I woke up on the morning of September 28, 1996 feeling as I had for the last several weeks, like I'd be pregnant forever and starving. Whenever I look back on that day a surreal and eerie feeling comes over me, knowing how oblivious I was to the events that were about to unfold. Not only was I going into labor that day, but I was going into a battle that had bittersweet consequences. A battle that I lost, but set me up to fight a war I intend on winning.
It all started because of my feet. I spent the later part of the morning and early afternoon at my mother in-law's house, taking walks and standing around talking and having fun. After one of her sons noticed how badly swollen my feet were, I was convinced to go have it check out, "just in case". My instincts told me it was no big deal, but I sold out my instincts to her experience (she was the mother of four after all) and felt insecure due to lack of my own.
At the hospital I saw a doctor who check my blood pressure, my urine, my swelling, and my weight, then deemed it, drum roll please, edema! After looking in my chart he ask would I like to have this baby today. I thought he was humoring me so I said that would be great! He said something like, "Let's check your progress" and so now I was laying flat on my back naked from the waist down because of swollen feet. I was 4cm (as I had been for a few weeks), 50% effaced, -2 station. I can't really tell you why I remember all of that, but I do. He asked if I wanted to be induced and because I'd just read in my trusty "What to Expect When Your Expecting" book that induction entailed drugs, I said no thanks. Then things got weird. For the first time in all my vaginal exams I felt pain. It wasn't super intense, just painful compared to all other vaginal exams and by far more uncomfortable. So just like that, my membranes were stripped. No informed consent, no permission to do so, he didn't even tell me what he'd done. I had to find that out later. Also, for the record, I wasn't "due" until October 5th.
My first contraction came very soon after that, in the parking lot actually. I remember dismissing it as a stronger Braxton Hicks, and pressed on in my quest to get my fifth meal of the day. It was about 6pm. As the early evening progressed, my contractions got stronger and closer, but I kept waiting for them to be unbearable. My naive mind kept telling me I have want to cry or scream before it's time to go to the hospital. Sadly, it wasn't until I actually got to the hospital that I felt that way, and not because of any physical pain.
I arrived at the hospital shortly after 11pm and was greeted by a nurse who I felt clearly did not like her job or women. She moved without a purpose, practically cleaning her nails while talking to me. Everything she said was either dripping with sarcasm, disdain, or both and I swear she was popping gum. After I checked in, got the gown on in the bathroom, she insisted the first thing I do before going to my labor room was pee in a cup. I actually took the cup in the bathroom and tried a few times but I simply had no pee. When I told her this she stared at me blankly and replied: "We can't really do anything until we check your urine". I looked her squarely in the eyes, grit my teeth through the contraction and asked her: "What the hell does that mean?" Her reply: "Ma'am, we need your urine." My contraction was stronger and longer than ever before so I closed my eyes and rode it out. When it was over, I didn't open my eyes right away. In my minds eye, I glimpsed what this must have looked like. Me standing in the bathroom, door half opened, in a stupid Kaiser hospital gown. Her standing arms folded with that indignant look in her eyes. It irritated me. I opened my eyes and said: "I have no pee, I peed earlier use that." Then I pushed my way passed her. Round one over.
I have to admit that short exchange between me and the nurse took a lot out of me. I was feeling anxious and intimidated that I pissed off one of the people who would be "delivering" my baby. I felt like I'd made an enemy. It wasn't until I got into the bed, and had my first cervical check that I felt some relief. I was 8cm dilated. Awesome news! Then the doctor told me he was breaking my water. I remember looking over at my ex-husband who quite frankly looked like a lost tourist in all of this, and asked the doctor if we had too. He looked at me with extreme annoyance and said: "Either I break your water or your going home". My jaw literally dropped and the harshness of his tone brought tears to my eyes. I looked at my ex-husband again for help and before I could reply he did it. He stuck that hook into my vagina, rather roughly I might add, and broke my water. Coming from a woman who grew up with domestic abuse in my family (my dad beating my mother), both parents on drugs, and surviving sexual abuse myself, I can safely say it was the single most humliating and terrifying thing I'd felt since my childhood. He didn't just break my water, he broke my spirit that day as well. Round two over.
