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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.

 

 

Working on writing book about Birth

Anyone who knows me, knows that I’ve been working on writing a book about birth for a couple of years now. Anyone who’s ever written a book, knows that writing a book is a tricky process.

For me, the trickiest bit has been deciding on the angle to write it from. I know what specific topics I’m passionate about. I’m just trying to figure out how all the theses I have evolved over the years can fit together like nice a big puzzle. And how it’s going to have the most impact on improving the culture of birth in the world.

So far I have come up with an outline I’m pretty proud of. Here goes :

 

 

The Epistemology of Woman-Centred Maternity Care :

Bridging The Gap Between Natural and Medical Models of Birth

 

 

In the book I would like to offer solutions to a problem as I see it. While so many advancements have been made in the field of maternity care, and we now know more than ever before, the outline of the problem is this :

1.The statistical rates of mortality, morbidity and complications are still higher than they need to be in much of the world, as evidenced by considerably lower rates in a few places in the world. While poverty is a factor that contributes to much of those statistics, and is a factor that is beyond the scope of this book to address, there are other easier to address factors besides poverty that can be reduced, and I shall highlight some of them. The natural process of birth and medical management of birth exists in a delicate balance. Many experts point to evidence that overuse of medical intervention in birth has tipped the scales of safety towards less safe outcomes. While benefiting those who need it, it has been suggested that its over reliance and use on those who don’t need it has in fact, CAUSED some complications and poor outcomes for mothers and babies.

2.Beyond the statistics, are many women and children who are physically and emotionally damaged in small and large ways by the management of their births.

3. In an effort to avoid this overuse of medical techniques in birth, a small but growing percentage of the population of North America has turned instead to avoiding the hospital altogether as they do not feel safe giving birth there. There is also an alternative philosophy to the medical management model, which is woman-centred care. The field of midwifery is generally responsible for the knowledge produced on woman-centred maternity care, although many individual doctors practice this way, and not all midwives practice woman-centred care. Woman-centred care is the topic I would like to delve more deeply into in this book so that everyone can get a clearer picture of what that means, what it entails in real life practice and how it can make significant differences in outcomes as well as people’s real lives.
So while there is a body of knowledge that comes out of the experience of midwives and the experience of homebirth, there is a tremendous gap between that body of knowledge and mainstream medical maternity care.

4. Furthermore, the body of knowledge that is still missing from both these perspectives of midwives and medical professionals is the epistemology that can come from the experience of the women doing the birthing themselves. I would like to suggest that by piecing together the knowledge from individual women’s experiences and formulating a collective position, it would be possible to bring maternity care a a whole new standard, as well as bridge the gap between the medical and natural birth worlds.

Everything in our world is always improving and evolving. There is no reason why the culture of human birth should not. I strongly believe, however, that the improvements will not come from more technology, but from a deeper understanding into the human psyche of labouring women themselves. It is the inner mental and emotional experience of labour that can offer the clues to understanding the delicate hormonal balance that controls the normal process of birth. While medical advancements have made it safer than ever before to use medical interventions such as epidurals and cesareans in birth, they will probably always be less safe than the non-man-made process of birth. Just as infant formula can be made as close as possible to breastmilk, it will always remain a far cry because it is impossible to create the living enzymes, antibodies and ever changing micronutrients in breastmilk. The long term effects of medical interventions into the process of birth is far greater than anyone can comprehend. I would like to suggest, despite all our advancements and 100,000 years of human history, shockingly little is understood about the normal, uninterrupted process by which human beings come into the world. I would like to bring more understanding of this into mainstream knowing. It is my hope that by fitting the missing pieces together, we can have a future world where human beings start off their lives with less trauma and more love because it is this that makes us human.

 

I’m putting it out there for anyone reading this : If you would like to add your contribution to the book, please let me know. You can email me at kaurina at prenataljourney.ca or call 1 – 604 809 3288.

