Sunday, October 19, 2008

Giving Birth

Fair warning, what follows is a rambling essay that spans across at least four different topics and has not yet been fully proof read or edited. Read at your own risk.


So I have taken a break from political blogging. I started this blog to write essays (not blogs), but I felt so strongly about the presidential election this year, I wanted to do my little part to help Barack Obama win :-), so I transformed this space into a much more traditional, rapid-fire post format in order to sway maybe one or two votes Obama's way. Not sure I succeeded, but I felt better in the process.

Granted, the election is far from over, but a combination of the complete tanking of the American banking system (blamed mainly on the Republican party), McCain's (to me surprising) completely dysfunctional presidential campaign, and Obama's practically flawless campaign have combined to turn this presidential campaign into a blow-out, with or without me involved. And I'm giddy.

We are about to watch a transformation of both political parties. Obama appears to be ready to take the baton from the Clinton's and to continue the transformation of the Democratic party into something relevant for this century, not a socialist party. But one where the government plays an active and important role in attempting to assuage some of the excesses of the free market.

The Republican party is completely dysfunctional right now (like McCain's campaign), and losing the white house in combination with losing even more seats in Congress should seal the deal on Gingrich/Bush/Cheney brand of Republicanism. A new/non-boomer generation will have a chance to re-brand. It may take a while, but it will be interesting to watch.

So, with that being said, I have to explain why I haven't blogged for about two weeks.

That is because my wife had our third baby just a week ago, a baby girl. The baby has been in the NYICU for the past week or so because of some issues that came up shortly after birth. What issues were they? Nobody knows for sure. For ten long days, the hospital staff treated it like it was an infection, keeping her in the NYICU to finish an anti-biotic, although no bacteria was found in any of their tests. But now she's home, and we're happy and glad that whole hospital ordeal is behind us.

But giving birth is an interesting experience for me personally. Everything is political I've heard it said, and of course health care is no different. So, here is my story on the political ramifications of our baby girl's birth.

But before I go into that, I must give you a little Turley family birthing background. While my wife was pregnant with our first baby, we casually came across an article in a random parenting magazine describing the Bradley Method of childbirth. Well, for a variety of reasons both my wife and I were interested, and we decided to look further into it.

Interesting enough, we found (unknown to us) someone we knew was on an internet list of Bradley instructors in the Tempe area, and that someone went to our church. After contacting her, we discovered she was not currently teaching, but she knew someone who was, and that someone also went to our same church. From her, we started Bradley.

Well, I won't go into the details of Bradley, but let me put it this way, Bradley is to hospital childbirth what homeschooling is to public schooling. To me, having a Bradley style home birth, followed by a Dr. Spears inspired attachment parenting in the early years, finalized by homeschooling them all the way through childhood just seems like the most natural and logical way to both bring a child into this world and prepare them to face the world. And I'm always slightly surprised when the most committed home birthers/breast feeders, stop when their child turns five... :-) But I know that's a rather simplistic (and wrong) view of the world. But if you are interested, read here for the full story about we we home school.

You'll find that homeschooling is really sort of a rebellion and for me the Bradley method is a rebellion of sorts as well. Like homeschooling, it takes a major commitment from both the mother and the coach (usually the husband) to learn about birthing, to practice and prepare together for labor and to do everything from a proper diet to exercise to ensure that the actual birth will go as smooth and complication free as possible.

The main disadvantage to Bradley, though, is that it can make some people (people like me), a little too extreme about birthing. I went into the births of our first two babies very suspicious of our medical system. For good reason I might add. We have far too many Cesarean sections, major surgery, for no medically sound reasons. So, the good thing about Bradley, is that it keys you in on the many unnecessary aspects of hospital births.

You see, hospital births is this mixture "lowest common denominator" and "expect and prepare for the worse" approach to birthing. Neither of these views of birthing, in my view, are entirely appropriate, but I understand where they come from.

But what's interesting is that most people go into the birthing without really knowing what to expect, and just allow the hospital staff to do whatever they want. But there are risks to almost everything. Some examples:

1) Vitamin K shot. This article describes the pros and cons of the shot and suggests alternative. The con? Potential link between the shot and childhood leukemia.

2) Prophylactic eye ointment. This article describes the reasons for this ointment. This one is obvious and should only be done with babies born to a mother with gonorrhea or chlamydia. Because its impossible to get all mothers who have it to admit to it, the doctors give it to all babies...

3) Hepatitus B vaccinations in the hospital. Again, another unnecessary shot given to all babies just in case. An article here.

Ok, with that as an introduction, let me describe what happened with the birth of our third child. Despite our Bradley instruction, we have chosen not to home birth. For all three births, we have decided to hedge our bets by choosing a midwife to deliver our children as naturally as possible but to do so at the hospital.

In some ways, this choice was forced on us because for both of our previous births, my wife was diagnosed with Intrahepatic Cholestasis of Pregnancy where the mother is at risk of having a still born baby. The only known treatment is inducement before 37 weeks. For that reason, our first was born at 37 weeks, our second at 36 weeks.