Everything after that was blurry. I remember vomiting. I remember not wanting my ex-husband more than a foot, if that, away from me. I remember being asked if I wanted something for the pain, but I don't remember what I said. I know I didn't receive pain medication, but I just can't remember what I said. Then I remember being told it was time to push. I didn't believe them, because I'd read that women felt the urge to push when it was time. I had absolutely no urge to push, but I didn't want to argue. God knows what they would have done if I argued. An image of foreceps delivery came to mind. It scared the hell out of me. However, when the nurse said to push during the contraction, I got a bit of my spirit back. Surely she was joking, I thought. She wants me to push when it hurts the most. I stalled. One contraction went by, then another, and another. Still no urge to push. In all honesty I had no urge to birth anymore. I wanted to crawl into my own bed, pull the covers over my head and cry. I didn't do that though. I held my breath, chin to chest and pushed. Just like they told me to.
As I was pushing, I heard the doctor (A totally new doctor by the way. Somewhere during my haze I guess they must have changed shifts or some such thing!) say something about tearing. I don't know exactly what she said, but I blurted out: "I don't want to be cut". Very shortly after that, my friend who was present for the birth, said: "Do you know she is cutting you". I didn't know. All I knew is my bottom was on fire and I felt like not pushing but people were yelling at me to push. All my focus was on that. I heard what my friend said, and I wanted to scream, but I didn't. I pushed. Then at 2:14am, my baby was born. Less than four hours had passed but it felt like a lifetime. Round three over.
Josiah, my son, was loud and strong from the beginning, but at the time I didn't care. I had very little interest in him. I just wanted to go to sleep. I can remembered feeling exposed as she stitched me up. The tugging and pulling I felt as she did it made me sick to my stomach. I remember feeling like nothing but a piece of meat. When she was finished, I mumbled something like everyone has seem him, you can go home now. I am not even sure anyone heard me, but after that everything was a blur. I don't remember what my ex-husband said or when he left. Or his mother, who was there, or my friend. I don't remember transferring rooms. I don't remember how. I just remember being in the bed and having my my uterus pushed on and my pad checked. It hurt like hell and was again humiliating having someone pulling at your underwear to check your pad. I asked if I could do it, and the nurse said something like I heard you were trouble. I shut up and let her do it. She was so smug and her touch was rough. I felt scared and alone and wished they allowed husbands to stay overnight. Round four over.
I remember not wanting to nurse Josiah anymore like I'd planned too. I know that I loved him, but I just didn't have anything to give just right then. I laid there, with him beside me in that glass crib that they put babies in and at that moment I needed him near me. I picked him up and as stared at him. I didn't really know what to think, except that he looked like his father to me. The thought made me smile. The smile warmed my heart and then I cried. I didn't really know why I was crying. Was I happy or was I sad?
Later that evening, I made the mistake of allowing him to be circumcised. He wouldn't nurse after that. I thought, he knew I didn't want him earlier when I refused to nurse him and now I let them hurt him, so he no longer wants me. I cried again, but this time I knew why I was crying. After an hour of sheer heartbreak, I tried nursing him again, and after he got on with a very painful latch, I decided I wasn't going to be sad, because I didn't want people thinking I was weak and looking for pity. There are women in the world being beat by their husbands, raped, and I am not going to let myself be selfish enough to wallow in any grief over what happened to me.
Then, just like that, I had a hard time remembering what happened to me. Out loud I pondered: "What did happen?" I remember, deep inside, being afraid to ask why did it happen. That was the scary question. I buried it, let it go. Didn't think about it again. As time went on and I learned about other women and their birth trauma I vaguely remembered being unhappy with my birth. I thought, Boy was I being a brat. Women have had worst birth trauma's, unnecessary c-sections, terrible iatrogenic injuries and even death. I felt guilty for ever thinking I had a bad experience and so I buried it further. Not until sometime in September of 2004, about 5 hours after finding out I was pregnant again would I recall to memory what happened in the early morning of September 29th as if it was yesterday. It was as clear to me then, as it is to me now. I cried and cried alone in my bed and silently I vowed never again.
Saturday, April 10, 2010
Monday, March 29, 2010
Thursday, March 18, 2010
Want to have a healthy and safe birth? Try the 6 Healthy Birth Practices.
