculous. Dismissing science so that I never have to alter my beliefs about anything is one way to go, but it's not a way I actually think is very reasonable.

-Rachel
Mom to Abigail Rose
5/18/02

[Rachels]

Chances are excellent. Chances are excellent. That's what I said. I didn't say chances were absolute. They're excellent. The W.H.O. recommendations for care in normal birth allow for a 10% cesarean rate for safe care. That's a 90% vaginal birth rate. That's what's medically indicated worldwide, and I think 90% is an excellent chance. It's not a judgement about the 10%. You're trying to make it so, and it just isn't.

This is getting ridiculous.

-Rachel
Mom to Abigail Rose
5/18/02

[papal]

Yep, do you remember the big hoo-ha about her getting the really nice Silver Cross stroller on Ellen Degeneres' show?

[JenCA]

I had a good-sized baby (well, good-sized for me, since I'm 5'2" and 105 lb). She was 7lbs., 14oz and 20.25". I pushed for 3.5 grueling *hours* and ended up being vacuum assisted (unfortunately).

[ddmarsh]

Honestly the point is being missed entirely IN MY OPINION. I've had 4 sections, my first was failure to progress after induction and lying in a prone position in bed. With babies 2 and 3 I went for a VBAC and one had a decelerated heart rate and an emergency section, the other was stuck (for 2 hours of pushing after 4 hours of labor and NO meds, not by choice, LOL). The research indicates after 4 sections the rate of rupture goes up quite markedly and so I opted for a scheduled section. I never did manage to have a vaginal birth and certainly don't feel badly or guilty about it, but I knew that I had explored all of my options after my first section and was pleased with that.

The point is not that YOU are uneducated about it, it's really that much of the medical profession does not do an adequate job of educating us, giving us access to the whole spectrum of information in order to make a fully informed decision. No one is at all saying that anyone is bad or uneducated, etc. and nothing is wrong about having a section - SEE ABOVE. I think everyone is just saying that we do ourselves as women a huge favor by broadening our perspective a bit and this, I think, applies not just to this topic but many other topics that affect our lives.

[Jeanne]

A good outcome for everyone's sake is what seems to fuel the c-section rate. I've had both with my girls - a terribly brutal vaginal birth with my first, and then an emergency c-section for a breech presentation with the second. I sobbed for hours leading up to the section because it wasn't what "I" wanted. I was so heartbroken and disapointed to be in that position.

I personally know 3 people who have delivered 10lb+ babies vaginally, that shouldn't have. They are living with the outcome of it today because of severe birth injuries. My bottom line is the safety of my kids. I would never have an elective section and would try my hardest to avoid it, but if I am under the care of an insured medical facility and they are calling for a section, then what else is there to do? I am not in love with elective c-sections nor do I sanction planned sections for the sake of convenience, but when we live in a "sue-happy" country, and many woman do not have access to midwives, what then? Doctors, hospitals, and nurses are punished for the smallest infraction that years ago, would have been laughable.

It would be wonderful if the US would embrace evidence based care, but until rationality returns, the change will likely be slow.

[lisams]

I have a perfect example! I was induced due to sudden high, high blood pressure. It was not my regular dr. that attended the delivery, he was not on call that night. The dr. that was attending was wonderful, totally listened to my desire to avoid a c/s (she even said to me "Honey, you are the only one who has mentioned c/s, you can do this, no one here thinks you need a c/s"). I had to push for 2 hours but finally DD arrived via vaginal birth.... so I go to my 6 week post partum appt. with my regular dr, and he is shocked I pushed "so long" and said that he would have had me in the OR getting a c/s after an hour of pushing. I probably would have gone along with his orders just because at the time you put so much trust in your drs. word. To think that I could have had a surgery to deliver DD is worrysome when she arrived just fine the way she did.

I am not anti c/s just as I am not anti heart surgery. See, both are things I would like to avoid(which may on the surface sound like I am anti c/s and heart surgery) but if it was medically needed to save my life or my child's, well then OF COURSE I would thank God for the procedure.

