Cesarean Recovery

With the number of cesarean sections increasing in our country annually, many women do not really understand or know that recovering from a cesarean section is much different from a vaginal delivery. After my first cesarean section I learned this the hard way and wish I had a couple tips on making recovery more bearable.  But we often forget that the recovery after a cesarean birth is not just physical, but it is also emotional for a large portion of cesarean section mothers.

The different types of healing to be considered are in the hospital, long term, when you return home with your new baby, and also things you should be aware of such as when to call your health care provider post cesarean. (I also want to thank ICAN and their Recovering from a Cesarean White Paper in aiding to my post today)

While in the hospital :

• Get as much help as you can from family members, your partner, nurses, and other hospital staff. That is what they are there for and during the hours, and days immediately after your surgery, you will need it even if you do not want it.
• Stay hydrated and eat. You may not want to eat, but working on eating a well balanced and healthy diet, as well as staying hydrated (stay away from sugary drinks such as fruit juice and soda) will help to make you start to feel semi human again.
• If private rooms are available opt for one so someone (family member or friend) can stay with you to help you during this time.
• Use a pillow between your legs, and/or on your side to help sleep to be more comfortable. In the days, and even weeks following your cesarean it will not be easy to get comfortable. This is completely normal.  It took me almost a full 2 months to even get comfortable in my own bed at home after my second c-section.
• Take pain medication that is being offered if you are in pain. With my first child, I was breastfeeding and was overly concerned about any of the medications being transfused though my milk so I opted for over the counter pain medication such as motrin instead. But it certainly made my recovery longer, and made taking care of my son harder. (As ICAN recommends, ask your provider about a stool softener, as narcotic pain medication can cause constipation.)
• Get up and walk around.  It may hurt like hell, but it will help to get you back on your feet sooner rather than later. The longer you wait, the more painful it will get up, and the harder it will be.
• The use of a pillow to protect your stomach while coughing, standing up, nursing or moving around in bed is a smart idea.
• Do not hesitate to ask for a lactation consultant in the hospital. Breastfeeding after a cesarean section is more difficult not just for mom because of her incision, but also for baby. Check out the ICAN white paper on Breastfeeding After a Cesarean.

The first couple days in the hospital may feel like you are dying, I know because I have been there, but in most cases, you will only get better. When you get home, there are some more great tips for healing, although your housework may suffer for the first couple weeks, I am sure no one will mind too much.

When you get home :

• Focus on yourself, and your baby. You just had major surgery and your baby needs you.
• Have your partner help/do the household chores. Laundry, dishes, cooking, or anything else that needs to be done. Don’t worry, you can put off the dusting, cleaning the bathroom, mopping, and all the big chores for a couple weeks, your house won’t be mad at you!
• Do not lift anything that is heavier than your baby for at least 4-6 weeks. Those infant carriers/carseats are tempting to pick up, especially when going to an appointment for you or your baby, but stay away from it. You do not want to hurt yourself, or have an extended recovery.
• Ask others for help. If you have older children it may be helpful for your partner to take some time off from work, or have an available family member come over to help you. During the first weeks after my second cesarean section my toddler not only got the flu, but I was the only person he wanted making it difficult on me because I could not pick him up.
• Take it slow!  Get back into your normal household routine over a long period of time. You do not want to over do it because you will certainly pay for it later on.
• Have access to baby stuff such as diapers, bottles, burp cloths, wipes, or whatever you and your baby need for a couple hours in several places around the house. If your bed is the only place you are comfortable, make sure you can set yourself up to be able to hang out with baby, change diapers, and everything else you need right there.
• Co-Sleep!  Room in with your baby, so when it comes time for midnight feedings, you do not need to get up or go far to take care of your little one.
• If you have school age children, have others help to prepare their lunches, lay out clothes for the next day and anything else that needs to be done. To spend quality time, sit on the couch, or someplace comfortable and assist them with their home work, or read a book. Find ways to spend time other than anything that may put a physical strain on you.
• Considering hiring a post partum doula. They can really be heaven sent in a post cesarean situation!
• Don’t push yourself. If you want to take a shower and get dressed for the day, make that your only goal for the day.
• Pajamas are your best friend. They are comfortable, and help to remind others you are still recovering from major surgery.
• Remember how important it is to continue to remain well hydrated, and eating healthy.

Many do not think of the long term or emotional recovery of a cesarean section. I personally did not even encounter the emotional recovery until my cesarean baby was 3 months old. Be gentle on yourself, you aren’t the first to go through this, but many people around you may treat your feelings like nothing because cesarean sections have become so common. I can’t tell you how the phrase “a healthy baby is all that matters” feels to me still today.  Do not let others discount your feelings on your experience.

For your long term recovery…

• Contact your local ICAN (International Cesarean Awareness Network) chapter. These are women who have been there, and done that and know how you feel and what you are going through. They are an excellent support system internationally and are such a huge blessing for many mothers. I know they were to me!
• Write out a birth story, express your feelings on paper, or on a blog, get it out. Keeping your feelings inside may be harder in the long run.
• Keep your baby as close to you as possible for as long as you can.

If you experience any of the following symtoms or problems, you should contact your care provider immediately.

• Any type of bleeding from your incision.
• Leaking, redness, or any type of fluids coming from your incision.
• If your pain does not decrease over time.
• Symptoms of post partum depression such as anxiety, fear, problems sleeping, depression, or anything else you may equate with something more than just the baby blues.
• Cramping or pain in your arms or legs that will not go away.
• Continuous headaches, migraines, or backaches.

Over all, be gentle on yourself.
You just went through major surgery!

Loyally Devoted to Doctor

I recently read the book The Highly Sensitive Person by Elaine N Aron, Ph.D. In the chapter called Medics, Medication, and Highly Sensitive People, the author states:

“Keep in mind, too, that it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal. In the medical realm you hear these sorts of extra feelings when people describe their surgeon or women talk about the person who delivered their child, which is perfectly normal. The solution is simply to know why it happens and compensate for it appropriately.”