INTRODUCTION
1. LET LABOR BEGIN ON IT'S OWN
2. WALK, MOVE, AND CHANGE POSITIONS
3. HAVE CONTINUOUS SUPPORT
4. AVOID UNNECESSARY INTERVENTIONS
5. GET UPRIGHT AND FOLLOW URGES TO PUSH
6. KEEP YOUR BABY WITH YOU
1. LET LABOR BEGIN ON IT'S OWN
2. WALK, MOVE, AND CHANGE POSITIONS
3. HAVE CONTINUOUS SUPPORT
4. AVOID UNNECESSARY INTERVENTIONS
5. GET UPRIGHT AND FOLLOW URGES TO PUSH
6. KEEP YOUR BABY WITH YOU
Friday, March 12, 2010
Increase Womens Access to VBAC! Petition
Increase Womens Access to VBAC! Petition
I've signed this petition and urge all of you to do the same!
I've signed this petition and urge all of you to do the same!
Thursday, March 4, 2010
Informed Consent - The Myths Vs. Reality
When discussing maternity health care practices there is one phrase that will inevitably be mentioned and that is informed consent. The belief is that women should have informed consent before any procedure, intervention, or alternative action is taken by the provider before, during, or after labor and birth. This supposedly ensures that she is given the optimal chance at being involved in making choices regarding her health care, but does it really?
The Surgery Encyclopedia defines informed consent as: a legal document in all 50 states. It is an agreement for a proposed medical treatment or non-treatment, or for a proposed (emphasis mines) invasive procedure. It requires physicians to disclose the benefits, risks, and alternatives to the proposed treatment, non-treatment, or procedure. It is the method by which fully informed, rational persons may be involved in choices about their health care.
Let's examine the language and implications of that definition. On paper and at first glace, informed consent seems like the gold standard in allowing for participatory practice in maternity health care, but upon closer examination there are some limitations. Because informed consent begins with the caregiver proposing a certain course of action, it suggest that the caregiver has already decided that action is best. Yes, the practitioner may disclose information on not taking that particular action, or other alternatives, but is this enough to be considered participatory care? Let's look at an example of how informed consent may be given:
In that scenario many would argue that she was given informed consent and in the truest definition of the word, she was. The doctor proposed a course of action, told her the risks and benefits of that action and also discussed the option of not taking that action. He also presented another option (although the patient was already aware of the option and had already declined it) However, when we consider that scenario closely, it's then we can see the true limitations of informed consent. Did the doctor prescribe that particular course of action without bias? Since that action was the only alternative mentioned besides one the patient clearly did not want, I would be inclined to believe no, he did not. The bigger question is why weren't more alternative augmentations discussed? There are a host of different options that could have been presented but were not.
Having said all that, it has been clear to me for a long time that we need more than informed consent to really be participants in our maternity care. We need informed choices. As I learned from both my Doula studies and experiences, the act of informed choice is a process. It suggests that a dialogue is opened between the practitioner and patient. The communication is such that in certain situations the patient may face, multiple options are presented to the patient, with risks and benefits of each, in addition to the option (if possible) of doing nothing. The patient can then carefully weigh the pros and cons of all viable options, without pressure or bias from the practitioner, and then can give her informed consent. Informed choice invites the patient to truly become a participant in her care, and should always be the first step before obtaining informed consent. In this scenario the caregiver has engaged the patient and in doing so builds a positive atmosphere in the birthing room. No longer is the caregiver inviting the patient to "sign off" on a procedure or course of action the he deems necessary, but is "engaging in a dialogue to help the client take responsibility for her own choices."
In closing this post, I want to add that it is important for expectant mothers to know that there can be situations that are true emergencies. In these situations it goes without saying that discussions will have to be limited, if there is time for any at all. This is another reason why informed choices are so valuable, because the act of discussing choices and options should happen not just during labor, but throughout pregnancy at prenatal visits. The open dialogue and subsequent trust the practitioner fosters as result is invaluable in those instants of true emergencies. Not only does the doctor get to understand his patients wishes more deeply, but the patient in turn is able to trust the doctors expertise and opinions if an emergency should arise.
The Surgery Encyclopedia defines informed consent as: a legal document in all 50 states. It is an agreement for a proposed medical treatment or non-treatment, or for a proposed (emphasis mines) invasive procedure. It requires physicians to disclose the benefits, risks, and alternatives to the proposed treatment, non-treatment, or procedure. It is the method by which fully informed, rational persons may be involved in choices about their health care.
