Tragedy and Hope - Heartache, Death and Birth

At Victoria General Hospital right now there is a man who is waiting for a caesarean section, he waits because his wife, unlike every other mother-to-be is no longer able to wait as she is brain dead. She suffered a fatal cerebral hemorrhage on December 28, 2013. Her husband left to get her some Tylenol for a headache she had, and came home to find her unresponsive. He called 9-1-1, and while they were able to sustain her on life support, the damage was too severe and there is no hope for her recovery. She was 22 weeks pregnant at the time. She has been kept on life support since, in the hopes that her unborn son might be born safely at 35 weeks (in about 7-8 weeks time), or emergently if her body begins to fail her before then. Given his current gestational age – the baby already has an excellent chance of surviving the birth (80 percent).

The arrival of Iver Cohen Benson is expected to be bittersweet – a miracle born out of a terrible tragedy. Shortly after his arrival, his mother will take her final breaths and his father (Dylan Benson) will have to say his final farewells to the body of his life partner. He will embark on a new life then – the life of a new father, the life of a single parent, the life of a widower.

I applaud Mr. Benson for having the courage to take it on – he appears to determined to give his son the best life that he can. He has taken leave from his work to be at the side of his unborn son. After his arrival he will need to be by his son’s side for any required stay in the NICU, and after that the hard work will begin. The job of being both mother and father to a very small child while attempting to grieve and heal from a tremendous loss in his life.

Mr. Benson is going to need an incredible amount of support. Not just from his family and friends but also from his community. He is going to need all of the support he can get – all the support that most new mothers need, he will need. All the support that single parents need – he will need. All the support that widows/widowers need, he will need.

It warms my heart to see the outpouring of support that has begun for Mr. Benson and little Iver, but it needs to be understood that the support that has been given so far is just that. A start. This is the beginning of a very long (and potentially very expensive) road ahead, a road that will be navigated alone.

To give some idea about the costs of being a widowed parent to a newborn infant/toddler/pre-schooler think about the following :

1. If Mrs. Benson had survived, she would have received maternity/parental benefits and as a result of her employment (provincial government) her wages would have been topped up while she was on leave (up to 85% during 17 weeks of maternity leave and 75% while on parental leave) – and Mr. Benson would have been able to continue to work. After a year of leave if Mrs. Benson returned to work – she would have earned her income as well as being enabled to contribute to the daycare expenses of the child. If she chose to become a stay at home parent, daycare expenses would be avoided. In Victoria the costs of a full-time infant space is about $1150 per month – nannies are more expensive with live-in nannies costing about $1500 per month and live-outs costing $15 per hour.

2. If Mrs. Benson had survived, her family would have benefited from extended health benefits that she receives as a result of her employment. Unless Mr. Benson also has extended health benefits through his employment, those expenses will be out-of-pocket ones in the years to come.

3. If Mrs. Benson had survived, she may have chosen to breastfeed her son. Given her death and her son’s likely prematurity, he will likely need donor breastmilk. If you are in a position of donating breastmilk, please consider doing so to a breastmilk bank where donor milk is appropriately screened and pasteurized) – in BC information on doing so can be found at www.breastfeedingmatter.ca/html/milk-bank.html - babies like baby Iver benefit immensely from these donations. Eventually, baby Iver will likely need formula – and this can be tremendously expensive, particularly if baby Iver has any sensitivities and is in need of a hypo-allergenic breastmilk. The costs of formula feeding can exceed $500 per month. An excellent resource for those who formula feed is the fearless formula feeder at www.fearlessformulafeeder.com .

4. Being a parent is a very hard job, and being one to a small child is a special challenge that frequently involves sleep deprivation. It’s hard enough when there are two parents able to take on the challenge – as one can often provide some respite for the other. As a result of Mrs. Benson’s death, that respite might be unavailable or might come at a cost – on average babysitters in Victoria charge between $10-$15 per hour.

5. Being a widow is no easy task either. Mr. Benson’s story reminds me of Matt Longelin’s in some ways (www.mattlogelin.com) – he too was thrust into new parenthood and widowerhood at the same time when his wife passed within 48 hours of the birth of their daughter, Madeline. Accessing psychological counselling can run about $160 per hour.

