Like Watching a Movie When You've Already Read the Book

I am blogging about this with the permission of the mother involved.

There’s a caesarean by choice mom in Ontario (Alliston) who has contacted me – and unfortunately her story seems to be unfolding pretty much as my story unfolded with the birth of my daughter. Except, her OB told her at 33/34 weeks that she would not do a caesarean unless there was a medical indication for one, but if a medical indication presented itself that they would move to a caesarean as soon as possible. The doctor implied that the “Ministry of Health” would have a problem with her undertaking a maternal request caesarean (I call BS!). My doctor failed to refer me until 32 weeks, and I did not know if my request would be granted until I was 36 weeks.

The woman was upfront about what she wanted with her care provider from the start of her pregnancy (as was I). Had the doctor been upfront with the woman at that time, she could have moved on to an alternate provider that might have facilitated her request (as might I have). Instead, she was treated paternalistically (as was I) by a doctor who seemed sympathetic, who seemed to listen and to understand – but who ultimately frustrates what is desired by the patient by ensuring that what is wanted cannot be realized.

After being informed by her doctor that her care plan is unlikely to be realized – this woman has been left scrambling. She’s gone back to her family doctor hoping that if he advocated for her that her plan would be facilitated. No luck. She’s written a letter to her doctor that says she does not really consent to a vaginal birth and that she is worried about the potential harms of vaginal birth for both herself and her daughter. She’s pointed out the NICE guidelines on caesarean by choice (she’s Canadian so they don’t really apply). She tried to give her doctor Pauline McDonaugh-Hull and Magnus Murphy’s book “Choosing Cesarean: A Natural Birth Plan”. Her doctor declined reading it. She is currently left hoping something goes wrong so that she can have the caesarean she wants. Her OB wants to begin performing “stretch and sweep” procedures at her 37 week appointment next week.

I’m saddened that nobody has seen fit to refer this woman for a psychological assessment – as the idea of a vaginal delivery causes her a considerable amount of anxiety, they are declaring they won’t do the caesarean without a medical need – without recognizing that the mental health impact of an unwanted vaginal delivery IS a medical need. Rather than investigate that, they just out-rightly have denied this woman access to the care she needs and are doing so in a rather unethical way, by having delayed referral to the point where alternate care is not possible. The lack of understanding and compassion is appalling – as is the lack of recognition that a woman has a right to decide what to do with her own body and she should not be unreasonably prevented from doing so. This woman has not fallen through the cracks, so much as she has been shoved into a crevice.

So what would I do if I were faced with that situation?

I might start contacting lawyers and legal aid to figure out if there was some way to avoid having my rights violated. I might write a letter to the College of Physicians and Surgeons of Ontario calling out the behaviour of the physician. I might contact the media about my plight. I would contact Birth Trauma Canada for advice. I might contact the Office of the Ombudsman and file a complaint. I might contact patient rights organizations with my story. I might go to a different hospital with a reputation for being more “woman friendly” at 39 weeks and beg for a caesarean. I might hire a psychologist to try and advocate on my behalf – or maybe contact a perinatal social worker to see if she could help. I might ask the doctor to provide me with a medical reason not to perform the caesarean. I would go to another care provider – even if it meant the on-call OBGYN at the hospital and I would continue to make my wishes known in as clear of a way as possible.

And ultimately, if all that failed and I was still subjected to a vaginal delivery I did not want. I’d do what I’ve done – try to handle it as best I can, to try and cope with what has happened, to try and not let it impact my life more than it needs to because you can’t change the past – you can only do what you can to make the future a better place.

I’m really sorry that I cannot do more for this mother – it is like watching a movie when you’ve already read the book. Sometimes you can only hope for a different ending.

P.S. If anyone can help make a different ending happen - please drop me an email at qualitycareforbcmothers@gmail.com. - Thanks.

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"