As you can see, it's been a while since I last posted. I'm starting to feel more at ease. I didn't realize how bad things had gotten. I adjust to the increase anxiety so easily that it isn't until it's gone that I realize where I've been. The last few months were really bad. It's good to start to feel a little safer, a little less anxious, and a little more in control.
Anyhow, best wishes to everyone in 2009! I hope this is the year of healing for me.
Wednesday, December 31, 2008
Tuesday, December 9, 2008
Uterine Inversion
I haven’t advertised my blog. I don’t link to it on any bulletin boards. I don’t include it in my online signatures. I have only told a few people about it, my husband, counselor, and best friend; however, I did set up the tools to see how or if people are finding it. Some of the queries have been sort of interesting, and I thought I’d try to address one today.
I had a partial uterine inversion after my daughter’s birth. According to Baby Center’s website, since I don’t feel like delving into a journal article today, a uterine inversion is defined this way:
Uterine inversion is a potentially life-threatening complication of childbirth that occurs in as many as one in about 2,000 births.
Normally, within about 30 minutes of a vaginal birth, contractions cause the placenta to separate from the wall of the uterus. After it separates, it comes out through the vagina on its own or with the help of the doctor or midwife, who may pull gently on the umbilical cord. (With a c-section, she manually removes the placenta right after delivering the baby.)
Sometimes, a placenta doesn't separate normally. And, in rare cases, attempts to deliver it cause the uterus to literally turn inside out such that the top of the uterus (the funds) comes through the cervix or even completely outside the vagina. This is called a uterine inversion and it's a true obstetric emergency. It can cause serious bleeding and shock, and requires immediate treatment.
So, my uterus didn’t come all the way out through the cervix, it just collapsed on itself. I had a low-lying, anterior placenta. This means that the placenta was below my belly button in the front. Some studies have shown a correlation between cord traction being applied to the umbilical cord and the incidence of inversion. I’ve never really believed that to be true in my situation. The doctor did attempt cord traction, but the umbilical cord tore off the placenta. Given the location of the placenta, I’ve never been able to figure out the physics of how this would cause the uterus to collapse from the funds, top of the uterus. The doctor then tried to manually remove the placenta. At this point in time, he still hadn’t diagnosed the inversion. It wasn’t until much later after I’d gone into shock that they diagnosed the inversion as part of the problem.
I had so many complications, that things sometimes get tangled up in my brain. I’m never really sure which complication or procedure caused the results; however, I was in massive amounts of pain. I was hemorrhaging, and I went into shock. I know the blood loss caused me to become hypertensive, extremely low blood pressure, but I don’t know if that was from the inversion or retained placenta. It was probably a combination of both.
There are several ways they can attempt to correct an inversion. In my situation, the doctor used nitroglycerine to relax the uterine muscle, so that he could put it back in place. After that, they performed the D & C, and used cytotec and pitocin to get my uterus to contract back down to the normal size.
There are some advantages to having this happen. I really didn’t have any blood clots because the doctor had done such a good job scraping out my uterus. I only bled for about a week, and then had discolored discharge for an additional couple of weeks. I couldn’t go without using personal hygiene products, but it was much less than I’ve heard some women discuss.
Unfortunately, there are some disadvantages as well. Obviously, since I was in surgery I missed out on the first hours of my daughter’s life. I needed blood transfusions. I had a difficult recovery. I ended up with PTSD because of my feelings of helplessness. I was incredibly weak from the blood loss. Just carrying my daughter upstairs to her room exhausted me. I’m also at risk of this happening again in any future pregnancies. The odds of having another placenta accreta / retained placenta are very high due to the D & C they performed. Because I’ve already had one partial uterine inversion, the risks for that are increased as well.
I had a partial uterine inversion after my daughter’s birth. According to Baby Center’s website, since I don’t feel like delving into a journal article today, a uterine inversion is defined this way:
Uterine inversion is a potentially life-threatening complication of childbirth that occurs in as many as one in about 2,000 births.
Normally, within about 30 minutes of a vaginal birth, contractions cause the placenta to separate from the wall of the uterus. After it separates, it comes out through the vagina on its own or with the help of the doctor or midwife, who may pull gently on the umbilical cord. (With a c-section, she manually removes the placenta right after delivering the baby.)
