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What the heck is Birth Trauma?!

Birth Trauma

Birth Trauma is a topic that has been weighing on my mind quite heavily the last couple of days. There have been ongoing protests outside BC Women’s Hospital in the last few months, and more are planned for different locations and hospitals around the Lower Mainland and Fraser Valley. The protests certainly caught my attention with this video on you tube Birth Rally at BC Women’s Hospital.

 

 

I know Birth Trauma and Post Traumatic Stress Disorder as a result of a birth experience exists, but this was the first time I was seeing people openly speaking out with terms like “Obstetric Violence” and actually naming the doctors who imposed unnecessary medical procedures on women without their consent. Seeing the signs just gives a glimpse of the tip of the iceberg. It’s hard to understand exactly what they mean until you take a closer look at what happened, why and how it causes the actual experience of Trauma. Then after that, the important question of, “What do you want to do about it?” needs to be asked.

One of the organisers of the events, Kalina Christoff, has also provided a detailed explanation of what exactly happened that caused her distress, what she did after to start a dialogue with hospital staff, and why she eventually felt like holding rallies was the only way left to create change for other women. You can read her story here : Vancouver Birth Tauma.

 

Untangling the mess

The term ‘Birth Trauma’ can refer to two things – physical damage to babies during birth; and the psychological damage to mothers during birth. Of course, there is also psychological damage to babies that can happen during birth but since that is harder to study, research in the area is relatively new and scarce. The content of this article will be about birth trauma to mothers. (I believe that mother-baby are not separate and what causes stress and harm to mothers, causes that to babies as well. And when mothers are treated well, babies are treated well. You can’t stress the mom out and say you’re doing it to take care of the baby. The mom’s stress will stress the baby out too.)

The general public has a perception of what Birth Trauma means. They usually assume birth is pretty painful and can be so unbearable that it can be traumatizing. So an epidural seems like a pretty good solution. Or they may think that women may feel traumatized only when their babies are injured or die during the birth process. While these events may happen, there is a much more multi-layered dynamic.

First of all it helps to understand the process of Labour and Birth as made up of two distinct processes

1. The natural course of events that would take place if there was no human intervention, and

2. The human intervention that takes place, usually in the form of medical procedures, some minor and some major, both of which can alter the course of the natural process itself.

 

What Causes Trauma?

While the natural process may be painful and difficult, that in itself does not cause the experience of trauma unless there is some cause for strong anxiety or fear. The more common cause for feeling traumatised is feeling the loss of power over your own body and situation when people do things to it that are outside your control. That is the cause of all trauma – Feeling Powerless over your own situation.

In other areas of life, you can see how certain types of situations can cause people to feel traumatised. Eg. Bullying, for example, where the victim feels like they have no power to prevent the bullying, War is another situation where people can feel traumatised, both the civilians who have no control over the events in their lives, and the soldiers who have to obey orders and do things that may not necessarily choose themselves.

 

So how can trauma happen in a birth situation?

Firstly, during labour and birth, the moms are in a vulnerable state. They are dependent on the care providers for helping them and their babies safely through the process to varying degrees. They also have some level of trust that their care providers will take care of them appropriately. Physically, they are vulnerable because they are in pain, half-dressed and may be exhausted and not thinking straight.

While most of the time, care providers are motivated by moms and babies best well-being, the fact is that they are also human. Just because we, as a society are trained to believe that we should always trust doctors, doesn’t mean that every doctor will never abuse his/her power. They are human. It would be ridiculous to think that everything a doctor does is always for the safety of moms and babies in birth. It’s not unreasonable to realise that there are other factors that effect decisions doctors, nurses and midwives make in labour. For example, scheduling, time, other patients, being tired, not wanting to do extra work, differing payment amounts for various procedures, peer pressure, lacking in experience or knowledge about certain situations, and as Kalina experienced, needing to train student doctors, nurses and midwives.

This leads to a heck of a lot of medical procedures done that kinda, maybe needed to be done, but probably not. Things are done to speed things up, make extra money, train students, get it over with so they can go home, go to sleep or go on to the next patient. The thing is, nobody is going to come right out and say that. They say things like, “The baby could be in danger,” “The baby’s heart rate is not looking good,” “It’s best for you and your baby,” and so on. Most mothers and fathers would not have the background knowledge to know the difference between a real problem, and a fudged one. They might happily agree to any procedure thinking it was saving their baby’s life. That probably won’t lead to feeling traumatised unless the procedure directly or indirectly causes some unexpected damage or pain, and the mom realises later on that the procedure may not have been necessary.

