Peachy Keen Birth Services Blog

A recent blog post I read proclaimed “DON’T Carpe Diem!”

Don’t seize the day.

The writer of the post very eloquently quips:

There was a famous writer who, when asked if he loved writing, replied, “No. but I love having written.” What I wanted to say to this sweet woman was, “Are you sure? Are you sure you don’t mean you love having parented?”

I love having written. And I love having parented. My favorite part of each day is when the kids are put to sleep (to bed) and Craig and I sink into the couch to watch some quality TV, like Celebrity Wife Swap, and congratulate each other on a job well done. Or a job done, at least.

I agree with the writer of the blog post to a large degree, like a 99% degree (and I would love to know who the “famous writer” is she quoted, since she didn’t give a name). So much of the job of parenting is just getting through the day with everyone alive and still sane.

Believe me. I know. My kids are 6, 5 and 2 1/2. I feel for the author of this post.

But this is where we diverge.

In all the messy, screaming, hectic-crazy shuffling, sticky, me-pulling-out-my-hair, bath, teeth-brush, story, night-night, now it’s FINALLY time for me and hubby to hang out, my GOD are you asleep YET? I feel that I have CARPE’d the freaking DIEM.

Seized the day.

And sometimes Carpeing the Diem was surprisingly gross. Especially during the newborn barfy phase. Or potty training.

Carpe literally means “to pick, pluck, pluck off, cull, crop, gather“.

It relates to harvesting. Have I harvested my kids to the fullest of the day? Or have they harvested me? I still can’t decide who this is supposed to relate to.

Have I been a perfect mom? Have I enjoyed every mind-numbing moment of separating a 6 & 5 year old who love to wrestle? Have I enjoyed 30 minutes of figuring out that the unintelligible sobbing if a two-year-old relates to the fact that she heard change in my pocket and wanted to put it in her piggy bank? No. It sucked-ass while I was in the midst of it. I had moments where I was wondering why I thought I was cut out for being a mom. I have (not past tense like I “have HAD”, but present tense, have) moments where I am thinking “Go to bed so my grownup life can begin!”

So I understand where this author is coming from. I really do.

But there were moments of helping the kids to dress, singing silly songs about underwear, scrambling to figure out what these little souls would be fed for lunch, sitting on the edge of the tub for 15 minute while the 2-year-old goes poo-poo, snuggle-buggling, and frantically piling into the van that are etched into my mind as checkmarks of accomplishment.

So this is where the author of that post and I diverge. For her, “Carpe Diem” is taboo because it is an unrealistic standard forced upon moms. Every day has to be perfect, and you have to be reveling in the perfection every moment of every day to be “carpe-ing” the “diem” Only on a perfect day can you have “Carpe’d the Diem”.

But for me, every one of those seemingly-mind-numbing checkmarks is “Carpeing” the “Diem.”

For me, Carpe Diem means I can look back on the day with 3 very-small children and think “My kids are fed. My kids are happy. My kids have a roof over their heads. My kids had some kind of fun today. My kids are glad I’m their Mommy. We laughed about something.”

Perfection is nowhere in there for me to have considered myself to have “carpe’d” the freaking “diem”.

So yes, DO “Carpe Diem.” However you do it. Because just by loving your children, you are seizing the day. And never let some blog post tell you that no mom could be good enough to live up to “Carpe Diem.”

Are you a childbirth conspiracy-theorist?

Every so often as I’m teaching a childbirth class and covering informed consent, I’ll have this moment where I wonder if I just sound completely insane and paranoid. This is about how it goes down:

Me: “Technically, unless it’s a dire emergency, before performing any procedure, no matter how big or how small, your provider is supposed to obtain informed consent.”

Students: “Okay, good. So they can’t do anything before we give them permission?”

Me: “Not exactly. They’re not supposed to. Most providers wouldn’t. But a small percentage do perform interventions against their patients’ wishes. So you have to choose carefully when picking a provider, and be aware of what is happening at all times.”

Students: [shocked] “Wait, so even if they know you have refused, some will still do something against your wishes?!?!”

Me: “Yes. MOST won’t. MOS’T are honest, upright people. But some do, usually because they are convinced they are doing it for your own good.”

Students: “Give us an example.”

Me: “Okay. I have had more than one student talk to me about their birth, and even though it was discussed beforehand that they didn’t want AROM, the doctor broke their water during a vaginal exam and only told them as he/she was doing it. It was all done by the time they had a chance to protest, and there’s no un-breaking it.”

By this point their eyes are huge and a shocked hush has fallen over the class. I’m not sure if it’s due to this new information that a small minority of providers don’t bother to ask permission or respect their clients’ previously expressed wishes before performing an intervention, or because they are wondering what kind of a paranoid nutball they have signed up to take classes from.

I can tell you from the universal gratitude I get at the end of class and after the births that it is the former… but I can’t help but have that twinge of self-doubt sometimes. Am I a childbirth conspiracy-theorist?

I have decided this week that I am not.

Last week, one of my students told me, quite upset, that her midwife had stripped her membranes not only without her consent, but (get this!) after her telling the midwife “no!” What I gathered was an attitude of “Calm down, it won’t hurt that bad…” and then proceeding to do it anyway.

This prompted me to ask on my Facebook page:

“Have you had a care provider do something without your consent, or even after you expressly declined? What did they do? How did you react?”

