From Heaven to Hell in 30 minutes

Overwhelmed

2010-05-05T12:36:00.004-05:00

One of the things I still struggle with is having a heightened anxiety level. It doesn't take much to get me worked up. Anyhow, I'm really struggling right now. It's really nothing PTSD related - it is work related. My company is undergoing a merger / buy out. Since I am a shareholder, that means a lot of financial decisions to make in a very short period of time without enough information to make good decisions.

To top it off, no one really knows anything about the company that's buying us out. They're very large, almost 9000 employees. It's going to be weird to be just a number instead of the CEO knowing my name. In my current position, I'm 3 steps away from the CEO. Now, I'm probably 10 steps away from the CEO. I don't know if I'll be asked to move or to travel. I don't know if my duties will remain the same or change.

I also just found out that I may be invited to participate in new company's employee stock plan. They're inviting 40 employees to join, and I was invited to the preliminary meeting. I thought initial stock offerings would be in the $25,000 - $50,000 range, but they're looking at $120,000 to $250,000 range. I don't have THAT kind of cash sitting around. They're supposed to make offers by the end of the month, and I only have until June 30th to decide. At that time, I will have worked for this company for only 45 days. Do I really want to jump into bed with them?

Anyhow, all of this uncertainty has me on edge. I just want to crawl into bed, and hide under the covers. That won't be happening anytime soon, but it sure sounds appealing.

Identity

2010-02-05T10:13:00.004-06:00

I'm participating in a PTSD research study looking at the concept of self / identity as it relates to PTSD. It made me start thinking about how my sense of identity has helped or hindered my ability to learn how to cope with this disease.

In some ways, I think I was pretty lucky to have PTSD strike me during my daughter's birth. There's a huge change in identity that comes from having that squalling child placed on your belly. You're not just responsible for you anymore, you're responsible for that little person as well. For a lot of people, just that change from individual to parent can change your concept of identity. You're never quite the same person that you were. For me, those changes were just more extreme due to the PTSD.

It's also made it easier to accept that I will never be the person I was before this happened. It was easier once I realized that just by giving birth I wasn't supposed to be the same person I was before. It's much easier to accept the more extreme changes once you accept the basic ones.

Calming myself down

2010-01-08T10:01:00.002-06:00

Last night was a better night - at least until my husband woke me up in the middle of the night because he was ill.

I called my best friend, and she reminded me of who I am, of what I believe, and what I know deep in my heart that I have to do, even though I don't want to do it. It brought me a measure of peace that I haven't had since I realized what had happened.

The sleeping part of last night was rough simply because everyone in my house decided to wake up in the middle of the night. I had a really hard time quieting my brain to go back to sleep, but I did manage it around 3:30 am.

I've wanted to do some artwork to try releasing my emotions, but I haven't been able to bring myself to do it. I guess I have a hard time with things that are not concrete. I'm always looking for a grade, and art is so subjective that I haven't been able to let myself just create. I may try that again this weekend. It's just that I look at the blank page and freeze.

Struggling

2010-01-07T10:00:00.002-06:00

I'm really struggling right now. I'm finding it difficult to control my edginess and irritability. It's creeping into my interactions with my daughter and with the dogs. Usually, I can find my zen when I get home, but the last couple of nights the dogs have ended up in timeout, and the peanut has been kicked off of my lap for squirming.

I'm not sure how to deal with all of my feelings right now. I don't know how to stop the edginess from manifesting itself in my life. My husband knows something is wrong. I disappeared to the computer last night after the peanut went to bed. He knows I'm disconnecting, and so do I. I probably need to think about counseling again, but I kind of want to wait until I receive the records.

Just when I think I have this thing under control, something makes me feel like the PTSD has smacked me in the face with a baseball bat.

Where I'm starting

2010-01-06T10:10:00.002-06:00

I requested a new copy of my medical records yesterday. Before I jump to any conclusions, plans, or assumptions I need to verify that the records have indeed been changed. Hopefully, I'll have a new copy this week.

I had a rough night last night. This situation was preying on my mind. I took a pill, and still couldn't sleep. I just feel like they're all out to get me, even though in the rational part of my brain I know that's not true.

How on earth did I find myself in such a freaking mess?

It shouldn't be this hard to give birth. It shouldn't still haunt you two 1/2 years later. I shouldn't be in this place where I am right now.

What do I do now?

2010-01-05T15:18:00.002-06:00

I orginally got a copy of my medical records from my daughter's birth just a few months after she was born. At that time, I read them, discussed them with my family practice doctor, and decided to enter counseling to learn to cope with my experience. I put the records away, and completely forgot about where they were.

Last summer, things were really getting to me again, and since I couldn't remember where my records were in addition to them being somewhat incomplete, I requested a new more complete copy of them. By the time I received them, I was back in counseling, and I'd relaxed enough that I didn't really feel the need to read them.

When I was sick over Thanksgiving, I found the new set of records. I paged through them, re-read the narratives, and threw them out. I noticed that they specifically mentioned me "consenting" to procedures. However, I didn't remember that being in the original set of documents. However, the other day, I noticed the original set of the records was buried at the bottom of a drawer in my daughter's changing table. I made a note of their location in the back of my mind, and went about my business.

Yesterday morning, I woke up a little bit before the alarm went off. As I was laying in bed, it suddenly hit me. They'd changed the original records. It bothered me a bit, but I had work to do, so I put the thought aside.