This is why I hope that Mr. Benson can far exceed his fundraising goals and succeed in being the dad he wants to be and giving little Iver the best life he can. I hope little Iver brings him joy. I hope Iver is able to meet his full potential and always knows how much he is loved by his father and his community. I hope the financial toll of losing Mrs. Benson is mitigated to the degree possible – because the loss of a mother is already tragic enough without it also imposing financial ruin on those left behind as they try to grapple with the void that is left.

I should add that I do not personally know the Bensons – but I wish them the best possible outcome under these horrible circumstances.

If you would like to consider donating to Dylan Benson and his son, Iver – they’ve established a donation page at http://www.youcaring.com/help-a-neighbor/baby-iver-fund/133560 entitled "Baby Iver Fund"

No, Dr. Maiman this might not be a cause for celebration...

I have a problem with automatically celebrating declines in rates of caesareans without understanding why the decline happened, and whether or not there was any significant repercussion from the change. I have a problem with the assumption that vaginal birth is good, and caesarean birth is bad. I have a problem with a very superficial understanding of what is a very important health issue for both women and their children.

In short, I think the focus on caesarean rates is wholly detrimental to the health of women and their children. Which is why – I get annoyed by articles like this http://www.nlm.nih.gov/medlineplus/news/fullstory_144198.html - that trumpet the decline of first time caesareans as some kind of public health success story. It might be, but the disservice to women and their children, comes from the assumption that the road to better health and well-being goes straight through the birth canal.

The issue of birth – and the issue of planned caesarean versus planned vaginal birth, is complex, incredibly complex, and the focus on rates of caesarean over-simplifies it. The focus on the rates of caesareans, ignores many things that matter a great deal and deserve greater attention.

There are so many things that I’d like to know before considering whether or not the movement in caesarean rates is a good thing and off the top of my head here’s just a few things:

1. Was the decline in the rate of urgent/emergent caesareans or in the rate of planned caesareans?

2. Was the decline a result of a change in the demographics of women giving birth – for example were the moms younger, more likely to be a healthy weight at the start of their pregnancies, were they less likely to be gestationally diabetic, were they planning on larger families?

3. Were there more 3rd and 4th degree tears?

4. Were more moms suffering from incontinence a year after the birth?

5. Were there more low APGAR scores?

6. Were there more deaths?

7. Did more or less moms consider the births traumatic?

8. What happened to rates of post-partum depression and/or PTSD?

9. Were any moms who would choose caesarean denied access to their delivery method of choice?

It’s true that the risks of caesareans mount with the number of caesareans that are had – and for women planning large families it is important that they pursue the birth plan that gives them the best odds of success. However, I must strenuously disagree with the assertions made by Dr. Maiman in this article that “The risks to mother and baby are much higher in a caesarean birth than in a vaginal birth” and “Vaginal delivery is the preferred method for having a baby, Cesareans should only be resorted to when its absolutely necessary.”

Vaginal delivery is not the preferred method for delivering a baby for many women – particularly those who suffered adverse consequences that could have been avoided had they been delivered by caesarean. Further, it is very debateable as to whether or not the risks of caesarean are “much” higher for both mother and baby than a planned vaginal birth. There is some evidence http://www.ncbi.nlm.gov/pubmed/19941705 - that looked at 40,000 term deliveries from 1994-2002 and compared planned cesarean for breech with planned vaginal for cephalic and found the maternal morbidity (life-threatening) was similar in each group but that life-threatening neonatal morbiditiy was decreased in the pre-labour cesarean group.

However, as long as we’re focused on the headline cesarean rate, and lowering it, at what might be tremendous cost – we will never get to what really matters: the health and well-being of mothers and their babies.

Yes, cesarean mothers also give birth...

Language is powerful. The words we use can convey ideas, foster understanding and create new ideas. Words can also be used to exclude and to inflict harm on others. Words, aren’t just words – they are filled with meaning and are the primary tool that human’s use in social interactions with others.

Recently, I came across a tweet, although I’ve heard the same sentiment expressed elsewhere: “Cesarean mothers did not give birth.”

My immediate reaction is that this might be the dumbest sentiment that I have ever heard expressed, but also a kind of anger at the ideas that are implied by this sentiment. The idea that caesarean mothers are somehow lesser mothers than those who both planned, and managed to have vaginal deliveries. The idea that the only “real” birth is a vaginal birth. In this statement is a kind of backhanded insult to every woman who ultimately became a mother via caesarean – a kind of one-up-womanship that should be called out for the kind of garbage that it is.

