March 22, 2014

Let's Talk Cs

Talking about C-sections is always a tricky business. If you’ve never had one, it’s all fine and well. For women who have, and I’m not one, it can be very fraught. I say this because I have personally experienced backlash from someone over their C-section and what they thought I thought about it. I’ve talked to women who were traumatized by their deliveries that ended in C-section. On the other side, I’ve talked to women who, whatever their reasons, have been extremely defensive about their C-section and its necessity.

I bring this all up because I came across a great article today in The Atlantic called “When a Placenta Tries to Kill a Mother.” It’s written by an OB/GYN, and it’s about an extremely dangerous pregnancy complication, often associated with multiple C-sections, placenta accreta. This is when the placenta gets confused, usually when there’s a scar from a previous C-section, and instead of growing and stopping, it grows into, and sometimes through, the uterus itself. This is a life threatening complication for both mom and baby. I have a friend who had this happen to her. In her case, she had one of the most serious kinds where the placenta completely blocked her cervix, grew through her uterus, and had begun to invade her bladder. Yeah, this is some serious stuff. Thankfully, my friend made it through ok, but it was no walk in the park.

It is for times like that that I am forever thankful for modern medicine. This is something that can’t be diagnosed without modern imaging, and it has to be handled surgically, usually with a pre-term C-section followed by hysterectomy. That means no more babies. It’s a very scary surgery that can end in NICU and ICU stays for mom and baby.

This is something that can just happen. But in this day and age, when the most recent CDC numbers put the C-section rate at 32.8% in the US, it is more often than not caused by a previous C-section. And the more C-sections you have, the more likely you are to develop this condition in a later pregnancy. Wikipedia (citing a respected medical journal), tells us that after two C-sections your risk of placenta accreta is 0.13% and after four 2.13%—that’s an increase of more than 16 times.

I am not going to sit here and argue with you about why you might have had a C-section. That’s between you and your doctor. But I am going to advise you that if you did have a C-section, advocate for yourself for a Vaginal Birth After Caesarean (VBAC) for your next pregnancy. The biggest argument against VBAC is traditionally that there is a 1% chance of uterine rupture from the scar. Well, according to a 2010 study, the mortality rate of an elective repeat C-section is 13.4 per 100,000 versus 3.8 per 100,000 for VBAC. That means the woman having the “safer” repeat C-section is 3.5 times more likely to die in childbirth. 

I will return to my mantra. Educate yourself. Trust yourself. It can be hard to find doctors or hospitals that will accommodate VBACs. In my opinion this is for litigious reasons, not medical ones. The argument is often made that it is unsafe to attempt a VBAC unless a hospital has an on call anesthesiologist in case things go south. Well, if the hospital can’t perform a truly emergency C-section, then one could argue, are you safe there at all? If your doctor won’t consider it, find one who will.

I am not saying that horrible things don’t happen. They do. I’ve had some pretty shitty things happen to me, and there’s nothing to be said that’s going to make me feel better about it. I don’t wish a negative outcome on anyone. That being said, don’t choose out of fear. Bad things happen even when we do everything right. That’s not always something we can control. Choosing surgery out of fear because you feel it’s safer or it’s known, might not actually be safer. As the author in The Atlantic wisely put it:

There’s an obvious metaphor here, of course, about pregnancy and motherhood, and how they can devour a woman from the inside. But the setup for a placenta accreta often starts long ago, with a prior pregnancy. The other metaphor is that we carry some of the choices that we make forever, and some of them we never heal from entirely.

Despite all that, your story isn't done. Whatever the past, you can choose for yourself what you want your future to look like. It’s up to you.

March 18, 2014

The Whole Bible

I read the Bible. I started with Genesis. I ended with Revelations. I skipped the Apocrypha.

Before I started this little project I had previously read no more than a few verses at a time. I fully admit, it was a very few verses indeed. For years I had a hand-me-down Bible from my Mom. The front had an illustration with little Golden-book style children sitting at Jesus’s feet. I read the first few lines of Genesis a few times and that was about it. I probably wouldn’t have read it at all if it weren’t for my book project. I’m sure there are those that wince at the fact that I started reading the Bible to check off an item on a list, but I did read it, and truly, I don’t think God minds. This time around I went with the black, leatherette version with my maiden name embossed in gold on it. Also a gift from Mom.

More importantly, for the most part I enjoyed reading the Bible. Now if anyone gets mad at the “for the most part,” I suspect you’ve perhaps not read this whole thing. There are some parts that are quite tedious, especially in the Old Testament. I understand that the measurements for temples were important and that the head counts for the tribes were important. I am no scholar, but I definitely had the feeling that the Old Testament, in its day, served not only as a religious text, but also as a law book, a cultural rule book, and a history book. That’s a lot to expect from one book. It can’t all be fire and brimstone and manna from heaven.

It may come as no surprise that I most enjoyed the Gospels (the books in the New Testaments that talk about Jesus’s life). I respond better to stories, and it truly is an amazing story. It left me feeling lighter and more hopeful after I read it. I admired Jesus’s patience. I barely have patience to explain things as complicated as tying shoe laces to my four-year-old, let alone the concept of grace. Of course entire books are written on the subject of grace alone, and I will leave it to those much better suited to it.

Now that I’ve come to the end of it, I rather miss my Bible reading time. For a few seconds I wondered if I shouldn’t just start again at the beginning. I quickly thought better of that. But I have yet to figure out a coherent plan. For the moment, I’m going to play it by ear and see where life takes me. I never thought it would take me here, after all, and things have turned out pretty good.

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