This morning, I grabbed my original copy of the records, and re-read the notes on my daughter's delivery. In the original narrative, there's no mention of the doctor obtaining consent for the D & C, manual removal of the placenta, or fixing the uterine inversion. However, I'm positive that the current records have been altered to include "consent" issues.

What do I do? I don't know if I should request another copy of the records. I'm not sure if I should file a complaint with the hospital, state medical department, or find an attorney. I had registered a complaint with the state medical department a couple of years ago, and I'm sure my records were altered to avoid punishment at that time.

I don't know. I'm perplexed, frustrated, and angry right now. I feel like I've been re-violated because they're unwilling to face up to their own actions.

I'm Doing It!!!!

2010-01-04T12:13:00.003-06:00

Since my last post, I've managed to not do any birthday party planning. It's amazing how far I've come on this PTSD journey. I can now right about what my problem / trigger is, and I can work out a plan to cope with it. I never thought things could get this good.

I'm doing it AGAIN!

2009-12-30T11:58:00.002-06:00

Three years ago, give or take a couple of days, I reached the halfway point in my pregnancy. At that time, I went in for the "big" ultrasound. That test kicked off the complications I would experience through the remainder of my pregnancy.

Since then, as soon as Christmas is over, I start obsessing about my daughter's birthday party. What should the theme be? Where should it be held? Who should we invite? What kind of cake? What kind of gift? The baloons, tableware, and gift bags are scrutinzed and accepted or rejected.

It didn't click the other day when I searched for Dora the Explorer party invitations for over an hour. It didn't click when I started investigating venues. However, today my sister-in-law posted on facebook about her baby's "big" ultrasound. The light bulb went off, and I realized I'm trying to once again take back control over my pregnancy. Since my pregnancy is over, the next best thing is the birthday party.

I'm going to try to control it a little bit better this year than last year. I'm going to try not to get too caught up in the details.

Here we go again, but I see improvement

2009-11-21T06:14:00.003-06:00

I was triggered yesterday. I have to admit that I was struggling a bit before I set foot in the door. Once I left work, and started to drive out there, I found myself having some intrusive thoughts about running into my former OB. My concern with every new doctor is which section of the clinic they work out of, I'm terrified that I may bump into my former doctor on my way to an appointment with a new doctor. Anyhow, I saw the only doctor at my clinic that does the essure procedure. (Thank God, it was a woman.) We were discussing my candidacy for the procedure, and she went back through my hospital notes in great detail. That was a sure-fire way to make me feel like a freak of nature. Then suggested having another child by c-section - since no one would blame me for making that decision after my difficult first delivery. When I turned that suggestion down, she suggested I bring my ipod along to "relax' me during the actual procedure. She had no way of knowing that my husband and nurses used my ipod as a distraction for me in the first couple of hours out of surgery, so I wouldn't ask a lot of questions about what had happened. (I had a brief flashback in the appointment over this one.) And, followed all of that up with a quick exam to analyze my anatomy for the procedure.

By the time I left, I was really struggling. I was shaking, edgy, anxious, and having intrusive thoughts. I was planning to take the rest of the afternoon off, but I made the decision to go back to work instead. Within a half hour of getting back to work, the worst of the intrusive thoughts had gone away, and the shaking had subsided. I was still a bit edgy, and anxious, but those symptoms take me longer to deal with than the others.

Overall I was better in a couple of hours because I've learned to read my body and symptoms. I've learned how to deal with them - acknowledging them, and switching them up. And, finally I've learned to cut myself a little slack when it happens. I still find an occasional new trigger, but the disease itself is becoming manageable in a way I never believed that it could be managed.

By the way, I also managed to advocate for myself during this whole encounter. I was upfront with her about my PTSD diagnosis, and I made her aware of my need for a great deal of communication to cope with medical procedures. I also made her aware that my daughter's birth caused the PTSD, so she was really trying to be sensitive of my needs. She didn't quite make it, but she definitely tried.

Giving Birth Online

2009-11-10T15:04:00.002-06:00

Dear Radio Station Host-

I know that it's "news" that someone in our community chose to broadcast their child's birth live on the internet. I can understand choosing to play the end of this event on the radio once to encourage conversation. However, I do not understand choosing to replay it over, and over, and over again. Just because you found the experience of giving birth to be the best moment of your life doesn't mean that every other mother or father feels the same way about their children's birth.

The sound of a newborn's cry can be amazing, but it can also be terrifying when it doesn't happen. Just stab the knife into every mom or dad whose baby was rushed to the NICU by replaying those sounds over and over again. What about the mom who gives birth to a stillborn child. That's a knife in the heart to those moms as well because they didn't and will never hear the sound of that baby crying in those moments. What about moms who have complications after the baby is born. The sounds of a baby's cry can shove them back into the delivery room where people are flooding the room trying to save mom's life.

I know society chooses to portray giving birth as joyful, fulfilling, amazing and miraculous, but that isn't every woman's experience. I work as a moderator on a forum for moms who are struggling with birth trauma. They've had experiences that leave them with mental health issues like PPD, PTSD, and other postpartum mood disorders. Everyday with their new child is a challenge. Listening to your broadcast replaying those moments can cause a mom with PTSD to have nightmares, flashbacks, and other anxiety issues. I know because I suffered from them yesterday and last night.