Birth marks the end of a pregnancy – it is the process by which a woman becomes a mother, and hopefully emerges physically and psychologically healthy from with (ideally) a baby whose health has not been compromised by the process. The definition of birth bears no mention of mode of delivery because, frankly, mode of delivery is irrelevant to the definition.

A caesarean birth is not a “fake” birth, they do not issue “caesarean certificates” instead of “birth certificates”, they do not ask for “date of caesarean” instead of “date of birth”, and my kids both celebrate “birthdays” – regardless of how they were born.

Sometimes the things people say go beyond being stupid – it’s a shame though, that such silliness can hurt so many and that such silliness is often in an over-abundant supply.

While we're at it - bottle fed babies are also "fed", adoptive mothers are also "mothers" and stay-at-home moms and working moms equally love their children.

When Nurses make Medical Decisions Instead of Doctors and Patients...

I think I know what really happened in my case. It is disturbing.

The head nurse at Victoria General decided that elective cesarean for whatever reason deserved to have the lowest priority and to never actually get on the slate.

A health professional who I had never met, who I had never discussed my pregnancy with, who decided in her judgement that I was not deserving of respect for my medical wishes.

Where have I come up with this theory?

From an OBGYN nurse who frequents an online discussion forum who decided to comment on a thread I started for Cesarean by Choice Mothers. She declared that there was no way that an elective cesarean was available in Victoria and then indicated why.

According to Tikitorch at Kids in Victoria:

oh yeah who? i am an obgyn nurse and yes i have been on mat leave for the last 4 months but im sure nothing has changed... even if there was elective c sections, theres no way they would make it onto the slate that the head nurse puts in order of priority for the OR, anyone with any medical condition would be above that person.

BC medical does not pay for an elective ceseran section (*unless you had a previous c section, or a medical reason for it, for example active herpes, diabetes, macrosoma etc), so if in fact you found a doctor to do it for you, and the moon and sun aligned and you got on the OR slate, you would be financial responsible for it,.,

This should provide as a warning to mothers planning cesareans by choice at Victoria General - the head nurse will substitute her judgement for yours and your doctors.

Take Stock, Regroup, Just Keep Swimming

December was a personally rough month, as such it has been a while since I have blogged. Thankfully, there was a bit of a reprieve over the Christmas break and a few of the issues that were contributing to an overall feeling of being overwhelmed have been resolved and I have had some time to regain some perspective. Something that has been a channel for a lot of the anger I have over what happened and what I could do about it is looking untenable, and as a result I have been struggling. So I have needed to take stock, regroup, and move on.

On the stock front I have a lot to be immensely grateful for - I have a husband who I love. Between us we have four healthy children. We have stable jobs. We live in a beautiful city. I am immensely grateful that I have many good friends, and am immensely grateful to have met individuals who share a desire to change healthcare in British Columbia and Canada.

In terms of regrouping, I have made a commitment to myself to set aside an hour a day to exercise. I'm hopeful that it might be adequate to stave off some of the depression I seem to have developed. I'm hopeful it will give me time to think about how to move forward, and how to get closer to where I'd ultimately like to go. I'm hopeful that I can be a better wife and mother - and that I can find a better balance.

In terms of moving on - when one door closes, another may open. I'm hopeful I can do a decent job of identifying what those doors are and can have the courage and strength to walk through them.

All the best in 2014.

Patient Choice Cesarean, Urgent/Emergent Cesarean or Forced Vaginal Delivery - Is it Really That Hard to Choose?

There's a phrase I hear from healthcare providers and others who oppose patient choice cesarean, "No physician is obligated to perform a procedure that he or she thinks is not medically indicated."

They see the denial of choice as being justified. Perhaps they think that they are saving the healthcare system resources by denying the choice. Perhaps they worry that women are unable to make an informed decision in this regard. Perhaps they see performing a cesarean without medical indication as causing harm, to either the woman or the child.

For whatever reason, there are those, who when faced with performing a patient choice cesarean, will outrightly refuse to undertake the procedure.

This would not be problematic if timely access to an alternate provider who is willing and able to undertake the cesarean can be realized. Unfortunately, under the current system - this is often not possible.

So if a woman cannot access patient choice cesarean when it is needed (either planned at 39 weeks or done urgently after the commencement of labour) - what will happen to the patient?