Sometimes, a placenta doesn't separate normally. And, in rare cases, attempts to deliver it cause the uterus to literally turn inside out such that the top of the uterus (the funds) comes through the cervix or even completely outside the vagina. This is called a uterine inversion and it's a true obstetric emergency. It can cause serious bleeding and shock, and requires immediate treatment.
So, my uterus didn’t come all the way out through the cervix, it just collapsed on itself. I had a low-lying, anterior placenta. This means that the placenta was below my belly button in the front. Some studies have shown a correlation between cord traction being applied to the umbilical cord and the incidence of inversion. I’ve never really believed that to be true in my situation. The doctor did attempt cord traction, but the umbilical cord tore off the placenta. Given the location of the placenta, I’ve never been able to figure out the physics of how this would cause the uterus to collapse from the funds, top of the uterus. The doctor then tried to manually remove the placenta. At this point in time, he still hadn’t diagnosed the inversion. It wasn’t until much later after I’d gone into shock that they diagnosed the inversion as part of the problem.
I had so many complications, that things sometimes get tangled up in my brain. I’m never really sure which complication or procedure caused the results; however, I was in massive amounts of pain. I was hemorrhaging, and I went into shock. I know the blood loss caused me to become hypertensive, extremely low blood pressure, but I don’t know if that was from the inversion or retained placenta. It was probably a combination of both.
There are several ways they can attempt to correct an inversion. In my situation, the doctor used nitroglycerine to relax the uterine muscle, so that he could put it back in place. After that, they performed the D & C, and used cytotec and pitocin to get my uterus to contract back down to the normal size.
There are some advantages to having this happen. I really didn’t have any blood clots because the doctor had done such a good job scraping out my uterus. I only bled for about a week, and then had discolored discharge for an additional couple of weeks. I couldn’t go without using personal hygiene products, but it was much less than I’ve heard some women discuss.
Unfortunately, there are some disadvantages as well. Obviously, since I was in surgery I missed out on the first hours of my daughter’s life. I needed blood transfusions. I had a difficult recovery. I ended up with PTSD because of my feelings of helplessness. I was incredibly weak from the blood loss. Just carrying my daughter upstairs to her room exhausted me. I’m also at risk of this happening again in any future pregnancies. The odds of having another placenta accreta / retained placenta are very high due to the D & C they performed. Because I’ve already had one partial uterine inversion, the risks for that are increased as well.
Friday, December 5, 2008
Giving up my Power?
I was reading a Birth Trauma forum the other day, and the question posed to their site was, “When did you give up your power?” There were some interesting answers. Some women said they gave it up in their childhood. Some said the medical establishment slowly eroded it. Some women blamed their spouses for not agreeing with or supporting their vision of their birth.
Personally, I’m struggling with the question. I think there’s a bit of shame associated with it. It blames the woman by assuming that “she gave up her power”, like it’s always in our ability to have a great birth experience. That no one else or nothing else can violate us if “we just don’t give up our power”. I don’t see choosing to see an OB or choosing to see a midwife is “giving up our power”. I don’t see choosing a hospital or choosing a homebirth is “giving up our power”. You don’t automatically lose your power by making a choice.
I don’t think that’s the way they mean the question. I think they’re assuming that the women responding had typical, uncomplicated pregnancies. They’re assuming that there are no complications that can or should be taken into consideration when making the decision.
However, complications, while sometimes over-diagnosed, can be real. There are times, not all the time, when having your child in the hospital is the safest place for mom to be. There are times when having a birth attendant is the safest situation to be in for both mom and baby.
I have to say the question’s been bugging me. You see, I don’t think I gave up my power by choosing an OB. I didn’t give up my power by choosing to listen to him when complications arose. I didn’t give up my power by choosing to have my baby in a hospital. I didn’t give up my power by choosing an epidural. Let’s face it, I argued myself into an epidural despite the anesthesiologist’s objections to providing it. The doctor stole my power when he chose to perform a procedure without my consent. I didn’t give it up, it was STOLEN.
There’s a huge difference between those two concepts. I have to admit that I didn’t fight to get it back during the remainder of my stay, but that was my choice. I chose to focus on healing. I chose to focus on getting out of that hospital as soon as I could. I chose to focus on me. I didn’t want anything to get in my way, but there again; I guess that is taking back my power. It was my choice; therefore, the power was mine. I didn’t fight for answers; I chose to save my energy to fight for healing.
Maybe having a choice is having the power. Except for the procedures after my daughter was born, I made the choices. They might not popular in the home birthing community, but they were my choices.