Let's examine the language and implications of that definition. On paper and at first glace, informed consent seems like the gold standard in allowing for participatory practice in maternity health care, but upon closer examination there are some limitations. Because informed consent begins with the caregiver proposing a certain course of action, it suggest that the caregiver has already decided that action is best. Yes, the practitioner may disclose information on not taking that particular action, or other alternatives, but is this enough to be considered participatory care? Let's look at an example of how informed consent may be given:
A first time mother arrives at the hospital, membranes still intact, having regular contractions at about 6-7minutes apart. She has already labored at home for more than 8 hours. During her cervical check, it is discovered that she is only about 3cm dilated. Her contractions are manageable to her, but she can't help but express disappointment that she isn't further along. She doesn't have a written birth plan, but wants to labor without pitocin or other forms of drug augmentation because of fear of what it might do to her labor. After an hour of laboring in bed on monitors, her labor begins to slow. Her contractions are spacing and getting weaker in strength. Although her baby is fine, and she is doing well, her doctor suggests (trying to honor her wishes to avoid pitocin) that her membranes are artificially ruptured. He goes on to tell her that because they rupture her membranes, they may have to monitor the baby more closely as labor is better tolerated by baby with membranes intact, and that there is a slight risk of infection and fever if she labors too long with her membranes ruptured. He tells her the benefit is that it may put her in a better labor pattern and make the contractions longer, closer together, and generally more efficient. He also tells her that her that she could wait a few hours and see what happens considering the baby is looking good, but that in his experience, once a labor stalls, it usually requires some action to get labor going again. He reminds her that, although he knows she doesn't want pitocin, it is still a viable option that usually yields the fastest results. After hearing all of this, the mother decides to have her water broken, and in 7 more hours goes on to delivery her baby vaginally. She did, however, require an epidural (which she was also trying to avoid), not only because of the intensity of the contractions after her water was broken, but because she wasn't allowed to labor outside of the bed. The lack of freedom of movement increased her perception of pain.
In that scenario many would argue that she was given informed consent and in the truest definition of the word, she was. The doctor proposed a course of action, told her the risks and benefits of that action and also discussed the option of not taking that action. He also presented another option (although the patient was already aware of the option and had already declined it) However, when we consider that scenario closely, it's then we can see the true limitations of informed consent. Did the doctor prescribe that particular course of action without bias? Since that action was the only alternative mentioned besides one the patient clearly did not want, I would be inclined to believe no, he did not. The bigger question is why weren't more alternative augmentations discussed? There are a host of different options that could have been presented but were not.
Having said all that, it has been clear to me for a long time that we need more than informed consent to really be participants in our maternity care. We need informed choices. As I learned from both my Doula studies and experiences, the act of informed choice is a process. It suggests that a dialogue is opened between the practitioner and patient. The communication is such that in certain situations the patient may face, multiple options are presented to the patient, with risks and benefits of each, in addition to the option (if possible) of doing nothing. The patient can then carefully weigh the pros and cons of all viable options, without pressure or bias from the practitioner, and then can give her informed consent. Informed choice invites the patient to truly become a participant in her care, and should always be the first step before obtaining informed consent. In this scenario the caregiver has engaged the patient and in doing so builds a positive atmosphere in the birthing room. No longer is the caregiver inviting the patient to "sign off" on a procedure or course of action the he deems necessary, but is "engaging in a dialogue to help the client take responsibility for her own choices."
In closing this post, I want to add that it is important for expectant mothers to know that there can be situations that are true emergencies. In these situations it goes without saying that discussions will have to be limited, if there is time for any at all. This is another reason why informed choices are so valuable, because the act of discussing choices and options should happen not just during labor, but throughout pregnancy at prenatal visits. The open dialogue and subsequent trust the practitioner fosters as result is invaluable in those instants of true emergencies. Not only does the doctor get to understand his patients wishes more deeply, but the patient in turn is able to trust the doctors expertise and opinions if an emergency should arise.
Monday, February 15, 2010
If you are happy with your choices, why does mine bother you so much?
I'm not usually one to go on a rant. Not that people who rant are doing this, but when I do I always feel like I am jumping to conclusions. Perhaps I over analyze things for fear of making assumptions. Having said that, I feel a rant brewing. I believe it's been cooking up from weeks of reading articles and then foolishly going through the dreaded comments section. Seriously, if you for some reason want to change positive energy to negative energy, read the comments section of any controversial story and that outta do trick!