Perhaps care providers simply haven't thought about this in full - what happens to the woman, pregnant and desiring of a cesarean who is not provided timely access to one? What really happens?

Nature is a cruel wench - she isn't particularly patient, and the woman cannot just delay delivery until she finds a provider and a facility who can accommodate. The woman will eventually go into labour - this is nearly guaranteed. Either a medical need will then arise for a cesarean - in which case an urgent/emergent one will hopefully be provided - or medical need won't arise and at some point the woman will be fully dilated, and given no choice as to what she will have to do whether she wants to or not. She will deliver vaginally. The experience of which is foreseeably traumatic - or at least should be - as the patient will have been subjected to what can only be considered a Forced Vaginal Delivery or an urgent/emergent cesarean where either her life or her baby's is put at risk.

And the thing with traumatic experiences is that they don't just go away - and sometimes they don't ever go away. The physician will have avoided doing what he/she saw as a medically unneccessary procedure - but in so doing will have likely inflicted a rather large emotional toll on a woman as she is entering a very significant life transition.

I can speak to the experience of forced vaginal delivery as it is my own lived experience. I can speak to the toll it has taken on me, and how it has changed me and how having had that lived experience - I would not wish it on any other woman because it is it's own kind of hell.

That is the real choice facing health care providers when women come to them asking for a patient choice cesarean: Do you facilitate the request after having provided informed consent, or do you subject your patient to a Forced Vaginal Delivery or an urgent/emergent cesarean after medical need arises?

A Doctor who Listens: Worth Their Weight in Gold

I appreciate that my experience with the medical system has changed what I expect of it, and has sensitized me to certain things. In particular, I blame part of what happened with my pregnancy and birth of my daughter as a failure of my health care providers to listen and understand what my needs were as a patient, and to facilitate those needs as best they could. I communicated my wishes clearly, and expected them to be respected.

As I've blogged about before, also as a result of what happened, I needed to find a new family doctor. It took nearly a year, but I found one. It is a new relationship - and like any new realationship, it is particularly fragile. We've had a few encounters - and while I think the new Dr. is a good person, I think that it just is not going to work out.

Advocating for oneself in the health system is already a challenge. Recently (now a month ago), I had some female oddness happen - I emailed an OB I knew and asked what I should do about it. I made an appointment with the GP - and the GP's answer was basically to just do another appointment for a pap (no physical was done at that time). I asked for a referral to an OB and that it seemed like a good idea for a pelvic ultrasound to be done. He ordered the ultrasound but refused to do the referral at that time. We did the ultrasound, and I had another appointment with him to discuss the results. My Mirena is partially imbedded in my myometrium. I decided to ask for the referral to the OB I prefer to determine what should be done. My GP is refusing to refer and insists on removing the Mirena himself (a. I'm not sure removal is fully neccessary and I'd like a second opinion on that, and b. if it does need to be removed, I'd prefer to have an OB (and preferably the OB in Vancouver) remove it because if there are any complications the last place in the world, I want to go is Victoria General Hospital). Last Monday his receptionist called - and told me that he'd prefer to remove it - I reiterated the request for the referral. I called today (10 days later) to see if the referral had been put through. It hasn't. This is the last time I'm asking for it - and frankly, this experience has demonstrated that he is not listening to me and makes me question whether or not he would listen to me in the future with any issues that may arise. I am frustrated and annoyed.

I think the hunt for a family physician for the W family is back on - and I foresee going to a walk-in clinic in the interim to get the referral I need to access the care I need.

If anyone knows of (or is!) a family physician in Victoria who is accepting new patients and who listens to their patients - I promise a low-maintenance and grateful young family.

For Spouses of Women Struggling with Birth Trauma

Birth Trauma is hard on women - but its also hard on their spouses and on marriages and partnerships. A post done by the Good Men Project for spouses of those with depression has inspired me to think about what partners of women traumatized by birth can or should do for the women they love as many of the things mentioned in the post resonated with me and my experience. Nobody tells the partners of birth trauma victims how to cope or what to do - and for the most part how can they be expected to know what to do? This post is intended to try and offer some advice to those loved ones, who desperately want to do something, but just don't know what.

