Wednesday, July 18, 2012

More Unimaginable than an Unnecesarian: An Unjustifiable Deprivation of Personal Autonomy

I still have a hard time wrapping my mind around what happened to me the day my daughter was born. I just never imagined such a thing could happen in the 15th largest city in Canada, in a level 3 hospital, in 2010. I never imagined that a woman’s clearly communicated desires around her medical treatment could be so callously disregarded either negligently or intentionally. I didn’t fathom such an experience could materialize – I trusted the system, I trusted my care providers, I believed fully that a woman (or man) who is competent to make medical decisions could expect that those decisions would be respected - and that the system would do what it could to facilitate the needs of the patient. Before my daughter was born, I had confidence that I could trust those who work in the system, I had confidence that I could trust the hospital, I had confidence that I could trust that my care needs would be met – and that if they couldn’t be met (particularly after the treatment plan was agreed upon) that there was a very good reason why that was the case – a legitimate reason that wasn’t arbitrary in nature.

When I went into labour, I blamed my body for betraying me, I blamed myself for what was happening. As the labour and delivery nurse directed that I not scream and told me “my body was made to do this” – I hated myself. I prayed that maybe labour would be long enough that I would still deliver by way of caesarean – I trusted there was good reason why I could not be given the Caesarean, I trusted that there was good reason why I could not get an epidural. I assumed that others with more urgent needs or other unforeseen events had intervened – my doctor told me that paediatric appendectomies meant there was no OR available for a caesarean at the time I went into labour. It was bad, but maybe, just maybe it was one of those “bad things happen to good people because otherwise even worse things might happen to others, situations.”

After the delivery, few seemed to understand the significance of what had happened – and while I’m sure many meant well with their sentiments that not having the caesarean was “for the best”, and that “everything eventually goes back to the way it was” (bullshit), and “that’s what Kegals are for”, and “at least you have a healthy baby”, and, and, and – my grandparents (who I love dearly) even sent me a news article extolling the evils of caesareans (thanks, but not helpful). Unfortunately, these well-meaning sentiments did little to assuage the hurt and anger I felt, but rather only served to make me feel as though I wasn’t entitled to feel the way I did about what had happened. I felt alone and misunderstood – don’t get me wrong, I felt a bit odd and misunderstood before the delivery for wanting a c-section without medical indication but I understood my reasons for doing so and felt confident in my ability to make and defend that choice – but now I felt even more alone and misunderstood.

The passage of time has allowed me to put what happened into context – to question what really happened – not that the answers to date have offered any comfort. Unfortunately, that too, has done little to assuage the anger and hurt that lingers. If anything I am even more cynical today than I was in the immediate aftermath. There are some truly disturbing questions that run through my mind on a fairly regular basis...Was I subjected to a vaginal delivery without an epidural to save the health care system money? Did the hospital put its desire to lower the caesarean rate ahead of my legitimate right to choose a caesarean? Was I a victim in a labour dispute between anaesthesiologists and the health authority? Did someone else’s belief in the superiority of Natural Child Birth put their own values ahead of mine – the woman giving birth? If things had gone sideways during the delivery, would we have been safe? Why did my health care needs rank so low in terms of priority – surely there were other elective surgeries that could have been bumped with less severe consequences than bumping a woman who at 39 weeks pregnant has a significant risk of going into labour at any time? Did I not matter? Did my right to make health care decisions for myself not matter? Would my daughter have fared better during a caesarean delivery – would she have avoided the need for Narcan and resuscitation if access to the agreed upon treatment plan been realized? Has this experience put me in an unsustainable conflict with my professional life – or will it prevent me in succeeding in that regard going forward? Will I suffer pelvic organ prolapse or a greater degree of stress urinary incontinence at some later point in time because of what happened? Will I regain the confidence I once had? Will therapy be enough to overcome the damage done? Will the anger and hurt ever recede? How many other women have had the same experience? Will there be meaningful accountability for what happened? Will my daughter and other women be protected from this kind of violation in the future?