Many times, the risks to procedures are not explained before they are done. This can eventually lead to women feeling like they have no control over their situation because they don’t know what could happen or what they are agreeing to. Agreeing to a membrane sweep, induction, forceps, c-section and many other things has unwanted risks, but women are not told about them before they are agree to it. Worse still, it is common for membrane sweeps to be done by some doctors at 38 or 39 weeks without even informing or asking the woman’s permission. Forceps of vacuum can be great if the baby’s life is clearly truly in danger, but in those iffy cases where maybe, sorta the baby may be starting to show signs of distress, are the risks of forceps greater than the risk of waiting and trying other methods? Forceps can hurt the baby as well as cause permanent damage to the moms pelvic floor resulting in incontinence. If the mom is saying no, and the doctor does it anyway, can you start to see why some women say the way they were treated in labour was a violation just like rape?

 

birth trauma

 

That’s what causes the feeling of trauma and powerlessness. That’s what causes post-traumatic stress disorder after birth and  some cases of post-partum depression. It is estimated that 4% of women have post-traumatic stress disorder after birth. But birth is a funny thing in human experience –

1. It is one of the few things that only women do. Probably if men did it too, it would be handled a totally different way.

2. It is a private event behind closed doors so the birth is not in public awareness.

3. You may learn how to fix basic things in your car, how to do your own accounting, how buildings are made even though you are not a mechanic, accountant or engineer. But, even though every single person on earth is born, shockingly very few people learn any basic knowledge about birth. Most of what they know is from the media, which is saturated in complete misinformation. Because of this fact, the decision making power over decisions about your own body and baby in birth is often handed over to health care professionals. This is a huge amount of power.

4. Unlike war, which is associated with death, birth is associated with being a happy time with a new baby. It is extremely confusing for both moms and other people when the joy and love is totally mixed up with trauma and horror over the way they were treated.

So because birth is quite different than most things in human experience, the general public cannot even comprehend why some moms could have birth trauma. This is quite clear when you start to mention Homebirth. The most common response is, “Why would anyone want to give birth at home?” “To avoid the risk of having my decision making power over my own body and baby completely violated, duh! What else, would it be?” 

I have seen births with complications where the medical staff was awesome, focused and committed to honoring the mother’s wishes within the realm of safety. For example, there was a baby who was having a little trouble breathing and they figured it would be better to take her to the nursery. It was important to the mom to have a few precious moments to see and touch her daughter before she was taken away. The hospital staff totally respected the mom’s request and understood how important it was. They took a lot of care to explain and comfort the parents about everything that was happening with their baby in the nursery so that the parents would not be overcome with worry. It was very touching.

In other situations, however, I have seen medical staff get annoyed with moms’ reasonable requests and feel that they are unimportant. The attitude is that it doesn’t matter how moms feel. They should just be grateful to have a live baby.

The thing is this, there was a study done which showed women’s experience of birth was influenced most by the way they were treated by the people around them, not so much the length of labour, the amount of pain or even the outcome of the birth. Women can have extremely long, painful labours, and feel really good about them if their care providers and support people treated them with respect and dignity. Women can go through miscarriage and stillbirth, and even though that may be very upsetting, can feel soothed by care providers who treat them in a caring way and involve parents in making decisions. Women may have a short, straightforward labour and a healthy baby but feel terribly about their birth experience if care providers were brusque, demeaning or disrespectful to the moms.

As I am writing this, an article is published int he New England Journal of Medicine. Court-Ordered Care – A Complication of Pregnancy to Avoid. It highlights cases where mothers are forced by courts and doctors to undergo medical procedures supposedly for the health of their fetus. Now for the people who can’t see the stupidity and violation of that, I don’t know what else to say. But I know one thing, there is no one in the world who cares more about the safety of her baby than the mother herself. Mothers are not stupid. They are completely able to make decisions about what’s best for their babies and would do whatever they felt was necessary. The doctor doesn’t always know what’s best.

 

If you or someone you know feels like they have birth trauma, please read Kalina’s page Recovery from Birth Tauma. If you would like to talk to someone, you can call me at 604 809 3288, or email kaurina @ prenataljourney.ca. 

 

Kaurina Danu is a Birth Doula and Prenatal Class teacher is the Surrey / Langley area. She works to empower mothers who want to make informed decisions about their pregnancies, births and parenthood.