In the chapter about relationships, she talks about studies that were done that showed people are far more likely to fall in love under stressful circumstances. She applied this phenomenon to attachment in all relationships, not just romantic relationships. Later when I read the above statement in the medical chapter, so many things started to make sense to me.

Why do women love their maternity care provider, even when they may have done unnecessary procedures on them and not allowed them to make their own choices? Why do many providers use scare tactics? Why do women hold so adamantly to the belief that their provider “saved their life” or “saved their baby” or “was a great doctor” or “really took good care of me”, even when evidence to the contrary is right in front of them? Why do they fail to make important connections, such as that their c-section may have been one of the many unnecessary ones, or that there may not have been a true evidence based need for their induction? Why is childbirth treated like a major emergency with so much fear and anxiety around it? Why aren’t all women who give birth in this system severely traumatized from it, and instead defend and adore their doctors? The answer is simple: the culture of fear that surrounds childbirth actually endears women to their doctors. It cements the relationship between women, their doctors, and the hospitals their doctors practice at. It ensures that the women will keep coming back, and will recommend their providers to all their friends as they speak about them in glowing heroic terms. It is quite brilliant really, providers and hospitals have found the key to running a very successful business, and it has nothing to do with allowing women to make their own choices. They simply have to give the illusion prenatally that the woman can make her own choices for her birth, and then make sure that the actual experience of birth is one filled with fear, anxiety, and of course a healthy baby, and then the narcissistic provider will come out looking like roses to the woman who must endure the “horrors of childbirth”.

Of course, I am not really giving the doctors the benefit of the doubt here. They likely don’t know on a conscious level what they are really doing. They have been trained to act this way, by people who were also trained to act this way, and it is reinforced for them every time a woman profusely thanks her doctor for a job well done, and every time a woman tells her birth horror story where the good doctor makes an appearance as the hero who delivers her baby to her despite all the dangers that presented at the last minute. Both the woman and the doctor seem ignorant of the psychological effects that framing every average birth as a medical emergency creates.

In the statement above, the author states: “it is common to feel an attachment to anyone you have been with during an arousing experience, especially if it was a truly painful or emotionally significant ordeal.” This describes childbirth perfectly. The word “arousing” here is referring to sensory levels. That can mean physically, emotionally, sexually, or any other assault to the senses, good or bad, that can be had. We know childbirth can be described as “arousing” in many ways. It is also inherently “painful” and “emotionally significant”. Even when women use drugs, there is still some level of pain before she took them, and depending on what type of drugs she took, she may still experience pain while she is taking them. So really, all births fit this criteria. Births in a hospital, or at home, or in a birth center all have these same basic elements. It seems women are wired to form an attachment to the people who were with her and helped her through the event. This could be her partner, her doula, her midwife, her doctor, her nurse, or her friend or relative. I think this type of attachment likely had an evolutionary purpose at one time. It would be ideal to attach to an older, wiser woman who assisted with the delivery of babies who would have been there to care for the mom postpartum, and to slowly help her to bond and form an attachment to the baby. This wise woman would then help the mother learn to breastfeed and care for her new infant, while slowly pulling back her own attentions from the situation. This is what we have in homebirth midwives today. How would our ancestors have fared if a man had shown up in the tribe to deliver a baby, and then disappeared immediately afterward? The woman would be left adoring him, yet not having help from him to form an attachment to her infant. Never learning how to breastfeed or other infant care skills. What would have become of humanity? What is becoming of humanity?

Midwives and doulas seem to understand this phenomenon. Doulas usually visit a woman once or twice postpartum and are available if she needs to talk or has questions about the baby, breastfeeding, or the birth. Midwives start seeing a woman more and more as the birth approaches, and then once the baby is born, they start to taper off again, seeing her less and less until she is no longer needed at all. This is a much more natural and appropriate response to caring for a woman during such a pivotal transition in her life. What happens when women see doctors or CNM’s in hospitals though? They are likely seeing a practice, not a specific provider. They will likely not give birth with the same doctor or CNM they saw prenatally. They may never see the same doctor or CNM again after they give birth, or perhaps just once at the six week checkup. How does this affect women emotionally, or in her relationship with her baby, when instead of having a slow winding away from her provider, there is just an abrupt ending to the relationship? Does this interfere with breastfeeding, or affect feelings of trauma related to the birth, or feelings of depression related to her new role as mother? It is ingrained in our psyche to attach to these people who help us through such a major event in our life. How will the people we choose handle this responsibility? Are we choosing someone who will corrupt our experience and force an unnatural attachment to them by creating more anxiety around the experience? Are we choosing someone who will be there for us days, weeks, and months later to answer our questions about the baby or to offer us emotional support? Will the person we choose even be available for the birth, and will we ever see them again afterward?

Now I realize why other women feel the way they do about their provider. I did not attach to my provider, I was instead extremely traumatized by her actions. I still wonder why some women are traumatized, and others fall in love with their providers, given the same set of circumstances. I wonder if it is actually more natural, and thus common, to attach to a provider even when (or perhaps especially when) that provider creates an atmosphere of fear. It makes sense then why so few of us are speaking up about the system and the way women are treated. It makes sense that women are extremely loyal to their providers, even when many aspects of their births were disappointing or upsetting to them. It makes sense that many women are reluctant to accept that there is anything wrong with maternity care. It makes sense why the maternity care system is so hard to change and is met with so much resistance from every side.

