Monday, February 27, 2012

The Myth of Universal Healthcare in Canada - One Mom's Out-of-Neccessity Out-of-Hospital Birth

This morning I read a tale about a soon-to-be Canadian mom, married to a Canadian husband who was going to give birth to a Canadian, who because of bureaucratic lolly-gagging couldn't get health insurance to cover an in-hospital birth. As a result they welcomed their new addition in a hotel bath tub across the street from the hospital with the aid of a midwife. Luckily the child and mother were fine - but what kind of system do we have where this kind of thing happens in the first place? Where you want a hospital birth but choose a 'home' birth because of the expense?

This isn't a case of some medical tourist coming to Canada for the express purpose of obtaining free health care and then returning to their country of origin with no intent of making Canada their home. This is the birth of a Canadian's child, and even if his wife isn't yet Canadian - surely his child's birth should be covered?!? Should a Canadian be forced to choose between taking on the risks of a Homebirth to his or her child because the mother is not a Canadian - or paying the hefty cost of an uncovered hospital birth? Ironically, if the mother was Canadian and the father was an immigrant - the birth would be covered - so why should the child be disadvantaged because of the gender of its parent giving birth?

I am greatly disappointed in the Canadian healthcare system - that this family felt they needed to make the choices they made....what have we come to?

Thursday, February 23, 2012

A First Sneak Peek at the New Edition

Today I got a little look at the next edition - and was relieved to see a little embryo/fetus with arms and legs moving and a heart rate of 162. I was also pleased to see that there was just one womb monkey in there - given how sick I've been feeling with this pregnancy compared to the last, I was beginning to fear that there might be a whole 'wombful' of babies in there. Which would be challenging...anything more than one more would be challenging.

Why the sneak peek?

On Tuesday - after a fabulous birthday foot massage from Mr. W, I discovered some bright red bleeding/spotting. It didn't get worse (it pretty much is now brown spotting, fairly minimal) - but it was concerning. So I went to a walk-in clinic, on Wednesday morning and the Dr. there ordered an ultrasound.

Mr. W is now forbidden from giving Mrs. W foot massages - I don't know if its coincidence or otherwise, but I'd rather not take the chance.

Saturday, February 18, 2012

Reasons Why I'm Choosing to Birth Away from Victoria General Hospital

From what I've heard there will be dedicated obstetric anaesthesiology at Victoria General Hospital in the very near future. I am thrilled that this is the case, as I believe that as a tertiary care facility, the women and babies who give birth there deserve to know that the care they need will be there when they need it. It is a long-overdue standard, that women giving birth in level 3 hospitals in every other province have had for a long time.

It doesn't change my mind about avoiding Victoria General Hospital when it comes time to welcome little bean into the world. Here's why:

1. I don't trust them to respect my explicit wishes for how I want my baby to be born. They didn't last time, and according to the PCQO a lack of dedicated obstetric anaesthesiology was not the problem.

2. A repeat experience at Victoria General Hospital might be triggering - I simply do not know if I am emotionally capable of handling being 'there'.

3. Continuity of care - if I go to Vancouver I can have the same care provider (an OBGYN) manage my pregnancy and deliver my child in the way I wish for my child to be delivered.

Wednesday, February 15, 2012

A Roll of the Labia: The Impact of Childbirth on Sex and Vaginas

There are times when I really miss the way things once were "down there" - times when I'm quite honestly miffed that things aren't quite the way they once were, in part because I believe that had I had a c-section things would be 'the same'. Mr. W. swears its good - but sometimes I wonder if he's just being polite, because it isn't the same for me, so I can hardly imagine that it is as it once was for him. That's not to say that it is bad, it's just different. It's like going to your favourite restaurant only to discover that it's no longer there and has been replaced by some other establishment. You don't know the menu and you've got a deep craving for the old restaurant's 'house special' - but the thing is you can never get the old restaurant's 'house special' again, you're hungry and there is no other restaurant in town so you must learn the new menu. You just wish you would have known before hand that your favourite restaurant wasn't going to be around anymore so that you could have enjoyed and savoured the old restaurant's 'house special' one last time before it was no longer available.

