Saturday, August 15, 2009

The business of birth

I've been wondering a good deal more over the last couple months just how much a c-section is really and truly needed versus how much of it comes down to doctors worried either about liability or it being more difficult for them for me to have a natural birth. It's a lot harder to sue a doctor over a problem in a c-section (how often do you hear, "Well, maybe if it had been vaginal, it would have been okay!") than a problem that occurs without one. It's like medical intervention is a way to counter the claim that nothing was done. But it's not always that something should be done.

Now there are undoubtedly risks either way.

The major risk to a c-section is that my small intestine, the only set I still have, is adhered to my uterus, which will require separating them. Problem is that they're gray (usually they're pink), and so is the scar tissue, making it very difficult to tell which is what. So if my intestine gets nicked instead, that would be VERY bad to the point that it would probably kill me. At Stanford, the GI surgery team was going to not only be on-call, but IN the delivery room in the case that this happens. Minutes can be the difference between life and death or me.

The risks to a vaginal birth are that, in the extremely common lithotomy position (on the back), gravity narrows the pelvic cavity and puts all the pressure toward the back, and I have an internal j-pouch rather than a large intestine that is surgically stapled rather than naturaly attached. There's the risk that this could push the j-pouch away from where it's connected, or that I tear. A preineal tear would be very back news for my j-pouch as well. It's been repaired once, but it took four years of surgeries and hospitalizations to fix after the accident (I was a pedestrian in a cross-walk, and a driver ran a red and hit me, with the bunt impact rupturing my intestine).

Both carry risks to my intestine, only one of these options guarantees my intestine being touched. So I'm considering a natual childbirth, but rather than dry or on my back, in water. Water helps prevent tearing, and being more upright or forward would alleviate a lot of the pressure from my intestine and back.

I really want as few medical interventions as necessary, and I HATE drugs. I've only taken Tylenol twice in the last two years, once for one of my migraines, and once after the first egg retrieval. I really try to not take ANYTHING unless necessary, and when I would be in the hospital, I'd be in pain but not ask for pain meds, so when they realized it was making my vitals go up, I'd get put on a PC pump that automatically administered 10cc of Demerol an hour with a pump I could hit twice more, at least 15 minutes apart, per hour for an additional 15cc each hit. They generally don't like to automatically administer pain drugs, but I wouldn't ask otherwise...even though Demerol is awesome. But still.

I want as few drugs as necessary going into this baby. The drugs from a c-section do go into the baby. It doesn't seem so coincidental that there has been such a noticeable rate in certain childhood illnesses since pain drugs and c-sections suddenly exploded in popularity. I'm not blaming the mothers. Not exactly. The side effects of drugs don't always come out until many years later. There have been many drugs over the last century that would be routine to use for several years, until there was suddenly a connection between the drug and birth defects of mental impairments. Now I understand than not 100% of deformities and retardation come about from drugs, and that both have been around far longer than any drugs we use today, but the rates should't be rising right along with the rate of use of drugs. I wouldn't doubt if, in 10 years, a lot of our routine drugs are banned. It's nice to think that they're all tested and tested and are completely safe, but this isn't the case. It's really not. Look at how often new drugs are being recalled while the older drugs remain. The older drugs have been thoroughly tested with time. The new ones don't undergo 15 years of testing, what are the effects of use 15 years later. They're rigorously tested, yes, but what happens to the users 15, 20 years down the road? There was...oh god what was the name of that one drug...anyway a very common drug used in the 50's that was later found to be resulting in infertile babies. Earlier in the century another drug used during pregnancy was leading to babies being born without arms and legs, but deformed hands and feet.

A good effect of the insurance worries we had was forcing me to have to research these things far more in depth on my own to try to figure out different options and risks aside from what doctors had to say that would ultimately be in THEIR best interest.

2 comments:

  1. thalidomide was the drug...and it's still on the market...you just have to go through several steps to dispense it.

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  2. Wow, thalidomide IS being used again. Just over the past few years, and its use is highly controversial.

    From 1961-1998 it was banned, but was only approved for one use in 1998, and then for a second use in 2006, and yes, it's a lot of hoops to get it, at least in the US. But it does look like it's being used for more things anyway.

    But there's another one that just goes by a few letters that resulted in so many infertile women too. I actually forgot about thalidomide altogether. Same time period though. Both drugs thought completely safe at the time.

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