 

 

Community Birth Program in Surrey Memorial opens its doors

Community Birth Program in Surrey

A fantastic new program has opened in the Jim Pattison outpatient clinic at Surrey Memorial Hospital for expecting mothers in Surrey, Delta, White Rock and Langley. The Community Birth Program is modelled after the South Community Birth Program in Vancouver, BC.

Both the Vancouver and Surrey programs are based on the groundbreaking and innovative Collaborative Care model where Physicians, Midwives, Nurses and Doulas work together as a team. Doulas are provided to clients at no charge because of funding from Fraser Health Authority. That means that even low-income women, immigrant women or women who have never even heard of Doulas can have one to support them through pregnancy, labour and post-partum. The women are thrilled to bits to have someone give them personalized attention, in their own homes, and help them navigate the new territory of parenthood, especially if it’s also in a new country. (If you’re not sure what a doula does, read my page What is a Doula?)

Fraser Health decided to provide funding for this program because of the immense success the Vancouver program is having. Significantly lower c-section rates, shorter hospital stays and higher breastfeeding rates. These is all great news for mothers and babies, but also for the budget of the Medical Services Plan so it makes sense to fund doulas and midwifery/physician collaborative care if it’s going to save on the other end with reducing unnecessary medical  procedures.

Normally, reducing the medical budget compromises patient safety, but for maternity care in particular, there’s lots of room for reducing unnecessary medical procedures while not compromising necessary ones. For example, the World Health Organization suggests that the optimal C-section rate is probably around 15%. Less than that and women who really need it, may not be getting it, which is often the case in impoverished countries. But more than 15% and probably too many women are having cesareans that may not always be necessary.

To find out what the cesarean rate is in the hospitals near you in BC, go to British Columbia Cesarean Rates. For example, Surrey Memorial Hospital has a cesarean rate of  28.65%. So there’s room for reduction. While a small number of mother’s would rather have a cesarean, the vast majority would rather avoid one. So reducing rates would benefit moms as well as reduce costs. Pioneering programs, such as the Community Birth Program and many others that are effective at reducing intervention rates without compromising safety are important for helping maternity care providers as a whole understand how to effectively reduce rates. 

I’m really glad the Surrey Community Birth program has finally opened after years of preparation. It’s going to be a really positive direction for expecting moms in Surrey and the Fraser Valley. While maternity services in BC are already so good,  and has continued to improve over the past years, there is always room for improvement. 

What I would like to see is good quality prenatal education that is available to ALL first-time moms – that effectively teaches pregnancy nutrition, making informed choices and real labour coping strategies. (I say “effective” and “real” because obviously, I have my opinions about how ineffective and unrealistic some prenatal classes are in regards to those topics)

Choosing an appropriate caregiver for pregnancy is one of the most important decisions women make that effects the path their birth will take. I always teach in my prenatal classes how to figure out if your caregiver matches the kind of birth you want. But by the time they come to my classes, their already in their third trimester. It would be great if women got more information about caregiver choices early on (like before they even get pregnant, or at least in early pregnancy). When women go to their doctors for the first pregnancy test, what I would really like is for those doctors to provide a handout about the three kinds of maternity care providers in BC – Family Physicians and Midwives for low-risk pregnancies and Obstetricians for high-risk pregnancies. 

I would also like every pregnant woman to be informed by her initial doctor about what a doula is and how a doula can help her in labour and delivery. It is up to the woman to choose if she wants one or not, but I believe every woman should at least get the information that such support exists and is proven to be helpful. There have been numerous scientific studies which prove the effectiveness of doula support at reducing unnecessary medical procedures while increasing maternal satisfaction and breastfeeding rates. If a doula were a drug, it would be unethical for doctors to not recommend them. But doulas are not a drug, and are not at the moment funded by the Medical Services Plan, so expecting families hire a doula privately. Maybe someday there will be MSP funded doulas available to all women. But for now, there are three options:

1. Find a volunteer doula. The BC Doulas Association has a list of newer doulas willing to volunteer their services. Give them a call. In Surrey, you may also be able to find a volunteer doula through the Healthiest Babies Possible Program.

2. Interview a few doulas in your area and ask if they are flexible with their rates or if they have payment plans. I am very flexible with my rates because I know not everyone can afford them but I am passionate about providing support to women who want it, and lots of doulas feel the same way.

3. Register with the South Community Birth Program if you live in Vancouver or the Community Birth Program if you live in Delta, Surrey or Langley to get access to midwifery care, physician care and doula support.