Maybe it's un-lady like or vain to care about anything other than whether or not there's a healthy baby and being able to go about mothering in as short order as possible; a vagina's purpose is to give birth after all - using it for sex is just secondary. Except for many women (myself included), childbirth is/was a secondary purpose, one that I certainly would have exempted my vagina from ever having doing if I had been given the choice.

I imagine if men gave birth, they'd know exactly what the impacts of doing so would be on their penises' form and function and how that varied by mode of delivery. They'd have measured every aspect, both before and after - and would have reems of scientific studies and data on the matter. Of course because men don't give birth - there's scant information out there on how childbirth and mode of delivery impacts the form and function of vaginas.

One scientific study I found, "Sexual function, delivery mode history, pelvic floor muscle exercises and incontinence: A cross-sectional study six years post-partum", by Dean, Wilson, Herbison, et. al in the Australian and New Zealand Journal of Obstetrics and Gynaecology 2008; 48: 302-311 - seems to indicate that delivery by caesarean confers some benefit in this department. The study received responses to sexual function questions from 2765 women at 6 years post partum and found that women who had delivered exclusively by caesarean section scored significantly better on questions relating to their perception of vaginal tone for their own and partner's satisfaction compared to those who had vaginal and instrumental deliveries.

While not scientific in nature I decided to ask a group of mothers who had given birth to indicate whether or not they had delivered by cesarean or vaginal birth and whether or not things were "better", "worse" or the "same". Thirty women in total responded, 12 who had experienced vaginal births or vaginal and cesarean births and 18 women who had experienced only cesarean births. Among the vaginal or mixed birthing women only 2 (16.6 percent) indicated that things were "the same" - 4 (33 percent) reported that it was better 5 reported that it was "worse" (42 percent) and one reported that it "was different but not bad". Among the 18 women who experienced caesarean births 10 reported things as being "the same" (55 percent), 3 reported things as being "better" (17 percent), 4 reported things as being worse (22 percent), and one reported that "sex isn't the same" but did not indicate if it was any better or worse. From this informal and non-scientific survey among women who had vaginal births, 50 percent indicated that things were the same or better meanwhile among those who had caesarean births 72 percent indicated that things were the same or better.

I would think that women's sex lives should matter enough to study this further...

Tuesday, February 14, 2012

Two Really Big Flaws to Cost Studies on C-Section versus Vaginal Birth

Everyone knows that vaginal birth is a lot less expensive than a surgical birth...and that women who are demanding c-sections for nothing more than convenience are drains on the social resources of the health care system.

What everyone doesn't know is that most of the cost studies that compare the costs of c-section to vaginal birth are fundamentally flawed - so much so that the cost difference between the two planned methods of birth might even be negligible.

Flaw 1: Prospective versus Retrospective

Imagine you are driving a car - now imagine that you have your car in drive but are looking exclusively in the rear view mirror, now apply your foot to the accelerator and drive on the basis of this rear view mirror information. This is using retrospective information to make prospective decisions.

Most cost studies that compare the costs of vaginal birth to the cost of surgical birth use this approach. After the outcome of the birth is known (surgical or vaginal) the cost of the birth is estimated and all of the costs of the successful vaginal births are averaged and all of the costs of the surgical births are averaged - if it's a 'good' cost study, the costs of unplanned or emergent surgical births might be seperated out from the costs of planned surgical births. When advocates for natural childbirth cite a figure for the cost-savings of avoiding c-sections they will often do some simple math whereby the average cost difference between a vaginal birth and a surgical birth is applied to the number of c-sections that are proposed to be avoided. Unfortunately this ignores the reality that many planned vaginal births end in urgent/emergent c-sections and as such there is likely to be a large difference between the expected cost of a planned vaginal birth and the actual cost of a vaginal birth.