Women who don't have the great birth experience often feel isolated. They're not allowed to talk about their child's birth because society doesn't accept these experiences as valid. When a woman tried to talk about it, she gets shut down. She's told not to share her experiences with other women who are pregnant. Trust me, talking about hemorrhaging at a baby shower will get a woman verbally shot down in less than 30 seconds. The last thing they need are more reminders that "they did something wrong" or "they failed".

Please consider that not everyone experiences things the same way before you decide to replay a soundtrack of a very emotional experience over the air.

Concerned Listener

Humpty Dumpty

2009-10-20T12:29:00.002-05:00

Humpty Dumpty sat on a wall.
Humpty Dumpty had a great fall.
All the king's horses and all the king's men
couldn't put Humpty together again.

I caught the last 20 minutes of Trauma last night. One character told the other that he needed to go get help. The other character responded, "what if once I let it all out I can't get it all put back in?"

That's the way I feel now about my PTSD. In the early days, I talked about my trauma. It gushed out of me on a daily basis. It was like I had to find a place for it to go that wasn't inside me, so I talked, and talked, and talked some more. I had friends tell me to let it go, and still I talked. I had people tell me it didn't matter what had happened to me, and still I talked. I thought that by talking, I could get it all out.

Now, I know that there's more to it than that. Talking about it was like opening the vent on a pressure cooker. It allowed me to open the appliance safely. However, now I worry that I might let something out that I don't want to have to put back inside me.

PTSD became the filter that my thoughts were processed through. PTSD became the glasses that I saw the world through. PTSD became my dirty little secret. It became my binky.

So, now I have to find away to allow myself to break enough that I can re-assemble myself into the person I want to be. I guess I'm ready to take that fall.

Facing Forward instead of Looking Back

2009-10-13T12:03:00.002-05:00

My daughter was in her rear-facing carseat for a long time. Most kids turn around at a year, but she was so small that she didn't hit the minimum weight requirement for an additional 7 months after that milestone. We looked forward to the day that she'd be facing forward, that she could see out the car window, and that we could hand her things from the front seat. The day she turned around was a celebratory day! She was finally a big girl.

PTSD is the same way. You have to find ways to look forward instead of backward. We have to fight to live in the present, and not the past. It's hard to accomplish this, and once in a while we all fall off the wagon, but you have to get up and try again.

The month of September was hard, very, very, very, very hard. I was finding myself starting to slide back down that slippery slope of looking backwards. So, I've started trying to re-focus myself on the present and the future. I've made plans to take my daughter to the pumpkin patch this weekend. I'm trying to make plans for Halloween. I'm looking at November, and trying to see what I can line up, and I've made plans for a weekend getaway just before Christmas.

The past is gone. I cannot re-live it. I cannot change it. I must find a way to move forward into my future.

33 weeks of memories

2009-10-07T10:44:00.001-05:00

I had an email from my sister-in-law yesterday. She’s pregnant for the third time. In my head I know this is a good thing. They want this baby. They’ll do their best for this baby. However, it’s making me anxious, edgy, and upset. I chickened out of calling her yesterday. I sent a brief Congratulations e-mail. I didn’t put it together until this morning, but her baby is due on the same day Peanut was due.

That’s what has me freaked out. They have the same due date. Each week I’ll be thinking about my disintegrating pregnancy and birth. There’s no reason to suspect that her pregnancy will go the same way that mine did. It’s incredibly rare for that to happen, but for the next 33 weeks I’ll have that reminder of ickiness.

I have to find away to break my association between those dates. It’s not my pregnancy. It’s not my birth. It’s not me. But it hurts. I’d love to have another child, but I know that neither my husband nor I can face another pregnancy. We’ve decided to have the big V performed this year. I know this is the best decision we can make. But I’m still sad that I will only have one child, one pregnancy, one birth.

Thirty three weeks of memories…

The value of routines

2009-10-06T11:59:00.003-05:00

The last month has been difficult, trying, and chaotic. I have Bell's Palsy, my husband has a cracked tooth with an abscess, my daughter switched daycare centers, one of my dogs has an ear infection, the other dog has a nose infection, my grandmother passed away, and my water heater fan needed to be replaced. We have been flying by the seats of our pants for the last month. As a result, I'm edgy, anxious, and irritable. I've been triggered by my health issues. I feel like everything's out of control. However, October is a new month, and we're hoping to get back into the swing of things.

I've found that having a flexible routine is key to my ability to cope with the PTSD. There's something comforting about knowing, in general, what's going to happen next. I don't feel the need to plan every minute of the day. I don't obsess over eating dinner at 6:30 pm instead of eating at 5:30 pm, but I've found that following my routine makes it easier to stay on track. It keeps me in the present and looking forward. It reduces my anxiety levels which I desperately need after the last month. Reducing anxiety means less irritability which makes life better for my entire family.

I can't wait to get back to my routine. Get up, get dressed, get peanut to daycare, go to work, pick up peanut from daycare, cook and eat supper, play with peanut, have an hour or so with my husband, and go to bed.

Is birth women's war?

2009-10-01T10:07:00.001-05:00

I’ve been thinking on this post for a while. I’ve started writing it, and put it away because I couldn’t find the words. However, after reading this blog post, I decided to pick it up and try again.