Lisa

[cdlamis]

Great example Lisa!

Daniella
Mom to Julia 6-13-02
And baby #2 EDD 12-30-04!!

[mamahill]

I took Rachel's comment to mean that if I was happy with the birth experience, then she's happy for me. Personally, I was not happy with my birth experience until I got the epidural. I was "holding out" because I thought I should. In reality, the tension from being in labor for 3 days and the back labor was making my cervix close while my uterus was contracting harder. I had just about every intervention, short of a c-section (which was discussed), that was possible. Was I happy? Overall, sure - I got a healthy baby, and I didn't have complications. But I was unhappy enough (scarred, emotionally) that I couldn't even discuss the labor/delivery without crying for the first couple months. Ainsleigh was over a year old before I could stomach the idea of another child. And why? The labor and delivery.

Therefore, based on that experience and knowing what I know now, I'm going to use a different OB and I'm going to read a heck of a lot more on the birthing process (something I thought I didn't need since I was taking a childbirth education class). I'm still going with a hospital birth, and if I have back labor again you can bet that I'll be calling for the epidural, and I don't feel defensive about it, nor that it makes me less of a mother. And from emails I've exchanged with Rachel, I know that she is happy for me.

I think Rachel gets a lot of flack (I know I've given her some) for being so passionate about certain parenting issues. But I think if we step back and look at the information in the spirit of how she's trying to provide it (as information, not law), we'll appreciate and learn from it even more. I know I have.

Ok, enough kissing up ;) :P !

[lizamann]

I have a friend named Paul, but everyone in his family calls him Apple. And his sisters' REAL names are Berry, Cherry, and Peaches. I'm not kidding! And they don't live in Hollywood.

[Rachels]

http://instagiber.net/smiliesdotcom/otn/love/kiss.gif

Right back atcha, babe. :) I am happy for you.


-Rachel
Mom to Abigail Rose
5/18/02

[jojo2324]

I just saw a snippet on Extra, and it featured a picture of Gwyneth and her DH walking with the baby through London. So I would think it was vaginal if she was able to go for a walk 3-4 days after delivery.

(But I'm not sure - I have not had a c-section, so maybe it is possible. Just have heard it's very painful those first few days after.)

[gisele]

Rachel, I stated above that after at least 8 hours my labor was not happening. I was not induced immediately. I also was positive for strep B. In the book, when the labor does not happen for a while after the water breaks and the mother is positive for strep B, it does say to induce. I can find that page for you. I checked and checked the book to understand my situation. I did not misstate any research point.

The statements you made about induction kinda illustrate my point. You're basically saying that induction isn't really necessary and the risk of infection is only minimal when the water breaks. So the way you stated things above implies that I should not have been induced. I don't think you mean that, but that is how it comes across. I know you're just trying provide information. I think it would be better if you didn't come across so strong, or say "In general, etc". You don't know my (or anyone else's) full medical/childbirth situation, so telling us how it's supposed to be done according to research doesn't always go over well. Medicine isn't an exact science.


>
>As for Henci Goer, I'll have to recheck my copy of Thinking
>WOman's Guide, but I can tell you that the research does NOT
>show that a woman should be immediately induced if
>contractions don't start when her water breaks. After 18-24
>hours, the risk of infection starts to increase, but before
>that, assuming nobody is doing vaginal exams, it's very
>minimal. And amniotic fluid keeps being produced; it totally
>repenishes itself every two hours. Again, not criticizing you
>or your birth in any way-- just clarifying a research point
>that was misstated.
>
>-Rachel
>Mom to Abigail Rose
>5/18/02

[Rachels]

I never said it was and I never claimed to know your history or anyone else's, and I never said I was commenting on a particular birth. In fact, I have repeatedly said the opposite. As such, everythign I'm saying is general and not applicable to any poster, which I've stated repeatedly.