What can birth activists do to help women form healthy attachments during this transitional time in her life? It may be tempting to try to convince all women to have a homebirth with a midwife since we know that they are probably the best option for healthy attachments and a healthy weaning away as well, however, if a woman has already formed a strong attachment to a certain provider, it may be more realistic to recommend having a doula. A doula will be there prenatally, for the birth, and postpartum, and therefore can provide much of the physical and emotional support that new moms need and deserve. Some moms may hire a doula, yet keep her same provider that she has formed an attachment to, and others may find that a doula is a stepping stone to having a homebirth the next time. One day I hope that maternity care shifts to being centered around the mother again, and not around the provider and his schedule or routine.

Violence in Maternity Care

The non-profit organization Solace for Mothers: Healing After Traumatic Childbirth is asking anyone who has experienced or has witnessed violent maternity care, to write a letter to Lynn Rosenthal, the presidential advisor on violence against women, and First Lady Michelle Obama.

Solace explains:

We invite you to join us in writing to Lynn Rosenthal and Michelle Obama in an effort to bring awareness to the violence women experience at the hands of some maternity care providers. First Lady Michelle Obama has made recent remarks championing the rights of childbearing women, and may be an ally for this cause. Lynn Rosenthal is a former executive director of the National Network to End Domestic Violence.

We are calling for an official review of perinatal practices to investigate common and flagrant violations of patients? rights; mainly the right to informed consent and refusal. We are asking that enhanced and enforced mechanisms for accountability follow the investigation.

What can be considered violent maternity care? Solace states,

The World Health Organization (WHO) defines violence in this way:

“the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation.”

Violence in maternity care is expressed in many different ways. There can be physical violence, such as forcing procedures which women have explicitly refused. There can be emotional violence, such as coercion, manipulation, or verbal abuse. There can be an exertion of power or force over women’s legal rights by individual health care providers and/or by hospital policies such as threatening to call child protective services if a woman does not agree to a procedure or threatening to withhold care in labor if a woman does not agree to the provider?s suggested intervention. ?Informed consent? refers to the legal right of all patients to have the risks, benefits and alternatives clearly explained prior to any procedure. All patients ? including laboring women - have the right to accept or refuse any suggested treatment. Withholding informed consent through the use of physical force, coercion or manipulation is an act of violence and is illegal.

Provider-perpetrated violence during childbirth can result in the birthing woman suffering traumatic stress, anxiety disorders such as posttraumatic stress, postpartum depression and other disabling mood disorders.

For more direction, please click here to visit the Solace for Mothers webpage about the campaign.

To read the letter sent to Lynn Rosenthal and First Lady Michell Obama from Solace for Mothers, Click Here.

Please write letters and spread the word to anyone who may have experienced or witnessed violent maternity care.

Danielle’s Birth Stories

I have been meaning to sit down and really write out my birth experiences from my two boys, so I figured this week, since we are focusing on birth stories, what a great time!

I will start with the pregnancy of my first child, Camden. When I got pregnant, I was not all that educated about natural birth in general. I had worked as a doula, but through a crappy agency which I separated from rather quickly. So when I found out I was pregnant, I figured seeing a female Obstetrician would be like seeing a midwife. WRONG!!!!!!! But, I was pleased with my provider for the most part. I was considered a “high risk” patient because of surgery which I had on my cervix in my teen years, so of course like so many other women, I blindly followed what my Doctor told me, because of course, Doctors are never wrong…. right?
As my pregnancy went on I started seeing another female Obstetrician in this practice I proceeded to dub “The Wicked Witch” she was mean, old, cold, and simply rushes me without ever answering any of my questions or concerns. Then it seemed as though, every time I would schedule an appointment with MY OB/GYN I would always end up seeing this other Doctor. It was driving me crazy! Same went for if I had to call the “on call” for the evening, something felt wrong or something was off, and this same Doctor would always insist I went to L&D and be checked. By the time my son was finally born, I am sure they were all glad they wouldn’t be seeing me again!
Then in early November, our family was struck by a tragedy. My husband’s brother died suddenly at the age of 23, which sent our whole family into a tail spin, this was 4 weeks before my due date. From that time on, I proceeded to get sick daily, sometimes several times a day, I started losing weight despite eating like I regularly did before. At my last visit at 39 weeks and change, the Wicked Witch expressed concern that I was losing weight (15 pounds by this point) and that we should go ahead and schedule an induction before it has an impact on my son. Of course like any mother would, I freaked out and agreed. I didn’t want to have something happen to him, and in a way, I was happy because I was uncomfortable like EVERY pregnant woman was in the end.
I went in that Tuesday to get induced. It was December 11th 2007, and we showed up at 6:00am, and they escorted us up to my L&D room, and looking back on it, I wish I knew what I was getting myself into.

My L&D Nurse came in for my little questionnaire/intake and when I said I did not have a desire for an epidural, she and the Wicked Witch OB laughed at me, and told me I would change my mind shortly. From then it just proceeded to get worse!? By 9:30 I was hooked up to pitocin, which in my opinion is PURE EVIL!? Like they had said, after 2 hours of pitocin, 3cm dialated, I was begging for an epidural. I got the epidural but it didn’t seem to do much for me. The OB came back around at noon time, checked me and said I made no progress. I was still at 3cm, -1 station, 80% effaced. Which was a total blow to me because I was hurting and I thought I would have progresses SOME! She told me she was going to go have lunch, see a couple patients and she would be back around 2pm.? My husband and my mother went to get something to eat, I tried to rest a little bit, and eventually she came back. At 2pm, there was again no progress. And this is when she said, well, I am going to come back at 3, and if there is no progress then we are going to have to book an OR. I knew then my worst nightmare was coming true. This cascade of interventions was directing me straight to a cesarean section. From the start of my pregnancy, when I was told about placenta previa (which corrected itself) via ultrasound, I cried at the thought of a cesarean.
She came back at 3pm, and there was no progress, or at least that is what she told me, and they started preping me for surgery. The OR was cold, and bright, and without my husband, it would have been even more terrifying.? In the back of my head I was happy I was about to meet my son, but I was scared to death.
He was born at 4:37pm screaming, 7pounds and 7oz. Which then one of the OB/GYN’s commented, someone of my size (petite frame and short stature) would have never been able to birth that baby. Ya ok!? My mother, my size, gave birth to an over 10 pound baby, HER FIRST CHILD!

