Rachel Heath

Intentional Living: learning to be fully present

Archive for the category “Pregnancy and Birth”

On Abortion and Women’s Health

The main presidential candidates are really pushing the issue of abortion rights this year. I don’t believe it’s much of a priority for either Romney or Obama, but I expect Obama’s healthcare policies will have an effect on the way abortion is handled in this country.

Full-disclosure: I define myself as neither republican nor democrat. I would call myself generally anti-abortion, but I realize that it’s an incredibly complex issue and I don’t believe there are blanket right-and-wrong answers to be found here.

I’ve heard dozens of commercials along the same theme: republicans want to take “critical” healthcare away from women. Republicans aside, as a birth professional, I’d like to speak to the notion of abortion being “critical” for women’s health.

Today, I’m not addressing the issue of abortion from a religious or political standpoint, but from a healthcare standpoint. No, really! I’m not going to bring up Jesus. I’m not going to endorse a political party. I’m just going to share some research-based evidence.

First, it’s important to explain how abortion is performed and how it affects the body.

Abortion and miscarriage affect the body in some similar ways. A woman’s body has the amazing ability to detect genetic abnormalities and deformities in a developing baby, and 95% of the time, will spontaneously abort a baby that is developing with serious problems. This is what causes most, but not all, miscarriages. Even in a natural miscarriage, the body undergoes a massive hormonal shift that seriously jacks you up (ask any woman who has experienced miscarriage). Most women report that the emotional healing takes much longer than the physical recovery.

Abortion is different because it’s not a spontaneous, natural function of the body. Instead, it’s the removal of a (usually) normal, healthy baby, which confuses the body. There are two types of abortion practiced commonly in the US:

Pharmaceutical Abortion

This is a pill, usually Mifepristone, that blocks progesterone, an important hormone in pregnancy. It is used alone or in conjunction with Misoprostol. Among other things, this causes the uterine lining to break down and be sloughed off, along with the baby, just like in a miscarriage. The FDA has approved Mifepristone for use up to 49 days past your missed period (7 weeks) but on their website, Planned Parenthood says it administers it for up to 9 weeks (I suspect in conjunction with another drug).

The packaging notes risks including vaginal bleeding or spotting, cramps, pelvic pain, vaginal burning, itching, or discharge, headache, tiredness, difficulty falling asleep or staying asleep, anxiety, back or leg pain. The chief among these is very heavy bleeding, but thorough studies haven’t been performed on this particular risk yet. The sudden hormonal shift triggered by a pregnancy loss is often stronger for women who undergo abortion because the loss was caused chemically, instead of by the body’s own hormones.

In my opinion, the biggest risk of this method is that it isn’t always completely effective. In about 5% of women, tissue may be left in the uterus which can cause infection (a very serious risk with a host of other potential side effects), thus necessitating a surgical abortion. Of course, miscarriages can also be incomplete, but I couldn’t find any definitive numbers from sound studies that indicated what percentage of miscarriages end this way.

Surgical Abortion

The most common surgical abortion procedure performed in the US is called Aspiration Abortion. Basically, the cervix is dilated manually (sometimes with the assistance of drugs) and a vacuum device is used to remove the baby, placenta, and other tissue. The farther along you are in pregnancy, the riskier this procedure is, with success rates slipping lower past 6-8 weeks of pregnancy.

Risks include post-partum depression, cramping, severe bleeding, blood clots, infection, cervical tearing, uterine tearing, scarring, incomplete abortion, repeated abortion, undetected ectopic pregnancy, and rarely, death.

Another type of surgical abortion, somewhat common but less often used than aspiration abortion, is D&C, or Dilation and Curettage. The cervix is dilated and a sharp, spoon shaped blade (a Curette) is inserted and used to scrape out the inside of the uterus. Typically, this procedure is performed after an incomplete miscarriage or abortion, but some less-modern doctors still perform D&C abortions routinely.

Risks of Dilation & Curettage include postpartum depression, cramping, hemorrhage, uterine perforation and/or tearing, cervical damage and/or tearing, infection, scarring, incomplete abortion, and rarely, death.

Abortion is presented as a safe way to terminate a pregnancy. However, even apart from the possible risks and complications listed above, a host of statistics show that abortion, particularly surgical procedures, can have a long-term impact on fertility and general health.

1. Abortion can leave you sterile.

Approximately 3-5% of women who have induced abortions are rendered sterile, and the percentage is higher if you had an active venereal disease or infection at the time.

