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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.

 

 

Don’t fall into the trap of “The Big Baby Fear”!

When I had my second kid, who was 9 pounds at birth, I thought that was pretty big. In fact, most of the doctors and nurses at the hospital were also surprised at his size. But then I started meeting tons of women who said to me, “9 pounds! That’s nothing my baby was 10 and a half.” One woman even said, “I had my 11 pound baby naturally no problem.” My midwife told me about a 5 foot woman she had as a client who had a 12 pound baby at home with no tears on her perineum.” Recently I read about the woman who gave birth naturally to a 13 pound baby. I started to think that 9 pounds wasn’t so big after all.

After talking to hundreds of pregnant women, however, I can safely say that most expecting moms, and their doctors have a paranoid fear of “The Big Baby. They are afraid the baby will be too big to come out get stuck.  I’ve even heard some women and one doctor say that they are afraid a large baby will make contractions more painful. This makes no logical sense whatsoever. But what about the worry that the baby might be too large to fit through the pelvis? Is this fear justified? It may be, in certain situations, but I would like to point out how there are other factors that are even more important than simply the baby’s size. In this video I explain how the baby’s position, or the way it is facing is more important than it’s size.

The position the baby is in is greatly influenced by the position the mom is in during labour. So moms can help baby to get into a good position by being upright, forward leaning or lying on their left, instead of lying back. This can be a challenge if mom has an epidural or morphine. This is why avoiding epidurals or narcotic analgesia as much as possible during labour, can help speed up labour and avoid cesareans.

Some other factors that affect the baby’s ability to easily fit through the pelvis have to do with the pelvis itself. If a mom has a big pelvis, there may be no problem. If she doesn’t have a large pelvis, or if the baby is not in an optimal position, then again, mom can get into upright positions that open the pelvis more to expand the pelvic outlet and help baby pass through.

You know how you start to feel your joints getting looser and falling apart in pregnancy? That’s due to the hormone relaxin. Relaxin softens the ligaments holding joints together, so that the pelvis can move and expand a little bit during labour. For example, squatting can expand the pelvic outlet by 33%. So squatting or other pelvic opening positions can be excellent in labour of baby is coming very slowly. Please not that if things are going really fast, do not get into a squatting position, cos then things are going to go too fast.

Hope this information help! If you would like to get more useful info or to take prenatal classes in Surrey, Langley or the Lower Mainland, email info@prenataljourney.ca or call 604 809 3288.

 

 

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