Personally, I’m struggling with the question. I think there’s a bit of shame associated with it. It blames the woman by assuming that “she gave up her power”, like it’s always in our ability to have a great birth experience. That no one else or nothing else can violate us if “we just don’t give up our power”. I don’t see choosing to see an OB or choosing to see a midwife is “giving up our power”. I don’t see choosing a hospital or choosing a homebirth is “giving up our power”. You don’t automatically lose your power by making a choice.
I don’t think that’s the way they mean the question. I think they’re assuming that the women responding had typical, uncomplicated pregnancies. They’re assuming that there are no complications that can or should be taken into consideration when making the decision.
However, complications, while sometimes over-diagnosed, can be real. There are times, not all the time, when having your child in the hospital is the safest place for mom to be. There are times when having a birth attendant is the safest situation to be in for both mom and baby.
I have to say the question’s been bugging me. You see, I don’t think I gave up my power by choosing an OB. I didn’t give up my power by choosing to listen to him when complications arose. I didn’t give up my power by choosing to have my baby in a hospital. I didn’t give up my power by choosing an epidural. Let’s face it, I argued myself into an epidural despite the anesthesiologist’s objections to providing it. The doctor stole my power when he chose to perform a procedure without my consent. I didn’t give it up, it was STOLEN.
There’s a huge difference between those two concepts. I have to admit that I didn’t fight to get it back during the remainder of my stay, but that was my choice. I chose to focus on healing. I chose to focus on getting out of that hospital as soon as I could. I chose to focus on me. I didn’t want anything to get in my way, but there again; I guess that is taking back my power. It was my choice; therefore, the power was mine. I didn’t fight for answers; I chose to save my energy to fight for healing.
Maybe having a choice is having the power. Except for the procedures after my daughter was born, I made the choices. They might not popular in the home birthing community, but they were my choices.
Wednesday, December 3, 2008
Am I an advocate or a wimp?
So, I feel like I wimped out by choosing to not speak to the doctors tomorrow. I know that it's not so much a matter of wimping out, so much as it's a matter of choosing to focus on fixing myself. However, I tend to use negative phrases or comments to describe myself instead of positive ones, so it's easier for me to say I wimped out.
My counselor told me that I'm becoming an advocate because I chose to provide my doctor with my writings instead of just cancelling. I'm not sure how I feel about that. I don't want to be an advocate. I don't want to be an activist. I just don't want anyone else to feel the way that I do right now. I don't want another woman to feel like she's powerless. I don't want another woman to feel like she's been coerced into procedures that she doesn't want. I don't want another woman to feel as isolated as I do. I don't want another woman to feel like she has no one to talk to, or no one who understands her. I don't want another woman to feel like the nurses are re-traumatizing her by their dismissive attitude. I don't want another woman to believe that she's worthless, like she's a vessel, like she's nothing. It's a horrible feeling to know that no one believes you count for anything.
I'm tempted to show up at the hospital tomorrow even though they're not expecting me. I'm tempted to see if I can make it through the discussion without breaking down. I don't know. I know that it would be incredibly hard for me to be strong enough in my beliefs that I don't feel like I'm being judged as worthless, ignorant, or unreasonable in my expectations.
In 37 years, I've learned that problems don't go away by themselves. Ignoring a problem won't make it go away. Not talking about a problem doesn't get it resolved. There's a problem in our maternity system. When 10% of women test positive for PTSD after their children's birth there's a systemic problem with the maternity care in the US.
I don't know how we fix it. If there's anyone that understands that complications can be real, that some women need more care or interventions than others, it's me. I know that homebirths aren't the answer to the problem. I know turning care over to midwives isn't the answer to the problem. I know that birth abuse can happen at home, in the hospital, or in a freestanding birth center. I know that midwives, doulas, and doctors can all be perpetrators. I guess that's why I cringe at being called an activist / advocate. Too many people see the solution as being so simple as making homebirths the norm, or midwives the norm.
Maybe it's a simple as making sure that doctors, nurses, midwives, and doulas are making the decision to provide patient centered care. Maybe if we had a more open dialogue between caregivers and their patients on their childbirth philosophies we'd have better outcomes. Maybe if caregivers were more open about how they really practice their craft patients would be able to find a caregiver that provides them with the type of care they desire. Instead we get blind-sided. The on-call caregiver delivers your baby instead of the person you've developed a relationship with. We get stuck with a nurse who's having a bad night, and doesn't want to be at work, so she takes it out on her patient.
