Guest Post: Jessica, from natural to C-section

From Kellie:  Jessica and I worked together and were instant sister-soulmates! Even though I am, like, 100 years older than her she taught me a lot about pregnancy and natural childbirth.  I learned a lot from her birth experience with Eli as well and, whether she knows it or not, she helped guide me to have a different experience for myself and my own son. I am sorry for her experience, but knowing her the way I do, I know that if she can inspire others to not be afraid to speak up..or be prepared for scenarios they otherwise wouldn't have been....well that would make her very happy.



So. Eli's birth story.  Let's see if my mama brain will cooperate.  I knew from the beginning that I wanted to have a natural birth.  It was mostly based on the thought of "My mama did it that way, why can't I?"  That was about the gist of it - I knew no more, no less.  I received many of the same expressions from family and friends -  "Ooo girl, you have no idea what you're talkin' about!" and "Just wait. You'll get the epidural. I bet you."  So much love and support!! (insert sarcastic face here)  Whatever.  I knew what I wanted and My husband Brandon was totally on board on with it - whatever I wanted my experience to be, he supported it.  That was SO helpful for me.  

We had some friends who were also expecting and they told Brandon about the Bradley Method for natural child birth so we looked into it.  It sounded great!  We found a teacher in the area and even though she already started the course (I was about 30 weeks at the time and it's a 12 week course) she let us join the class and gave us a little catch up sesh (that's short for session, I'm so hip) before our first class.  So. Much. Information.  Honestly, I was little overwhelmed at first but I'm incredibly thankful we found out about Bradley courses.  Even for those NOT planning a natural birth, Bradley courses have a WEALTH of information regarding pregnancy, labor, breastfeeding, and postpartum.  There is a ton of education to prepare you for your little bundle.  

Fast forward about 8 weeks.  I had been having an extremely easy pregnancy (no morning sickness, no low back pain or sciatica - I know, you wanna shoot me) but my blood pressure had been high pretty consistently for a month or more and I started swelling a whole awful lot.  I guess that's what happens when you're due in the middle of a Texas summer...  So anyway, by the time I was at my 39 week check up, my blood pressure was higher than normal (again) and swelling was still severe so I was put on bed rest.  I went back to work crying because I felt bad having to tell my coworkers they were on their own!  Eep!  

Within 5 days of being on bed rest, I lost 4 lbs of water weight - Whoa! That was a lot of swelling.  We tried going to the pool so I could walk in the water to help things move along.  Nothing happened.  More walking in water, more nothing happening.  My due date came and went (Kellie ain't lying about that guessing game of a due date - It don't mean much!!)  People would ask when I was due and I would promptly throat punch them.  Not really. Just in my mind.  

At 41 weeks (a Wednesday) my Doc did a non-stress test (I think that's the name) and I was having mild contractions during it.  That's probably because she just shoved her hand up my hoo-hah.  Too graphic?  #sorrynotsorry.  Doc said she wanted to induce by Friday but was "SO SURE" I was gonna go into labor before that.  Yeah, right.  I woke up Friday morning at 4:30am to some mild, semi regular contractions - about every 10 minutes.  We called the hospital to check if they had room for me to be induced and (prayers answered) they were full.  Yay, more time!  But, by noon the contractions had made their departure... We called Doc and she said I could come in and she could break my water first to jump start things.  We figured that was better than Pitocin and went with it.  Before we left I ate a large bowl of spaghetti (boy was that a bad idea. note to self: stick with bland foods next time).

 We headed to the hospital at 4pm.  She broke my water.  An hour passed and nurses were not impressed and started me on Pitocin.  I probably should have just been like "NO, GET OUT OF HERE PITOCIN WITCH!"  But, I obliged.  An hour later - owie!  Things were movin'.  The anesthesiologist came in a few hours later while I was DEEP in a very painful contraction and trying to relax through it.  My husband told him no, she wants a natural birth (my husband being my sweet voice when I couldn't speak - love him)  And the guy said "I need to hear it from her if she wants it on the table."  Go away, dude, I'm a LITTLE occupied!!!  I managed to get out a "No" and he was on his way.  I had no concept of time but a few hours later (midnight?) I felt the urge to push.  Nurse checked and I was fully dilated/effaced - it felt so good to push!  It made the contractions so much more bearable.  3 hours of pushing later - no progress.  My son, Eli, was still at the same station and had no plans of going anywhere.  

