To Jill (Duggar) Dillard From One Mother to Another

Hi, Jill!

I think you've started to realize that you grew up in a cult.  IBLP and ATI taught you that adoption was extremely dangerous spiritually but you have spoken of being willing to adopt.  Those same teachings implied that men with beards and long hair were possessed by the devil but your husband has experimented with a variety of lengths of hair and beards.

You are learning that the world has more options available and that's a good thing.  I want to warn you, though.  Growing up in a high-demand religious movement like IBLP or ATI (or Vision Forum) puts you at higher risk for being pulled into other high demand groups.  My concern is that you are ensnared in the most risky form of natural childbirth (NCB) ideology that conflates an unmedicated home birth with being a good mother.

IBLP/ATI/Vision Forum promise people that following "Biblical" rules will lead to happiness, fulfillment, and a life free from pain or trauma.  Jill, you know that didn't work in your family.  The rules that were supposed to protect you and your siblings instead provided cover for your parents to abdicate their responsibility to seek help when Josh admitted to molesting you and Jessa.  The rules didn't stop Josh from molesting three other girls - and neither did your parents. Your parents were too invested in chasing the limelight of fame for having a lot of cute, well-behaved kids to act like parents.

NCB fits the same pattern.   Facing labor, delivery and raising a child is frightening.  Pregnancy and children take whatever illusions we have about control over our lives and dash them. You saw your mother's last two pregnancies end with Josie being born at 25 weeks and Jubilee's stillbirth which has to make the thought of starting a family more nerve-racking than normal.  Believe me; I get it.  I grew up in a family where my twin and I were born very prematurely and our middle brother died in infancy.   NCB offers a seductive lure; labor and delivery will be safe, painless, and empowering as long as women follow the right rules.  Women need to learn the right mental state by meeting with their midwives during pregnancy.  Labor coaches should be picked by their ability to support your goal of birthing at home.  By laboring without pain medication or medical support, women will realize their personal strength and feel empowered by the memory of a triumphant vaginal birth to a healthy baby.  Thanks to following these rules, the mother and baby will bond instantly, breastfeed perfectly, and everything will be great.

It's a nice dream - but is a dream worth the lives of your sons?

Israel's birth was a comedy of errors.  His water broke before you had contractions and you thought you saw meconium.  You chose to labor at home for the next 48 hours.  I wonder if you realize today how dangerous that choice was.

• Once the amniotic sac has broken, there is a risk of bacteria that normally colonize the vagina migrating into the uterus and causing a potentially life-threatening infection in Israel.  The longer the time the membrane has been ruptured, the higher the risk of infection.  Most doctors would want to be sure that Israel was tolerating labor well and that you weren't showing any signs of an infection before letting labor progress past 24 hours after the membranes broke.  
• On top of the risk of infection, meconium staining in amniotic fluid can be dangerous.  Meconium is the first bowel movement passed by an infant.  The danger with meconium is that a baby who is distressed before birth will instinctively gasp for air.  The gasps draw meconium down into their trachea.  When the baby is born, the meconium can obstruct the baby's breathing or go into the lungs leading to pneumonia or scarring.

After 48 hours, you went to a hospital with a labor and delivery department.  I hope that you told them the truth about how long your water had been broken and the fact you thought you saw meconium.  I hope that the reason they let you labor for another 24 hours was that Israel was doing fine on continuous monitoring and neither of you were showing signs of infection.   

Your shock when the OB/GYNs told you that Israel was breech was memorable.  You spent 70 hours in unproductive labor trying to birth a baby who was in a position that could not be delivered vaginally.   You agreed to a C-section and gave birth to a giant 9 pound 10 oz baby boy who was as healthy as a horse. 

There is a bit of irony in Israel's birth; trying for a home birth with a midwife increased the chances of him being born by C-section.  Some OB/GYNs are willing to try a procedure called an external version on breech babies.  Near the end of the third trimester, you'd get an ultrasound to check Israel's position.  If he was breech at 36-38 weeks, the doctor could give you an epidural and attempt to roll Israel from the breech position to a vertex position.  The advantage is that Israel would have been around 6 pounds 10 oz to 7 pounds 10 oz and more easy to wiggle into the right position.   Not all OB/GYNs do external versions - but the 13 OB/GYNs in the practice I went to did them if a woman wanted to and was a good candidate.   If an external version couldn't be done, at least you would have had time to plan mentally for a C-section and would have missed 70 hours of labor.

The reason Israel's birth was a comedy instead of a tragedy is because Israel was a strong, healthy baby before birth.  His placenta was working well and giving him enough oxygen between contractions that he could tolerate being cut off from oxygen during the contractions over the course of nearly three days.  Israel benefited from some good luck, too.  He didn't have any issues from meconium inhalation and didn't develop a massive infection during the long labor after his waters broke.

Perhaps you hoped your dream home-birth was merely being deferred until your next child.  But, Jill, even midwives admit that a home birth after C-section (HBAC) has a 383% HIGHER chance of stillbirth than a "normal" homebirth.  The stillbirth risk of a HBAC compared to a low-risk hospital birth is 1185% higher. 

Truthfully, I doubt you realized the risks you were taking - but you saw the outcome when something went very wrong during Samuel's birth.

I wondered a bit when I heard that Samuel had been born.   All that your family had stated was that you were in labor for 40 hours before having a C-section.  I've had several friends and family members who had successful and unsuccessful vaginal births after C-sections (VBACs) - but no one was allowed to labor more than 16 hours prior to vaginal delivery or C-section.   Maybe you found an OB/GYN with a very laid-back approach to VBACs - or maybe you tried a vaginal home birth after C-section (HBAC).

Alarm bells really started ringing, though, when I saw the picture of Derick holding Samuel.  Derick was wearing the standard hair-net and disposable sterile gown that support people get decked out in for a C-section.  Samuel was wearing a diaper, a nasal cannula, an IV in his right arm, three monitor leads, a blood pressure cuff on his right leg and an oxygen saturation lead on his left foot.   Samuel, in other words, was wearing the standard outfit of a NICU baby. 

The pictures released from the hospital look like two parents enjoying a new baby - but NICU parents know the signs.  I recognized the monitoring cords on Samuel trailing around Derick; Jack had the same ones.  Jack also had the little bit of reddened skin on each cheek after the stickers that hold the nasal cannula were removed for a bit.    Samuel and Jack shared a dislike of weaning off oxygen and having their little fingers take a bluish tint when they got tired during a wean. 

The picture of Jana cuddling Samuel was adorable - and brought back memories of schlepping Jack around the house with cords that weighed more than he did.    Honestly, I don't know how you managed a newborn on oxygen with a curious toddler in the house - but you guys managed somehow.

You have been blessed with two little boys who survived rough starts in life.  If you are blessed with another pregnancy, please do not risk your child's life and your own life by attempting a home birth after two C-sections!   Find a local obstetrician and let them decide if you are a candidate for a vaginal birth after two C-sections at a well-equipped hospital.  If the doctor recommends a repeat c-section, be grateful that we live in a time and place where the operation poses few risks to you or your child. 

A vaginal birth is not worth a child's life - or yours.