I am looking for : childbirth experts – midwives, doctors, nurses and doulas, as well as, moms who would like to add their own experiences.

I know your time is valuable, so I would make it as easier as possible for you to add your input. If you prefer to writing, you can write me an email on the aspect you would like to contribute. If you would like to do an interview instead, I can set up a convenient time for you to do an interview.

 

I appreciate your time and wisdom.

Best Prenatal Classes Ever!

I’m awake at 3 in the morning writing improvements to the lesson plans for my upcoming prenatal classes in May. I’m so excited I can’t sleep. These are going to be the best prenatal classes EVER! Muah hahahah!

In my page on Birth Stories, I talk about the experience that led me to becoming a doula – a positive experience. But what led me to becoming a Prenatal Teacher was the negative experience I had as a first time pregnant mum in the health unit’s prenatal class series. The teacher was nice enough – a retired nurse who cracked lots of jokes. The other parents-to-be in the class were nice enough, although we didn’t get much time to really interact or bond, as I had hoped. And I guess the teacher covered all the topics she was supposed to. Yet, when all the classes were over, I had a clear and distinct feeling that they were a total waste of time. And that we were left pretty much as unprepared for labour as when we had started.

The fact is, I had already read everything the teacher had said in pregnancy books, which incidentally, also did not leave me feeling prepared for labour. I managed to find a few books, at the time mostly by Sheila Kitzinger, that included several birth stories written by actual mothers. That I found infinitely more useful than the regular pregnancy textbooks. I really can’t understand how textbooks can be of any use to people about to give birth since labour is not a written test you’re going to take.

Anyway back to the classes. I asked a few other moms to be what they thought of their prenatal classes, to which they replied, “Well, it wasn’t that useful to me. But I wanted my husband to take it so he could learn.” Then I asked the husbands what they thought of the classes, and they said, “I didn’t learn anything useful.”

Great. So why the heck would people take prenatal classes if they were totally useless?!

I wondered for a long time about what would make classes more relevant to real mums in real birth. And the journey has been fascinating. Ok, truth be told, I find everything about birth fascinating cos I’m a birth junkie, that’s why I do what I do. But it brought me to questions of, who decides what is taught in prenatal classes, the history childbirth education, and the history of pregnancy books as well.

There is a range of types of prenatal classes available out there. On the one side is the “hospital-type class” which teaches people what to expect when expecting and what to expect when in labour and so on. That’s the kind of class I took in my first pregnancy, not cos I actively chose it, but because it was the cheapest kind and all I could manage at the time. These classes are typically taught by nurses based on their years of experience as a nurse.

Then there are the classes which try to promote theories on what helps women have a more natural birth. Childbirth preparation classes were first introduced by Grantley Dick-Read, author of the Book Childbirth Without Fear. He was so surprised when he witnessed a painless birth while attending a homebirth as an obstetrician, that he pioneered the “groundbreaking” concept that birth is a normal event. This was during the 1940’s when women in labour were routinely given general anesthesia and had their babies removed by forceps and other pleasant things. Then in the 50’s, Dr Fernand Lamaze, a French obstetrician, developed the Lamaze method based on what he had witnessed in Russia. It was Elisabeth Bing who then popularized it in America. At around the same time, Robert Bradley developed the Bradley Method “husband-coached childbirth”. Wow! husbands in the delivery room? Shocking!

I don’t know about you, but most of these founders of childbirth education classes seem suspiciously like men. I would hazard a guess that maybe they’ve never actually given birth before. Just saying. But they’ve seen birth, right? That counts. And yes, they’ve done a great service to improving the field of birth. But what about these women who were actually doing the birthing that the “experts” observed. I wonder what kind of classes they’d come up with if we got them into a room together and asked them to brainstorm up some classes. Would they be similar to the types of classes we currently have, or dramatically different?

I’m sure you can figure that one out.

Of course, over time, those techniques, those very old techniques, have been modified and improved upon. And there have also been some significantly new models of childbirth education such as Hypnobirthing and Birthing From Within. Birthing From Within was actually developed by a woman, Pam England, who actually gave birth. Unbelievable!