It's so hard to make the right choices. No matter what we choose, someone says we're being too inflexible. We're taking risks by having the baby at home. We're taking risks by having the baby in a hospital. We're taking risks by breastfeeding, or we're taking risks by formula feeding. It's enough to make your head spin. Why don't we support each other instead of questioning each other? Why don't we bond together as a team instead of looking for the saboteur?
Advocate or wimp? I don't know. I know I won't let this drop.
My counselor told me that I'm becoming an advocate because I chose to provide my doctor with my writings instead of just cancelling. I'm not sure how I feel about that. I don't want to be an advocate. I don't want to be an activist. I just don't want anyone else to feel the way that I do right now. I don't want another woman to feel like she's powerless. I don't want another woman to feel like she's been coerced into procedures that she doesn't want. I don't want another woman to feel as isolated as I do. I don't want another woman to feel like she has no one to talk to, or no one who understands her. I don't want another woman to feel like the nurses are re-traumatizing her by their dismissive attitude. I don't want another woman to believe that she's worthless, like she's a vessel, like she's nothing. It's a horrible feeling to know that no one believes you count for anything.
I'm tempted to show up at the hospital tomorrow even though they're not expecting me. I'm tempted to see if I can make it through the discussion without breaking down. I don't know. I know that it would be incredibly hard for me to be strong enough in my beliefs that I don't feel like I'm being judged as worthless, ignorant, or unreasonable in my expectations.
In 37 years, I've learned that problems don't go away by themselves. Ignoring a problem won't make it go away. Not talking about a problem doesn't get it resolved. There's a problem in our maternity system. When 10% of women test positive for PTSD after their children's birth there's a systemic problem with the maternity care in the US.
I don't know how we fix it. If there's anyone that understands that complications can be real, that some women need more care or interventions than others, it's me. I know that homebirths aren't the answer to the problem. I know turning care over to midwives isn't the answer to the problem. I know that birth abuse can happen at home, in the hospital, or in a freestanding birth center. I know that midwives, doulas, and doctors can all be perpetrators. I guess that's why I cringe at being called an activist / advocate. Too many people see the solution as being so simple as making homebirths the norm, or midwives the norm.
Maybe it's a simple as making sure that doctors, nurses, midwives, and doulas are making the decision to provide patient centered care. Maybe if we had a more open dialogue between caregivers and their patients on their childbirth philosophies we'd have better outcomes. Maybe if caregivers were more open about how they really practice their craft patients would be able to find a caregiver that provides them with the type of care they desire. Instead we get blind-sided. The on-call caregiver delivers your baby instead of the person you've developed a relationship with. We get stuck with a nurse who's having a bad night, and doesn't want to be at work, so she takes it out on her patient.
It's so hard to make the right choices. No matter what we choose, someone says we're being too inflexible. We're taking risks by having the baby at home. We're taking risks by having the baby in a hospital. We're taking risks by breastfeeding, or we're taking risks by formula feeding. It's enough to make your head spin. Why don't we support each other instead of questioning each other? Why don't we bond together as a team instead of looking for the saboteur?
Advocate or wimp? I don't know. I know I won't let this drop.
Monday, December 1, 2008
I'm Thankful for:
I thought I should try to write something a little bit more upbeat, and with Thanksgiving last week, I thought I could write about the things that I’m thankful for from the night of my daughter’s birth.
- My doctor was well-trained, competent, and he kept it together until help arrived.
- My daughter is healthy.
- I still have all of my parts.
- The nurses let me stay in bed until I was ready to get up.
- Someone took the time to donate blood, and it was available for me when I needed it.
- I could focus on healing myself because no one expected me to room in with my daughter, and the nursery staff was great.
- My husband took the first week off work, and he drove me around town whenever I wanted to go out which was heavenly after being on bedrest for 4 weeks.
- My best friend was there to give my daughter all of the love and affection she deserved while my husband and I were tied up with my complications.
- My husband's best friend for coming to the hospital in the middle of the night to help my husband make decisions, and let him go home to get some sleep.
- My health insurance that pays for the counseling sessions that have helped me learn to live with the resulting PTSD.
Wow, that was more than I expected, and easier that I thought it would be. I guess there were some good things that happened that day, it’s just hard to remember them.
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