If you are expecting and would like to register with the Community Birth Program go to Fraser Health – Community Birth Program for more information. If you would like to BECOME  a doula with them, also contact them.

 

 

Celebrities and their Births

I’m not one for jumping on the celebrity gossip bandwagon, but since many people seem to be concerned about celebrities and their pregnancies, babies, and not to mention, their figures after having a baby, I think it is interesting to find out what choices they are making for their Births. 

Jessica Alba just had her baby girl. She used hypnobirthing for her birth. Hypnobirthing is a method using visualization, or light hypnosis during labor to relax deeply and release pain and fear so people can get through it more easily. Read how Jessica Alba describes her birth.

Singer, Erykah Badu chose to have homebirths for all three of her children, attended by a midwife and a doula. For her last birth, her two older children watched their baby sister being born.  Read how Erykah Badu describes her birth. People are sometimes surprised about older siblings being present at birth. They imagine a lot of screaming, pain and trauma. They imagine the kids being freaked out. But in reality, planned homebirths are usually a quiet event. If mom is yelling or making noise, it’s not in a frightening way. Kids tend to do very well watching the birth of their sibling and feel much more connected to the baby and the miracle of life afterwards.

There`s a whole list of celebrities who chose natural birth, waterbirth or homebirth :

Ricki Lake, Talk show host – Had such an amazing, life-changing experience with her home water birth that she went on to make a movie about childbirth called The Business of Being Born.

Pamela Anderson, Actress – Had two home water births

Charlotte Church, SInger – Also had a home water birth

Cindy Crawford, Model – Two homebirths

Ani DiFranco, Singer – Homebirth

Demi Moore, Actress – Two homebirths

Alanis Morissette, Singer – Homebirth

You can read what they and other celebrities said about their births. Totally throws the “Too Posh To Push” theory out the window!

Because homebirth, waterbirth and various natural birth methods are relatively unknown in mainstream consciousness, it’s great when celebrities have non-mainstream births. It lets people know that every birth doesn’t have to be treated like a medical emergency. Yes, there are some situations where there are real problems and benefit from medical help, but in actual fact, it is rare if labor is left alone to follow it’s normal course. Complications arise so frequently in most births today BECAUSE of medical interventions. A little intervention here, a little procedure there, and the whole natural process of birth gets thrown out of whack, then people end up with real problems.

The most devastating thing that comes to my mind when I think about celebrities and their births is that of Anna Nicole Smith. We all know what happened to her a few days after she had her baby. But I was shocked with her interview before her death when she described the reason for her cesarean. She said doctors told her that from the ultrasound, her baby was going to be too big to birth. Now I don’t know if that is what they really said, or if that was how she understood it, but the fact is her baby was just over 6 pounds. 6 pounds is not a big baby for any mom, certainly not for a mom who`s 6 feet tall.

I am flabbergasted that no one picked up on these discrepancies. Are people so afraid of birth that they will believe that a 6 pound baby is too big to birth? Of course the doctors didn`t actually know how big the baby was going to be before it was born. What people don`t realize is that no one can tell accurately from an ultrasound exactly how big a baby is. The accuracy is give or take 2 pounds. That means if a doctor predicts from an ultrasound that a baby is about 9 pounds, it could be anywhere from 7 to 11 pounds. That`s a huge difference. But even if a baby is large, that doesn`t automatically mean that it`s going to get stuck.

A pregnant woman`s body produces the hormone relaxin. Relaxin relaxes the joints. Most importantly, it relaxes the joints of the pelvis. The pelvis is not rigid in labor, but can expand up to 33%. Think about it. The two bones at the side and the sacrum and coccyx at the back can move slightly to make the pelvic opening larger to let a large baby pass through. That`s why squatting and other pelvic opening positions are effective at letting babies out easily. If a mom is sitting or lying on her back, the pelvic bones don`t have much room to move. This is just fine most of the time because most babies have enough space to get through. But if baby has a large head, or mom has a small pelvis, open positions become more important.

Although people tend to be shocked when they hear of 9, 10, 11 or 12 pound babies, it doesn`t always mean they are to big to birth vaginally. There have been a lot of moms who were told their pelvis was too small to birth a baby larger than 8 or 9 pounds, but then went on to have subsequent vaginal births for even larger babies than the ones that were `stuck`. If an ultrasound looks like you may have a `big baby`, ask yourself, “So what?” Don`t get sucked into the fear and panic. Understand that ultrasounds are not totally accurate. Learn the skills to help you get into a good position for pushing and to help you have an easier time in labor.

