Friday, March 28, 2014

Canadian Healthcare: Not as Universal as Some Might Think

In Canada, every baby born in Canada, is Canadian (*with the exception of some babies who might be born to diplomats). It doesn't matter where that baby's parents are from - and as a Canadian every baby born in Canada is entitled to access to the publically funded Canadian healthcare system. But, when should that baby's right to publically funded healthcare begin? Should that baby have different access, because of the origin of one or both of it's parents than another baby also born in Canada? Should it matter if that baby's mother is Canadian or if it's father is Canadian? Should it make a difference if, at some future point, that baby's mother will be eligible for publically funded Canadian healthcare?

It may come as a surprise - but, access to publically funded healthcare in Canada is not universally available to all pregnant women in Canada.

There are pregnant women in Canada who are uninsured and must pay out of pocket for healthcare services related to pregnancy and childbirth - many of whom intend on making Canada their home, many of whom are carrying the children of Canadians, many of whom will ultimately have access to publically funded health services.

The fact that these women will bear Canadians, and might well become Canadians or otherwise entitled to access to publically funded healthcare seems a fact that has gone unrecognized by whoever thought it was a good idea to exclude access to publically funded health services from these women.

I imagine the intent was to save healthcare resources for the Canadians who pay for the system - but I will argue that this policy is not only cruel, it is short-sighted and might well cost the very same healthcare resources it was intended to save.

Pregnancy and childbirth are exceptional times in a woman's life - at no other point is the health of both woman and child more vulnerable. At no other time is the health of the child so intertwined with the health of its mother. Care during pregnancy and childbirth matters - a lot. What is done or not done - echoes for the rest of that woman and that child's life. If access to high quality care is delayed or denied, there are consequences - both physical and psychological. Access to that care should not depend on the mother's ability to pay for it.

Right now, the policy is that unless you are Canadian or a landed immigrant you are not entitled to publically funded health care, and if you happen to be in either British Columbia or Ontario there is a three-month waiting period for eligibility - so if you were a Canadian living abroad who recently returned, you might also find yourself excluded from publically funded health services. It doesn't matter that there is a massive back log that impedes the processing of immigration applications. It doesn't matter that you may be married to a Canadian or that the baby's father is a Canadian. It doesn't matter that you would ultimately become eligible for publically funded health insurance or that the services that you are seeking to access are considered "basic care".

So what does this mean?

This means that the health and well-being of mothers and children in Canada might be at risk. This means that basic care might be foregone if the mother cannot afford to pay for it or if doctors and charities are inadequately resourced to provide it. This means that conditions that can be managed or diagnosed prenatally might go undiagnosed and unmanaged. This means that a mother might decide to give birth unassisted or at home, even though a hospital based birth might be better suited to her needs and those of her child. This means that some of the truly adverse consequences of pregnancy and childbirth - some of which might be avoided with better care - will be realized.

Who will pay for those left disabled as a result of inadequate care during pregnancy and childbirth?

Here's a hint, pregnancy and childbirth is far more dangerous for babies than it is for mothers. Those babies are Canadians. They are likely to pay with their lives or their health - and if they pay with their health, guess who is on the hook? Guess which resources will be used? Further, if the mothers eventually become eligible for access to publically funded healthcare - who will pay for the longer run consequences of inadequate care during pregnancy and childbirth?

Is it not better, to pay for an ounce of prevention? Is it not more fair to give every baby born in Canada the same access to healthcare - even before their births - regardless of whether it happens to be their mothers who are Canadian or their fathers who are Canadian?

Pregnancy and childbirth are exceptional - and are deserving of an exceptional policy response that recogizes the need to meet these health needs for these women and these children.

I encourage my reader's to sign the following petition demanding change to this shameful policy.

Background information:

- Uninsured mother's likely to have inadequate prenatal care.

- Tyee article on uninsured mothers in Canada.

- Mother gives birth in Hotel due to uninsured status.

- Canadian doctors call for action on uninsured.

Wednesday, March 26, 2014

Guest Post: Maternal Choice Cesarean, One Mom's Story

The following is a guest post from a brave cesarean by choice mother who is willing to share her experience in the hopes that others might be better able to understand and support cesarean by choice. She is now 3 months post-partum and enjoying motherhood the second time around. I thank her for her submission to Awaiting Juno and for the permission to post her story on my blog.

I had a c-section with the birth of my second child. It was elective, by my request. The first birth I experienced was an extremely unpleasant experience that I preferred not to repeat.