My recovery sucked, and during that time, I reached out to ICAN and learned there was no chapter in my area. So, I started one.
In September 2008, we learned we were expecting our second child, and even before I got pregnant, I knew I never wanted to go through another cesarean, nor would I willingly go through it.
My pregnancy was? uneventful, NOT HIGH RISK, attended by amazing Midwives, and so much different from my first.
On May 16th, I was doing a baby fair at our local hospital for our ICAN chapter, talking with mothers all day, giving out information, and around noon time, I started to feel… off. Something just wasn’t right.? Thankfully for me, my Chiropractor was at the booth right next to me at the baby fair so I made my way to him and got adjusted. Once I got adjusted it all clicked. I was going into labor at a baby fair. Were we in a movie?

Next thing you know, the women doing the booth with me said I looked white as a ghost, like I was ready to pass out, so they made me have some water, and eat candy. Lovely combo, but it helped! I wrapped up the fair and headed home. I called my doula and let her know what was going on, but I wasn’t certain I was in labor yet.
I laid down when I got home and tried to take a nap, but I couldn’t get any rest at all. My contractions kept getting closer and stronger. It seemed as though my labor was progressing fast, and I wasn’t sure what real natural labor was like because of my induction the first time around. I called my doula back up and she decided to head on over, and off to the bath tub I went to relax and try to work through the contractions.? Back labor, all the pain was in my back, and later on I found out my little guy was posterior.? By the time my doula got to my house, and things really started to rock n roll, it was around 8pm.? I watched the season finale of Brothers & Sisters which I had DVR’ed, listened to music, and spent a ton of time on the birth ball. Hours seemed like minutes, and next thing I knew it was midnight and I called my midwife. I told her I had been laboring for a while, and things were getting more intense, contractions were about 90 seconds apart, and we still had a 45 minute drive to the hospital I picked, which was one of the most VBAC friendly in the area. So around 12:30am we headed off to the hospital in a 3 car caravan. Myself? laying in my doula’s backseat trying to sleep in torrential rain on the highway. My best friend in her car, and my husband in our car.? We arrived at the hospital between 1 and 1:30am.
We got all checked in, and my midwife greeted us, and gave me a little check. I was 2-3cm which made all of our jaws drop. My labor was so intense we all swore I would be further along!? I decided to get on my hands and knees with the birth ball for a while, then take a shower, I thought about getting in the tub, but it was nearing 4-5am and we all wanted sleep. I couldn’t rest for the life of me.
At this point I asked for an epidural so I could sleep. I knew no matter how much I planned that I would not have one, things change when you are in the actual situation.
I got the epidural around 6am.
I was able to sleep until at 8, when my midwife came back and checked me again 3cm at most.? What was going on?? Why was I not dialating? What was wrong with my body?? Contractions started to slow, then get back to being a minute apart, then slow, then get quicker. Something was just not right, and on top of it all, I am sure the epidural was not helping either.
Around noon time my midwife popped back in and checked my cervix one last time.

Still 3cm and now my cervix was starting to swell, and we were having complications.
I was devastated, my VBAC was crashing and burning in front of my eyes.
My body was defective, I could not birth my baby, my own plan had blown up in my face.
My epidural to sleep, selfishly kicked me right in the ass!

My Midwife consulted the on call OB/GYN who came in to talk to me, along with the Resident who was on call. They were both amazingly warm, friendly, and comforting, and at that point I knew that a cesarean would be how my son was born. But I was not as bothered by it this time around, because after nearly 26 hours of labor, something was wrong, seriously wrong. My mothers intuition turned on and my son was in trouble.

At 1:59pm Benjamin Emil Elwood was born, bruised and looked like he had been through a war! When they opened me up, he was jammed behind my pelvic bone, which his forehead was pressed up against it all that time. He wasn’t coming down, his head wasn’t applying pressure to my cervix for it to dialate. At that moment I knew I made the right choice consenting to the cesarean.? I knew in the long term, it helped my son, and that was simply the way he needed to be born. During the days after my midwife would come see me every morning, sit, chat, and just helped me get through it all. I still today, cannot write about this without crying because the scars from his birth are still fresh. Nearing 6 months old, the pain of the failure is not any lighter. It seems like it was yesterday.

The story I tell is a story of a completely unnecessary cesarean section with my first child, and a life saving cesarean with my second.
The story I tell is a story of pain, and hurt, and betrayal by the one person I trusted the most, my Doctor.
The story I tell is a story of hope for other mothers to learn and become educated from my words.
The story I tell is the story of my sons, the loves of my life, and the ones who have made me the mom, advocate, and woman I am today.

All in all, I am now the North East Regional Coordinator for ICAN, a chapter leader, and the head of a maternity care campaign in my state of Connecticut. My experiences, my children, and my battle has made me become so active that I have been honored to support other women who have been where I have, and I have helped others to prevent unnecessary cesareans.

I love what I do.
I love the birth community.
I love ICAN.
I love being a Birth Activist!

Does a Laboring Woman Have Any Rights?