I quite like the little write up about the paradigm of prenatal classes that is developed out of the experience from the perspective of mothers themselves – Birthing From Within. Now we’re getting somewhere!

Hypnobirthing was also developed by a woman, Michelle Leclaire. Ok, by now you probably have a lot more information about childbirth classes than you’d care to have. So let’s get to the point.

Basically, birth is not a cognitive process. It is an instinctive process. And anything that involves learning a bunch of new information and trying to remember it in labour, is probably not going to be of much use. What is useful, however, is reconnecting with the instinctual part of ourselves and deepening an understanding of the experience of the natural process of birth as well as how to avoid factors that make it go awry. Of course all that is what I cover in my classes, duh.

I’ve developed the content of my classes over several years and included useful elements of many of the above schools of thought, as well as the knowledge I’ve gleaned from talking to hundreds of mums and dads and of course, from my own experiences of giving birth and supporting women in labour. So far the feedback has been great. Even people taking the refresher class who had already taken prenatal classes elsewhere before are so thrilled with my classes.

So that’s been encouraging for me to keep making more improvements in the direction of what works for real women in real life birth.

I have a deep hope to make classes a life-changing event, and to improve the world one birth at a time. So back to work on my class plans, and Have an Awesome Day!

ps. If you don’t live in Surrey or Langley and can’t make it to the group classes, I offer private classes anywhere in the Lower Mainland, BC, Canada. See Prenatal Class Schedules. And if you live somewhere else entirely, do your research and find a class that suits your birth preferences. I also do birth plan consultations over the phone for far away people. For more info check out Birth Plan Consultations.

 

 

I didn’t know about midwives!

“I didn’t know about midwives!” I hear it all the time. I’m always surprised that most people, in particular, expecting couples, have no idea that having a midwife be their primary caregiver is even an option. Ok, I admit, before I had kids, I had no idea either. I thought midwives only existed in the middle ages. (I’ve come a long way since then)

So let’s set the record straight now : If you have a low-risk pregnancy, you can choose to have a midwife if you want.

Across the world, and in different provinces or states, the regulations and scope of practice of midwives (called Femme Sage in French) varies so check out the rules in your area. In some countries, like in Northern Europe, midwives are the primary caregivers for the majority of pregnant women and obstetricians mainly only manage high-risk pregnancies. In some countries, what they refer to as midwives are nurse-midwives who work in the hospitals and are not the primary caregiver.

Here in BC, Canada, midwives practice independently, meaning you don’t have to have a doctor if you have a midwife. The midwife handles all prenatal appointments, birth, and care up to 6 weeks post-partum. Before 1998, midwives were not part of the Medical Services Plan (MSP) so women choosing a midwife had to pay for their services themselves. In 1998, midwives organized under the College of Midwives of British Columbia, became included under MSP. So it is now free for women to have a midwife.

They are all highly trained to attend low-risk hospital births as well as home births. They are well-integrated with the rest of the medical system so they are able order medical tests, do basic medical procedures, refer to an obstetrician for a high-risk issue, handle problems at home births and transfer easily to a hospital if a need arises.

Most midwives are booked solid, so if you want to consider a midwife, try registering ASAP. Preferably as soon as you find out you are pregnant. Despite most people not knowing about them, they are very popular amongst those who do. One of the reasons is that their prenatal visits last 45 minutes so parents have a lot of time to ask questions, discuss things going on in their lives, and build a relationship. There are many things that affect the health of moms and babies, not just medical or physical things. Stress at work, financial issues, other kids the mom has, nutrition, relationships, fears, all impact your health. Women love having a midwife because they get enough time to discuss and resolve anything that may be affecting their life while they’re pregnant.

They may also choose a midwife because midwives tend to have more skills involved with the natural birth process, and tend to use less medical interventions. Of course there are also many doctors who are skilled at supporting natural birth and only use interventions when necessary. Generally speaking, midwives follow the Midwifery Model of Care.

