Reducing Anxiety in Early Pregnancy

With home pregnancy tests, many women now find out they are pregnant much sooner than ever before. This can be good because the mother can start preparing herself for a new baby; she can start eating healthy, taking her prenatal vitamin, making sure she is getting enough folic acid, and she can quit smoking or drinking or taking any medications that would not be acceptable in pregnancy. This can also have it’s downside however, as now women get to obsess and worry and be anxious about their pregnancy during the very early weeks when the likelihood of miscarriage is much higher. How can women reduce the stress and anxiety of early pregnancy?

First, take some time to plan when you will tell people and what you will tell them, and make sure that you and your partner are on the same page. You will need to think about when you will share the news of the pregnancy. Some women like to share the news right away, others like to wait until they are in the second trimester, or have heard the heartbeat, or have had an ultrasound. This is an individual choice and one you might want to give some thought to before deciding. You also may want to think about if you will tell people the exact due date of your pregnancy, and the exact week you are on. Now is the time to think about how you may feel in later pregnancy and if you really want the pressure of many excited friends and family members weighing on your mind - and on your phone, and your email, and your front door - when you are inevitably a few days (or more) past your due date. Some women choose to give a due month or a due time period instead of a due date. If you choose to go this route, you will also need to give out your month of pregnancy and not your week, otherwise people can easily calculate the week of your due date. You might also want to consider whether you will be sharing the names you are thinking of for your baby, and if you choose to find out, whether the baby is a boy or a girl. What you choose to share is up to you and there is no right or wrong choice. It is worth giving a little thought to though before you announce your pregnancy.

The next thing you may want to consider is when you will go to your first prenatal visit and what you will have done there. The latest trend in prenatal care seems to be getting women in as early as possible and giving them one or more ultrasounds in very early pregnancy to determine their dates. It is important to know your dates so that if you go into labor early you will know if the baby is premature and needs special treatment, or if you go past 42 weeks you may need to have special monitoring to assess whether the baby is still doing well enough to continue with your pregnancy. However, there are more ways to date a pregnancy than an ultrasound. If you know the first day of your last period, or if you know the date you ovulated or conceived, then these dates will be sufficient in determining gestational age. As your pregnancy progresses your care provider will also measure fundal height and this will confirm your dates. There is also generally a routine ultrasound offered around 20 weeks to check for birth defects. So, when you combine the first day of your last period or the date of conception along with your fundal height measurements along with the measurements of the 20 week scan if you choose to get this, your care provider should then have a pretty good idea of what the gestational age is. Therefore, you may choose to forgo any early dating ultrasound unless you have some medical indication for one.

It can be exciting to see your baby on ultrasound, but you may want to consider a few things before having very early ultrasounds done. Though I feel ultrasounds are relatively safe, some people worry about the number or duration of them. Having many ultrasounds in early pregnancy when the fetus is still developing isn’t proven to cause any harm, but some women still feel that they may not be entirely safe and choose to avoid them. Some women choose to get just one or two ultrasounds throughout their pregnancy. Other women only get an ultrasound if there is a medical indication to do so. The reason that I might recommend not getting early ultrasounds though is that it often can contribute to anxiety instead of alleviating it. Many women who have early ultrasounds find themselves being highly worried for weeks over findings that were out of the range of average, such as slower growth than was expected or not being able to find a fetus or heartbeat. In most of these situations, any issues work themselves out and later ultrasounds show all is well. Why worry yourself over a very early ultrasound when the discrepancy of how the fetus grows may vary widely at that stage? Of course, if you have any indication for an ultrasound such as cramping, bleeding, or a medical history that might require one, then this is a different situation.

Most women in early pregnancy have one major concern; miscarriage. Pregnancy loss can be a very sad event, and it is understandable why women fear this happening when the chances are much higher in the first trimester. There is no way to prevent miscarriage in early pregnancy, and this lack of control or ability to stop it can really produce a lot of anxiety in some women. It is important for women to aware though that no matter how many times they visit their providers in early pregnancy, or how many ultrasounds you get, there is still no way to prevent miscarriage. Women will need to decide for themselves what may reduce their anxiety or add to it in early pregnancy. Some women will want a lot of reassurance by a care provider, others will not even visit a care provider until the second trimester. Whatever you decide, you may want to factor in anxiety levels when you make your decisions about how you will handle early pregnancy.

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.

A Healthy Baby - Birth Poetry Contest

All she wanted was to birth a healthy baby
She was excited about the months ahead
She knew her baby was a blessing
She wanted what was best
She changed her diet and started exercising
She wanted to birth a healthy baby
So she did what the books and websites told her

All she wanted was to birth a healthy baby
A boy is what they told her
She never NEEDED an ultrasound
She knew EXACTLY when the one night of passion that created the life happened
She wanted the gender to be a surprise
Her measurements were always right on target
She never really wanted an ultrasound
But they made her feel like something could be wrong
Something that only the magic wand with goopy gel could tell her
She wanted to birth a healthy baby
So she conceded and did what her providers told her

All she wanted was to birth a healthy baby
They said the baby looked big
Just last week, her measurements were right on target
She did not understand
She wanted to birth a healthy baby
Would his size really make a difference?
Before now she had faith in her body
But they made her feel unsure
She wanted to birth a healthy baby
So she listened, and scheduled another ultrasound