2. Abortion significantly raises your chances of developing future ectopic pregnancy.

Women who experience some kind of post-abortion infection (25-30% of abortion patients) are 5-8 times more likely to develop ectopic pregnancy. Ectopic pregnancy, when a fertilized egg becomes implanted outside the uterus (for example, in a fallopian tube) is almost always fatal to the baby and is an enormous risk to the mother’s life. The number of ectopic pregnancies in the US has more than quadrupled since abortion was legalized, and over a tenth of maternal deaths in the US are due to ectopic pregnancy, a trend that is visible in other countries with legalized abortion.

3. Each abortion significantly increases your risk of future pregnancy complications.

Dilating the cervix manually is a difficult task even with pharmaceutical help, because the cervix is meant to stay hard and closed until labor begins naturally. Minor to severe tears in the cervix and uterine wall often result. One hospital study I found reported that 12.5% of abortions required cervical sutures, while another study reported up to 22% of women needing suturing. Suturing is a service that outpatient abortion clinics usually don’t provide. Alarmingly, the risk of cervical and uterine tearing nearly doubles for women under 17, since their cervix is still maturing.

Incompetent Cervix, or a cervix too weak to hold the weight of a developing baby, is found in 75% of women who have undergone dilation for an abortion. The risk of miscarriage, premature birth, and labor complications goes up by 300-500% in women with this kind of cervical damage.

Risk of placenta previa, where the placenta develops over the birth canal, increases 7-15 times after induced abortion. This condition increases the risk of fetal malformation, perinatal death, and hemorrhage during labor.

4. Each abortion makes it increasingly unlikely you’ll be able to deliver a baby vaginally in the future.

1 in 3 American women have had at least one abortion by the time they are 45 years old. This may help to explain our unbelievable cesarean section rates, since women who have undergone surgical abortion almost always have some degree of tearing (and suturing), and thus, scar tissue. Scar tissue in the uterus can impede its ability to contract during labor, and scar tissue in and around the cervix can make it difficult or even impossible for it to dilate.

5. Abortion increases risk of handicaps in future babies.

The side effects of induced abortion increase chances of premature delivery, complications of labor, and abnormal development of the placenta in later pregnancies. These reproductive complications are the leading causes of handicaps among newborns.

6. Abortion significantly increases your chance of developing breast cancer and other cancers.

A recent study on Chinese women showed that women who had undergone one abortion were 82% more likely to develop breast cancer than women who had not had an abortion, and that number rises with each procedure. “Induced abortion prevents breast tissue from growing from immature type 1 and 2 lobules into mature type 3 and 4 lobules, which makes pregnant women more susceptible to carcinogenesis at extremely high levels of cancer-promoting estrogen during pregnancy,” Doctors Angela Lanfranchi and Joel Brind note in the study. Estrogen levels increase by 2000% during the first trimester, but those lobules don’t mature until the third trimester, so abortion during the 1st and 2nd trimester puts women at a high risk for breast cancer.

Induced abortion also raises a woman’s risk of cervical cancer 2.3 times, and up to 5 times with multiple abortions. Risk of ovarian and liver cancer are supposedly also raised, though I couldn’t find specific numbers.

7. Women who have had abortions report a multitude of emotional and psychological effects.

There is only one positive emotion that researches have consistently found present among women who have had an abortion: relief. 8 weeks after an abortion, one study reports that 60% of women report negative reactions. 55% expressed guilt, 44% complained of nervous disorders, 36% had experienced sleep disturbances, 31% had regrets about their decision, and 11% were on some form of psychotropic medicine.

A study of the medical records of 56,741 California medicaid patients revealed that women who had abortions were 160% more likely than delivering women to be hospitalized for psychiatric treatment in the first 90 days following abortion or delivery, and rates of psychiatric treatment remained significantly higher for at least four years.

Women report over 100 psychological and emotional reactions to abortion including a variety of sexual dysfunctions, depression, post-traumatic stress disorder, self-destructive behavior, personality changes, anxiety attacks, chronic sleeplessness, difficulty concentrating, self-hatred, addiction and/or substance abuse, difficulty bonding with future children, thoughts of suicide, attempted suicide… the list goes on. The risks are exponentially higher for women under 17.

Abortion has a dramatic impact on women’s health. I absolutely believe it is a critical part of healthcare, namely, educating women on the potential cost, long-term effects, and risk of irreversible damage to their bodies. I don’t share this information to condemn women who have had abortions or those who feel it is their only choice. Certainly, I believe there are cases where an abortion is an acceptable option and the risks are warranted.

I share this information because I care deeply about women’s wellbeing and about their reproductive and general health. I care deeply about our right to make informed choices about our healthcare, and these risks are not being presented clearly and consistently to women considering abortion.