Birth Trauma is devastating for women - when a woman is traumatized by her birth, her entire notion of herself as a woman and her role as a mother have been shattered. It can be a massive struggle for a woman just to make it through the day - many moms continually relive their birth experience and accompanied with the demands of motherhood, they feel overwhelmed. Spouses of women might try a gentle approach, they might try a firm approach, they might try to get them to open up, they might suggest things they think will help, they might buy presents and say encouraging things, they might get frustrated and argue. It seems as nothing a spouse does for a birth traumatized woman makes any difference - she just will not move-on. She seems unable to be grateful for all the good that remains.

Spouses of those traumatized by birth need to know, that birth trauma is not about women being in a "bad mood", or being upset because things during the birth didn't go "their way". Birth trauma is serious and debilitating. It is not about women "playing the victim" - or being trapped in "pity parties" - or being "selfish". Having a traumatic birth experience is like being in a car accident, or having your home destroyed by a flood. There might have been things that could have been done (or there might not be anything that could have been done) to avoid what happened - but the traumatized woman never asked for what happened to happen. The circumstances were entirely beyond her control - and if she could go back in time and have things happen differently, she would.

If your wife was injured in a car accident and had several broken bones - you wouldn't tell her to brush it off and continue as though nothing happened. If your wife was car-jacked and assaulted - you wouldn't tell her that sometimes that happens, and she was just unlucky but that she should be grateful to be alive. You would be patient, you would understand that she might be shaken from the experience - that she will likely need time (maybe a lot of time) and rehabilitation. Depending on how bad the experience was you might even have to come to terms with the idea that your wife might never be the same again. She might have to find ways to cope with the lingering injuries, she might not be able to do the same things she used to do, she might not ever be as social or as unguarded as she once was.

This is what birth trauma is.

Just because your wife made it through the birth physically, doesn't mean she wasn't injured psychologically. And just because you can't see the injury, does not mean that it does not exist, does not mean she is not debilitated.

After my daughter's birth, I was left reeling. It has taken years and a lot of therapy and self-care to get where I am. Three and a half-years on and I am not the same as I was and I doubt I ever will be. I won't seek care from Victoria General Hospital if I can avoid it. I am sensitive to feeling like my care providers are not listening to me. I am far more territorial of my person. I avoid movies with birth scenes in them. I am far more critical of those who judge personal decisions. I am less tolerant of intolerance and injustice. I am more skeptical and cynical. I am more angry. There are friendships I have had to discontinue - and other ones that have begun because of what happened. Birth trauma completely changed my outlook on life and who I am as a person.

When a woman is battling Birth Trauma - it is like she is in the deepest, darkest ocean - being crushed by the pressure of the water, and unable to determine the direction in which she should swim to reach the surface. All a woman wants to do is not feel the way she does, to not feel as though the day their child was born was also the worst one of their lives. They want to reach the surface and breathe -they want to swim to shore.

The natural reaction is to throw them a rope and pull them up to safety - to make them "see" how wonderful things are, to not focus on what happened, but on all the good that is. To make them move forward.

The problem is, that trying to pull women from the depths of Birth Trauma - might make things worse. Telling her to be grateful for her healthy baby. Telling her that what happened to her has happened countless times to countless other women. Telling her that she can not let what happened impact her mothering. Telling her to snap out of it and move on. Telling her that she should be happy as other women have it far worse. All these things are just as likely to drive the woman deeper into the trauma - and might add a dose of depression to go with it. Not only will she be unable to swim to the surface for air, the pressure to deny her feelings and needs for the sake of others might well crush her as she becomes a means to an end, rather than an end in and of herself.

For mothers, there is already tremendous pressure to sacrifice and put aside your needs for those of your family. Mothers already fear harming their children in some way by failing to do things the "right way". Mothers fear being labelled, they fear being seen as ungrateful. Mothers fear being judged as being weak - motherhood and birth are a kind of female machismo - and to admit that birth defeated you in some ways, is almost like admitting you are a lesser woman. There is tremendous stigma attached to mothers who are not blissful in their births and motherhood. We have been told from the time we are little girls, that being mothers is what women do and that good mothers are self-sacrificing. It does not matter that by accepting the stereotype of the good mother, we restrict women to biological essentialism - and that the sentiment is decades out of date and harms many women. The instinctual reaction for a mother is to sacrifice herself and her needs - to insist on soldiering on as a good mother does, personal needs be damned! Mothers will revert into themselves, put emotional barriers up and they will shut down. Trying to force a woman to move on, at what is likely the most emotionally challenging time of her life creates far more problems than it solves.