I'm not the type of person who shares my life choices all over the Internet, but I want to share my experience for the knowledge of those considering the same choice. I’ve heard about 1% of childbearing women opt for a maternal request c-section. My experience was very positive; everything I had hoped. After a less than ideal vaginal birth, it felt good for things to finally go in a way that was ideal for me.

There is stigma against choosing to have a c-section. The phrase “too posh to push” comes to mind. There’s also some confusion about women being happy with the procedure. “Why would anyone choose that?” Well, the answer to that question is highly personal! And trying to insult women by calling them too posh to push isn’t going to make us feel obliged to answer.

Still, there’s the stigma. I chose to avoid it, along with the demand for an explanation by simply not telling anyone who was not close with me. Since before I conceived my second baby, I knew a MRCS was my preference. I would even say that it was my plan. My husband witnessed the vaginal birth of his first son, and to say that he was on board with my plan would be an understatement. Next, I told my mom. She was on board. My family was on board. My husband's mom also was on board. She had four precipitous labors (that means she labored and birthed extremely fast). She told me she never understood why anyone would want a natural birth. She had four and she hated all of them. She never had any other choice, because her labors were literally that fast. And, kudos to her, she was the only woman who was honest about this with me during my first pregnancy. Since I ended up laboring for 24 hours, an unfathomable amount of time to her, she thought a c/s was a totally reasonable option.

One night I went out with one of my best girl friends. I was craving some crepes, so we went to a diner. I decided to tell her about my plans. With her being a feminist and also generally extremely supportive of any choice her friends would make, I was shocked and hurt when she said, looking bewildered, "Why?! You're so young! C-sections are terrible! (She has no kids.) My aunt had a c-section and all of her staples flew out of her when she puked!"

So, don’t expect support from everyone. Also, take no shit from anyone. That’s my advice. It doesn't matter why you want a c-section. You don't owe the world an explanation. You especially don’t owe them a polite explanation. After all, people who think they deserve any say in what you do and do not do with your vagina are also not polite. And those who think that you are going to damage your offspring and rob them of gut flora and IQ points by choosing this are also wrong and not polite. They also tend to believe everything they read on the internet. You’re better than them!

At the time of my first pregnancy I was coming from a religious and homebirth-affiliated background. My friends who were mothers were all pretty smug, proud, and touted all things natural, so that was the route I chose to go down, too. It was scary to be pregnant so young. I was 19. I almost home-birthed, but my mom talked me out of it, so I ended up having a vaginal birth in the hospital. The staff was overall great and really kind to me, even though I was a horrid patient to have. Still, the birth was just terrible, physically and mentally: 24 hours of labor, three hours of pushing, 8lbs 13oz of baby on my (previously) small frame… It just wasn’t good. I tore externally (but not all the way to the back) and I also tore internally. I did have an epidural, but I decided to let it wear off while I was pushing, so I felt the tearing, and I felt my baby being born. I had vowed to myself that I’d never forget (like my friends who said they did), but now I wish I could forget.

My internal tearing was the main problem. It happened because my baby was big and stuck in the birth canal. We couldn’t get him past a certain point without forceps. It was the posterior wall of my vagina that tore, into the wall of my rectum, almost all of the way through. I still remember what it felt like when my doctor began to stitch it up. Sexual intercourse stopped being so painful around nine months later. It was a disturbing thing to work through. Not to mention the stress incontinence. I couldn’t cough, sneeze, laugh hard, jump, or run without peeing myself. Despite wanting a second kid, I couldn’t agree to the idea of another vaginal birth. I got dizzy and faint thinking about my first one. Plus, I didn’t want my unpleasant symptoms to worsen. My psyche and my body thanked me for my c-section. A vaginal birth was so undesirable to me, that if it were my only option, I’d never have had another baby.

One day my mother ended up randomly joining me for my OB appointment. I hadn’t brought up the issue yet. My mom spontaneously did. "If she wanted to have a c-section," she said, "would she be able to?" My OB said that would be okay and she asked me why I wanted to. I told her I didn't want to relive my vaginal birth and cried. She was really kind. She comforted me and read the dictation she wrote after my first birth. She said between that, and my emotions, my request was totally fine with her. She even scheduled the surgery for the exact day that I wanted, even though she was planning on having it off. She came into the hospital early that morning for my family and I, and then went home.

The rest of the story is short in comparison to what I’ve already written because it was a breeze after that. It was simple, easy, relatively pain-free, happy, and everything that I wanted to happen. That isn’t the reality for some surgeries, but for mine, it was.