Flaw 2: A Tunnel Vision Approach to Cost

The second flaw that is endemic to cost studies comparing c-section to vaginal birth is a type of tunnel vision on which costs are included in the comparison and which costs are excluded in the comparison. Typically most cost studies take a very narrow view on the costs of labour and delivery. It is the resources used by the mother and baby while in the hospital for the specific birth event. Once mom and baby are discharged the meter stops. As mode of delivery can have an ongoing impact on the use of health resources this is disingenous. So what kind of costs are currently being excluded in cost analyses on mode of delivery: 1. Cost of ongoing care for birth injuries, 2. Cost of reconstructive surgery, 3. Cost of incontinence supplies 4. Cost of psychological counselling, 5. Cost of litigation, 6. Cost of stillbirth, 7. Cost of pelvic floor injuries.

Friday, February 10, 2012

Wish List: The Business of Being Born Counter Documentary

I would like nothing more than if the next time a friend said to me, "You should watch 'The Business of Being Born'", I could respond with, "I have, and have you seen the counter-documentary that demonstrates how dangerous the ideas espoused in that movie really are?". Unfortunately, there is no counter documentary to direct my well meaning but mislead friends to. There is no "Beyond Reason: The Religion of Being Born", or "Juno Cries", or "Mothering Mortality", or "Balanced Birth". There's ample material for a movie, there is no shortage of compelling stories from women who have been harmed by the push for normal birth and more specifically 'natural birth' and at the extreme end the trend towards embracing homebirth. There's plenty of evidence out there to suggest that a more moderate approach could be very beneficial for both women and their babies. But as of yet, nobody has taken up the cause and made a documentary that exposes the Natural Childbirth movement for what it is: a religion that places process (vaginal, unmedicated childbirth) ahead of outcome (healthy mom and baby).

I am not a documentary maker, I am not a journalist, I am very much so just a blogging, working mom - who feels compelled to add her voice to the chorus of women who see the harm caused by over-zealous natural birth advocates. However, I very much so feel that this movie is overdue. The moderate mothering voice needs to recapture maternity care, needs to refocus on the true goal of giving birth: a physically and psychologically healthy mother and baby. That goal isn't realized by pushing women into natural childbirth. That goal will only be realized by empowering women with balanced information so that they can make the best choices that best meet their needs and those of their children.

Wednesday, February 8, 2012

Regional Variation in Referral Practices and Approach to CDMR

I learned something last night - something that had I known last time, I would have taken a very different approach to my pregnancy and birth plan. I learnt that the referral practices in Victoria are very different from the referral practices in Vancouver - so different that I would almost expect them to be from different provinces or different countries instead of just a short hop-skip across the Georgia Straight. Specifically, I discovered, that it is infinitely easier to get an OBGYN to look after you for your pregnancy in Vancouver than it is here. Victoria has some weird custom whereby the OBGYNs do not take low-risk pregnant women on until fairly late into their pregnancies. In contrast, in Vancouver - a woman can ask to be referred to an OB (instead of the choice of GP who does maternity care and midwife) and actually expect that request to be carried out in a timely way.

I anticipate my first meeting with my OB will be in 4-6 weeks from now - when I'll be about 12-14 weeks pregnant. That is 22-24 weeks sooner than my first meeting with the OB in my last pregnancy.

I also learnt that in Vancouver, a scheduled c-section is just that - a scheduled c-section (regardless of the reason) and that I should expect a specific time and date for my c-section at some point between 39 weeks and 40 weeks gestation and that I should not expect to be 'bumped'... apparently bumping in my new OBGYN's experience is very rare (less than 5 percent of the time) and generally of a short duration (an hour or less) when it does occur. I cannot begin to tell you the kind of piece of mind this brings - unlike my last pregnancy where I was on tanterhooks for 36 weeks fearing that my request would be denied, only to have my request granted, breathe a sigh of relief for 3 weeks and then ultimately be denied what was a very well informed and clearly communicated decision on how I wanted my child to be born.

So it looks like I will be shlepping back and forth to Vancouver over the coming months - and that's okay, I want the person who will deliver my baby to also be the person who looks after me during my pregnancy - and given that I prefer a surgical birth route, the person who will deliver my baby isn't a GP and isn't a midwife.

Logistically, financially, and emotionally - this appears to be a very workable plan. If I were drinking, I'd pop open that bubbly we didn't quite get to before seeing two lines on the pregnancy test -- but I guess some fancier potato chips and fancier ginger ale will have to do in my morning sickness induced quesy state.