I have been doing a lot of reading about the case of a woman who exercised her legal right to informed consent and refused a cesarean, and subsequently had her baby taken away because of it. This woman’s case hits very close to home for me. She labored in a way that was described as “combative,” “uncooperative,” “erratic,” “noncompliant,” “irrational” and “inappropriate.” I can imagine that the midwives who assisted in the delivery of my son would label the way I labored in much the same way. These terms are all very subjective, and I can imagine them being used for a patient that was vocal about refusing procedures they wanted her to comply with. The court records were vague on the next similarity, but it also seems that this woman was in an abusive environment. She even called the police from her hospital room. From everything I have read, it seems that they are using her accusations of abuse as proof that she was being irrational, and I have seen no description of what abuses occurred, as if the entire subject is too crazy a notion to spend any time on. I think if there was abuse, this is a pretty good explanation of her actions during labor. Another explanation is that she was previously treated for PTSD. A woman who has had PTSD in the past who enters a hostile environment, is in the vulnerable position that being in labor creates, is pressured and perhaps abused, will be triggered by all this and react - there is simply no way around that. When a person with PTSD is triggered, they go into panic mode which will insight the fight, flight or freeze mechanism. She obviously went to “fight”, since she could not flee or freeze at such a time. Instead of the people around her being understanding of her responses, a psych evaluation was done while she was in labor. Her past history of being treated for a mental illness was dug up, and a case was made that her and her husband (since he agreed with her), were not fit parents and the child was removed from their care.

There are several alarming factors in this case. It is legal for a woman in labor to refuse care. Every person has a legal right to informed consent and refusal. Informed consent means that the person will be given the risks, benefits and alternatives of a procedure. Informed consent includes the right to refuse care. But people always say, what if it is an emergency and the baby will die without treatment? The fetus is not legally a person, and therefore a pregnant woman has the legal right to make decisions for her own body, regardless of how those decisions affect the fetus. Furthermore, a parent of a living child has the right to choose or refuse medical treatments for their child. The only legal way that any person can be forced into medical care is if a court order is obtained that deems them incapable of making that decision. I am assuming that the psych evaluation during this woman’s labor was the first step in them trying to obtain a court order. This did not work however, because the first person to examine the woman deemed her mentally capable of refusing care. The second person to examine this woman was unable to complete his examination before her healthy baby was born.

I had no idea that it was legal to have a psych evaluation done while a woman is in labor. I am guessing that this is the only way to obtain a court order, but it seems that it should only be allowable for that purpose. It is unclear to me whether or not these evaluations had any bearing on the decision to remove her child. I find it very unsettling that a woman’s mental health can be evaluated for any purpose while in labor since women enter a different state of mind in order to accomplish the monumental task of giving birth. Is this natural alternate state of being understood by the evaluators? Do they realize that what they are seeing is not mental illness but just a woman in “labor land”? Are they able to decipher the natural affects of being in labor from true mental illness? It seems that any findings from a woman in labor would be in question, so the fact that this was even done with seemingly no understanding that they may not get accurate results is just extremely alarming.

Many people are quick to point out that the c-section refusal was not the final reason given for the removal of her child, but it was her mental illness and her and her husbands unwillingness to work with the system in having their child returned to them. As for her mental illness, she had been treated in the past for PTSD. She had completed her treatment. Many women have a history of being treated for a mental illness. If a woman has ever been to therapy, chances are there is a diagnosis of some kind in her records somewhere. Many women have been on medication at one time or another. Lots of women have been treated for postpartum mood disorders. Will these things now be held against us when we have children? Is it legal to remove a child from a home just because a woman has been treated for a mental illness in the past and they feel that she is therefore at greater risk of abusing or neglecting her child? The irony is that the very system who caused my PTSD can now remove any future children I have because of it? And this is all perfectly legal in this country? As for their unwillingness to work with the system, I can understand that. In those first weeks after being traumatized and devastated, and seeing things through this lens of overwhelming emotions, I am not too sure that they would be capable at that point of seeing the benefits of cooperating with the people who just did this to them.

So, does a laboring woman have any rights? Do the laws of informed consent and refusal apply to her? Why is it that a woman is stripped of all her legal and civil rights during the window of time that she is giving birth, yet she has personal and parental rights at any other time in her life? The laws of informed consent are on the books, but they can’t be upheld legally. If she is violated and damaged, she can not sue for compensation simply because no lawyers will take a case like that. I was just told last week by a lawyer that I had no legal right to refuse any unwanted physical contact or medical procedure during my labor since I had signed a blanket consent form upon arriving to the hospital. Apparently, according to him, a woman can scream “no” and “stop” all she wants to, but she has no legal rights do so, since once she signs that consent form she is allowing the hospital and it’s staff to do whatever they deem necessary from that point on. I disagreed with him, but he holds the beliefs and opinions of most of the lawyers and judges and health care providers in this country. In order for a woman to have any rights, it has to be able to be upheld legally in court. Otherwise, it is just a useless law written in a book somewhere and has no power or bearing on women’s lives. Therefore, I would say that no, women have no legal rights while in labor or giving birth. I think this is the singular problem with our maternity care system. If a woman has no legal rights to refusal in an emergency, then everything becomes an emergency, and she suddenly has no legal rights over anything that happens to her from vaginal exams, to IV’s, to fetal monitoring, to episiotomies and c-sections. In order to change the system, women must be granted their legal rights. Education can only go so far. We can all be highly educated victims, or we can change the system and insist that we have a right to informed consent and refusal in maternity care.

NHS YouTube Video Campaign Teaches Teens that Birth is Humiliating

The Leicester NHS Trust posted an anti-teen pregnancy campaign video on YouTube aimed at teaching school-age girls and young women that sex (or unprotected sex) should be avoided because it can result in pregnancy, which will end with birth, which is excruciating, humiliating and shameful.

From The Sun on May 15, 2009:

The video appears to have been filmed with a mobile phone camera to give an air of authenticity and had more than 1,000 hits before it was removed.

At first it looks like another sad example of happy-slapping featuring a gang of secondary school pupils crowding round in a school playground.

Excited children are seen running towards a crowd with youngsters egging on what seems to be a fight.

A girl in the centre is seen screaming while another has blood on her cheeks.

But as the camera moves in closer one of the teenagers can be seen on the ground in the middle of labour.

In explicit detail it shows the girl giving birth and the baby being delivered by a fellow pupil as other students yell and jeer at her.

The footage was intended as a shock tactic to highlight rocketing teen pregnancies by harnessing the publicity power of the internet.