If you’d like references to any of the studies I mentioned, please ask in the comments, I’m happy to email them to you. I just chose not to include them because this was already such a long post.

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On Expecting Goodness

A few months ago I wrote about my disappointment and grief on the day that would have been my estimated due date. I should have been anticipating the any-day-now arrival of our second child, but… I wasn’t.

We lost that baby on December 6. I said it before, and I’ll say it again: My baby was not taken by God because He has “a better plan,” No. She was stolen from me by satan, and I refuse to attribute his works to my Jesus and call it sovereignty. It’s God’s good pleasure to give me good things and He holds nothing back. So I will expect His goodness, even when my circumstances are less than good. I will not allow my experiences to define who God is.

In the days after the miscarriage, there was a deep desire of my heart that I was scared to ask the Lord for or even admit to myself. But it was there, gnawing, all the same. I want to be pregnant again on my estimated due date. That wish sat at the back of my mind over the following months as we hoped and hoped and hoped and were disappointed time and time again.

I began to think it wouldn’t happen. Maybe there’s something wrong with me. I started obsessively reading WebMD on my phone looking up obscure conditions and realizing with horror that I have one or two of the symptoms, I must have This Thing, I’m never getting pregnant again, I’ll never have the family I imagined.

Then that still small voice spoke gently to me, “Stop. Stop worrying about this. Just live.” So, that’s what we did. I enjoyed every moment of the summer doing things you can’t do when you’re pregnant. I learned to appreciate my little girl and my precious time with her. We let go of what our family was supposed to look like and embraced what our family did look like, might look like instead. I finally relaxed, stopped charting my cycle, stopped wondering if this would be The Month.

It was during this time that the due date snuck up on me, and I was completely blindsided.

On the day I wrote that post… on my estimated due date… I was pregnant, though I didn’t know it. God heard the prayer I never prayed, knew the deepest, most guarded desire of my heart, and gave it to me, surprised me with it. Don’t you love when He does that?

Today, I’m 12 weeks along (in my second trimester) and due in April. Soon we’ll be finding out whether we’re having a boy or a girl (we think boy), and we’ve already received numerous words about this baby’s destiny and identity. This time, Isabella is old enough to understand what’s happening, which is wonderfully sweet. She says “baby,” she kisses my belly, she diligently carries around a baby doll.

Still, this wasn’t my plan. If things had gone right, I would be holding my newborn right now. However, I’ve determined not to let the grief of losing one baby dampen the joy of expecting another. I have to admit, the season is bittersweet, but becoming sweeter by the day as I watch my belly grow and begin to dream again.

On Today

Today.  Sigh.

Today is a significant day.  About 40 weeks ago, Stephen and I were celebrating our second pregnancy.

Today a notification popped up on my phone and cheerfully reminded me “Due Date!”

Obviously, I’m not 40 weeks pregnant today and it feels like shit.

Thankfully, no one has been dumb enough to tell me that “God is in control” or that “The Lord has a plan” because I know, absolutely, beyond any shadow of a doubt, that God’s plan is not and never would be to snatch a baby from a woman’s womb.  Let me be unequivocal: God is good.  Satan is bad.  We live in a fallen world and the enemy comes to steal, kill, and destroy.  So when it happened, I knew exactly who to blame.  We prayed, we spoke life, we believed, but as I continued to bleed, in the midst of the fear and sorrow, I just couldn’t muster enough faith to stand up and trample satan’s wretched face.

In the months after, I processed the miscarriage in my own way and came to a sort of uncomfortable peace with it.  Not a peace that says, “It’s ok” but a peace that says, “I will NOT allow my circumstances to determine God’s character.”

As we’ve drawn closer to today, it’s become more real for both Stephen and I.  We’re feeling a tangible loss; a special member of our family isn’t with us, and can’t be replaced, and we won’t be meeting her for a very long time.

But God gloriously and elegantly takes what the enemy intended for evil and finds a way to bring us a blessing in it.  So right now I’m finding it important to stay in a place of gratitude for the good things, large and small, that I’ve been able to dig up in this season of garbage.

Happy Hour

Ok, maybe it’s stupid, but margaritas and summer evenings outside go together SO PERFECTLY.  Margaritas and pregnancy… well, they just don’t.

My Body

It’s mine again.  I’ve worked hard to get my groove back and I’m in the best shape of my life. It’s an inconsequential thing, but I’m thankful for it all the same.