It was 3:15ish in the morning and I was beyond exhausted.  Doc said, in a very cautious manner, "I think it's time we discuss a c-section".  All I remember is saying "okay" and everything else is a blur.  I remember them giving me anti-nausea medication for my spinal tap - threw that up after the second sip.  Awesome.  They managed to get me into a wheel chair (still having extremely tough and close contractions, mind you) and rolled me over to the OR.  They gave me the spinal and I felt sweet relief in what felt like seconds (I don't even remember feeling a jab - I was mid contraction and they were asking me to be still - OKAY, I'll try.) 

At 3:42am, Eli was born and crying.  I cried.  It took a few minutes before they brought him over to me because they were concerned he aspirated his poop (I forget the word, lol) and then I saw my sweet babe.  He was absolutely perfect.  After that, they took him away (Hubby went with) and I got taken to the recovery room... Had I known then what I know now - I would have asked he be brought with me to breastfeed.  I didn't see my son again until 7:30am.  FOUR HOURS LATER.  I was so exhausted and not in my right mind that I didn't ask about it or get a nurse - I just wondered where my son was and when they were bringing him.  It was a surreal experience... I've just had my baby and now he's not with me.  What? 

 A Doula would have been worth every penny it would have cost to have there with me.  To be my voice when I had none, and to consult about things I had no knowledge about.... while I was in a such a vulnerable state. Still years later, I am left with these blocks of missing moments I should have been able to enjoy but didn't even get to experience.  Get educated and don't be afraid to have a voice. 

I think some valuable advice for new Momma's would be: even when planning for a natural birth, be knowledgeable about all outcomes so that you can be prepared.  It wouldn't hurt to have someone else there who knows what to expect so that they can be your voice when you are not in your right mind.  Know better, do better.  

We do plan on having another (or more) child[ren] and my goal is for a VBAC.  At the same time, I am realistic and I plan on being 100% prepared if I am in need of another c-section and will know exactly what to ask/demand for the next go round.  Don't let precious memories be taken away from your first birth experience; be more prepared than I was.   You shouldn't have to wait for a second chance. :)  

I could write out a long list of theories as to why I wasn't able to birth naturally with Eli but dwelling on the past isn't going to change it.  All I know is that next time I would like to have a midwife instead who won't pressure me (and in turn stress me out) about being induced if I go past my date unless it's absolutely, 100% medically necessary.  So, that's all... Do I get a cookie, now? ~Jessica

The opposite of Mother Friendly Care: When Birth is Traumatic

I literally copied and pasted this from the Midwife Thinking Blog...I hope that is legal? I gave credit so I assume I'm safe, anyone know? 

I also found this interesting...The Pregnant Patients Bill of Rights
Here is a very strong (Trying to find the right description...bold, graphic?) blog on Birth Abuse 

This is a guest post by Elizabeth Ford (website) who is based in the UK so is writing from a UK perspective. Elizabeth explored birth trauma for her PhD and generously agreed to write a post for MidwifeThinking. There are lots of references for students and/or those who like to access original sources of information.

Artwork by Amanda Greavette: http://amandagreavette.com

For most women, birth is not the blissful event of three easy pushes and welcoming their precious baby into the world. Even for those women who have a short straightforward vaginal birth, it can be a tough slog and a real test of the depth of their resources. However, for some women, birth is much more than that. It is a physical and psychological trauma. The aftermath of a traumatic birth can affect a woman for months or years and impact on her bond with her baby, her relationship with her partner, her decision to have another baby and even her willingness to engage with future health care.

Birth as a trauma

Childbirth is a common event in society so is viewed by most people as “normal”.  It may therefore be difficult to understand how it can be traumatic for some women. However, case studies and other research make it clear that women can suffer extreme distress as a consequence of their experiences during childbirth. A small proportion of pregnancies and births involve events that most people would agree are potentially traumatic, such as stillbirth, severe complications, or undergoing invasive medical interventions without effective pain relief.  Other women may have a seemingly normal birth but feel traumatized by aspects such as loss of control, loss of dignity, or the dismissive, hostile or negative attitudes of people around them.

Post-Traumatic Stress Disorder

Recently it has become recognised that women who experienced a traumatic birth can develop post-traumatic stress disorder (PTSD). Some women experience childbirth as threatening and frightening and go on to develop PTSD symptoms.

The American Psychiatric Association defines the symptoms of PTSD as (1):

1. Persistently reexperiencing the event, by flashbacks, nightmares, intrusive thoughts, and intense distress at reminders of the event.
2. Persistent avoidance of reminders of the event, and emotional numbing and estrangement from others
3. Persistent symptoms of increased arousal. This means difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance or an exaggerated startle response

For a diagnosis, patients must report experiencing all three types of symptoms for longer than one month. Many women (around 30%) experience these symptoms in the days or weeks following birth, and this is a normal way of coming to terms with a stressful or overwhelming event. It is only when symptoms do not get better that PTSD is diagnosed (in 1 to 5% of women).

