Friday, November 11, 2011

The Haunting of Mrs. W.

I never took the decision to request a csection lightly. I had my reasons for wanting one - I wanted to know with a fair degree of certainty what my experience would be like, I wanted to reduce the already small chance of a catastrophic outcome for my baby, I wanted to protect my pelvic floor, I wanted to avoid an emergency csection and the risks associated with that, and I wanted to keep the girly bits I had largely as they were - for they were mine and I was comfortable with them. I didn't particularly fear labour pain (although I certainly do now), as I could not conceive what labour pain was like. It was my body, my choice and I decided c-section.

I breathed a big sigh of relief when I secured a date for the surgery.

Then, I arrived and fasted and I got bumped....

No worries, it's not like I was in labour.

And then bumped again...oh well, I still wasn't in labour.....AND then I was....

The c-section didn't happen. An epidural didn't happen. Fentanyl and gas. 2nd degree tears. Upon birth, my daughter needed resuscitation and Narcan.

The experience haunts me to this day....

I could have handled surgery, I would have been over surgery by now. Instead every now and again it hits me like a steam engine. It's a terribly depressing thing to know that choice, particularly choice on a matter so personal is an illusion. I have no confidence I won't (if I decide to have another child), be there again.

But isn't it worth it, to have a healthy child?

I would give my life for my child....but it's disturbing to think that my autonomy as a person, my ability to say my body, my choice could be so readily violated - in the absence of any medical justification to be deprived of those services. It's revolting to know that such services exist, and that as a result of some sick game between the BCMA, the anesthetists, the ministry of health and VIHA, timely access to medical care was denied.


  1. I fear that in Canada we are very far away from accepting the idea of elective c-sections at maternal request as a truly valid birth option. We speak of "choice", when it comes to birth, but all that really means is denying analgesia, rejecting medically-recommended c-sections, and possibly birthing at home.

    The fact that the BC Ministry of Health feels that they do not need to urgently act in order to ensure that they are able to have OB anesthesiology available 24 hours a day for emergency c-sections; that they do not feel compelled to ensure that women have access to epidurals at all times, then elective c-sections at maternal request are not even an issue for them.

    I find it surprising in this day and age. Surprising that this should be the case in Canada, where I always thought we were so progressive...

    I'm rather steamed at some of the responses to my comment thread yesterday on SOB because even there it seems that we cannot have an up-front discussion about c-sections. Everyone is willing to go to bat for the women who complain that they had an "unnecessarian", but cannot view the opposite as valid unless there was a seriously injured or dead baby. In short, we don't accept c-section as a valid choice.

    Well, the only way to begin to change hearts and minds is to start with the facts -- facts about c-section safety. And now it is possible to build on the work of Pauline Hull and the revised N.I.C.E. guidelines.

    What I find truly shocking though is that there seems to be an attitude that women should birth naturally because that is their lot in life, and if they do not want to suffer, but choose a c-section instead, that is "an example of female laziness". Really, there should be a press complaint made about the Globe and Mail for that piece.

    And now a question to you Mrs. W -- if fate were about to present you with the birthday present of having a face-to-face casual small group encounter (no more than 5 people) with the head of the WHO's Pregnancy and Maternal Health Unit (I'm not up on the current name, but you know the ones, the ones responsible for propagation of the unfounded 10-15% c-section rate), what would you want to question them about? What would you raise? I would like to explore their attitudes toward (or rather, against) c-section. What say you?

  2. Monika - its hard to know where to begin - there are so many questions when it comes to maternal much left unsaid and unknown. I do think that the headline measures (death, physical disability) do not scratch the surface - and that differences in access to medical technology need to be taken into account. A csection rate of 30% plus in a country with advanced medical technology might cost little in the way unnecessary death/disability compared to a country where the access to such technology is limited. A csection in an undeveloped country is a very different prospect than a csection in a country with an advanced medical system. As such measuring use of intervention is perhaps inappropriate without accounting for the context in which the intervention is occurring.

  3. I would also like to explore their thoughts on patient autonomy, the right to self-determination, and maternal mental health.

    I think the way to get a better discussion on birth is to reframe it....with a greater focus on a broader set of outcomes rather than procedures.

    I think that the use of a csection (or any other intervention) in birth needs to be contextualized better. Can you imagine if the headline measures of birth were mortality, morbidity and maternal satisfaction? Why not measure maternal trauma and try to minimize that?

  4. Note: I think facts on csection safety are needed, but I think the argument around self-determination and maternal mental health are perhaps far more persuasive.

  5. The SOB comments were somewhat surprising...