Is childbirth women’s war?

When I was pregnant, I asked my grandmother about my mom’s birth. At 85 years old, she could still vividly remember that day and her experience. My mom can still relate the stories of my and my sister’s births. My best friend can pull her memories of each of her children’s births at a moments notice. When you get together with a group of women at a baby shower or a wedding shower, it seems like birth stories come out of the closet.

I believe that we’re genetically programmed to remember the experience of giving birth. The combination of the hormones, the pain, the fear, the anxiety, the joy, and the love imprint those memories deeply into our brains. It’s not that big a stretch to believe that those memories can sometimes be improperly stored causing PTSD.

All over the internet, on discussions of PTSD after childbirth, you’ll see an argument stating that this cannot be a mental health disorder because it’s a natural occurrence in a woman’s life. However, no one debates the validity of PTSD in soldiers returning from war. Men have been going to war for thousands of years. Why is their experience considered to be out of the norm, but a woman’s childbirth experience is dismissed or trivialized?

Men have found some interesting ways to cope with the fallout of the experiences long before the PTSD diagnosis was made during the Vietnam War. They formed and joined groups like the VFW or the American Legion. They go, and hang out with others who have had similar experiences. It’s a safe place to discuss the horrors of what they saw, the feelings they had, and they can process the events.

Yet, women don’t have these types of places to go. In today’s society, new moms are often isolated from society. We’re left to navigate this new terrain by ourselves. Our parents are working, so we frequently don’t have our moms or dads to rely on in those first few days. Our husbands go back to work typically a few days or a week after the baby is born. We struggle to establish breastfeeding, caring for the other family members, and try to get enough sleep to function. There are days when just getting a shower seems like an insurmountable task. Is it any wonder that those memories can get hung up under those conditions?

I’ve heard some people wonder if PTSD after childbirth is a rich nation’s problem, but I don’t think it is. I think no matter where women give birth, that they’re at risk of developing this condition. Women in third world countries know that childbirth isn’t safe. Their entire pregnancy is spent in an atmosphere of anxiety. Will I survive? Will my child survive? If something goes wrong can they get me to a doctor or a midwife? They live with those fears for months. Those months of anxiety set them up for developing this condition when their childbirth experiences go awry. Just because they don’t have the resources for diagnosis and treatment doesn’t mean that they don’t develop the condition.

Others have blamed the medicalization of childbirth on the development of PTSD. However, I know that medical procedures don’t cause PTSD. It took months of counseling to admit this, but my PTSD had nothing to do with the medical procedures that were performed. They were entirely the result of the way that I was treated while I was in the care of the doctors and nurses at my daughter’s birth. The PTSD was a result of a lack of communication, a lack of understanding, a lack of consent, and a hostile birth environment.

Yep, I did call it a hostile birth environment. This is something that doctors, nurses, midwives, doulas, and support people can change. Medical professionals can choose to treat a birthing mom respectfully. They can choose to speak to her with honesty. They can accurately, and without coercion, discuss her options. They can choose to allow her to make a choice, so that she can own that decision. They can choose to make sure she understands the positive and negative consequences of her choice.

A Trip to the ER

2009-09-17T15:51:00.005-05:00

So, last week I ended up in the emergency room of the hospital where Jennavive was born. I've been having problems with dizziness, and I'd seen the doctor the week before. She thought it was just vertigo - be patient, and it should go away on its own. However, I started having a lot of tingling, numbness, nerve pain in my face on my way to counseling Thursday night. I called my husband, asked him to pick up peanut, and went home. When I got home, I looked in the mirror, and my face was completely lopsided. My husband got home 1/2 hour later, and I asked him to take me to urgent care. As we started to head out of town to the clinic urgent care, I changed my mind, and asked him to head to the ER.

We stood behind a couple of other families waiting our turn to get checked in when the triage nurse came out of her room to start prioritizing patients. She spoke to the family in front of us, told them to stay in line, and came back to talk to me. I explained about my face drooping. She grabbed my arm, told my husband to check me in, and dragged me into the emergency room. I sat down on the bed, and she started strapping monitors to my chest, a blood pressure cuff around my arm, and taking a quick history. Two minutes later, the doctor was at my bedside asking questions and listening to my story. He told me that they were going to do an MRI. Another nurse came in, and started setting me up for an IV. (Doesn't anyone ask permission anymore?) I balked. I told her that I'd had a rotten birth experience, and I really didn't want the IV. I got lucky, the lab tech walked into the room to do a blood draw, so she told me that as long as the tech got a sample that they'd skip the IV.

I’ve been having problems since then. I was diagnosed with Bell’s Palsy. It’s not a big deal. It goes away on it’s own over time. It’s not pleasant, but not dangerous either.
But, it’s causing me nightmares, the feeling of being objectified, the feeling of being controlled, the feeling of being dismissed or ignored all coming raging back to me. I’m struggling to cope. My In-Laws have very graciously moved into our home for this week since I’m not allowed to drive. They’re making meals, performing projects around the house, mowing, and cleaning. It’s great that they’re willing to do this. I appreciate all of their efforts, and yet I feel like screaming – “GET OUT, I can do it MYSELF”. Except I cannot do it myself, and I know it. I know it’s the PTSD talking. It’s the dichotomy that I live with. My rational brain knows that everyone is looking out for me, everyone just wants to help me get better, but the irrational side feels like a little kid fighting off a temper tantrum. I want to fling myself on the floor, kick my legs, and scream at the top of my lungs.