What causes trauma & PTSD?

Research has been carried out into what makes someone more likely to develop PTSD following childbirth. These risk factors fall into three categories: those that exist before the birth; aspects of the birth itself; and the type of support and care women get after birth.

Some women will be more vulnerable to a traumatic birth because of pre-existing problems. For example women with a history of psychiatric problems and previous trauma are more likely to be traumatised by their experience of birth. In particular, a history of sexual trauma or abuse is associated with PTSD after birth. There is some evidence that women with a history of trauma will be more vulnerable to PTSD following birth if they have inadequate support and care during the birth (2-5).

During the birth, certain complications and events may be more stressful to women than others. Broadly speaking, women are more likely to get PTSD if they have an emergency caesarean or assisted delivery (forceps or ventouse). However, women who have a vaginal birth are still at risk (4, 6). Other stressful aspects of birth, such as blood loss, a long labour, a high level of pain, or a large number of interventions are not clearly related to getting PTSD. Importantly, women who feel out of control during birth or who have poor care and support from midwives and doctors are more likely to get PTSD (3, 5, 7). Furthermore, if a woman is overwhelmed by the experience and copes by dissociating (feeling like she is mentally “not there any more”, or having an “out of body experience”), she will be at higher risk of PTSD (8, 9).

Following the birth, support from friends and family, and possibly that from health professionals, may help women resolve their experiences and recover from a traumatic birth (5, 10). Conversely, a lack of support may prevent recovery or possibly cause more stress and thereby increase symptoms.

Feeling angry when birth is mismanaged

In some cases births are mismanaged and a woman can feel unable to get past her experience. She may go over and over the events in her head and feel angry that she was denied the experience she could potentially have had (11). This can form part of the symptoms of PTSD (intrusive thoughts, irritability & anger). However, PTSD is considered to be an anxiety disorder, and so for this anger and preoccupation to be diagnosed as PTSD, the other symptoms listed above must also be experienced. A woman who feels very angry is struggling with a valid emotional response to being discounted or not listened to during the birth, or even being mistreated or assaulted. Even when women don’t fit into the “PTSD box” (fulfilling all the symptom criteria), they may have a spectrum of subclinical trauma reactions which would benefit from support, counselling, or psychotherapy.

Is PTSD the same as postnatal depression?

PTSD has different symptoms to depression. Depression symptoms encompass a depressed mood i.e. feeling sad, empty, tearful or irritable, in addition to diminished interest or pleasure in activities; significant weight loss or weight gain or decrease or increase in appetite; insomnia or hypersomnia; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; and a diminished ability to think or concentrate, or indecisiveness.

In contrast, trauma symptoms are focussed on the traumatic event (re-experiencing it, avoiding reminders of it) and a diagnosis of PTSD is not possible without having experienced a traumatic event.  This is not the case with depression. However, in practice symptoms overlap and a majority of women who have PTSD will also have depression (3, 4).  Effective treatments for PTSD and depression differ. Recommended treatment for PTSD is psychotherapy, and only long-lasting or complex cases of PTSD benefit from anti-depressants.

Do women expect too much from childbirth?

A question that is often asked by health professionals is whether women have too high expectations of achieving a natural or drug-free birth, contributing to them being traumatised when birth does not go as expected. The answer to this is rather complicated but research studies point towards it not being the case. Firstly women’s expectations are found, on average, to be similar to their experiences (12, 13). That is, if a woman has broadly positive expectations she is more likely to have a positive experience. Secondly, if unrealistic expectations were linked to PTSD we might expect to find more trauma responses in first time mothers. This has been found, but subsequent analysis suggests it is due to the higher rate of intervention in these women (14). Finally, one study looked at this question directly and found that a difference between expectations and experience in the level of pain, length of labour, medical interventions and level of control was not associated with PTSD symptoms. However, a difference between expected support from health professionals and the level of care experienced was predictive of PTSD symptoms (13). Women don’t seem necessarily to be traumatised by the events of birth not happening as they expected, but may be affected when they do not receive the care they expect.

Implications for maternity care

Research in this field is at an early stage and more needs to be done before making policy recommendations. However, the body of evidence points towards several considerations. Firstly, some women enter pregnancy and birth with existing risk factors for PTSD, and these women may need particular care. Health professionals should be aware that women with a history of trauma, abuse (particularly sexual abuse) and psychiatric problems are at higher risk of PTSD following birth. There is some evidence that a lack of support during the birth may put these women at particular risk (5).