Many women say, “I’d rather get an obstetrician because if anything happens they’ll know what to do.” That is a reasonable statement, but it may not be totally accurate. A lot of people have the paradigm that midwives know a little, and obstetricians know a lot. It is probably more accurate to think of it this way : midwives are experts in natural and normal birth. Obstetricians are experts in dealing with complications in birth. Both fields are extremely important. If a woman has a high-risk pregnancy, and obstetrician is the best option, but if she has a low-risk pregnancy, there is no evidence that an obstetrician is the best option. Although there are some obstetricians who really understand the dynamics of how to promote natural, normal birth, many obs tend to use more interventions.

Women with low-risk pregnancies actually have three choices – midwife, family physician who does maternity care, and obstetrician. In rural areas, the physician may be the only option. We are quite lucky here to have the best of both world, so to speak, because the system is so integrated. So in the case that anything were to happen, midwives and physicians are able to include an ob on the team.

Now you know your options but in the end it always comes down to, “What do you want and what is important to you?” If you haven’t read my last post on Respecting the Mother’s Preferences for Birth you can read it. You know yourself. Is it important to you to have a natural birth as possible, or do you feel safer with an obstetrician. Do you want to interview a few physicians, obs, or midwives to see if they line up with topics that are important to you, or do you want to choose the first one you get. It’s all up to you.

Here are some links to Langley and Surrey midwives if you’d like to look into having a midwife for your birth :

Midwives in BC

Surrey – Sage Midwifery

Panorama – Village Health Midwifery

White Rock – Crescent Moon Midwifery

Walnut Grove – Grove Midwifery,  Triton Midwifery

Willowbrook – Family Health Clinic

 

What are thoughts on the subject? Add your comments below.

 

© copyright 2011 Kaurina Danu The Prenatal Journey

Review of One World Birth videos

September 1st was the launch of the new internet video channel One World Birth. I decided to take a look at some of the videos.

The videos are all short clips of interviews with various experts from Europe and America discussing their views on topics around birth.  There are some well known natural birth names – Ina May Gaskin, Michel Odent, Sarah Buckley, Sheila Kitzinger and so on. It brings to awareness the polarity that sometimes exists between people who want to promote natural birth as much as possible, and people who want to promote medical intervention in birth as much as possible.

I would like to think that moms who really need medical intervention can get it, and moms who don’t really need it aren’t pressured into having it, whether cesarean, induction, pain meds, fetal monitoring, IV, episiotomy etc. But often the definition of “really needing medical intervention” is the area of debate. There are some situations in birth, although rare, where doctors or midwives all agree are serious problems which require medical intervention. There are some situations where all doctors and midwives agree no medical intervention at all. But the majority of situations in birth fall into the grey area. Different caregivers disagree on the course of action.

The videos on One World Birth begin to bring to light some of the problems in maternity care and the solutions. The Revolution in Birth is one particularly interesting video. I love what they say about how improving maternity and the way mothers and babies are cared for during this important transition in life, will improve society as a whole.

“The topic of birth should not just be a topic for doctors, midwives or pregnant women. It should be a topic for all those interested in the future of humanity.”  – Michel Odent, MD

“Natural birth has become an endangered species. And we need to save it because the future physical, emotional, mental health and well-being of our culture depends on it.”  – Sarah Buckley, GP

I also quite liked the section “60 Sec Experts” where 3 doulas only have 60 seconds to answer common questions about childbirth –

How painful is childbirth?

How to relax during birth?

How do I know if breastfeeding is working properly?

Is a doula a midwife?

What’s the difference between braxton hicks and contractions?

Is it better to tear or be cut?

 

I’m looking forward to more videos on One World Birth. It will be interesting to see the development of the topics as the film makers travel around the world.

 

 

© copyright 2011 Kaurina Danu The Prenatal Journey