But Leicester NHS did not anticipate YouTube?s stringent content rules and today their clip was replaced after less than a day online with a message saying ?This video has been removed due to terms of use violation?.

Renee of Womanist Musings has the video linked in her post ?Naughty Girls Give Birth in Public in Great Britain.? Please visit her site to view the video which is no longer available on YouTube and read the rest of her sociological analysis of the video, some of which is excerpted below:

This little video teaches young girls that should they engage in sexual activity, the punishment for their behaviour is a painful labour. It is very reminiscent of the punishment assigned Eve for giving Adam the apple in the garden of Eden. The father is quite typically absent from this scenario mirroring the privileging of masculinity in our social discourse. It is women that are constructed as ?controlling? sex and therefore the abandonment of men of their parental obligations is rarely a subject that receives much discussion. Note that this ad is supposed to serve as a warning against teenage sex and yet it is aimed solely at girls as though she became pregnant by herself.

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This advertisement teaches young girls that pregnancy is a punishment rather than a natural outcome of sex, this further supporting the idea that unless conception occurs inside the patriarchal family it is a sign of lasciviousness whereas; a man is not stigmatized for participating in pre marital sex. Though this ad is projected to teach kids to act responsibly when it comes to sex, it comes across as highly sexist in its determination to make women responsible and produce fear about a natural biological process.

From a birth activist perspective, this campaign?s premise is extremely troubling. Many women experience psychologically and emotionally traumatic births for reasons such as inadequate emotional support, a fearful birth space, a birth space full of strangers or care providers who resort to humiliation or bullying to gain compliance. In other words, the feelings that some women experience in a hospital would mimic the presumed feelings of this teenager giving birth while taunted by schoolmates.

The goal of this video was clearly to show birth as a humiliating, painful and scary consequence to bad behavior, which is one of the reasons that Catherine Skol is suing obstetrician Scott Pierce. Pierce allegedly told a nurse that Skol deserved to feel pain for not calling before coming to the hospital and that sometimes ?pain is the best teacher.?

So where will teenagers see positive birth videos? Unfortunately, they will not see them on YouTube, which routinely censors or removes birth videos or requires that viewers be 18 years of age. One of the many negative consequences of moving birth from a home model to an industrialized hospital model in the last 70 years is that birth is that the birth process has become unfamiliar to most people. This goes for all mammalian births?how many of our parents or grandparents moved away from rural areas where they regularly saw animals give birth?

Internet birth activism and flooding social media outlets with positive and realistic images of normal birth have never been more relevant or necessary.

Solace for Mothers Launches New Friends and Advocates Discussion Board

We are pleased to announce the Solace for Mothers Friends and Advocates Online Community which provides a forum for those who support mothers who have experienced birth trauma, have been impacted by witnessing birth trauma, or want to connect with others to advocate for gentler birth practices.

Solace for Mothers is committed to providing resources and support to professionals and loved ones supporting women through the difficult emotions following a disappointing, hurtful, or violating birth experience. Spouses, family, and friends of mothers who have experienced traumatic births are offered a space to find information, support, and resources through participation in the Friends and Advocates Forum. Birth attendants are also provided with the opportunity to process their own emotions in response to births they have attended. Birth professionals and birth advocates are provided a space to discuss the causes of birth trauma, how policies and programs can be enacted to prevent trauma from occurring to childbearing mothers, and methods of treatment when trauma has occurred.

The Solace for Mothers Friends and Advocates Online Community welcomes birth activists, mothers, families, and professionals, all of whom are stakeholders in providing healthy, safe, and empowering births that enable families to successfully transition to parenthood. Users of the online community are invited to contemplate and discuss the current state of birth and what evidence based practices best support childbearing women, their babies and families. Advocates who are interested in becoming involved in organized efforts to promote these practices are encouraged to participate and share their thoughts.

The Friends and Advocates Online Community can be entered from www.solaceformothers.org/advocates-forum.html. The forum is made public for browsing and registration is required to post and respond to topics. To view the online community, go to: http://forums.solaceformothers.org/mb/birthtrauma

Mothers are welcome to participate in the Friends and Advocates role but they are invited to register and participate in the Online Community for Healing Birth Trauma (www.solaceformothers.org/forum.html) which provides peer support to women who have had traumatic childbearing experiences. Birth professionals, family members, and friends please respect the privacy of the Community for Healing Birth Trauma and register only for the Friends and Advocates Community.

If you have something to say regarding childbirth and want to be a part of a larger conversation, please join us. We are interested to read your stories, thoughts, hopes and goals for the future! Please also feel free to pass this invitation on to organizations and individuals who would be interested in the topics of birth trauma and improving maternity care.

Warmly,

Sharon Storton, Founder of Solace for Mothers, Inc.
Jenne Alderks, Creator and Moderator of Online Communities
Jennifer Zimmerman, Creator and Moderator of Online Communities

A Lawsuit is Filed Over Abuse During Birth

Catherine Skol, a former police officer, gave birth to her fifth child nine months ago.? She was treated in an abusive manner by the doctor on call and has filed a civil suit against him.? You can read about her story and the lawsuit she has filed here, here, and here.

Catherine Skol was the victim of abuse and harsh mistreatment.? Unfortunately others have also endured this type of treatment when giving birth.? Her case is particularly horrific, and I am sure she is suffering from the effects of this trauma in her life.? I personally am thrilled that she has brought a lawsuit in order to try to bring this doctor to justice.

The fact that Catherine Skol secured a lawyer and was able to actually sue her abusive doctor is perplexing.? I have heard many stories of trauma over the last few years, and there are many other women who have had similar experiences.? I have only ever heard of one other woman being able to bring a legal case over this type of treatment at a birth, and there were unique extenuating circumstances that made retaining a lawyer and getting a settlement possible for her.? I have never heard of any other woman being able to get a lawyer to even talk with them about a birth experience where they were abused or mistreated.? As an example, I myself called several lawyers about my birth experience and was unable to even get past the receptionist.? This is quite common, no matter the severity of the experience, if there are no physical damages it is pretty much unheard of that you will be able to retain a lawyer to file a suit.