This time, my wife only experienced the symptoms (itchiness) really late in the pregnancy, and her blood tests were consistently normal, so no inducement was scheduled. Nonetheless, we worried because she did start to feel the itchiness late, but even late blood tests came back normal. My wife did go in the day of her due date with the thought of doing an inducement. Our midwife basically said that if we wanted to induce, just show up at the hospital and let it be known, and by golly an induction will be done. But her body did not cooperate (everything closed up, the baby was pretty high up in the womb), so we decided to wait a bit longer with baited breath.

Well, four days after the due date, early Saturday morning, contractions came. We have never spontaneously waited for labor before so we had trouble recognizing. My wife diagnosed gas, so I left for the drug store at 4am to buy gas medicine. She took the medicine, the pains persisted. So, we assumed it was really labor, and at 5am, we were driving to the hospital, half suspecting we may have to return home. (We suspected gas because the pains would come anytime my wife would get up or move in any way, they were not regular at all - weird).

Well, it wasn't gas, it was labor and literally 4 hours later, we had our third baby, looking happy and healthy and big, nursing like a champ. And it was a text book Bradley labor. Me as her coach, wife resting in a Bradley style sideline position during most of the serious labor, then getting on a birthing ball when the contractions got harder. Then a bit of pushing, a little tangling with the cord, getting hung up around the baby's head, and out came the baby. No drugs, no vacuum extractors, no nothing.

But having a birth in the hospital gets tricky because the midwife goes away, and a whole system of nurses and doctors and procedures and hospital staff take over.

Meanwhile, we brace ourselves for a whole spate of rejections. No we don't want the eye ointment, no we don't want the PKU (we get that later), no we don't want the Hepatitus shot, for gosh sakes no bottles please. No we don't want to Vitamin K shot (why, I'm not sure I just know I need to reject everything)... Well, we had the Vitamin K shot because we were unprepared and couldn't remember if this was a necessary shot or not. And we were convinced it was necessary.

So anyway, two hours later, right after we were transferred to our new room for recovery, while my wife attempted to nurse, the baby coughed and sputtered and turned blue. The nurse came in, laid the baby down on the bed, stimulated the baby's body. The baby cried and breathed, and returned to a normal color. The nurse left briefly, my wife picked the baby up, but again she coughed. We pressed the emergency button, the nurse rushed in, picked up the baby, and rushed out. I followed.

The baby was rushed into the nursery where another nurse tried to administer oxygen to the baby (or something some such, they wouldn't let me in). I was left waiting and worrying in the hallway. This was particularly excruciating because they kept telling me the baby was fine, but everyone just seemed to be progressing to a more and more panicked state...

After about 15 or 20 minutes, the nurses had an oxygen mask on the baby and were rushing her upstairs to the NYICU for more treatment. They allowed me to follow and tried in the rush to explain to me what was happening, that the baby was not getting oxygen throughout the body. The baby was discolored, especially on the extremities, and was not crying. All bad signs. They suspected either an infection or a heart problem, maybe a narrowed artery.

Well, a heart doctor was called in, they immediately hooked the baby up to what seemed like countless tubes. She was administered an IV, given an antibiotic, given dopamine (her blood pressure was low) and who knows what else. They wanted to stabilize the baby and were also preparing to give the baby and Echocardiogram (EKG) to analyze the heart.

Everyone seemed convinced it was a heart condition. And I was bracing for a surgery. Well, our baby's system soon subsided enough that a heart condition was ruled out (really good thing), and the default assumption was an infection, and that Saturday began ten days of an anti-biotic treatment.

During that process, we were drilled with questions like, did you have an ultrasound that would have detected a heart issue? Were the bag of waters broken prematurely? Anything happen that could explain an infection?

Most annoyingly, those first few days, we heard, with no exxageration at least 10 times, good thing you didn't home birth...

Well, what exactly did happen to cause this.

Here are the possibilities based on conversations my wife and I had with each other, our midwife, the nurses and doctors, and the pediatrician we have seen a day after our baby was released:

1) An infection? Possible. No bacteria was detected in any of the cultures they grew from the samples they took from the baby. Does this fact rule out an infection? I have no idea. I guess its possible for someone to have an infection without doctors being able to find bacteria? I guess.

The baby's platelet counts were dangerously low (11 when they should be well above 100). For this, she received a blood transfusion, and her levels have been hovering in the 90's since, and the day of her release she broke 100. But apparently, a low platelet count points to an infection.

Another reason to suspect an infection was that the baby was immediately placed on antibiotics and has basically fully recovered. Either this was a coincidence, or the antibiotics killed off whatever bacteria she had.

Well, I can live with this explanation, but I'm not sure I'm ready to declare that to be the cause of the problem. For one, how is an infection possible? I guess bacteria live all around us and are pretty small creatures. I suppose it doesn't take much for one of those little things to get to the baby...

On my wife's due date, she did explore the possibility of being induced. In that spirit, her membranes were stripped, and I believe there is a small chance of an infection in doing that.