I was horrified by some of the responses. Please keep in mind that this was from only SIX different people responding. SIX!

• One mom was told that she was being given saline, when in fact it was Pitocin.
• Several had their membranes stripped without their consent.
• One had an internal fetal monitor (scalp electrode) inserted without bothering to ask for consent. This was when the baby’s heart-rate had been fine the entire time on the external monitor.
• A few episiotomies without consent.
• A couple AROMs without consent.

This is just from the the six on that Facebook post! I can tell you that I’ve verbally heard of many more stripped membranes, AROMs and coerced inductions from my students. And keep in mind that my students are EXTREMELY well prepared! They have far lower intervention rates in every category because they are prepared to ask questions, and decline interventions if there is not a medical benefit. So you can imagine how much worse it would be for a first-time mom who has taken only a hospital “here are our policies” class.

So no, I am not a birth conspiracy-theorist… because even though I believe MOST providers would not directly defy their client’s refusal of a procedure, I know that some will. And you really never know for certain which category your provider truly falls under until game day. So you need to be knowledgeable, aware, and confident enough to ask a hell of a lot of questions.

Technically, in any area of medicine, no matter how big or small a procedure may be, a provider is supposed to obtain your informed consent – except in the case of an absolute dire emergency, or when a patient is non-responsive. Obstetrics does not get a pass from this little requirement, contrary to modern customs. This means that your provider should OFFER certain information about any proposed procedure (as opposed to only telling you after you have grilled them for 3-hours, good cop/bad cop style).

Unfortunately, in regards to birth, full benefit/risk information is very rarely freely offered in a real practice setting. So the only other alternative is for you to know what questions to ask.

I teach the easy-to-remember acronym BRAINS. As in “Use your BRAINS“

• B – Benefits – What are the benefits of doing this procedure? What are we trying to achieve? Why?
• R – Risks – What are the risks of doing this? What other accompanying interventions will come with this? What are the side effects?
• A – Alternatives – What are my other options? What are the benefits and risks of those?
• I – Intuition – What is your intuition telling you? Does this make sense? If no, research independently and ask more questions, or ask for a second, independent opinion.
• N – Nothing – What if we do nothing? What if we wait a while?
• S – ‘Scuse Me – As in, please give us a moment to discuss and decide. Unless it is an absolute emergency (which it rarely is), you should be able to take a few minutes to discuss and decide alone. You can image that it’s harder to make an honest decision if the doctor’s staring right at you, waiting for an answer.

Use your BRAINS.

How would this play out in real life, you may ask?

Nurse: “The doctor has ordered a little Pit to speed up your labor.”

You: [B - Benefits] “Why does he feel we need to speed up the labor? What would be the benefit of speeding it up?”

Nurse: “He just feels like it’s going too slowly, and your water has been broken for a while now.”

You: [R - Risks] “What are the risks of Pitocin?”

Nurse: “None.”

(Mandi: This is a lie. If anyone ever tells you there are no risks to doing something, call them on their BS. There are drawbacks to everything. Sometimes the benefits outweigh the drawbacks, so just because there is a drawback doesn’t mean you should automatically refuse. But you deserve [and have the legal right] to know the risks.)

You: [R - Risks - Seriously, I would like to know the risks.] “I have read that it can increase the odds of fetal distress, and can make labor much more painful, increasing the odds of an epidural.”

Nurse: “Oh, that. Yeah, most Pitocin moms get the epidural.”

You: [R... still! This is an important category!] “Since I would be more likely to get the epidural, what are the risks of that?”

Nurse: “Drop in blood pressure, increased chance of fetal malpositioning due to limited range of maternal motion, shaking, and increased chance of cesarean due to fetal distress/aforementioned malpositioning and inability to effectively push due to loss of muscle control.”

(Mandi: The nurse is never going to tell you this. But I could really turn this into a 12-hour string of [R] questions. So for the sake of my sanity, the nurse is just going to very clearly come out and tell you the risks. This is why it’s important to take a comprehensive childbirth class so you are already somewhat familiar with the risks of different interventions.)

You: [A - Alternatives] “What are the alternatives? I’ve heard walking is fabulous at speeding up labor if time is truly a concern.”

Nurse: “Walk? What is this walking of which you speak? We’ve never had a patient walk here. I would have to call a board meeting to see if that’s a possibility.”

You: [I - Intuition] “That sounds ridiculous. Women have been walking during labor since the dawn of time. My intuition is telling me it’s fine to walk. But I would love to get a second opinion on that.”

Nurse: “I’ll see what I can do about that.”

You: [N - Nothing] “Seeing as this isn’t an urgent situation, would there be any risk to NOT starting the Pitocin right now?”

Nurse: “Um, no, I guess there wouldn’t be any risk.”

You: [S - 'Scuse Me]: “Okay. Thank you so much for your help. We’d like to have a few minutes alone before deciding how to proceed.”

Easy -peasy? Not exactly, especially not in the midst of labor. But I can darn-well guarantee you it’s better than getting steamrolled into unnecessary interventions. And again, I’d like to clarify that sometimes these questions help you to conclude that an intervention IS the safest, smartest option for your particular birth. But every woman deserves to have this information so SHE can make the decision that is best for her and her baby.

Use your BRAINS.

Mandi
Peachy Keen Birth Services