What spouses of the birth traumatized need to do - is to be there for their wives. If and when they talk, listen - refrain from giving opinions, just really listen. Women who are traumatized by their experiences need to be heard - they don't need your opinion about why everything is or should be okay (your body did not give birth). The thing I wanted more than anything, and the times when I felt my husband was really there for me, are the times when I felt validated and heard and sometimes just held. Your wife needs you to not be angry with her. Your wife needs you to be patient while she finds her own way out of the awful - she needs to feel and be safe when talking about it with you. However awful, the things your wife has to say - listen, and when you are done listening reaffirm that you love them still, reaffirm that you will be there for them, however long it takes and wait until they are strong enough to swim to the surface and the shore. Tell her it is okay for her to do what she needs to do for herself. It probably will be hard, you might need some help, but do not give up on your wife. Support her, love her, and be there for her until she gets to shore - she's the mother of your child, it is the right thing to do.

Forced Homebirth in a Hotel Takes BC Maternity Care to a New Low

I believe in access to adequate and timely healthcare to facilitate the needs of patients - and in particular the needs of mothers and their babies. I believe in informed consent. I believe in the prevention of birth trauma. I believe that when moms want access to medical care during pregnancy and childbirth - we owe it to them to provide that access.

Which is why I am scraping my jaw off my desk this today - I am shocked and appalled. I am also incredibly thankful, that for this mom and baby that the circumstances in which they were forced to give birth did not result in any physical harm.

A 17-year, first time mother was 8 days overdue and needed to be induced. They travelled to the Vernon Jubilee Hospital for the induction at 9 am on November 15. They needed to book a hotel room to wait for labour to begin - they returned to the hospital at 3:30 am and despite being unable to walk, the mother wasn't dilated enough and was turned away. They returned to the hotel and sometime after 4:30 am active labour began and progressed so quickly that they could not go back to the hospital. The aunt and grand-mother delivered the baby in the hotel room.

How is this acceptable care? How is this safe care? How does this respect the needs of pregnant women for informed consent and timely access to care?

This is wrong on so many levels. This apparently happened a year ago - I wonder if anything in Vernon has changed since it did?

On Causes

The other week we were flying back from a weekend vacation (a whole weekend of uninterrupted sleep and adult time with my husband) - and I did not have alot of reading material on my iPad and I was tired of scrabble, so I was reading the case law I had pulled sometime ago in support of my case. I was reading the Morgentaler decision - the decision that struck down Canada's abortion law in 1988 - there are so many striking parallels between a woman's access to abortion and a woman's access to planned cesarean. I was thinking how sad it is - how clear the law seems to be on the issues, yet at the same time - how insurmountable the challenge ahead is seeming. I was also thinking about how my experience changed me and mourning the loss of the wife and mother my husband and kids deserved to have - the woman who, had things unfolded differently, would be thinking and doing so many other things - a woman who would not be burdened by a cause.

Having a cause is a lot like having a chronic illness. A cause isn't something you give passing attention to - nor is it something you fully choose - it is the choice you make when the alternative is for whatever reason, unacceptable. It is what is done, when nothing else can be done and doing nothing is reprehensive.

The cause is also a life-preserver - a coping mechanism...it holds out hope that change is possible. That what is and what was, doesn't have to be what will be. Remaining committed to it, means that hope has not yet departed. It means that what happened to me does not have to happen to other women.

I have no doubt with respect to the right of women to expect the same rights as other patients with respect to their healthcare and their abilities to make medical decisions for themselves. There are tremendous barriers to exercising those rights and asserting those rights when they are violated - and those barriers need to be eliminated. That's not a small task - and it will require many who are committed to the changes that matter - mothers, doctors, OBGYN's, midwives, nurses, lawyers, judges and administrators. It will require a certain bravery and tenacity - and those who see the value beyond their own individual experience. It will require research and awareness. It will require resources and organizational capacity.

But none of these things should be seen as unattainable for far more has been found for things that matter far less.

Bad Evidence Drives Bad Decisions

Before I ever was a mom (and even now), I spent a lot of time with health statistics. Health statistics are experiences that have been reduced to numbers - they represent what happens to real people and describe how often specific things happen. Statistical analysis is a tool that is used to help figure out why those things happen - but it is far from perfect and far too often correlation is confused for causation. Equally problematic - the things that are not measured, often go unaddressed. When health statistics are done well - they shine a light on a problem and motivate positive change. When health statistics are done poorly - they keep real problems in the dark and hinder progress. Often, ideology colours the research that is undertaken and the result is a body of evidence that is at best poorly understood, and at worst used to make policy that does far more harm to those who it was meant to benefit.