We went to the hospital early in the morning in December to check in. Our check in time was 5am and the surgery was scheduled to start at 6am. No food or drink from midnight until after the surgery. The nurse directed us into a brand new comfortable hospital room. She asked some questions, got an IV started, and basically told me what to expect and what she would be doing for me. Two anesthesiologists came to my hospital room and explained to me the spinal I was going to get for the surgery. Pretty straight-forward, a lot like the epidural I’d had before.

My husband and I waited around in the hospital room. We felt pretty calm. We just chatted and had a good time until the OR was ready. When it was time to go down, my husband and I parted ways for a moment. He had to get his scrub outfit on. While he did that, I got my spinal. It was a good arrangement because he is phobic of needles. I hugged a pillow and curled my torso forward around it the best I could with my huge pregnant stomach being there. There was a nurse smiling at me, hands on my shoulders, talking to me. The spinal was actually not as easy as my first epidural. The anesthesiologist was placing… what I assume was a needle… and he hit a spinal nerve. That sounds terrible, but it really was not so bad. I said, "There's a weird feeling." They asked where. I gestured towards it and tried to explain. It was about a foot long vertical stretch, just a tad to the right of my spine. It felt like a weird minor pain I get sometimes on a tooth I have where it's chipped. That's the only way I know how to describe it. It lasted maybe thirty seconds total, and then it faded and the numbing started to happen.

My husband came back. They were monitoring my oxygen and blood pressure. A catheter was put in (SOO glad they did that after the anesthesia, not before). My OB asked if I could feel her touching me. I couldn't, so I said no. She felt different parts of my abdomen and body to see if I could feel anything. The answer was always a no. So, they started the surgery.

I still didn't feel anything. I had a bit of adrenaline, and the occasional chill. When the blood pressure cuff would squeeze my arm, it made my right hand clench uncontrollably. My husband made the mistake of holding my hand while that happened. That was a funny moment for me.

Anyways, my baby was born after not too long. The OB said something along the lines of, here he is, he is beautiful! Then he cried. I looked over and watched as they cleaned him up nearby, as per my request, before I held him. 8lbs, 3oz, 20.5" long! If I carried him to his due date he would have rivaled my first baby in size. Some people who have c-sections say they feel a huge amount of pressure as the baby gets pulled out of them, but I didn't feel that different or weird. Or anything. They wrapped Baby Andrew up and we got to hold him, cuddle him, look at his face. I didn't feel any pain and so I felt like I could be entirely mentally present. I was just so giddy and happy. I did not feel that way with my first birth. With this birth, I was just ecstatic and completely without pain.

While that happened, my OB performed my tubal ligation. She found out that I only had one ovary and one fallopian tube. Interesting. I asked the team if I could take a picture of my placenta and show my best friend, the one I had went out to the diner with, because she had always wanted to see a placenta. They let me, and then they asked what I wanted to do with it next. I didn't want it. And then we made fun of lotus birth together.

At some point, the anesthesiologist took pictures of my husband and I with the baby. I adore those photos. The anesthesiologists always stayed right by my husband and I, keeping us company, talking about life. We talked about our families together, and they answered all of the questions that I had in detail. They were absolutely amazing the whole entire time. My baby got to stay with us always.

Recovery was pretty easy. I threw up after my first birth, but not this time. I had occasional nausea but it stayed under control. The first thing I could have was chicken broth. Then, I believe I was eating snacks a few hours after the surgery. Those hours flew by, so it wasn't an issue for me. I started to feel just a bit sore, but it was nothing like how I felt with my first birth. Also, the pain was in a different location, and it felt less…disturbing.

I have no complaints about my recovery at all whatsoever. It was somewhere between day four and day five that I stopped taking pain medication. Again, sooner and better than my first birth. The only thing that was worse was standing up and walking for the first time after surgery. I had spent a lot of time lying in the hospital bed at an incline, so I hadn't had my torso straight for a while. Straightening it out was a bit painful and strange, but after the second or third time, it felt much more normal.

I haven't felt pain related to the delivery for a long while now. I'm a little over three months postpartum. Healing came so easily. I wonder if my mental preparedness played a part in that at all. I have had no issues at all whatsoever with intercourse. I felt “ready” 2-3 weeks after the surgery, but we were good and waited. My stress incontinence even seems to be gone… No more leaks, ever. I should mention that to my OB next time I see her to ask if she did something during the surgery to make that happen, or if it's just a happy coincidence. I know she was aware of the issue.