Time and Flexibility

In the last few months I’ve been honored to attend 3 beautiful births as a doula, and have discovered a great passion in me. I wouldn’t have been able to pursue this in the late stages of my pregnancy and the early months of my baby’s life.

Summer in the Rocky Mountains

There’s nothing better. And I’ve missed it for almost 2 years- in 2010 I was pregnant. In 2011 I was nursing constantly. By the time the 2012 hiking season rolled around, I would have been in my third trimester already. This year I’m going to soak up some wilderness.

Stephen

I can’t imagine a better support and comfort in this season. We’ve hoped together, grieved together, cried together, prayed together, and recovered (ish) together. He’s patient with my wildly unpredictable emotions from day-to-day, always willing to listen to me vent and process and be honest, and totally willing to wait until I’m ready to try it again.

Isabella

This wasn’t my plan – we were going to have kids close together, but I love being able to give Isabella my full attention and I love all the things we can do that we couldn’t if I had a newborn as well.

I’ll look back at this quality time with my firstborn as one of the sweetest, and though I may not feel it now, simplest times of my life. Of all the things I can be thankful for, this is the most important.  Izzy can’t bring back the baby we lost, but she’s brought me boundless joy and comfort in the midst of loss.

I started this about a week after the miscarriage. We felt it was a girl, and Stephen got the name in a dream. I needed to commemorate her, somehow. I just finished it tonight.

On something that’s just not fair

Every time someone asks me if we want more kids, I am suddenly rushed back to that awful night early last December, sitting on the toilet, doubled over with every wave of pain, totally helpless to stop the bleeding.

Miscarriage.  The word itself sounds broken.

Today I would have been over 36 weeks along.  I’ve mostly processed through it, but there are some days that the feeling of loss hits me so unexpectedly and so forcefully that I can hardly breathe.

I miss her so much, and I never met her.

On Informed Consent and Refusal

I can’t tell you how many women I’ve met who are dissatisfied with their birth experience at some level and, even years later, still have regrets.  Sometimes it’s because they didn’t understand what was being done to them.  Sometimes it’s because they felt pressured by their health care provider to do something they didn’t want.  Sometimes it’s because they had an outcome that, they learned later, probably could have been prevented if they had avoided a certain intervention.

I also know many women who trust their doctors implicitly, and while I never want undermine my client’s health care provider, I realize that the health care system is pretty dysfunctional and doctors are, unfortunately, motivated by many factors in addition to their patient’s well-being… but that’s a can of worms I don’t want to open right now.  My point is, many women expect to walk into the hospital, have their doctor tell them what to do, and be happy with the results, and it very often doesn’t work that way.  You have to understand the process of labor and the many medical interventions that may and probably will be suggested to you at some point.

If you don’t know your options, you don’t have any.  Many wonderful alternatives to standard medical interventions aren’t popular with most doctors because they may take longer, bring in less money, or be less convenient for staff.  And even though some procedures have been proven useless or even harmful, many doctors continue to recommend them routinely.

Did you know that your Health Care Provider must inform you of the following prior to performing a procedure?

  • The nature of the procedure and how it is done
  • Whether the procedure is new or experimental
  • Why they recommend it for you (is it universally recommended, and why?)
  • How it will affect you, your baby, and your labor
  • The benefits associated with the procedure
  • The risks associated with the procedure
  • Any alternatives that are available (a doula may suggest many helpful alternatives)
  • What you can expect your recovery to be like
  • If it’s possible to delay the procedure

It is your legal right to get answers to every single one of these questions.  It is your legal right to refuse any intervention (unless it’s an emergency, in which case doctors may do anything necessary to save you and your baby’s life).  That’s why education is so important before you get the L&D Ward.

When facing a decision during labor, the BRAINED acronym is a great way to make sure you are giving informed consent- or refusal- to whatever intervention your doc is suggesting.

Benefits. Why is this good for me, my baby, and the progress of my labor?

Risks. What are the risks associated with this?  What other interventions are likely to go along with it?

Alternatives. What are my other options? Is this a routine procedure, something that is universally suggested?

Intuition. Don’t underestimate the power of you gut. What do your instincts say?

Nothing. What if I do nothing?  What if we delay this intervention?

Emergency. If this is an emergency and there’s literally no time for an in-depth discussion, try to talk with the staff as they work.

Discuss.  Your Health Care Provider is legally required to give you and your support system (partner, doula, friend, or whoever you want) time to discuss the intervention privately.  You don’t have to make a decision right then and there.

If I could get one message across to women, it’s that you are under absolutely no obligation to consent to an intervention you aren’t comfortable with or don’t understand unless it’s a true life-and-death emergency.  I think many women feel as if they are inconveniencing and annoying their doc or have a fear of being “that” patient, but you have a right to get all the information necessary to make an educated choice.