I don`t want to portray the image that natural birth or homebirth is always better, it`s not. There is no such thing as better. One of the most important things that makes the difference in whether moms feel positively about their birth or not is how they were treated. When moms ask for information and are supported in making informed choices, they feel good about their births. Sometimes interventions are useful, and moms can feel good about using them when they want or need them. But when women are not clear about whether they really need an intervention or feel pressured into it, they feel disempowered. Negative birth experiences can be one factor causing Post-Partum Depression, Post Partum Anxiety or Post Traumatic Stress Disorder.

No one knows what caused Anna Nicole Smiths death. I don`t know if anyone looked into whether she had post-partum depression or if she developed a post operative infection. But I do know that women who feel disappointed about their birth experience can feel a lot of sadness, even though they are happy about and love their babies very much. If you or anyone you know is disappointed about their experience, or has post-partum depression, you can contact me at 604 809 3288 or info@prenataljourney.ca

Have a good day!

 

 

© copyright 2011 Kaurina Danu The Prenatal Journey

 

Respecting the Mother’s Preferences for Birth

Yesterday I did a quick review of the new internet channel about birth – http://www.oneworldbirth.net/ . After giving it more thought, I decided to add a point that I think is critically important in the debate, yet is often completely ignored. That is, what does the mom prefer for her own birth?

What does the mom prefer?! How does that matter?! Isn`t it just a question of safety and risk? Life or death?

Well, remember, in my review post I talked about most decisions in childbirth being in the grey area. What that means is there may be some risks to not using medical intervention, and some risks to using medical intervention. So caregivers and parents have to make a decision based on balancing the risks.

Because we are talking about those grey area situations right now, and not the out and out real and immediate emergencies, I would like to suggest that one critically important factor in deciding the course of action, besides weighing the risks, is knowing what the moms preferences are for her birth.

Seems simple really, but it is quite profound and has long lasting effects. Here`s why –

There are roughly 3 groups of women – Women who really don`t like medical interventions, women who do want medical interventions, and women who don`t care either way.  You may argue about which group is more common, or why they feel the way they do, but no one can deny that there are these three groups.

It`s funny because the women who really prefer natural birth simply can`t understand why some women don`t, and the women who really want a medical birth cannot fathom why anyone would want a natural birth. The point is not which is a better way. There is no such thing. The point is that different women prefer different experiences. The childbirth “Experts“ can debate all they want, but what do they women actually doing the birthing think?

Why this is so important is this : Say a woman who really wants a normal birth, goes to the hospital and has a long labor. The doctor comes in at some point and says, “Well, this has gone on for too long. I think we may as well do a cesarean.“The well-intentioned doctor may well be thinking, “No sense in letting her suffer. I`ll help her out by getting the baby out now and putting an end to her pain.“ This is an example of a grey area situation where there is no signs of distress in mother or baby. (i`m not talking about situations where there is a clear problem and a cesarean is clearly the best option.)

If the mom doesn`t have a discussion with the doctor about risks, benefits and her preferences, she may go on to have the cesarean then end up wondering for the rest of her life if it was really necessary. Besides physical effects, there can be emotional effects which can affect her self-confidence as a woman and as a mother.

If however, the woman doesn`t care either way, normal birth or cesarean, then she may be totally happy with her experience and won`t feel the same emotions as the woman who actually wanted the vaginal birth.

If the woman actually wanted a cesarean to start with, she would be so relieved and totally happy with her experience.

The thing is the doctor does not know which of these three categories of women his client is in. The doctor may not even know there are three categories. If you have a preference, it is your job to figure out what it is, and to communicate it with your doctor. It is easier to have these discussions during your prenatal visits rather than in thee middle of labor, although you can still discuss things as they arise.

That woman in the first example may still choose to go ahead with the cesarean, or she may not. But if she has a discussion with her doctor or midwife and takes into account her preference, she will feel much better about her experience, and feel more confident about herself and be more relaxed as a mom.

I hope you found this article helpful. Please leave your thoughts in the comment box. If you would like to schedule a birth consultation to clarify your preferences for birth (otherwise known as a Birth Plan) and write a list of important questions to discuss with your caregiver in prenatal visits, call 604 809 3288 or email kaurina @ prenatal journey . ca

 

© copyright 2011 Kaurina Danu The Prenatal Journey