I have come to the terrible and tragic realization that health statistics done poorly and obscured by ideology are endemic when it comes to pregnancy and childbirth.

It is the only way I can possibly understand the widespread propaganda that is largely focussed on promoting a specific kind of birth (normal birth) and a specific kind of infant feeding (breastfeeding) - even at the cost of the physical and emotional health and well-being of mothers and their children.

It is the only way I can explain Ottawa's and Toronto's public health stance on breastfeeding.

It is the only way I can explain the BC Minister of Health encouraging homebirth last year.

It is the only way I can explain all the "failure" felt by women who do not manage to have a normal birth or to breastfeed - all the while ignoring whether or not it really matters in the first place.

It is the only way I can explain why cesareans and VBACs are used as system measures, but rates of psychological trauma are not - it is also the only way I can explain why the costs associated with birth seem to end 6 weeks post-partum.

If health statistics and research in this area were being done well - the things that really mattered would be measured and better understood. If that was the case, maybe I wouldn't get the feeling that we are being penny wise and pound foolish, and short-changing the health and well-being of women and their children in the process.

Baby, I'd like My Boobs back - Thanks, Love, Mom

I've breastfed my son far longer and far more than I thought I would. I got a little lazy around Christmas last year and neglected to bottlefeed him for a few weeks. At the end - he wouldn't take a bottle. No way, no how. Not of formula, not of pumped boob juice. If it wasn't my boob, he didn't want it. I have been booby-trapped ever since.

It's kind of worked for us though. Aside from the night shift, where my now 14 month old toddler still insists on waking several times a night for some snuggles and some evening nourishment. I mean what's a little sleep deprivation - who really needs more than 3 hours at stretch anyways?

But the Mr. and I would like to go away for a weekend...and well...the boobs cannot be left behind. Furthermore I am ready to move on and would really like to get maybe a 6 or 7 hour stretch of sleep on a consistent basis. So, there's weaning ahead. And if my experience of weaning his big sister from the bottle is anything to go by, well, I don't imagine it'll get any easier - so I may as well bite the bullet and get done with it. That and leaving my mom with a baby who isn't yet weaned for a weekend seems kind of cruel...so best to get a start on it before that happens.

I get the sense that the wee little W won't be happy - I also know he'll get over it, and he'll still love me, because I'm mom and that has a lot of sway - even if it doesn't come with an all you can eat boob-fet.

But the WHO and their 2 year recommendation can go find a different boob to suck as mine are retiring in the very near future!

Ottawa Public Health Responds

I'll leave the following response from Ottawa Public Health with my readers:

Hello Ms. Williams,

Thank you for your valuable feedback on the Ottawa Public Health Make An Informed Decision About Feeding Your Baby web-page.

In 2013, Ottawa Public Health met the provincial requirement to qualify as a World Health Organization designated Baby-Friendly Initiative health facility. Our website was reviewed by assessors experienced in infant feeding to ensure quality and currency of the information. Our information sources include the World Health Organization, Health Canada, the Best Start Resource Centre.

We wish to reassure you that OPH strives to support all families regardless of the infant feeding decisions they make. Support is available for mothers who are breast-feeding, bottle-feeding with breast milk, or formula feeding. Avenues for offering information and support include prenatal education, Baby Express drop-ins and the Ottawa Public Health Information Line.

We are committed to meeting the needs of our community. The way in which information is presented on our web-site is being reviewed with your concerns in mind.

Many thanks for your interest in this most important subject.

Regards,

Tania

Tania O'Connor, RN, B.Sc.N

Supervisor (A)

Ottawa Public Health

Health Promotion and Disease Prevention

If that is what assessors experienced in infant feeding consider "quality and current" information - we have to ask ourselves, who are these people and why do they hate mothers who do not breastfeed so much?

Dear City of Ottawa: Lactavism is NOT Public Health

The other day, I was outraged by something a friend in Ottawa had pointed out on one of the discussion boards I participate in - I was shocked that a body of government would stoop to such a low level of unabashed fear-mongering and outright lactavism. It is one thing to find such things on biased webpages (The Alpha Parent, The Feminist Breeder, Natural News, etc.), but quite another to find something on the Public Health page of a major Canadian city. I always believed that such organization would hold themselves to a much higher standard - that they would have people employed who were actually committed to the health and well-being of women and as a result would be more immune from this kind of garbage.