I can't think of anything else to say, except that I am SO happy with my choice, so happy I was supported and able to make that choice, and I have not even one iota of regret. My husband also had a much better experience. It was so much less traumatic for him. I’ve heard people say their surgeries hindered them from bonding with their babies, but we felt like it was easier to bond with our baby this time. We had a better idea of what to expect, nothing traumatic happened, and my pain was very controlled. No complaints! I’m just grateful and happy.

Wednesday, March 12, 2014

Not now but not, not ever

The last few months have been personally challenging – and a big part of that challenge was coming to the conclusion that I had gone as far as I could go with respect to holding my care providers, and the hospital to account for what happened to me. That – one of the tools that I saw as perhaps being the most effective in terms of preventing the same thing from happening to someone else (litigation), simply was not going to be available for me to use at this time. I had invested a lot of emotional and intellectual energy into pursuing it and it is heartbreaking. I still believe that litigating was and is the right thing to do, but that it just isn’t possible right now, not because it is without merit but because what is needed to succeed at this time just isn’t available and there was no amount of wishing or wanting or brainstorming that could take care of the barriers that stood in the way. Those barriers were both structural and systemic and personal.

It is particularly difficult because I know, now – nearly four years after I had my daughter, that women in Canada are still struggling to access the care they need, when they need it. They are still struggling to find doctors who listen to what they need, who provide informed consent and who respect their right to make a medical decision for themselves after considering the risks and benefits of their options.

It happened in Alliston the other week – and is happening again as I type in Ottawa to another mother, a mother who just wants to be heard. A mother who just wants her right to informed consent and the right to make medical decisions for herself respected.

And it will continue to happen until there is profound change and a shift in focus away from the things that do not really matter and towards the things that do.

Which is why, while I have had to discontinue the case – I refuse to discontinue with the cause. Because there will come a time, when the barriers will be mitigated and surmountable but only if those barriers continue to be dismantled.

It’s why this blog will continue. It’s why the maternity legal action fund needs to be supported. It’s why the Cesarean by Choice Awareness Network will continue to grow and remain a place for women who would choose cesarean and those who support them to connect with each other and advocate for change. It’s why Moms Forward will be established. It's why I'll continue to tweet (@AwaitingJuno) and continue to raise awareness and advocated for change.

Because some day being a Cesarean by Choice mom will be better - with a strong community, with better access to compassionate and competent care providers, and meaningful recourse and support. I have not given up – but have accepted that there are things I can do, and things I cannot do, and that not now does not mean not ever.

I apologize for letting down those who had hoped that the litigation would proceed, and would like to thank all my readers for their continued support.

Thursday, March 6, 2014

An Update from Alliston, Ontario

My last post focussed on the difficulty a mom in Alliston, Ontario was having in trouble accessing her preferred method of birth - a maternal request cesarean. This post is intended to provide an update.

The baby arrived the day before yesterday, after an induced labour that lead to a normal delivery. The mother agreed to be induced by her OB because then she would be the doctor on-call so that if there were any bumps the mother felt the doctor would "be more lenient" in proceeding to a cesarean. The mother was able to get an epidural, and the baby arrived without any complications.

Prior to the delivery, the mother did all she could to secure a cesarean.

But the reality in Canada, even in 2014, is that sometimes even when you do all you can - it simply isn't enough.

I am also aware that it is possible that in this case, the mother will accept how things unfolded and might even be happy with the ultimate result. I do not believe she changed her mind about what she wanted to do - rather, she gave up on thinking that anything other than a trial of labour was going to happen, and under those circumstances made the best of it by choosing to be induced when her doctor was on-call and ensuring access to an epidural. It is her birth, and her feelings around it are for her to determine - and how she feels about it now might not be the same as she feels about 6 months or a year from now. Just as many women who plan on vaginal deliveries and ultimately wind up with cesareans are accepting and even happy as a result.

On the same token - there are many women who are forced into trials of labour and vaginal deliveries they do not want and are ultimately left psychologically scarred.

In closing I'd like to wish this mother my deepest congratulations on the arrival of her child and I'd like to thank all of those who offered advice and tried their utmost to assist in this situation. I'd also like to lament the fact that yet another mother has had her right to make a reasonable medical decision taken from her, and has made decisions that were ultimately very different from the ones she would have made had she been adequately supported. The physical outcome might have been better in this case - but I am by no means convinced that the overall outcome, the one that includes psychological health and well-being is better than what would have happened had her choice been supported.