Sunday, November 22, 2009

How am I high-risk in a hospital, but low-risk otherwise?

I've had some friends and family express concern here and there about the risks of home birth over being in a hospital with a c-section. Allow me to clarify how I'm high-risk in a hospital, yet regular, low-risk for a vaginal birth.

A recent study just came out (within the last year) showing that j-pouches and such are not of obstetric concern as once thought, and do not impede safe vaginal delivery for both mother and baby, but that c-sections come with substantial increased risk, including torsions, nicking of the small intestine, and irreparable damage to the j-pouch necessitating a permanent ostomy.

Any surgery that will deal with the intestine is a highly-specialized surgery. With a c-section, this means an OB/GYM rather than a GI will be the one dealing with the intestine. You wouldn't want a heart surgeon doing a brain surgery any more than I'd want a baby-delivery doctor doing a surgery on my small intestine. But since my small intestine is adhered to the top and front of my uterus as evidenced after I eat by actually watching food move through it, this would have to happen. An OB/GYN would have to attempt to separate my intestine from my uterus without causing any damage.

Thanks to the way hospital administration and all tends to work, if a woman's had any abdominal surgery at all before, even just a prior c-section, then a woman will be very hard-pressed to find a hospital that will allow a vaginal delivery. At that point, it's an automatic c-section. And don't try saying hospitals can't make you. Emergency court orders do happen forcing women against their will into ORs.

Now with a natural vaginal birth, it's not much different for me than anyone else. I can actually take pretty good hits to the stomach. My parents would have conniption fits if they were to have known I was taking shotokan and allowing 20-pound medicine balls to be dropped on my stomach from a height of about four or five feet.

The only risk to me that would be a slightly higher concern is a 3rd of 4th degree perineal tear straight through to the rectum, where my j-pouch is. The rate of tearing without an episiotomy is really statistically a lot lower than many people think, and most tears can be attributed to Pitocin causing faster labor, giving the body less time to stretch naturally, and the ol' lithotomy (back) position, which narrows the pelvic chamber and puts all the gravity and force downward onto the perineum.

Well, neither Pitocin nor the lithotomy position have any place in my birth plan, none at all. Further, water-births have an even lower rate of tearing at all as water, or indeed most types of moisture, give natural things additional elastic properties. Every notice how a strand of hair, after a shower can be stretched a good bit before it breaks, yet trying to same thing with dry hair results in instant, or almost-instant, snapping? Same thing with the human body and skin. Dryness is brittle, moisture is supple and elastic and stronger.

So this is how I'm low-risk for a home birth, yet such high risk in a hospital.

Deciding to go against the mainstream (and home-birthing is against the American mainstream, even for women with no medical histories at all) wasn't an overnight decision, nor was it one made without considerable research and thought. But it is safest, and the most recent doctor I saw (when Charlotte was breech, remember?) admitted that.

It was too much of a struggle to stay alive as a teen and young adult to make any medical decision lightly now. Even any medication that goes into my body comes with a good deal of thinking and re-thinking. I may do and eat the same normal things as everyone else, but when it comes to anything medical, what would be a very minor decision to anyone else comes with a lot of thought for me. My immune system sucks, my seizures are a result of all the medications and weeks of sub-60% blood oxygen levels, etc.. We don't exactly want to compromise anything any more than we must.

1 comment:

  1. Very nicely put! You have obviously done your research, and I think you are better equipped to handle what happens when babies are born than most are.

    I hope that you have a wonderful, safe and happy home birth experience. :)


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