Tuesday, July 30, 2013

The Reality of a Traumatic Birth

The reality of having the day my child entered the world also be the day in which I had the worse experience of my life - a severe deprivation of personal autonomy - is that it has not faded from the forefront of my mind. It has been more than three years and very rarely does a day go by when I do not think about that day. On a good day, it is just there. On a bad day, it brings with it all the negative emotions - the terror, the anger, the abandonment, the pain, the helplessness. On a bad day, there is little reprieve and I find my mood sinking like a lead weight in an overwhelming ocean. The upside is that the good days, the days when it just is what it is, are growing in frequency, while the truly bad days - the days when the thoughts come with all the baggage of the negative emotions associated with it are diminishing.

I have come to the conclusion that this is the reality of my traumatic birth experience. There will always be a psychological scar - it'll fade, sometimes it may not be painful - but it will always be there. The negative experience cannot be reframed as being a necessary evil. Which is why I feel compelled to do something about what happened to me - something concrete, something that might make a difference for another woman. It is why I blog. It is why I am holding my care providers, the hospital, and the health authority to account - in the only way I truly can. It is why I can't just move on - because moving on when things still need to change, means that what happened to me will always just suck, for no good reason - and in some way feels as though it would be accepting that the way things are is somehow acceptable. There will not be closure until I feel like I have done what I could to change what is wrong with maternity care - I do not believe I can move on until I am done doing what I can to make it better for other women, other moms, like myself.

I hope that those who love me, can support me in what I need to do - in order to reclaim the woman I once was. The woman who was confident that what she thought, felt and did - actually mattered. I hope that they do not see what I am trying to do as being the actions of a "selfish bitch" - and see that what I am trying to do, needs to be done. I hope that they can be proud of what I do accomplish - and I hope they might understand a little about why I cannot just move on. I hope that I can make a difference. I hope that I can be the mother my children and husband deserve.

Tuesday, July 23, 2013

Birth asphyxia and niggers

Before anybody gets their panties in a knot - "niggers" is what my just three-year-old calls fingers. It is kind of funny and cute, given that she does not know everything that is wrong with the term (but I hope that she will soon be calling her digits "fingers" in the near future). She calls herself "Newno" - she can say "juice" just fine, and she can say "no" like a pro - but "Juno" seems to still be beyond her. To be honest, unless you are fluent in Newno-ese, she can be somewhat difficult to understand. When she counts, she rarely gets past three - "one, two, three, lemon, two, one". She does not sleep through the night most nights. Looking back on her baby photos - there's more than a few where her left eye appears to be lazy and looking towards her nose (a paediatric ophthalmologist evaluated her shortly after her first birthday and has said that it is nothing more than pseudo-strabismus).

That's not to say she's not without her strengths - she can identify an animal and the noise it makes likes nobody's business. She's also fearless - put the kid on a horse and she is more than happy when it moves, she hasn't met a slide or a ride that she doesn't like. She enjoys playing with other kids. The kid can shake off most tumbles and scrapes with ease. She aced her first dental appointment. She is more of an omnivore than most three year olds. She enjoys helping others - and is particularly fond of helping me when I bake. She engages in imaginative play. She has a smile that melts my heart. She is potty trained.

Meanwhile, I have a friend who has a son who is just a few months older than my daughter and he will cheerfully recite the alphabet and counts to twenty.

There is a part of me that wonders about whether or not the circumstances of her birth has had an impact. There's part of me that wonders if the cord around her neck, cord blood pH of 7.0, her being born not breathing and needing resuscitation has had an impact on her development. Until the past year, there really hasn't been anything that has significantly set her apart from her peers. There's part of me that wonders that, if she had had the same entrance into the world that her brother had - would she be the kid who counts to twenty and knows her ABC's and is fully intelligible even to those unfamiliar with her lingo.

I would love nothing more than to have full confidence that the circumstances of her birth did not have any impact on who she is or her capabilities - but what if it did?

Thursday, July 18, 2013

How to get there from here?

I want to live in a world where women are empowered to make medical decisions for themselves and can be assured of timely access to medical care to facilitate those decisions. I want to live in a world where access to epidurals and maternal request cesarean is not a matter of luck. I want to live in a world, where no woman chooses to give birth at home because she thinks her right to make medical decisions will be violated in the hospital. I want to live in a world where being psychologically scarred from the experience of birth is better understood and a far rarer event. I want to live in a world, where the information provided on birth is balanced and reflects current evidence. I want to live in a world where women do not feel the need to justify having had a cesarean or having chosen to formula feed. I want to live in a world where there is a lot less focus on the things that do not really matter (mode of birth, type of feeding), a lot more focus on the things that do matter (physical and psychological well being), and a whole lot less mommy guilt.

