Tuesday, September 10, 2013

Mothers Matter - Thoughts on Maternal Suicide and Suffering in Canada

The Canadian Medical Association Journal editor – Kirsten Patrick - believes that maternal suicide needs more attention - I agree, however, why wait until mothers are dead to examine what is wrong and do what needs to be done to prevent harm?

When a mother decides to take her own life it is an outright tragedy – a family is shattered, and often times the lives of her children are also in jeopardy. The fact that Canada does little in comparison to other countries to better understand and address the issue is a shameful reflection on Canada and its commitment to those who decide to bear children. In the UK and in several other countries, there is a case-by-case analysis of maternal deaths. If we bothered to do the same we might learn a lot about what can be done to prevent such a tragic outcome.

That being said, why wait until a mother is dead to examine whether or not the needs of those bearing children are being met? Those who ultimately take their lives are likely a very small portion of the mothers who suffer as a result of childbirth. We need to better understand the impact of childbirth on women in Canada – and we need to go beyond what we currently use as performance measures of our maternity care system (whether or not a caesarean was performed, or a VBAC was attempted IS very superficial). We need to go beyond the period of pregnancy and the 6 weeks’ following birth. We need to go beyond administrative data - data that reflects only on what was actually done and does not reflect at all on what SHOULD have been done. We need to invest in mothers by investing in better information – information that could actually be used to improve the system of care and prevent the most tragic outcomes. We need to invest in mothers by investing in better care in the first place. We also need to invest in supporting mothers and demanding accountability for when mothers are failed either by the system or those who care for them.

In the aftermath of my daughter’s birth – I experienced the most negative emotions I had ever felt in my life and have had some of the darkest thoughts. Anger. Betrayal. Pain. Inability to concentrate. Terror. Isolation. Shame. Disempowerment. Disillusionment. Feeling as though I no longer mattered and that I did not even have the right to be angry about it all (I had a healthy baby, after all). Feeling as though asking for accountability for what happened was asking too much. Feeling as though the only thing I could do was suck-it-up and move on, and at the same time being completely unable to actually move on. Feeling as though others were at risk for the same thing to happen to them. These thoughts that absent the hope that things will get better, that things can get better and that I still had much to be very thankful for -are likely not much different from those that plague the mothers who take their lives. I am very thankful, that hope never left – even with what had happened and the damage it had done. However, I remain very angry as I see that what happened to me was entirely preventable.

Yes, there is a pressing need to better understand why mothers commit suicide – but it is just the tip of the iceberg. There is a pressing need to understand the whole toll of having children on Canadian mothers – and doing what can and should be done to minimize that toll. A superficial examination will continue to fail to address the real needs Canadian mothers as it will fail to enable an understanding of what is wrong in the first place. Looking only at mothers who eventually kill themselves, is still a superficial examination of the broader problem. Further, unlike Kirsten Patrick – I believe that we may even have to (and should – for in some cases the mothers are the last people who are “at fault”) lay some blame and demand accountability in order for things to actually change – particularly if part of the reason mothers are suffering is a result of glaring violations of patient rights and negligence in care that have gone undetected and unaddressed for far too long.

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