You're correct about Strep B-- I missed that part in your original post. It changes the rules. But even if I hadn't missed that, my points would remain the same. Technology is grossly overused in this country to the detriment of women and their babies, and that is well-proven.

I don't know how many different ways I can say that, for the record, I am talking generally and not specifically. If you choose to assume that I'm telling you you had a bad birth, I have to ask you to take responsibility for that. It's not at all what I'm doing and not what I think, and I have said that over and over and over and over and over...

-Rachel
Mom to Abigail Rose
5/18/02

[stella]

I was out of the house and walking about 1/2 mile within three or four days of my surgery. So I don't think we can go by that alone...

Now if she were running, I'd have to vote vaginal!

[gisele]

Rachel, I was trying to explain to you why people get upset with some of the research you post. I NEVER say that you told me I had a bad birth. I NEVER said you claimed to know about anyone's medical I know you are talking in general and I SPECIFICALLY said *I* know you are talking in general. I was just trying to say how you could explain in a way that people wouldn't get upset.

I was just trying to HELP you explain WHY people can get upset.

I'm done here.

[Rachels]

Again, though, it's a shoot the messenger situation. I don't post stuff that hasn't been replicated and well-verified. If hearing research is upsetting, okay, don't read it. But don't blame me for what it says. I share it because of my conviction that women should have access to information that affects them and their bodies. If someone doesn't actually want that information, they're more than free to ignore it. My values lie in the opposite direction. It changed me greatly to read it, and I think it's exciting and powerful stuff. Empowerment is a good thing not because it forces us all to do the same thing, but because it gives us ideas and avenues to choice.

-Rachel
Mom to Abigail Rose
5/18/02

[gisele]

fwiw, I never disagreed with your research - I am familiar with it and it's well known. All I am saying is you sometimes need to consider your delivery and timing (and I already explained why). I know sometimes that is hard to see when you are passionate about something and want to educate.

[Rachels]

Agreed. But my timing here was in response to someone who said she wanted the chance to birth even a large baby vaginally. I said chances were excellent that she could, and then people who HADN'T jumped all over that statement. So I don't think this is a timing issue.

-Rachel
Mom to Abigail Rose
5/18/02

[deborah_r]

Just my personal experience, but Henci Goer's book just scared the hell out of me when I was pregnant! I'm sure it is helpful to many, but I couldn't handle it. Childbirth was such a huge unknown looming in my head and reading about it extensively really wasn't helping me, because I still didn't know what it was going to feel like, so I was still terrified. I now feel like I didn't stand up to my doctor enough or ask the right questions. I still don't understand why I ended up having a c-section and have many doubts about the decisions we (DH and I) made when the time came (as far as agreeing to be induced). We were so worried about the health of the baby and with the doctor telling me something I had never even heard of before as a reason for inducing (excess amniotic fluid), we didn't know quite what to do. I had heard of too little amniotic fluid being a problem, but not too much.

So I still don't know if we made the right choices. Don't know why there was excess fluid. Don't know why I never dilated more than 3 cm after gobs of pitocin. Don't know why the baby's heartrate kept going dangerously low with contractions.

Don't know what my point is here - I guess it's that I tried to be educated about childbirth, but my emotion got the best of me and some stuff, I just didn't want to know about. I did take childbirth education which was very informative, and the instructor did warn us about different things doctors might try to tell you you needed to do, when really you didn't.

[candybomiller]

Deborah,

You got a healthy baby and healthy mother. You didn't make the WRONG choices. I think the situation is a positive.

Are YOU happy with your experience?

[jubilee]

There has been a lot of interesting conversation because of this post, but as for the original post- YES, definately try again for a vaginal birth for #2.

My first son was 9# 13oz -vaginal
My second son was 9# 9oz -vaginal

Congrats on your pregnancy!

[stillplayswithbarbies]

Deborah, I read Henci Goer's book after I had already given birth once, but I can see where it might have been overwhelming to read before I had my first.