This is not about making an informed choice - that would mean encouraging women to have a discussion with their doctor about what is best for themselves and their babies in their particular circumstance. This is about fear-mongering and bullying moms into breastfeeding and that is wrong. The information on this page is exclusively about the benefits of breastfeeding and the risks of formula feeding. There are no sources provided or even statistics on what the actual relative risks are. According to this page, breastfeeding is the magic bullet that is the golden brick road to good health, and formula feeding is plagued with illness, obesity, tooth decay, cancer and death.

I can only imagine how such information would be received by a new mother - who like all mothers, only wants to do the best for her child. How this information might drive such a mother to make truly bad choices with regards to her own health and that of her child - including buying unscreeened breast milk from donors over the internet rather than feeding her child formula, or waiting until there is a health crisis to switch to formula - and then feeling terrible about it.

That is not good Public Health.

So I emailed the City of Ottawa (and would encourage you to do the same - they can be reached at healthsante@ottawa.ca ) the following:

Dear City of Ottawa -

I am a mother and I write out of concern about the following webpage: http://ottawa.ca/... that purports to encourage women to make an "informed decision" regarding infant feeding. I am disappointed that the City of Ottawa would consider such a webpage appropriate or helpful to mothers.

Many mothers, for whatever reason, find that breastfeeding is not appropriate for themselves in their particular situation. Some mothers do not make enough milk. Some mothers are survivors of childhood sexual abuse and find breastfeeding psychologically difficult. Some mothers must return to work in order to economically provide for their children and cannot accommodate breastfeeding. Some mothers are on medications that are not compatible with breastfeeding and pose risks to the infant. Some mothers find breastfeeding painful and inconvenient.

These women need to know that formula feeding is a safe and appropriate option for meeting the nutritional needs of their babies and they need clear instructions on how to formula feed appropriately.

The webpage by the City of Ottawa is nothing less than fear-mongering and does little to provide for the informational needs of mothers. Worse, the information provided by the City of Ottawa may inflict emotional harm on many women - as they are lead to believe that the choice to formula feed will lead to tooth decay, obesity, cancer and death.

All women deserve to be supported during pregnancy, childbirth, and the year post-partum - and the City of Ottawa has determined that it should make women who for whatever reason need to formula feed to feel worse than they already do. Please revise the information on your website to be more balanced and sensitive to the the emotional and informational needs of mothers.

Sincerely,

Janice Williams

Perhaps if more women take a stand against this kind of garbage - it can be treated as the toxic trash it truly is.

Canaries in a Coal Mine: Birth Trauma Survivors

The experience of the birth of my daughter has been by far, the most negative experience of my life - it was the most terrifying, most painful, most disempowering, most psychologically wounding and dehumanizing thing that I have ever known. The only saving feature is that my daughter emerged from that experience, ultimately unscathed - and for that I will always be grateful. It was the kind of experience, that having had it - knowing it first hand - you would do anything to prevent any other human from experiencing the same. Indeed - I expect that I never will be the same, that I never will look at things in the way I would have had I never known Birth Trauma.

Much as veterans look upon war with different eyes than civilians, or, those who have never known war - survivors of Birth Trauma look upon birth much differently. They see the destructive potential of birth, they know it can decimate the lives of women and their families. Their struggles in the aftermath are often silent - the stigma of admitting that birth was not what you thought it should be, that birth was negative - is often too great. Their pain is often dismissed (this is particularly true if the child born of the birth is ultimately healthy). So rather than learn from them, rather than honour them, rather than help them in whatever ways are possible: we expect them to get on with the business of mothering.

And that is shameful, because these mothers see what others can not: the toxicity of the system and the culture that is prevailing. Birth Trauma victims are the literal canaries in a coal mine. Furthermore, by empowering these women, to speak up and speak out about their experiences AND just as importantly, to HEAR what they have to say and to LEARN from them- it is possible that the system could change. That other women might avoid the same suffering - or that when such suffering happens, that maybe it doesn't have to be as damaging.

The experiences of Birth Trauma victims are awful - worse is to fail to take the opportunity to learn from them and to prevent others from enduring the same harm.