Hopefully, acknowledging it will let it fade.

The good news is, I did advocate for myself in the ER after I got over the initial shock. I did get them to explain things to me. I did avoid an unnecessary IV. I did manage to keep myself in the present, and fight off the flashbacks. Even though my blood pressure skyrocketed to my PIH days of pregnancy, I kept my calm. I did ask a ton of questions the next day at the clinic appointment. I can hear my counselor telling me that I did a good job. My husband feels like I did a good job. The rational part of my brain knows that I handled this better than Jennavive's birth. I just wish the fall out was a little bit easier to handle.

How Family Members Cope

2009-09-08T12:47:00.002-05:00

In the last few weeks, my husband has been talking more and more about Jennavive's birth. Even though 2 1/2 years have passed, it's like it's suddenly become burdensome to him. The first year, he refused to talk about it unless it was with someone extremely close to him. The second year, he became a bit more open, but still didn't really discuss it. Now, it seems like every week he's coming home and telling me about discussing it with a co-worker, a casual friend, or a distant relative.

I know that I've been struggling a bit lately simply because I'm getting asked A LOT about future children. (What is it with the two to three year spacing?) Anyhow, I'm sure my husband is getting some of those same questions, but it bothers me that it's bothering him so much now.

Rage - the Drug of Choice for PTSD

2009-08-31T16:27:00.002-05:00

Personally, I kind of like the way that righteous, justified anger makes me feel. When I'm angry I feel powerful, not weak. When I'm angry I feel invincible, not helpless. When the anger is justified, those feelings seem even stronger because I'm "standing up for the little guy" or "showing the man".

I allow myself to fully experience it. I relish it. I wallow in it. I'm almost seduced by it. I don't let myself let go of it, because I like the powerful way it makes me feel. Justified, righteous, and powerful - it's like a drug to my brain. It feeds the PTSD. I burn with the emotions.

The problem is, when I'm angry there's no room for happiness. There's no room for remembering or appreciating my daughter's joyful laugh. I lose so much if I let it take over. I don't appreciate a bouquet of fresh flowers, a beautiful garden, or a sunny blue sky. I hate what I lose when it has me by the throat, so I'm trying to teach myself to let it go.

My boss told me once that I needed to forgive the doctor to heal. Sometimes I wonder if he's right. The anger shouldn't be a security blanket that I hold close. I should hold my family close.

I had a dream

2009-08-28T14:48:00.001-05:00

I had a PTSD dream last night. It was odd for several reasons:

1. I was a man.
2. I had conquered PTSD.

In the dream, I was a motivational speaker. I went around speaking to other people about what it’s like to live with PTSD, how to work with PTSD, how to be more than you were because of PTSD. It was amazing to see myself as healed, as more, as open as I was in the dream. I viewed PTSD as a mountain to be climbed, a wall to be scaled, a battle to be fought, or a war to be won. It was a part of me, and yet not THE defining part of me. It was simply a fact like having brown hair. In the dream, I considered myself stronger, wiser, and more powerful than I was before the trauma.

I hope I’m on my way to that being my reality.

Snapping Turtles in Truck Beds

2009-08-19T12:42:00.003-05:00

One of my most vivid memories from the year I started first grade, is of a huge snapping turtle in the bed of a pickup truck. One of the men on the indian reservation had captured this turtle, and he'd brought it over to the church to show it off to all of the other families. He found this big stick, actually a good sized tree branch, and was poking it at this turtle. I remember watching the turtle snapping at the branch, he was angry, scared, and trapped. The turtle just kept spinning around in the bed looking for new threats.

The year I turned six was a crazy year. I lived in 4 houses and 3 states, one of those houses was on an Indian reservation. I attended three different schools, and I was physically attacked by my little sister nearly every day. My family went from being solidly middle class to living in subsidized housing because my father decided to get out of the military and go back to college. There was so much instability and upheaval in my life.

Using EMDR yesterday, I was 5 again. The fear, the anger, the hatred, the pain, and the feeling of being dismissed that I’d bottled up so many years ago, erupted from their hiding place as a result of my daughter’s birth.

I felt like that snapping turtle – everyone poking at me, no place to go, no place to hide. I was trapped, angry, fearful, hurting, and confused by all of the changes in my life. At 5 you have no control over your parent’s choices. You live where they tell you to live. You wear what they tell you to wear. You act the way you’re told to act.

I don’t want to be that scared 5 year old anymore.

I am a 38 year old woman. I am a wife and a mom. I own my own home. I have a career. I have friends. I am only trapped by my mind. I no longer live in an abusive home. I no longer have to worry about a roof over my head, food on the table, and clothes on my back.

I am not a turtle fighting to get free.

Begin with the End in Mind

2009-07-28T09:47:00.000-05:00

At work, when starting a project, my boss and I try to think about how we think an application will be used in the future. Right now we’re working on a project that will revolutionize, at least for our company, the way we collect and track subcontractor data and performance (safety, quality, and earned value). Our initial goal is very simple; however, we can both see that this has the potential to morph into something much more involved than what we’re trying to accomplish right now. We’ve been trying to make sure that this application has the flexibility to change as our company’s needs change. Every time we meet to discuss it, we’ll say “begin with the end in mind”.