Secondly, interactions with other people have a strong effect on trauma reactions. For example, PTSD is more likely following events which are perceived to have been intentionally perpetrated rather than following accidents (15). This effect of personal relationships and care is particularly relevant to childbirth (16). There is substantial research showing support during labour and birth improves both physical and psychological outcomes (17), and that perceptions of inadequate support and care are predictive of traumatic stress responses. Women who are traumatised often describe negative interactions with staff such as feeling rushed, bullied, judged, ignored or put off when asking for pain relief.

Understanding the importance of support helps explain why, for example, level of pain is not consistently associated with PTSD symptoms. It may not be the level of pain per se which is traumatising for women, but the experience of unbearable pain in combination with the perception of being denied pain-relief by an uncooperative caregiver. Women also report caregivers proceeding with interventions, such as forceps deliveries or episiotomies, without consent, and sometimes even when the woman has clearly expressed her wish not to have the intervention. Negligent care such as leaving women naked in stirrups with the door open can be intensely degrading and stressful. Many of the traumatising aspects of childbirth could be reduced with consistent and considerate care from maternity staff.

What to do if this has happened to you

If you have had a traumatic birth and don’t know how to get help, the first step is to contact the Birth Trauma Association (BTA; www.birthtraumaassociation.org.uk) who give information and support. They produce a leaflet which you can print out and take to your GP explaining the condition (your GP may not have heard of postnatal PTSD), and you can ask for a referral to specialist psychotherapy services. If you’re in the UK, you can also contact the hospital where you gave birth and ask for a debriefing session with a midwife or consultant to go through your birth notes. This is not a counselling session but may help you to understand what happened during the birth and why events proceeded as they did. If you have physical problems following the birth you can also ask for a referral to a gynaecologist or physiotherapist. If you do not feel able to go back to the hospital where you gave birth, because memories are too painful or it causes you too much anxiety, you could ask your GP for a counselling referral or you could consider contacting a private psychotherapist. Make sure they are registered with the relevant professional association (BACP or BABCP in the UK). Recently in the UK you can “self-refer” to psychotherapy on the NHS through your local IAPT service (www.iapt.nhs.uk). Talking to other women who have been through similar experiences may help, the BTA can put you in touch with other mothers.

And Dads…

It can be traumatic watching a partner go through a harrowing experience while feeling helpless and horrified. The information on PTSD above can also apply to partners. The BTA has a section on their website for dads or partners. It is worth reading this and seeking help for yourself if you feel this applies to you.

More resources and support

I’ve added some links below (this is MidwifeThinking). Please let me know if you have any other links or resources that you think should be included.

• National Childbirth Trust (UK) - Position Statement and contact details
• Birth Crisis Network (UK) and article – Sheila Kitzinger
• AIMS (UK) – article and list of support networks
• Joyous Birth – Information, stories and links to support
• Birth Trauma Canada – support and information
• Trauma and Birth Stress (New Zealand) support and information
• Birth Stars (Canada) – support and information
• Solace for Mothers (US) – support and information

Blog posts about birth trauma:

• Mama Muse – Trust Love
• Navelgazing Midwife – Birth Abuse

References

1. APA. Diagnostic and Statistic Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington DC; 2000.
2. Wijma K, Soderquist J, Wijma B. Posttraumatic stress disorder after childbirth: A cross sectional study. Journal of Anxiety Disorders. 1997;11(6):587-97.
3. Czarnocka J, Slade P. Prevalence and predictors of post-traumatic stress symptoms following childbirth. British Journal of Clinical Psychology. 2000;39:35-51.
4. Ayers S, Harris R, Sawyer A, Parfitt Y, Ford E. Posttraumatic stress disorder after childbirth: Analysis of symptom presentation and sampling. Journal of Affective Disorders. 2009;119:200-4.
5. Ford E, Ayers S. Support during birth interacts with prior trauma and birth intervention to predict postnatal post-traumatic stress symptoms. Psychology and Health. in press.
6. Soet J, Brack G, Dilorio C. Prevalence and predictors of women’s experience of psychological trauma during childbirth. Birth. 2003;30:36-46.
7. Cigoli V, Gilli G, Saita E. Relational factors in psychopathological responses to childbirth. Journal of Psychosomatic Obstetrics and Gynecology. 2006 Jun;27(2):91-7.
8. Kennedy HP, MacDonald EL. “Altered consciousness” during childbirth: potential clues to post traumatic stress disorder? Journal of Midwifery & Women’s Health. 2002 2002/0;47(5):380-2.
9. Olde E, Van der Hart O, Kleber RJ, Van Son M, Wijnen HAA, Pop VJM. Peritraumatic Dissociation and Emotions as Predictors of PTSD Symptoms Following Childbirth. Journal of Trauma & Dissociation. 2005;6(3):125-42.
10. Soderquist J, Wijma B, Wijma K. The longitudinal course of post-traumatic stress after childbirth. Journal of Psychosomatic Obstetrics and Gynecology. 2006 Jun;27(2):113-9.
11. Brockington I. Postpartum Psychiatric Disorders. The Lancet. 2004 January 24;363:303-10.
12. Slade P, MacPherson S, Hume A, Maresh M. Expectations, experiences and satisfaction with labour. British Journal of Clinical Psychology. 1993;32:469-83.
13. Ayers S. Post-traumatic Stress Disorder Following Childbirth Unpublished Ph.D Thesis, University of London; 1999.
14. Soderquist J, Wijma K, Wijma B. Traumatic Stress after Childbirth: the role of obstetric variables. Journal of Psychosomatic Obstetrics and Gynecology. 2002;23:31-9.
15. Charuvastra A, Cloitre M. Social Bonds and Posttraumatic Stress Disorder. Annual Review of Psychology. 2008;59:301-28.
16. Ford E, Ayers S. Stressful events and support during birth: The effect on anxiety, mood and perceived control. Journal of Anxiety Disorders. 2009;23:260-8.
17. Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews. 2003(3):Art No.: CD003766. DOI:10.1002/14651858.CD003766.

So, what's a Doula anyway?

From Kellie: Here's another Guest post....I couldnt wait until monday to put it up because I felt like it went perfectly with our Mother Friendly theme this week!  I have another guest post for you on Monday and the Momma who wrote it said that she so wished she would have hired a Doula for the birth of her son....it could have very well changed the entire outcome of her birth and birth experience.  Meet Daijeri, she is a Doula in training and services our area locally!

So you're expecting a baby. You've thought about names,  nursery themes, and car seats. You've found a doctor, debated birth settings and maybe picked a birth class. So what is left to consider? A doula of course!   

Now, you may be thinking "a do-what?" Maybe you have heard of doulas, or maybe you are like my husband who proudly told everyone his wife was becoming a dow-la for weeks. (He has since figured it out, thankfully.)  

A doula can be your best friend in navigating the sometimes overwhelming world of childbirth. Before your birth, we help you write out a birth plan and work through any anxieties and worries you may have. We also help you prepare your body and mind for childbirth.   

In labor, one of our main jobs is to provide you with information that empowers you to have your ideal birth, and to help you reassess and navigate those times that ideal just isn't working out.  Our other main job is to basically mother the mother.  We make sure her needs are met, both big and small. We help her manage her pain by providing massage, guided relaxation, or distraction. We help her get into positions that she can labor the best in. We help make sure her wishes are met the best they can be and that her voice is heard. Maybe most importantly, we make sure she knows what an amazing rock star she is. Birth is hard work, and no one should do it unsupported. Your doula will stay with you from your initial "I think it's labor!" phone call, until a few hours after you've given birth. We massage, we motivate, we reposition, and we empower.   

You may be thinking "but what about the fathers? Won't they feel left out?" The answer is no! Doulas work to help the father support mom as much as possible. We help fathers remember what they may have learned in childbirth class when they just can't recall it. Dads can sometimes feel a lot of pressure to be a super birth coach when they just aren't prepared for it. We can take some of the pressure off. We give them breaks to eat, rest, recuperate. We may run small errands so that they can stay with their laboring partners. We provide them with information they may not have foreseen the need for. So no, we don't overpower the dads, we empower them.  

 There are some things that doulas don't do. We never perform medical procedures, or give medical advice. We also can't make decisions for you. We give you all the information you need to make your choice, and we will support whatever you decide with no judgment.   

So what about after the baby comes? Is a doula's job over? Nope! There are also postpartum doulas who help mom and dad adjust to life with a newborn. We can help with meal preparations, light housework, run some errands, and even provide infant care so that mom can shower, eat,  and get some rest. We can also help mom and baby with their breastfeeding relationship and help jump small hurdles along the way. When we can't help, we can also point mom in the direction of an IBCLC who can.   

Even after we've stopped regularly coming for postpartum visits, you can still call or email when you have questions or concerns about your baby.   

After going through something as intense and wonderful as the birth of a baby, a bond is formed. You just might find a connection for life in your doula.  

 -Daijeri

yourbeautifulbirth.com