Another book that I like that is not so overwhelming is "Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation" by Pam England, Rob Horowitz

There are also childbirth classes based on this book, but I didn't know about them until later. (I took Bradley class which I loved)

That book might be an option for you for next time. Or you might want to go back and read the Henci Goer book now that you have given birth. It might answer some of the questions you have about your labor and delivery. It really helped me understand my first labor/delivery better and make a better plan for the next one.

...Karen
Jacob Nathaniel Feb 91
Logan Elizabeth Mar 03

[egoldber]

Karen, that was my experience as well. I read the Goer book trying to better understand what had happened to me during my first birth experience. It really opened my eyes to what my OB could have done differently. I know I had seen the book on the shelf before having DD, and I just passed over it. The Goer book will definitely be in my delivery bag the next time I give birth!!

[emilyf]

I'll admit I only skimmed most of the responses to this post, but I had a very easy delivery with a 9lbs 2 oz baby, I'm so glad I had no idea he would be so big, I think I would have been nervous! I've got a smallish frame too. But I only pushed 30 min or so and did end up with a decent tear but it healed fairly quickly.

On the subject of Apple though, there were several Asian families in my high school (I believe they were Thai, but not positive) whose daughters had Thai names but used fruit names at school. There were two Apples in the class ahead of me. I actually knew a non-Asian Apple at camp also, I'm sure it was a nickname though.
Emily \r\nmom of Charlie born 11/02

[deborah_r]

Candy,

Yes, that is what I comfort myself with, but no I am not really happy with my experience. I feel like my baby was just extracted from me, rather than that I gave birth to him. I mean, I don't sit here going "Oh, woe is me" every day, but I do wish things had been different and I worry that maybe my doctor was playing it a little too safe and also I know she had a vacation coming up later that week. She gave other reasons for recommending induction, of course she didn't say because she was going on vacation, but she didn't say I had to be induced, just that she recommended it.

I think no matter how much I researched, a part of me would not have been willing to override the opinions of my OBGYN who had umpteen years of schooling and training and experience. I'm not saying I couldn't question her judgement, but I would have had a hard time justifying to myself that my opinion on what to do was more "educated" than hers. But I believe I remember from Goer's book that there are doctors out there who will do unnecessary c-sections because it makes more money for the hospital, but you just never know. Everyone I have talked to around here who knows of my doctor has a very high opinion of her, so it is very, very possible that what happened during Kai's birth was exactly as it needed to be.

My main nagging thought is that my mother had 6 kids with no c/s, my sister had 3 kids with no c/s, my MIL had 4 kids with no c/s....so why me? :)

[sntm]

Evidenced based medicine is an interesting topic -- I can't think of the source (I'll try to remember or do a search, though I have no idea what keywords to use!) but it has been shown that under normal circumstances it takes 18 years (18 YEARS) for a scientifically demonstrated medical advance to become standard of care.

I know I am trying to speed up that process in my specialty, but I think that it shows that it is never a bad idea to become educated on your own regarding medical decisions. It's true that most resources available for non-medical people are not exactly the most pristine, but it at least gives you background with which to ask questions. I know I am delighted to address patients' questions, even if they sound ridiculous to me. It teaches me something. Not everyone is like that, though. Part of it is time constraints (you'd be amazed by how little docs actually make after incomplete reimbursements, overhead, insurance, etc. which is part of what leads to short visits) which makes addressing concerns more difficult. You just want to get the "necessary" info and get out of there. But, if a doc is really resistant to your questions or concerns, I would at least consider getting another opinion.

FWIW, one of my colleague's sisters just had a baby and we have been woefully discussing all of the things done that were not evidence-based. She had an uneventful delivery, but she certainly could have had complications or long-term outcomes that would be detrimental. I'd be just as PO'ed about that as I would about an unnecessary mastectomy, etc.

Peace.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
shannon
not-even-pregnant-yet-overachiever
trying-to-conceive :)
PREGNANT! EDD 6/9/03
mama to Jack 6/6/03