I am determined to not let what happened influence my parenting of our daughter (or our son after he arrives) – and in that regard I think I’ve mostly succeeded (all be it there are times when I wonder if I would be less frustrated or less exhausted if what happened, hadn’t or if she’d actually have an assembled baby book by now if what happened, hadn’t). I can’t say that what happened hasn’t influenced my marriage or my performance at work or who I am or my subsequent pregnancy – it has, in ways that are very significant. There have been countless hours spent reflecting on what happened – hours that if it hadn’t happened likely would have been spent doing or thinking about other things. It has likely made me less productive at work – I do what needs to get done, but my concentration isn’t what it once was and I don’t seem to quite go as ‘above and beyond’ as I once did, further, I feel conflicted and cynical about much of what I do and am far more sceptical about the health system and its intentions in general (really not a good combination for a person in my position) – thank goodness another maternity leave is around the corner. I sometimes think my husband gets angry with me for being unable to move past the birth – that I’m not as good of a wife as I would be if what happened hadn’t. What has happened has left me feeling powerless, overwhelmed, isolated, vulnerable and violated – there’s a certain confidence in my own abilities that I have struggled to regain – and I fear there are bits of myself that may have been permanently lost.

Is this kind of impact on individual women’s lives really worth avoiding “unnecesarians”? Can this kind of violation really be justified in Canada, in modern times? I must hope that the answer to both of these questions must be a resounding no.


  1. Sadly there is a deep current of misogyny surrounding childbirth. Autonomy and informed consent go out the window in terms of your medical decisions, because there's a deep seated belief that it's just something that women should go through. It's acceptable to treat labouring women in ways that you would never treat another (male) patient. You are very brave for standing up for yourself and for other women. Don't forget that the first civil rights campaigners on any issue always have it the hardest, but they forge the path for others to follow. I wish you every success.

  2. I don't understand why you feel you were ENTITLED to an epidural and a section. Neither of those are basic human rights. I don't understand why you feel you were betrayed by your body. Childbirth is, after all, a normal body function. Millions of North American women plan drug free vaginal births each year, and 25-40% of them end up in sections. You planned a pain free section, and you ended up with a drug free vaginal delivery. Plans don't always work out, and when we decide to carry a baby to term we have to accept this and do our best to prepare for any eventuality. We have to accept the reality that the anesthesiologist covering LD might be home sick the day we go into labor, might get into an accident on the way to the hospital, or he/she might be busy with emergencies. We have to accept that issues may arise at the last minute that make an epidural unsafe. If you had attended a prenatal class you would have been warned that there was absoultey no guarantee that you would get an epidural or a section, and you would have been encouraged to prepare yourself for that emotionally. In smaller hospitals, we have to accept that there isn't always going to be an anesthesiologist on duty. Hell, in the BC hospital, where I had my first son, there was no anesthesiologist OR OB/GYN on weekends, and of course, I went into labor at 30 weeks on a Saturday! No OB/GYN coverage meant there was no one there to recognize I was even IN labor until it was too late to stop it (no one to give me the epidural I desperately wanted, either!). In a perfect world, all women who want an epidural or a section would have access to one, 24/7/365, but we don't LIVE in a perfect world.

    1. Cassie - I feel and felt that I had reasonable expectations about what kind of care was or should have been accessible, and had I been informed my expectations were not reasonable I would have made alternate plans and preparations. Women should not be deprived of their right to make treatment decisions simply because they are pregnant - and they should be ENTITLED to a reasonable amount of access to epidural pain relief and cesarean section. If women are to 'take back birth' then they should be able to avail themselves of the full spectrum of choice and not just the spectrum of choice that is cheapest or fits the agenda of the natural childbirth industry. Given your profile information, you seem a bit hypocritical.

    2. Cassie, is that what we'd say to rape victims and accident victims? Didn't they know walking out alone at night or driving on the highway was dangerous? That in an ideal world, nobody would get raped or be in a car accident, but we don't live in an ideal world so shut up?

      I think you have resentment from your own birth going badly and are finding ridiculous ways to vent the frustration. In 2012, women are ENTITLED to make choices about their bodies, and as taxpayers or as patients paying Goid money for their care, they deserve to have doctors listen to them.

      It's not 1700. It's not OK to leave a woman to deliver a baby without pain relief and/or a c section if she so desires.

      If hospitals are understaffed, we need to find wats to address that, not to blame women for expecting a basic standard of care.