I want to live in a world where the voices of moms like me are not drowned out by voices of advocates of natural birth or home birth. I want to live in a world where maternal request cesarean is as understood and as researched as home birth. I want to live in a world of truly informed choice - where women are not "sold" on what they should do, but rather are given the information they need on the choices available to them and are free to make the decisions that best meet their needs and those of their family.

The reality is, that the world as it exists now - is still distant from the world as I wish it were. That's the challenge - getting there from here. Improving pre-natal education and the information available to pregnant women. Improving access to reasonable choices. Improving the hospital environment. Improving the legal context. Improving access to resources for those who have been through a traumatic birth or for those who are grappling with difficult pregnancies. Improving the knowledge base through research. Giving voice to the women who have no desire to buy into the ideology of Natural Childbirth. It seems as though there is still a lot of work to be done.

So how can we get the work that needs to be done, underway? What is the next logical step?

This side of the spectrum has no Lamaze. This side of the spectrum has no Childbirth Connection. This side of the spectrum has no mothering.com. This side of the spectrum has no International Cesarean Awareness Network. This side of the spectrum has no National Childbirth Trust. This side of the spectrum has no Power to Push Campaign. This side of the spectrum has no Business of Being Born. In short - this side of the spectrum has no large organization that is advocating for the interests of it's members and undertaking the work that needs to be done to improve maternity care for women who want to avail themselves of the advantages that modern medical technology can provide to make birth less painful and safer for themselves and their children.

That's not to say that this side of the spectrum is completely bereft of resources and advocates. This side of the spectrum includes Birth Trauma Canada. This side of the spectrum includes the Fearless Formula Feeder, Suzanne Barston. This side of the spectrum includes The Adequate Mother, a Canadian Anesthesiologist. This side of the spectrum has published a very well researched book by Dr. Magnus Murphy and Pauline MacDonagh-Hull "Choosing Cesarean: A natural birth plan". This side of the spectrum also includes Cesarean Debate. This side of the spectrum includes Dr. Amy Tutuer, the Skeptical OB. This side of the spectrum includes the facebook group the "Cesarean by Choice Awareness Network". This side of the spectrum includes me. This side of the spectrum has tremendously educated women who are working as best they can to facilitate change - to improve maternity care for mothers and their families. However, it remains under-organized and as a result is not meeting the potential to make maternity better for a large number of women. It needs to be better organized and better resourced in order to facilitate the work that needs to be done - there is a large mandate that is waiting to be met.

So how do we become better organized and better resourced? How do we catapult ourselves to compete with the well organized and well resourced Natural Childbirth industry? How do we harness what is a group of intelligent and motivated women and interested others to make change happen?

Those are the questions I am trying to grapple with. There must be answers. There is a will, there must be a way.

Thursday, July 11, 2013

Penny Wisdom and Pound Foolishness in Maternity Care

It is fashionable to bemoan the high cost of health care - it does not matter if you live in Canada or the United States - and that extends to the costs associated with maternity care. Never mind that comparing the costs of maternity care between countries is fraught with difficulties - different countries have wholly different population health statuses, wholly different litigation systems, wholly different health care systems - all of which might contribute to differences in the price paid for maternity care. Unfortunately, what gets forgotten is what is bought with the money spent on health care during pregnancy and childbirth - and the value of those things, in terms of improved outcomes and satisfaction with the care received. It is not unlike bemoaning the high-cost of pursuing a university education that is likely to lead to a much higher paying job AND completely ignoring the likely increase in income (and productivity) that will be realized after graduation. Unfortunately, the economics of pregnancy and birth, for whatever reason, seems to be done rather poorly - with a focus on very broad measures of outcomes (mortality) and very limited timeframes (sometimes only counting costs that accrue within 30 days of birth).

It is often forgotten that countries that have realized a lower cost of care for pregnancy and birth, may have done so by cutting corners on the quality of care available to women and their children - limiting reasonable access to options and sacrificing the lives and well-being of some women and children. Examples of the sort of tragedies that can result fill the pages of the Action to Improve Maternity (AIM) website a New Zealand based organization that has tried to bring some accountability and improvements to the midwife led system that is focussed on promoting normal birth. It is also not uncommon to hear tales of epidurals being denied or delayed in the UK or parts of Canada - again both countries where integrating midwifery into the system of care and promoting "normal birth" is the norm. A birth that does not involve an epidural is cheaper than one that does, but that does not mean that quality care was provided - particularly if the woman wanted an epidural and endured a painful and traumatic delivery as a result. A birth that results in a vaginal delivery is not necessarily quality care either - particularly if it leaves the woman traumatized, or herself or her child disabled.

I would not be surprised if well done economic studies on birth and intervention in birth would show that an ideologically driven system focussed on promoting and facilitating normal birth actually comes at a tremendous cost.