All she wanted was to birth a healthy baby
The repeat ultrasound showed the baby had gained more weight
How accurate are those things anyway?
Wasn?t the baby supposed to be gaining weight?
Nine pounds didn?t sound too big to her
Big babies ran in her family!
But predictions of a term birth weight of 10lbs made her doubtful
Her trust in her innate abilities began to fade. She became fearful
She wanted to birth a healthy baby
So she listened to her providers and scheduled her induction with a closed cervix, and intense fear

She came as she was instructed at 5am
She had gotten no sleep,
She had eaten no food
She was operating off adrenaline, and she was full of fear and anticipation
She wanted to birth a healthy baby
So she followed the rules and listened to what they said was best
The entire day seemed to be a rapidly moving blur of various demands, commands, and instructions

Put on this gown
Get in this bed
Let me start this IV
We are going to start Pitocin
You have to keep still
You have to stay in bed
You have to keep the monitors on
They are here to break your water
No you can?t get out of bed
We need to use these internal monitors
No you can?t have any water and certainly no food
Here? are a few ice chips
Didn?t your doctor tell you how this was going to go?!
Yes of course it?s painful
YOU should get an epidural and for the last time NO you can?t get out of bed
I am glad you are finally comfortable
Let me put this tube in your bladder, you won?t feel it
Hope you don?t get an infection
We are going to increase the Pitocin
Your baby?s heart rate dropped
Quick, turn to your left side
Breathe this oxygen
You are only 4 cm dilated
I?m going to call your doctor
Open the OR its 5PM!
Lets get her ready for her c/section?..

All she wanted was to birth a healthy baby
In her heart she wanted to speak up,
But she wanted to birth a healthy baby so she took their advice
She listened to her doctor
She listened to her nurse
When all along she was waiting for someone, anyone, is there one? all she wanted was one,
One person to hear HER voice
One person to help make HER voice louder and stronger

All she wanted was to birth a healthy baby?.and it seems everyone else, just wanted to control the process

Nicole Deggins, CNM -? www.yourbirthright.com
_{This poem was used as the opening to a presentation I gave at the national AWHONN Conference in San Diego Presentation title:? Using the Evidence to Reclaim the Role of Patient Advocate.}

This is a part of the birth poetry contest.

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.

Postpartum Depression, Bottle Feeding and Infant and Mother Separation at Birth

There is a new study out by the University of Albany done by evolutionary psychologists that puts forward the idea that a woman who feeds her baby a bottle instead of breastfeeds may be at risk for postpartum depression due to the fact that her body will interpret this as an infant loss. The article states:

“for most of our evolutionary history the absence or early cessation of breastfeeding would have been occasioned by the miscarriage, loss, or death of an infant, and, at the level of basic biology, a mother’s decision to bottle feed rather than nurse unknowingly simulates that loss.”

This was a small scale study, only 50 mothers were surveyed. However, they still found interesting information:

“those who bottle fed their babies scored significantly higher on a postnatal depression scale than those engaged in breastfeeding.? The increased risk of depression among mothers who relied on bottle feeding held true even after controlling for such factors as age, education, income, and the mother?s relationship with her current partner.”

They also found that mothers who bottle feed tend to hold their infants more, which they have seen in primates whose babies have died and they cling to those babies for prolonged periods afterward. What I found most interesting though was this:

The UAlbany research team noted that the common hospital practice of isolating newborn infants together in a nursery for the first couple of days after birth, and the resulting intermittent separation of the mother from her baby during the initial post childbirth period, could also serve to simulate child loss and contribute to or set the stage for subsequent postpartum depression.

“Bottle feeding and hospital procedures that simulate child loss may increase the risk of postpartum depression,” Gallup said. “These practices fall within a growing number of medical issues that could benefit from a perspective of human evolutionary history.”

It is very interesting and significant that the common hospital practices here are linked to an increased risk of postpartum depression. The Edinburgh Postnatal Depression scale was used in this study to asses whether women were suffering from postpartum depression. However, they could also have been suffering from postnatal traumatic stress, since the Edinburgh scale only picks up depression symptoms and not trauma symptoms, and separation from infants is a key trauma risk. Either way, connecting postpartum mood disorders with the routine practices of separation of infants and mothers in a hospital seems to be a step in the right direction toward reforming maternity care.

Reducing Infant Mortality

Please watch this video and then spread the word about how to reduce infant mortality. Click here to visit the website and get help with writing to your legislator, or sending them this video.

Reducing Infant Mortality from Debby Takikawas on Vimeo.

Join the Virtual Nurse-In on Facebook!

The Facebook group called Hey Facebook, breastfeeding is not obscene (official petition to Facebook) is hosting a virtual nurse-in in honor of world breastfeeding week. The group is hosted by the organization called The Mother’s International Lactation Campaign (M.I.L.C.) which is “dedicated to the normalisation, protection and promotion of breastfeeding”.

Participation is simple. Just post the words “hey facebook, breastfeeding is not obscene” into your status update. Then post a picture of someone breastfeeding their infant as your profile photo for the week of August 1st to 7th. This picture can be one of yourself, a work of art, or someone else. It can even be a cat nursing her kittens!

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.

New York Times article on YouTube birth videos

Lights, Camera, Contraction!

Ricki Lake debates Dr. Lisa on the The Doctors

Part One

Part Two

What do you think about what was said in this debate?