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.  

Samaritan Ministries is Going to Kill Someone - Part Two

In the first post in this series, I discussed the scary requirement that women who have ectopic pregnancies while on Samaritan Minstries health-care cost-sharing plan undergo "watchful waiting" and forego removal of the pregnancy until either the fallopian tube ruptures or the baby's heartbeat stops.   This is extremely dangerous for the mother because a ruptured fallopian tube can cause massive internal bleeding - and makes no difference in the outcome for the baby because the longest a pregnancy can survive in a fallopian tube before a rupture is 16 weeks which is two months prior to viability.

There are two other items in the "Maternity and Newborn Care" section of Samaritan Ministries that give me pause - and I need to give some background on how coverage works to explain my concerns.

Samaritan Ministries has two levels of cost-sharing coverage available.  The cheaper version is called "Samaritan Basic".  In return for a lower monthly cost-share amount, families have an inital deductible of $1,5000 for each medical issue that they need to cover (or have discounted by the doctor) before needs can be shared.  Once that basic benchmark is reached, 90% of the remaining cost is covered.  The older version is still available as "Samaritan Basic" and for ~$200 more a month, families receive a lower deductible of $300 a month and 100% of the remaining need is covered.

Here are the two sections that concern me:

Home Births—Home births have the $300 Samaritan Classic and $1,500 Samaritan Basic initial unshareable amount waived, and are not subject to prorating (see Section VI.D) because they reduce overall maternity costs.

After Cesarean—The $300/$1,500 initial unshareable amount is waived for a vaginal birth after cesarean (VBAC).

I have grave concerns about the morality of offering women a monetary reward in exchanged for increased risk during labor and delivery.

I believe that home births should be legal - but I also believe that women should be informed of the much higher rates of injury and death for both the infant and mother in the rare case that a condition or situation occurs where rapid, trained medical care is needed.  The vast majority of home births will end with a healthy baby and a healthy mother because statistically most births are uncomplicated.  The tricky bit is that there is no way to screen pregnant women perfectly to determine who will be able to deliver at home safely and who will have a delivery complication prior to delivery. 

 Within the CP/QF community, Jill (Duggar) Dilard and Jessa (Duggar) Seewald have attempted four home births - and ended up hospitalized after three of them.

Jill had her water break with Israel and was in labor for 48 hours at home before going to the hospital.  (Laboring for 48 hours after membranes have ruptured without medical care is a bad idea;  the longer the membranes have been ruptured the higher the risk of an infection beginning that could have bad outcomes for Israel.)  At the hospital, Jill and Derick were surprised to find out that Israel was in a breech position that could not be delivered vaginally.  Jill had an uncomplicated C-section with Israel.

Jessa's labor with Spurgeon was straightforward if extremely painful.  The baby was delivered without any problems, but Jessa lost a lot of blood when the placenta was being delivered.  Her blood loss was severe enough that she had to be transfered to a local hospital for treatment.  Thankfully, she didn't have any retained placenta pieces and the bleeding stopped easily.  Now, the Duggar spin is that the blood transfusion she received the next day was simply a precaution because she was really tired after birth - but blood transfusions are never a standard occurance after giving birth.   By comparison, I came into the hospital with poor blood volume due to HELLP syndrome when my son was born, bled fairly little during his C-section and never needed a transfusion.  Don't get me wrong; I felt like shit-warmed-over for the first week after his birth and needed wheelchair transportation if I was going farther than a few hundred feet - but Jessa Seewald was worse off than I was.

From my point of view, telling pregnant women that they should giving birth away from trained medical professionals, pain relief, antibiotics, blood transfusions, operating rooms and emergency support for their newborn to save money is absolutely sick.

There's a question I have as well - will Samaritan cover the entire medical cost of a home birth gone wrong without proration, deductibles or maximum?   As nasty as home birth side-effects can be for mothers, the side-effects for babies can be catastrophic.  When a baby is born after oxygen deprivation or meconium inhalation, the medical treatments add up fast: three days of full-body cooling with 1:1 or 2:1 nurse to baby supervison, oxygen support through a ventilator, CPAP, or ECMO, neurological testing, blood work, dealing with feeding issues... a baby can rack up $10,000-$50,000 in charges per day.  Don't forget:  Samaritan - unlike commerical health insurance or  Medicare  - doesn't cover durable medical equipment once the kid is discharged.  My son went home on a medical-grade monitor and oxygen from a concentrator.  Those are rented at $300 per month each.  That doesn't include the disposable items he needed like nasal cannulas, NG tubes, specialized tapes to stick both to his face.    Samaritan does cover 45 days of home nursing care - which won't last long a baby goes home on a ventilator. 

The second issue surrounds vaginal births after C-sections which is shortened to VBACs.   VBACs carry a higher risk of side-effects to both the mother and infant.  The most concerning issue is that the scar from the previous C-section will rupture.  To qualify for a VBAC, women need to have a scar that is entirely contained in the lower section of the uterus.  These type of scars have a 1% chance of rupture during a VBAC so women who want to attempt a VBAC need to do so in a hospital where the baby can be monitored and an emergency C-section can be done if a rupture occurs.  A uterine rupture carries a higher risk of postpartum bleeding leading to a transfusion or an emergency hysterectomy.  Very rarely, the baby suffers injury or death from oxygen deprivation between when the rupture occurs and when the baby can be delivered by C-section despite being in the hospital.

I would hate for a woman to feel compelled to try a VBAC for finanical reasons; that seems cruel to risk serious complications because a family badly needs money for other things. 

My largest concern is for women who decide to try a VBAC at home.   Having a VBAC in the hospital mitigates the risks of bleeding and rupture by having an operating room and mass blood tranfusion protocol immediately available if the baby shows signs of distress.   Havign a VBAC at home raises the risk factor exponentially.  First - not all women who have had a C-section are good candidates for a VBAC.  Because my son was born very early, I have a scar that reaches into the upper section of the uterus.  These types of scars have between a 6-12% chance of rupture during labor.  Spacing between babies is also important for VBAC candidates; a pregnancy conceived earlier than 18 months-2 years after a C-section more likely to have a uterine rupture because the scar didn't have time to fully heal before being stressed by the next pregnancies.  Since home birth attendants are almost never OB/GYNs or CNMs in the US, mothers who are being cared for by non-medical professionals prior to a home birth may not be screened appropriately.  Second - if a rupture or catastrophic bleeding occurs, precious time is wasted in transporting the mother to a hospital, getting her stabilized and starting a C-section.   This can directly lead to the death of the baby or the mother.