My rant is about peoples choices. Yes, I write about choice a lot, because I, like the great Morpheus of the Matrix, believe everything begins with choice. Let's examine the word for a minute. Choice in it's most stripped down form, implies ownership, yet I don't think people always own their choices. They may think they do, but their actions, emotions, and words say otherwise. I believe when people don't own, or take responsibility for their choices, it's usually because they are not happy with them. When you are happy with your choices, you don't feel the need to defend them or explain them. Or my favorite, get defensive and hostile when a person makes a choice opposite yours.
Example #1. I chose a natural birth. I blog about my experience and my satisfaction with my choices. You, having chose a medicated birth, read my blog and immediately become defensive. You launch into explaining why you had the birth you did. You also accuse me of trying to make people who don't birth "naturally" feel bad.
So, not only are you seemingly unhappy with your choices, you are also not owning your feelings, by blaming me for how you feel about your choices.
Example #2. A story is written about the high induction rate, and how many of the inductions done are not medically indicated. The article talks about the risks of inductions, one being the cascade of interventions that can sometimes lead to unnecessary cesarean sections. Again a woman who chose an induction reads the article and feels attacked. She explains her baby was suspected to be too big at 39 weeks. She needed an induction. Later as the induction failed she found out her baby was in danger and she needed an emergency c-section (that took 2 hours to happen from the moment the doctor say c-section time, to the moment she was on the table). The baby is delivered and low and behold her baby was 8lbs and she is only 5'4! She is pissed that anyone would assume her induction and subsequent cesarean was unnecessary!
In that scenario, one might argue that the women really didn't have a choice, because she was not given true informed consent and while I can agree with that, I don't agree that she sees it that way. She is angry that her decision to have an induction is questioned, and so again I have to wonder how secure she is in her decision. Perhaps maybe she feels she didn't have all the facts. Perhaps she secretly wonders how necessary her cesarean section was, but if she allows herself to question the events, she questions her judgment and role in the events that took place. That is an admittedly hard thing to do.
There are other examples I could give, but I'll stop with those two. The bottom line is that when a person is happy and secure in the choices they've made, another person words or actions can not make them feel otherwise. If you've felt defensive, angry, or guilty about choices you've made, you have to explore why, instead of blaming others. Own your feelings and take ownership of your choices.
My rant is about peoples choices. Yes, I write about choice a lot, because I, like the great Morpheus of the Matrix, believe everything begins with choice. Let's examine the word for a minute. Choice in it's most stripped down form, implies ownership, yet I don't think people always own their choices. They may think they do, but their actions, emotions, and words say otherwise. I believe when people don't own, or take responsibility for their choices, it's usually because they are not happy with them. When you are happy with your choices, you don't feel the need to defend them or explain them. Or my favorite, get defensive and hostile when a person makes a choice opposite yours.
Example #1. I chose a natural birth. I blog about my experience and my satisfaction with my choices. You, having chose a medicated birth, read my blog and immediately become defensive. You launch into explaining why you had the birth you did. You also accuse me of trying to make people who don't birth "naturally" feel bad.
So, not only are you seemingly unhappy with your choices, you are also not owning your feelings, by blaming me for how you feel about your choices.
Example #2. A story is written about the high induction rate, and how many of the inductions done are not medically indicated. The article talks about the risks of inductions, one being the cascade of interventions that can sometimes lead to unnecessary cesarean sections. Again a woman who chose an induction reads the article and feels attacked. She explains her baby was suspected to be too big at 39 weeks. She needed an induction. Later as the induction failed she found out her baby was in danger and she needed an emergency c-section (that took 2 hours to happen from the moment the doctor say c-section time, to the moment she was on the table). The baby is delivered and low and behold her baby was 8lbs and she is only 5'4! She is pissed that anyone would assume her induction and subsequent cesarean was unnecessary!
In that scenario, one might argue that the women really didn't have a choice, because she was not given true informed consent and while I can agree with that, I don't agree that she sees it that way. She is angry that her decision to have an induction is questioned, and so again I have to wonder how secure she is in her decision. Perhaps maybe she feels she didn't have all the facts. Perhaps she secretly wonders how necessary her cesarean section was, but if she allows herself to question the events, she questions her judgment and role in the events that took place. That is an admittedly hard thing to do.
There are other examples I could give, but I'll stop with those two. The bottom line is that when a person is happy and secure in the choices they've made, another person words or actions can not make them feel otherwise. If you've felt defensive, angry, or guilty about choices you've made, you have to explore why, instead of blaming others. Own your feelings and take ownership of your choices.
Saturday, February 13, 2010
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