Advocacy starts before doctor appointments
Reflecting on our November podcast about childbirth and postpartum advocacy
Earlier this month, I joined Garrett Wood, founder of kozēkozē—an innovative perinatal products company bringing comfort to moms, to enhance the bond between her and her baby, leading to better mental health outcomes—on her podcast alongside one of our peer advocates, Marlese Kaufman, to talk about advocacy when it comes to childbirth and postpartum. Both Garrett and Marlese experienced traumatic first births, which were complicated by infections. They bravely shared their stories with us on the podcast. Garrett’s labor was long and painful, complicated by chorioamnionitis: infection of membranes, the chorion, amnion or both, surrounding the fetus. Marlese’s labor began at home but was so excruciating it became unmanageable as a home birth, so she transferred to the ER and opted for an elective C-section delivery. She subsequently suffered from septic shock after delivering her baby.
I definitely recommend listening to this super raw episode. It’s not often that we hear women’s challenging birthing stories nor that we create space for women to share their truth of what was “meant” to be magical but was actually traumatic. We’re fed fairytales when it comes to becoming a mother—conceiving, being pregnant, giving birth, and postpartum. We’re rarely educated about the emotional and physical reality, even less so from a medical standpoint. Marlese reckoned with her experience, sharing the below:
I got it in my head that home birth was the way for me to give birth to my first child. It felt like the powerful thing to do. What happened for me was I really fell down this social media hole of how home birth and birth without medication and birth without “Western” intervention is the most powerful you can be as a woman. This is your opportunity to be everything you were born to be! I really got kind of swept away in this mentality […] To fast forward, my water breaks at home. I'm ready, right? I've got everything set up ready to go. But my labor just went on and on and on. For like 20 hours. Really intense. I am one of those women who just kind of goes 0 to 100. My labor is not slow. It was like 0 to 7 centimeters real quick and then just stayed there, which is extremely painful. […] The only comfortable place for me was the bathtub, so I get into the bathtub. And I really want to pause here and just say how vulnerable you are during birth. I once heard someone say, ‘Whenever birth is in the room, death is lurking in the corner.’ You really need people in the room with you, who are protecting your life and your baby's life. And I feel looking back on my experience that the people in that room with me, excluding my husband who was also brand new at this, were not really looking out for my life. I think they were kind of just letting things happen.”
Society rarely frames childbirth for what it really is: a major medical event. So much of Garrett and Marlese’s trauma came from not understanding what was happening to them medically. Not all pregnancies and births are innocuous and “low risk,” but many women enter this huge medical event with little to no information on how to prepare for it. At the same time, women are experiencing a healthcare system that increasingly fails them, especially when it comes to giving birth:
The US, despite being the top spender on healthcare, has the highest infant and maternal mortality rate among high income countries. This disproportionately affects Black mothers, who are 3x more likely to die than White mothers. (Source: The Commonwealth Fund)
The number of women experiencing both pregnancy complications and childbirth complications has increased 31.5% since 2014. Specifically 14.2% for childbirth complications. (Source: BlueCross BlueShield)
4 in 5 pregnancy-related deaths in the US are preventable according to data from the Maternal Mortality Review Committees (Source: CDC)
Marlese experienced this after her second birth when she felt something was wrong 6 weeks postpartum but had to spend another 4 weeks convincing her doctors to examine her. As it turns out, she had Retained Products of Conception (RPOC), which is when fetal or placental tissue remains in your uterus after a pregnancy, and had to undergo a dilation and curettage (D&C) procedure to treat it. As women hurtle themselves against a gender-biased healthcare system that often gaslights and dismisses them when they say something doesn’t feel right, it’s easy to fall down social media rabbit holes that peddle toxic expectations around what giving birth “should” be and continue to misconstrue expectations. Despite Marlese’s experiences, she was adamant about the following:
There is nothing wrong with Western medicine. There's nothing wrong with needing intervention. And in fact, it can be life saving for both you and for your baby. So don't let anyone tell you that you are less than because you gave birth in a hospital, because you took that antibiotic, because you had that procedure. It doesn't make you less of a mom, doesn't make you less of a woman. And it's really a privilege that we have […] access to these things despite our very flawed health system.
A big takeaway from our podcast is how important it is to have an open dialogue with doctors, even if you’re planning a home birth. Advocacy starts before doctor appointments. This is why taking the time to research and choose an obstetrics care team that you trust because they encourage you to ask questions is advocating for yourself. It means you are serious about holding yourself and your doctors accountable through a major medical event like childbirth. Beyond birthing classes and prenatal check-ups, this means engaging obstetricians and their health care staff in conversations about your delivery: What are the complications that could lead to an emergency C-Section? Do they anticipate that you may need to be induced? If the baby doesn’t come on your due date, at what point would they recommend induction? How do they typically manage pain beyond the epidural? How do they manage active labor right after delivering the baby? If you are planning for a home birth, what is your contingency plan? How do they treat infections if it were to occur during delivery? These are conversations that help build trust, so you can be involved in shared-decision making.
After recording the podcast with Garrett and Marlese, I realized I mostly had questions around induction. It’s a topic that’s come up frequently with women who are first-time mothers. As someone who hasn’t given birth nor been pregnant yet and will have to plan far ahead due to recurring fibroids, I thought I’d share what I’ve learned after consulting with OBGYNs:
Induction of labor is a method to kickstart the labor process if it doesn’t start naturally. It involves helping contractions begin that help the cervix change so a person can give birth.
But inductions are not just for when labor is not spontaneous. They are also used when a pregnancy becomes complicated and delivery is recommended to mitigate risks to the mother and baby.
A pregnancy is considered full-term between 39 weeks 0 days and 40 weeks 6 days. Early term is between 37 weeks 0 days and 38 weeks 6 days. A preterm delivery is one that occurs at 36 weeks 6 days or earlier.
In the U.S., we calculate the due date based on a 40-week gestation period, counting from the first day of the last menstrual period. That being said, it’s very difficult to predict an exact time and date a woman might go into spontaneous labor.
Induction of labor becomes a consideration based on the assessment of the baby’s well being and the health of the pregnant mother and may be recommended by your provider if the pregnancy becomes post-term, extending beyond 41 or 42 weeks.
Something else to consider is that about half of pregnant people will not go into labor on their own. When people talk about induction of labor, this can include anything from “old wives’ tales” to medical induction like using Pitocin, a medication that makes the uterus contract. Pitocin has multiple uses in obstetrics. For example, it can be used to start labor or augment labor as well as a hemorrhage control agent, helping to control for loss of blood.
Your care provider might suggest induction if there are concerns about your health or the baby's, ensuring the safest possible delivery. Health reasons for a pregnant person that may lead to a recommended medical induction include preeclampsia, diabetes, or even UTIs. It's a decision made between the pregnant person and their provider.
Sometimes, induction is done by choice regardless of specific medical reasons if the mother requests it. But ultimately, it’s all about making sure the mother and baby stay safe during delivery.
When it comes to labor, care providers think about 3P’s: Passenger, Passageway, and Powers. Passenger refers to the baby and its position, size, and how it moves through the birth canal. Passageway references the mother’s birth canal. And Powers refers to the contractions of the uterus that provide the force needed to move the baby through.
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