So, when I read this blog post, it made me start thinking about the way I am inconsistent in applying it to my PTSD journey. When I started counseling, my counselor defined some goals to achieve – no more nightmares, being able to look at my daughter’s baby pictures, and not crying every time I talked about the experience. We accomplished all of those things, at least most of the time, but I’m still having problems. The problem is that I didn’t define me. I simply defined a change in the symptoms.

Now, I’m heading back to counseling to deal with this again. I’m trying to get all the way down to the roots, so I can free myself from this burden. I have to redefine my image of me. In some ways I’ve accomplished it. I’ve actually become more accepting of my body since my daughter was born. I now own a swimsuit, something that had been missing from my wardrobe for at least 10 years. I bought a slinky dress that had my husband salivating (according to him, I’d never looked sexier). I’ve made peace with my cantaloupe sized boobs, and will actually wear deeper v-neck and empire waist shirts than I ever did before. I’ve learned to ride a bike – I mean trike, but it’s still a big change. I love work. I’ve always felt safe there, and despite the sleepless nights, the anxiety, the edginess, my performance remains stellar. So, what’s left? I don’t know, but obviously something is still missing because I’m haunted again. I’ve had three nightmares in three nights, this isn’t normal anymore, and I don’t like it!

Weeds On My Mind

2009-07-23T07:56:00.003-05:00

My husband has been working on a major landscaping project for the last few weeks. Actually, he’s finishing up a major landscaping project from when we first moved into our home 5 years ago. For some reason, despite the use of landscape fabric and rock, the weeds have overtaken the landscaping around the front of our house. The weeds have even taken root in the tiny area between the pavers of the front sidewalk. Every year, it’s a pain in the butt to go out and weed the area. We’ve lost plants / shrubs to the ever increasing weed population. The sidewalk has started to spread wider as the weeds have pushed the pavers apart. This year, we’ve had enough. We’re pulling up all of the rocks, the landscape fabric, and the pavers, and starting all over with new fabric, mulch, and rebuilding the sidewalk.

So, how does this relate to my PTSD?

The weeds are the thoughts from the past that keep intruding into my present. They’ve been choking the life out of me for the last two years. It seems like every six months, I go through and yank them all out, but pretty soon they’ve taken over again. I have one passing thought, I don’t acknowledge it, I don’t challenge its validity, and I just let it hang out. The next thing I know, there’s another one, and another one, and another one. They grow huge, the roots dig down deep into the fertile soil of my brain, and they begin to take over.

I have to find away to turn my hyper-vigilance inside myself. I need to use it to root out the weeds / thoughts when they’re tiny instead of letting them grow big and strong. I need to finish my landscaping project, and free myself from the weeds in my mind. I want to be able to spend that time having fun, focusing on my family, being ME instead of dealing with the garbage of the past.

It’s not easy. I know it will take a lot of work, but I’m done with this… just like I’m done with fighting the weeds in my yard.

Acknowledging Irrational Thoughts

2009-07-20T12:38:00.002-05:00

Wow!

I feel so much better. Putting a face on why I'm feeling the way I do, acknowledging my feelings instead of stuffing them makes them so much easier to deal with on a daily basis. It's completely irrational to be afraid of a billboard, a piece of mail, or a tv ad. I know that in my head. It's why I was stuffing everything down. It's too irrational to deserve being voiced. It's much easier to be angry. To blame everything except what's happening in my own head.

Denying irrational thoughts doesn't eradicate them. It reinforces them. Getting rid of them means accepting that the thought is real, and debunking it. I know this, but sometimes I get caught up in the feelings and stop listening to myself. I just feel.

Change requires constant monitoring of my thoughts. I requires that I debunk untrue thoughts and that I reinforce accurate thoughts. That's the only way to get past this.

I was never in danger driving to work, well no more danger than anyone else on the road is in on a given day. I was never in danger while watching TV or getting the mail. I must remember to reinforce those accurate thoughts to make it harder for the irrational ones to get through.

Clogged, Stuck, Trapped

2009-07-15T10:14:00.004-05:00

So, my PTSD has been flaring up over the last several months. I know that my first trigger was the ER episode. I thought I had handled it well. I thought because I could watch the episode later that I was better. What a crock, it was just my brain faking me out again.

Then, the billboard was put up on the road I take to work. Every morning, I see that sign on the road. A few weeks later, a new billboard was put up on the road I take home from work. Great, now they've got me coming and going. Then they started their direct mail campaign. It's looking me in the eye from my mailbox when I get home. Then they started the TV ads. This week, it made the front page of the local paper. I feel bombarded and trapped. I can’t get away from the reminders.

"It's a suite experience!"

All I can think is its dangerous.

Watch out.

Don't go there.

It's NOT SAFE!

Run!

Trapped!

Hide!

Fear!

Escape!

Pain!

I'm anxious, edgy, and fidgety. I’m not sleeping well at night. I had still been keeping the nightmares at bay, but last night they came back with a vengeance.

I realized things weren’t quite right back in May. I told my husband that I NEEDED to go away on vacation. I thought a change of scenery, a change of routine would help, and it did for a while. But, like always, it was a temporary fix. A few weeks ago, he told me, “you just don’t seem like yourself”. The warning lights started flashing bright green and red. I’M BACK!