Get educated before your birth.  Make sure you have a strong support system, like a doula, who will help you understand your options so you can self-advocate.  Remember BRAINED if your health care provider is recommending an intervention you aren’t sure about.

Taking a New Direction

I actually wrote this post on Saturday but didn’t publish it till today (Monday) and of course, the sermon on Sunday was about dreaming, using Abraham as the example.  When God gave Abraham His promise, everything that Abraham did from that point on was intentional toward this dream.  God has given me a dream during the last few months so I’m going to take a cue from Abe and turn my sights in a new direction.


Dreaming can be scary.  It can be a risk.  What if my dreams don’t come true?  What if I fail?  What if I get my hopes up and end up getting disappointed?  But I’m in a season of risk taking and big dreams, where God has invited me to dream with Him- not just to dream His dreams for me, but to dream my own dreams for myself.


If allowing yourself to dream is risky, then certainly sharing your dreams with others is the most dangerous thing you can do.  Then, if I fail, I fail publicly.  By sharing my dreams, I am acknowledging them.  By sharing my dreams, I’m making myself accountable for them.  By sharing my dreams, I’m making myself vulnerable.  By sharing my dreams, I’m making them more real.

But I’ve decided it’s time to share one of my dreams… a dream that’s so close to my heart that I was barely able to whisper it to myself for months, that I’ve only just begun to have the courage to speak about to my most trusted friends.

I’ve decided I want to be a midwife.  Not just I want to… I have to.  I need to.  I know this is a calling on my life and nothing will stand in my way to get there.

I’m still surprised by this dream.  I remember, a few years ago, having a conversation with my sister-in-law Kelli.  She told me she wished she could have another baby because she thought childbirth was so magical and amazing and powerful and she loved it so much.  She told me all about the birthing suite she’d wanted that had a tub and a birth ball and all kinds of weird birthing equipment in it.  I remember thinking, “Good Lord… this woman is crazypants.”  I maintained that when (if ever) I had a baby, I wanted them to knock me out so I could just wake up and have a baby in my arms.  Because childbirth is hard and it’s gross and I’m not going to do it.

Nearly 4 years later, I was blessed to have a drug free waterbirth with Isabella (joyfully attended by Kelli)… how far I’ve come.  It’s amazing how much your perspective can change through a little education.  I’ve always been the kind of person that hates being to be told what to do, hates doing what everyone else is doing, and if you try to say I can’t do something I’m damn straight going to do exactly that, so when I became pregnant and learned that the way you’re “supposed” to have a baby is strapped to a bed in a hospital, hooked up to drugs, with nurses and doctors telling you what to do, and a 30% chance of a cesarean, I said hell no, there’s got to be another way, and immediately began researching.


I discovered a whole world where pregnancy and labor aren’t viewed as conditions to be treated, but a normal and healthy part of a woman’s life; where the woman has control over her care; where parents are educated about labor and delivery.  The midwives I met with took all the time I needed at every appointment, they made sure I fully understood all of my options and everything that was happening in my body and soul.  I felt personally invested in.  By my last postnatal checkup I was ready to have another baby just because I didn’t want to say goodbye to the amazing nurses and nurse-widwives who had cared for me for nearly a year.

My passion for the midwifery model of care has only grown.  When I’m around pregnant women, I have to restrain myself from drowning them with information, and when I have an open door to share about pregnancy, birth, breastfeeding… I leap through it.  Right now, writing this article, I’m holding back… I could write and write and write.  I just love this world.  I had an incredible experience and I deeply desire to bring other women into the same understanding and joy that my midwives were able to lead me to.

The thing is… I want to be a certified nurse-midwife. That’s a Bachelor’s Degree in nursing (4 years) and a Master’s in Midwifery (2 years).  We’re talking 6 years minimum of schooling… and I have a child.  I’ll definitely have more.  Obviously I’m not going to school full-time, at least not right away, and I would be surprised if I finish in 10 years.  The idea of ten years of schooling is profoundly intimidating to me.  By that time I’ll be 36.

My dear friend Annie put it in perspective for me: “The fact is, you’re going to be 36 one way or another.  Would you rather be 36 and done -or almost done- with your degree, or 36 and wishing you had started?”  It’s not like 36 is old… it just feels like a long time from now.  It sounds like a lot of work, being a wife and a mom and a student.  But I’ve set my mind on it.  I’m sharing it you-with whoever felt like reading this post- and I’m going to do it.

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