2) Some weird affect of my wife's ICP was a possible explanation my wife and I brought up. Our midwife also brought this possibility up. The tail end of the pregnancy had his weird ICP tension hanging over it. The itchiness was there but not the blood results. Were we risking the baby's life by not inducing? Every day we waited was another day we worried whether we were making the right choice.

So, when the baby is born with complications, you have to suspect ICP, right? The NYICU doctors completely dismissed this idea out of hand, though. But you know what, there our countless stories of doctors not taking ICP seriously, and to our knowledge, nobody knows why ICP babies can be born stillborn. So, by my book this is still a possibility...

3) Ok, now we get to the possibility that makes the most sense to me right now. Nobody at the hospital thought of this, remarkably, maybe because the idea is complete bunk, I have no idea. But it makes a ton of sense to my untrained mind, so this is the possibility that I'm running with. When my wife visited the pediatrician and explained to him the events of the birth, the first thing he said was:

Pediatrician: "Good think you were at the hospital when this happened."

Wife (in her head): "Oh great, another home birth hater. Oh wait, maybe he means, good thing I wasn't released from the hospital then it happened".

Wife (outload): "What do you think happened?"

Pediatrician: "Sounds like because the cord was wrapped around the baby's neck on delivery, perhaps some of the blood meant for the baby went back into your body. In other words, perhaps the baby just did not have enough blood. This would explain the low platelet count, and the blueness, especially on the extremities".

Wife: "You know, that makes a lot of sense."

You know, that makes a lot of sense to me too. Why? Because there was some confusion about that cord before I cut it. Our midwife looked at it, and there was no blood in it, so she assumed it had stopped pulsating into the baby. Maybe it never got a chance.

4) Or maybe it could have been something else altogether.

The bottom line is nobody knows for sure.

What is for sure is we discovered how loving and caring of a community we live in. Every single doctor and nurse without exception was cooperative, concerned, and considerate. They allowed my wife, after a day or two, 24 hour a day access to the baby to breast feed. Most of the nurses were very supportive of it.

Also, we knew many of our friends and family members were praying for us and the baby. We felt it, I felt it. Just this feeling of support and love is unexplainable. We had so many offers for help that we had to turn people away. We had more people that wanted to help us than we actually needed, which is also an incredible feeling.

But back to Bradley and homebirthing and politics.

How would this have gone differently if we had home birthed. I have no idea. Perhaps, the rush to the NYICU was completely unnecessary. I'm assuming a competent midwife would have most if not all of the equipment to revive a baby, to provide oxygen. Maybe a mad rush to the emergency room would have been necessary. Perhaps the baby would have revived on her own without the intensive intervention she received at the hospital.

I have no idea.

But while I was being bombarded by all of these events, with all of these questions, the newspaper had an article about how in the United States ranks 29th in the world in infant mortality (deaths from live births within the first year of life.

Some people think this low ranking is a result of our highly interventionist approach to birthing. I'm not so sure. In my brief research, it seems the evidence is not conclusive regarding the relative safety between home births and hospital births.

And there seems to be other factors for our low rankings completely unrelated. We have a growing trend of premature births, why? Black communities have a much higher rate of infant mortality than other communities in the US? The US has a much larger disparity between the rich and the poor than in higher ranking countries like Japan.

Indeed, I read a quote that infant mortality rates is one of the best indicator of state failure, and access to health care is no where near universal.

The bottom line is that we have no idea. The best advise I can give is to take ownership of your health. To make informed decisions. To study the alternatives, and to try to make decisions that you feel most comfortable with.

Coincidentally, there is a proposition on the ballot, Proposition 101, that is related to these issues. Its a way to preempt this growing wave to provide universal access to health care, by preserving a person's right to choose the type of health care they receive.

I definitely have mixed issues with this (like I do with education). I love choice. I support a woman's right to home birth. I support our right to home school. By signing your child up to a school, by entering the hospital to give birth, you are submitted you are basically allowing another system, another bureaucracy to manage and to control how your children will be taught and raised, how your birthing experience will go.

You can impose your will to some degree, but in significant ways, your freedoms are compromised.

To turn over the funding of your health care system to a government agency, in some ways can exacerbates the problem. You can only see certain doctors "in network".

But health care is such a fundamental need, like food, like shelter. Everyone should, fundamentally and morally, have access to these things, I think trade-offs are in order.

I think the biggest problems with our health care system does not fundamentally manifest itself in the nuances of a home birth versus a hospital birth. Bottom line is that our baby is home, healthy and happy. We didn't go bankrupt over it.

The fundamental problem is that too many people do not have acess to the same prenatal care, infant care post birth.

Bottom line, because of economics, too many people have no choices at all. And no proposition on a ballot is going to change that.

3 comments:

Crystal said...

I love this post and hearing your views on the politics of birthing. I agree with all of the questions you ask and the answers you propose. Great post Scott. I really enjoyed it!

James & Onalisa said...

Thank you for letting me read your posts!
Onalisa

tempe turley said...

Onalisa,

This blog is public and open to everyone :-).