I don’t want you back. I want ME back. I thought I had conquered you. Why won’t you leave?

I’ve lived with PTSD my entire life. My father is a Vietnam Vet. I was born only two years after he completed his second tour of duty. I didn’t know what it was called, but my memories are loaded with memories of my father’s struggles with PTSD. I watched him have flashbacks. I watched him fly into a rage over something that should have been trivial. I lived with his skewed perceptions of the world, of safety, of his belief structure.

And, now I struggle to make sure I don’t create the same environment for my daughter. I’m in counseling for her and my husband. I sought help to break the cycle of this illness. I will not allow my home to be a place of fear and anger.

My counselor thinks that this is old stuff. I have to find a way to get past the state of fear that I lived in as a child that the trauma of my daughter’s birth dredged up from the depths of my mind. I must find a way to find safety within myself because the outside world will never be 100% safe.

I must not fail.

Why can’t I just get away from all of this?

2009-06-23T15:00:00.001-05:00

My 20 year high school class reunion is coming up in August. My husband and I have decided to attend, so I’ve spent the last couple of weekends, blame Stacey and Clinton from TLC’s What Not to Wear (my husband does), looking for a dress to wear to the event.

It’s been difficult to find a dress. To start, I’m a larger than average girl. Not a lot larger, but large enough that I can’t fit into the dresses in the regular misses department at the stores. Therefore, my selection is pretty limited. Added to that, I was a wall-flower in high school, and I don’t want the dress that I buy to reflect that part of my past. I’m not that shy, scared girl anymore. I’m a wife and a mother. I own my own home. I have a career that I’m good at and enjoy. I’m a PTSD survivor. I want a dress that has people seeing the confident woman that I am now. I want them to see that I’m not shy and retiring, but willing to put myself forward the way I am now acknowledging my own faults.

I had bombed out at 12 different stores two weekends ago. I tried on approximately 80 dresses, but nothing hit all of the right notes. I’ve spent the last week grumbling about it to my co-workers. It was so frustrating to have one little thing wrong with so many dresses.

So, last weekend I dragged my husband to the local Macy’s store. We went through the entire store, and grabbed every single dress they had in my size (between 30 and 40 dresses total). I tried on sleeveless dresses, short sleeved dresses, and long sleeved dresses. I tried on casual sundresses, work type dresses, cocktail dresses, and even mistakenly tried on a prom dress. (We were just grabbing, not really looking at the dresses.) I tried on dresses that I would typically never consider. I’m pretty modest, so I don’t wear sequins, tight, or sleeveless clothes. However, given my insatiable desire to find the “right” dress, I ignored all of my own rules. So, I started trying all of these dresses on in the dressing room. I showed my husband each and every one of them. One of them had my husband’s jaw hitting the floor. It was like va-va-voom – totally sexy, slinky, sex-kitten dress, and I looked GOOD! Actually, I looked gorgeous. I’ve never seen myself like that. I’m not ugly, but I’ve never thought of myself as pretty. Anyhow, it just happens that this dress was on clearance for $40, so I decided to go ahead and buy it.

Monday morning rolls around, and I’m talking to a couple of co-workers about finding this great dress. I told them that my husband’s going to get a sitter, so we can go out for my birthday next month, and he’s even thinking about springing for a hotel room. In my mind it was a pretty innocuous, non-triggering conversation to be having, when Chantel says, “woohoo, baby number two making night”.

AARGH! I’m talking about a dress, not making baby number two. I’m not going to intentionally have any more children. My husband and I have decided that neither one of us in comfortable with the risk. My pregnancy and delivery were complicated. In fact they were more complicated than my hospital had ever seen. It’s not like they were just a little bit more complicated than usual, we’re talking almost off the charts complicated. The odds of having that many complications in a single delivery are higher than the odds of winning the lottery. For me, the risks of dying are very real. When your medical records record a conversation about placing mom in the ICU, she’s not making up stories, or exaggerating about nearly dying when giving birth. It’s rare, but moms do sometimes die. There’s no point in giving birth to another child when my odds of not being there to raise that child are so high.

Anyhow, I’m just frustrated. I know Chantel doesn’t know my birth story. I know she didn’t mean anything bad by saying this. She’s working under the typical assumption that most people have their children two to three years apart. It’s just that the casual way she said it kind of tripped me up a bit.

I’m so much better than I was. This experience has started fading into the background. It’s still there. I know I still filter every new experience through it, but it’s not like it was before. I guess I’m just a little naïve in thinking that as my daughter gets older things will stop triggering me. I keep thinking that it’s in the past, and yet I’m having a conversation about a sexy dress, and birth pops up. When are people going to stop talking about it? How old do I have to get before it stops being a common topic of conversation. It’s not that I can’t talk about my daughter’s birth. I do talk about it, but I don’t see the need to go into details with every Tom, Dick, or Harry that walks into my life.

Birth Rape Rears its Ugly Head Again

2009-06-05T12:34:00.002-05:00

After two years of living with the consequences of my OB’s actions I really should know better than to Google Birth Rape. It seems like every 9 – 12 months something stirs up the discussion fires on this topic. This time, Café Mom seems to be the instigator. There’s poll, a forum, and a journal / blog post on the topic. Now, at least one L & D nurse is weighing in on the subject as well.

