Monday, March 12, 2012

Measuring Mom's Well-being

I read a very interesting article today from the New Yorker by Atwul Gawande entitled "The Score" - it focussed a lot on the history of childbirth and the contribution of obstetrics to reducing maternal and infant mortality and morbidity. Specifically, it highlighted the work of an anesthesiologist named Apgar, who had devised the Apgar score. The Apgar score is a measure our of 10 taken at almost every birth at both one minute and five minutes. It gives two points if a baby is pink all over, two for crying, two for taking good, vigorous breaths, two for moving all four limbs, and two for a heart rate over a hundred. A baby with an Apgar of 10 is in good shape - perfect condition. A baby with an Apgar less than 4 is limp, and blue.

It revolutionized infant mortality. All of a sudden there was an immediate concrete measure of how well a baby was doing and a drive to improve that measure.

It is an example of a performance measure that performs well - in that its use enhances the outcomes that are desired.

There are many reasons why this measure is a shining example of what good measurement looks like. It's simple and provides instant feedback on the health status of the infant. Furthermore, it's responsive to the actions of the care providers.

So what would a similar score look like for mom? It might measure how closely moms expectation of birth matched her experience. It might measure her level of pain experienced during and after birth. It might measure the degree of tearing and the adequacy of repair. It might take into account post-birth infection rates. It might also measure adverse events (hemorrhage, shock, etc.). I'm sure maternity care providers, anaesthesiologists, and mothers all would have ideas on what a good composite MomStat would look like...the time for it has come.


  1. Mrs W,
    I read your blog for the first time last night with much interest and some tears. I had a very similar experience to yours and your description of your experience and thoughts in the aftermath of your birth experience resemble mine so closely it is eery.
    As a health professional who strives to ensure the comfort of my patients and who administers local anesthetic daily I don't believe that procedures must be painful. Indeed I strive to make patients as comfortable physically and mentally as possible.
    I gave birth at Nanaimo Regional General Hospital in 2009, was denied an epidural, dilated fully with my husband trying to help me as much as he could, while the nurses chatted in the corner. We were unprepared for this situation and he tells me my eyes were wild and I was scratching like a feral animal. I pushed for 3 hours until my baby went into distress, was threatened with the use of forceps and was denied the option of a C-section in this emergency situation due to "no OR or anesthetist being available." I was told that the only option to save my baby would be a forceps delivery with no anesthetic and that this would be done to me with or without my consent.
    I was terrified, bullied, denied every request, my questions ignored.
    My husband and I refused the use of forceps as I was in terror and agony and this led to a stand-off between us and the hospital staff while I screamed in pain and my baby's heart rate soared.
    Eventually a second team was called in and I received an untimely C-section. My baby was born flat and did noy breathe for the first 2 minutes of his life. His first Apgar score was 2. He was resuscitated and thank goodness recovered.
    After I returned home from the hospital I began having nightmares and flashbacks of the event and eventually sought therapy. I was diagnosed with PTSD and received treatment for it. I can say that the flashbacks are definitely fewer and farther between and I continue to be functional however, a part of me feels that I will never fully recover from the experience. I also get angry when I hear of similar stories and I recall all too well the terror I felt that day.
    I wrote to VIHA, the College of Pysicians and Surgeons, the hospital. Everything I received back was condescending and offensive. One was written by two female NURSES at the hospital who wrote that "vaginal birth is painful," that an "epidural is not available upon request" and the obstetrician who had to respond to my complaint letter had changed all of the details and ended the letter with a smug "the end result is a healthy mother and baby."
    Finding no recourse within the self-regulated medical system I contacted a lawyer who specializes in malpractice suits in BC. The end message was unless my baby was injured or died I would not have a leg to stand on since they would just claim funding issues.
    The fact that this could happen in this day and age in this country and there be no accountability is digusting to me.
    I do believe that misogyny is at the heart of this issue. If men were the ones giving birth they would be revered and taken seriously. I am appalled by this. I chose a young, female obstetrican because I thought that she would be compassionate and skilled as I am, but she turned out the be the biggest sadist I have ever encountered. I believe that a woman should have a right to choose and access to a method of pain control without judgement from uneducated and misinformed individuals. Anything less is archaic. My mother had a wonderful birth experience (in Ontario) 35 years ago. That I didn't is a travesty.

  2. Anonymous- it is sad and disturbing to hear women unable to access care that they should expect to be able to receive during labour and delivery in British Columbia in recent years. Your experience, my experience and every other woman's experience that is like ours is a travesty and a failing. It is sad that there is currently no way of knowing how often and where experiences like ours occur (there are no statistics in BC on the numbers of women who want epidurals or cesareans but cannot get them) - it is even sadder to know that there is limited recourse available for those who cannot access the care they need when they need it, absent horrific harm to either mother or child.

    A healthy baby and a healthy mom (at least in the physical sense) is something to be thankful for - but knowing that you could and should have received better care is something to be angry about and deserves recognition that the system can and should be improved upon.