Tuesday, February 7, 2012

Information Literacy for the Mother to Be

There's a lot of information out there on birth and parenting - it can be challenging to decipher what exactly is "good information". I am not an expert in information literacy, but I have taken a university level course in information literacy and I have also incorporated elements of information literacy into a countinuing education course that I occassionally teach. I think most moms might benefit from considering the following when assessing the information that they encounter:

#1. What are the qualifications of the author to write on the subject matter at hand?

#2. Does the author have an agenda - are they trying to sell you something?

#3. Does the author cite credible sources for the information they are providing? If the author is citing a scientific journal - what year was it published, is the journal "peer reviewed", what was the sample size (hint large sample sizes are to be preferred over anecdotal evidence)? Are the citations other opinion pieces?

#4. How does the information you are encountering fit into your own context?

#5. Is the author writing about a personal experience or an opinion?

#6. Are there other information sources that contradict the information source being considered? How do they compare?

#7. Is the author transparent about how they came to their conclusions and is the evidence consistent with the conclusion that was arrived at?

#8. Is the author being misleading? Is there relevant information that has been omitted? What are the author's biases?

I trust my readers are adults who are capable of assessing the information I provide on this blog. I also trust, that they know that I'm not a medical professional (6 years of university training - none of it in a 'medical field') and any medical decisions they make should be discussed with their own doctors in light of their own circumstances after a careful consideration of the information available. The thoughts and ideas presented here, are my own.

Monday, February 6, 2012

Nauseously Optimistic

Morning sickness has struck - and unlike my last pregnancy its not in its mild form but rather has caused me to feel like I want to puke, and the rare times when I don't want to puke, I want to sleep. This state of being is not good for clear thought - thus the relative pause in blogging.

That being said - one of my contacts through blogging has given me the name of someone who may be able to assist me in the 'end of pregnancy' matters. I am nauseously optimistic at this lead, as it seems to be legitimate. Further, as the lead is within the confines of my province, it would be considerably more economical than the current plan A (go to Oregon to have the baby). The logistics of this potential plan are appealing.

It would still involve some travelling but that is not neccessarily a bad thing, as given my prior experience of Victoria General Hospital - I truly wish to avoid it for baby number 2.

Progress is good - and a little help from the blogosphere has gone a long way. I'm nauseously optimistic at this point.

Thursday, February 2, 2012

Finding Trustworthy Prenatal Care

I met with my family doctor over 10 days ago, and asked to be referred to an OBGYN for my prenatal care. I specifically asked not to be referred to either Dr. who provided my care last time - and I told her why. I gave her a list of 3 names - she said she'd get back to me in "a few days". I've heard nothing, yet.

I fear that one of the reasons things went they did last time was because there wasn't an opportunity for me to build rapport with the OBGYN. We met once at 36 weeks (when he agreed to do the c-section, before meeting again when I was in hospital and in labour (and he was giving me the tale about pediatric appendectomies and no OR or anasthesiologist after I had already spent 2 days in hospital patiently waiting). It's a lot easier to lie to a patient when you don't really know that patient.

Perhaps it would have been different if I had been referred earlier in the pregnancy - maybe at 20-25 weeks, that's not the OBGYN's fault, but rather my primary maternity doctor's. It wasn't like I hadn't asked to be referred earlier, I had, repeatedly. But I trusted, and waited. I thought my primary maternity doctor "got me" - I thought she understood and was supportive of my wishes. At our last prenatal - she reassured me that the baby was not going to "come out that way"...

So understandably, I don't want to be referred to somebody who I will have to rely on to refer me again. It's going to be hard enough for me to trust this time around...

Why is it that only women who desire vaginal births are given any reasonable chance at continuity of care?

If you are an OBGYN (on Vancouver Island or in Vancouver) who is supportive of maternal request c-section, feel that you can actually make it happen and willing to take on a somewhat anxious pregnant woman (who likely has some degree of PTSD and trust issues) with an EDD of September 20,2011 - please drop me an email at awaitingjuno (at) gmail (dot) com.