I speculate that there are three reasons that Catherine Skol was able to retain a lawyer and file a civil suit.? First and foremost, she is a former police officer.? If there is one job where people (particularly men) will take what you say seriously, it is probably this one.? People would feel that surely a police officer wouldn?t be lying, or blowing things out of proportion, or not have been tough enough to handle the situation.? They would reason that surely a police officer deserves to be listened to.? Second, she was a seasoned mother and this was her fifth baby.? I?m sure it was thought that of course she knew what to expect, and how things should go, and was able to decipher that things were not going as they should because she had been through this experience four times already.? Third, she was denied pain medication.? There is a difference between not wanting pain medications or other standard treatments and being mistreated for your choices, and wanting pain medication or other standard treatments and not being allowed to have them.? I think either situation can induce trauma for a woman, but a lawyer would be much more sympathetic to a woman who wanted the standard pain medications and was denied it.? Both acts can be a form of mistreatment or abuse, but being denied what is considered to be standard medical care in that situation garners much more sympathy from most people.

No matter how Catherine Skol was able to retain a lawyer, I feel that this is an important case that could possibly set a precedence for other women who are abused while giving birth.? If Catherine Skol wins her case, women who have had similar experiences would then have a leg to stand on legally.? There would be a case they could show a potential lawyer in order to persuade him to take their case.? I am glad that she has gone public with this case so that providers and institutions as well as other women who have been mistreated are made aware of it.

I have read of some people expressing concern over why this woman would sue.? Many are very concerned about lawsuits being brought up in any form concerning maternity care.? Some say that lawsuits have caused the current atmosphere in the maternity ward, and how can more lawsuits possibly help the situation?? What will Catherine Skol, or women like her gain from a lawsuit?

There are a few things that can be gained from lawsuits of this type.? First, there are monetary damages.? Being traumatized is quite expensive.? Severe trauma may take years of various types of treatment to overcome.? Many people are not adequately covered by health insurance when it comes to mental health treatment.? Most people are either not covered or their coverage is limited in some way.? This means there will be extensive out of pocket expenses for months or years, which can add up to thousands of dollars.? Second, when a person is mistreated, in order to protect others from the same type of mistreatment, that person will desire to take some type of action.? They will also be looking for some type of closure for themselves.? In the hospital system that fears litigation, there is no room for debriefing sessions with staff members or providers who participated in the event, and there can never be an apology or an admittance of making a mistake.? Some women will never have the opportunity to see their providers again, and others will see them once at six weeks postpartum, but will generally not be given the time they need to even begin to process the experience with their providers.? This situation is bad for both the women and the providers.? If this scenario was possible, the woman could possibly gain some kind of healing knowing she has made her grievances known and that she has been heard, and a provider could possibly gain some understanding and compassion, and use the situation as a learning experience.? If there were adequate health care coverage in this country, and not such fear of litigation that provisions were made to allow a patient?s grievances to be heard and acknowledged, then there would be no reason to sue.? Since women who have been mistreated during their birth experiences do not have that, then they must sue to be heard by the provider, and to gain monetary damages.

The other reason it is important to file a lawsuit over abusive treatment is to try to change the type of maternity care that women routinely receive.? If it is possible for a care provider to be sued over this type of treatment, then care providers will begin to take notice when women complain over it.? It gives women power to be given the opportunity to voice their grievances, and since this is the working system in the country to do so, it is high time that women were able to use this system in this regard.? Not being able to even get a lawyer to consult with on a case like this leaves women damaged and powerless.? Powerless to get compensation for her own suffering, and powerless to prevent it from happening to anyone else.

Thank you Catherine Skol for having the courage to take advantage of your unique position and filing a precedent setting civil suit.? I hope you pave the way for women after you to also have the power to file a lawsuit, and I know that your even filing one has made a difference to this doctor and other care providers who have undoubtedly read about the case.

The Effects of Birth Trauma on Breastfeeding

Here is a recent article on new research from Cheryl Beck on the effects of birth trauma and breastfeeding. The article is entitled “Study shows birth trauma can impact new mothers’ ability to breastfeed”.

Highlights from the article include:

For some, the trauma propels them into persevering in breastfeeding to prove their “success” as a mother and perhaps to make up to their infant for the difficult birth.

Yet for others, birth trauma sets in motion a chain of events “intrusive flashbacks, detachment from their child, and physical pain” that can curtail their attempts to breastfeed.

Beck concludes that intensive one-on-one support for traumatized mothers may be necessary to help them establish breastfeeding. Sensitivity and awareness by medical professionals of the traumatized mother’s needs may also be helpful.

During the postpartum period, it is suggested that healthcare providers be attentive to the symptoms that may indicate a new mother is traumatized, such as being withdrawn, having a dazed look, or suffering temporary amnesia.

See the linked article above for more information.

Birth Vernacular

The language we use gives an impression of our knowledge on a given subject. Certain subcultures often use words that have special meaning only to them. The best example is local dialects. Here in Minnesota, we call soda, “pop”. We say things like “uffdah” and “ish”, which I am told most of the country is not privy to the meanings of. It is like this amongst the natural childbirth community as well. We are a subculture, and we use words amongst ourselves that have meaning only to us, or that mean something different to us then they do to others.

When this happens within subcultures, one can forget that the majority of people don’t use those words, or don’t use them in the same way. In extreme cases, it can even be difficult to communicate with people outside of your subculture about your subculture. A good example of this would be trying to explain the Star Trek universe to a non-Trekkie. Whether you are a Trekkie or not, I think you’ll know what I mean. Birth advocates must be mindful of this when representing their stand to the mainstream culture.

Certain words originate in a subculture and make their way into the mainstream culture, usually because there is no other term for it otherwise. A word that originates this way (among other ways) is called a “neologism”. If a word or phrase is going to originate from the natural birth community, ideally it should be clear and obvious and should not have any other meanings attached to it.

There are also words that have been shunned by certain subcultures, and replacements have been invented. In the natural birth community we could site “yoni” as an example of this phenomenon. These words are used as advocacy tools themselves. “Yoni” is used in place of “vagina” because that word’s origin was deemed unacceptable by some. Using these words with the general public usually wont have the intended effect. They can make the speaker seem uneducated or folksy. The audience usually will not understand the intended lesson meant for them.

Am I saying that we should abandoned our vernacular? No, not at all. It brings people together as a community when they share a language, or a dialect. We can use these terms amongst ourselves all we want. We do need to be careful, though, when we are facing the mainstream culture and taking our message of birth advocacy to them. We don’t want any confusion. We want to be clear about what we mean and what we say and how we say it.

With that in mind, lets examine some of the words or phrases that are used within the natural birth community. Some of these words or phrases are used in the mainstream culture as well, but the natural birth community uses them differently.

Let’s start at the beginning:

Birth

Birth is straightforward enough, right? You would think, however, we use this word differently then the mainstream culture, and notably incorrect. We say “my birth” or “your birth” as in “my birth was fast” or “its your birth”. We have to remember that mainstream culture doesn’t often talk this way. Also, it is incorrect english. In the examples above, what you are really referring to is when you yourself were born, not when you gave birth. The mainstream culture would say, “my labor was fast” or “when I gave birth, it went really fast”. This is a distinct difference and one that can cause some confusion if we forget who we are talking to.

Natural Childbirth

This was a term that was created in retrospect, which is called a retronym. Examples of retronyms are “acoustic guitar”, “snail mail”, or “cloth diaper”. After analgesics started to be used in most childbirths in this country, the term “natural childbirth” was coined to refer to drug-free births. Sadly, after using this term exclusively to mean “drug-free childbirth” for decades, the natural childbirth community seems to be loosing their descriptive term. The mainstream culture now terms any non-cesarean birth as a “natural birth”. Apparently, they can’t get the words “vaginal birth” out of their mouths or typed across their computer screens, so they had to steal a term that already had a well established meaning in both the natural childbirth community and in mainstream culture. As a birth advocate, if you use the term “natural childbirth” now, you run the risk of not being clear enough. The term “drug-free” may start to replace it as time goes on. If so, the good thing about this change is that women who had interventions will not feel the implication that their births were “unnatural”.

Birth Trauma

Within the natural childbirth community, “birth trauma” often refers to the emotional trauma that some women may suffer after a challenging birth. The hard part about using “birth trauma” to describe emotional suffering from childbirth, is that the term was already quite common in mainstream culture to describe a physically traumatic childbirth that results in injury, usually to the baby. For example, chiropractors often use the term “birth trauma” when talking about babies that need chiropractic adjustments after a difficult birth. The term “birth trauma” alone can therefore be confusing to anyone who has not heard it applied to the emotional trauma after a difficult birth. I often wish this term could be clarified by tacking on the word “emotional” to the front of it, because I don’t think it is specific enough to be understood by all.

Birth rape

Birth rape is a term that has been embraced by an even smaller sector of the natural childbirth community. Some women who have experienced birth trauma, of the emotional sort, have elected to refer to their experience as a “birth rape”. A birth rape is a very specific type of birth trauma. This word falls into the category of a word used as an advocacy tool itself. Whether the word has the intended effect is debatable, but it does describe something that no other word does. It describes being mistreated or abused while giving birth, whereas “birth trauma” can also happen from a painful birth, a physically difficult birth, or a birth that triggers a past trauma. I personally wish there was a gentler term that had the same meaning, as this can be a bit abrasive to the mainstream culture who has never heard it before, yet “birth trauma” does not feel specific enough when one was abused while giving birth.

Childbirth Education

This term is straight forward enough, and carries meaning in the mainstream culture as well as the natural childbirth community. However, the natural childbirth community uses nuances of the word “education” to mean different things. In other words, there is education and there is “education”. I see the term as having three meanings. Mainstream culture would likely tell you that childbirth education is hospital-sponsored childbirth classes that teach women and their partners about what to expect during labor and birth and during their stay in the hospital. Then there are natural birth advocates who will tell you that “educating” yourself means learning about childbirth from multiple sources; mainly books, videos, and private (non-hospital based) childbirth classes. This type of education is really referring to “preparedness” which includes preparing physically, mentally, and emotionally for labor and birth. Then there is the last type of “education” and that refers to learning about the selected provider, hospital or birth center, and medical interventions and procedures. This would include learning the ins and outs of the hospital system and how to navigate it, learning the intervention rates for a given provider or facility, and making choices of what you personally want based on the things you have learned, and then in turn teach your support team how to advocate for your choices. All three of these types are often referred to by the natural childbirth community as “education”, but the first type is all the mainstream culture registers when the term “education” is used. I wish we had three different commonly used terms for the things I mentioned above, such as “childbirth education”, “childbirth preparation” and, hmm that last one is hard…”maternity care preparation”? “Maternity care education”?

This is just a sampling of some of the words that I thought of that would make good examples. I am sure there are many more. Whatever words we use, we want to avoid confusion and clarify our meaning when needed. It is good to always keep in mind that the mainstream culture doesn’t always understand the natural childbirth community’s lingo. In some cases, certain words may sound shocking, silly, or unclear to them. If we receive this type of reception to the words we use, it will get us nowhere. We want our words to have meaning, carry our message, and be understood and well received. Thinking before we speak and choosing our words carefully is always good practice in any case. Remembering that we are not always speaking to people within our subculture may help us to become more effective birth advocates.