There seems to be some misconceptions about what women are referring to when they define their birth experience as a birth rape.

1. Just because someone, a nurse, midwife, or doctor, breaks your water doesn’t make it a birth rape. Just because birth is painful doesn’t make it a birth rape. Just because you have a cervical check doesn’t make it a birth rape. Most of the time, healthcare providers ask permission to do these things. If you consent, it’s NOT rape.

I had my water broken, but I consented. That procedure was not birth rape. I had an IV, but I consented. That procedure was not birth rape. I had several cervical / vaginal exams, but I consented. Those procedures were not birth rape. I was asked to lie on my side during the majority of my labor, but I consented. That was not birth rape. I had continuous fetal monitoring and EFM, but I consented. Neither of those were birth rape. I had a vacuum assisted delivery, but I consented. That was not birth rape. As long as you consent to the procedure whether it’s verbal or written it’s not rape. Just like when I consent to having sex with my husband it’s not rape.

2. Women who call it birth rape deserved what they got. After all if the baby has to come out, so whatever is done in that process is acceptable. If you go to the hospital as long as someone with an ID badge does it to you it’s okay.

Where I live, we have a Patient’s Bill of Rights. Competent patients have the right to decline any and all medical procedures. Competent patients have the right to be told what their diagnosis is, what the treatment options are, what are the risks associated with those options, and allowed to make their OWN decision. Therefore, the doctor, midwife, or nurse is not always right. They don’t have the power to force a woman to submit to procedures that she doesn’t want. They don’t have the right to coerce a woman into submitting to any procedures, and they don’t have the right to abuse their patients.

3. Women are just whining because they didn’t get the experience that they wanted to have.

What? There are a lot of things about my daughter’s birth that didn’t go the way that I wanted. I didn’t want to be induced. I wanted to go into labor on my own. However, complications prevented this from being possible. Did that traumatize me? NO! Did that result in a need for counseling? NO! It was simply a disappointment. Do I label any of those procedures that I didn’t want, but consented to, as birth rape? ABSOLUTELY NOT!

4. If it’s a rape, why don’t you report it, and have the perpetrators prosecuted?

I did report the actions of my doctor. I reported them to the State Medical Board, the hospital where he practices, and I sent him letter. However, the State Medical Board has the same attitude that a lot of women on this forum have- he’s the doctor, so he’s right. My report was denied because I didn’t have enough evidence to prove it. Doesn’t that sound like a typical rape case? It’s my word against yours. It doesn’t make what happened to be less truthful or less traumatizing. As to why I didn’t sue him, well like a lot of rape victims, I didn’t want to re-live it. I didn’t want to sit in the same room with him. I didn’t want to bare my emotions, and mental issues in front of a jury that doesn’t believe that birth rape happens.

5. You don’t develop mental issues from a bad birthing experience.

Actually, I did develop mental health issues as a result of his decision. I spent 18 months in counseling for PTSD. PTSD doesn’t go away. You learn to live with it, you learn to cope with it, but it doesn’t go away. I’ll have these scars for the rest of my life. They’ll gradually fade with time, but they will never go away. I live with nightmares, flashbacks, dissociation, and anxiety. I have panic attacks when I go to the doctor. I have had flashbacks during sex – what a mood killer. I’ve denied my husband sex because I’ve been terrified of having another child. My marriage was nearly destroyed because of the severity of my symptoms.

6. So what do I call my birth rape?

For me, birth rape refers to a specific procedure at a specific time that was performed without my consent.

My daughter was born at 11:32 pm. Approximately 15 minutes later my doctor asked the nurse to tell him when ½ hour had passed after the baby’s delivery. At that point in time, he knew that the placenta wasn’t detaching properly. Did he discuss this with me? No. He just kept biding his time waiting to see if it would change. Shortly thereafter, I notified the doctor that his ½ hour was up. Did he tell me then, that there was a problem with the placenta? No. He attempted cord traction to get the placenta to release. The umbilical cord tore off the placenta leaving the placenta attached to my uterus. Did he notify me then that there was a problem with the placenta, and offer me the opportunity to choose between treatment options of having him try to manually remove it or have it surgically removed? No. He just shoved his hand inside me, and tried to pull it out himself. Why wouldn’t I have seen this as a rape? He wasn’t saving my child. She was already born. He wasn’t saving me since at this point he didn’t see this situation being emergent. I was competent, and capable of consenting. He chose not to allow me to consent.

The pain of this procedure was extraordinary. It’s beyond the realm of anything I had ever experienced. It sent me into a place where I was incapable of providing consent for any additional procedures. Even though I didn’t consent to the D & C, even though I didn’t consent to the re-installation of my uterus, even though he spent almost an hour with his hand elbow deep in my hoo-ha trying to shove my uterus back into place, I’ve never considered those procedures to be birth rape. The situation had become emergent, I was mentally incapable of providing informed consent, and I was at the mercy of his skill, knowledge, and competency.

You see, Birth Rape is about power and consent. It’s not about sex. It has nothing to do with sex. In some ways, birth rape is worse. You’re in a place and surrounded by people who are supposed to keep you safe, but you’re not. You can’t advocate for yourself if they don’t tell you first what they’re going to do. You can’t fight for your rights when they deny them. My doctor wasn’t evil. He wasn’t trying to harm me. He got caught up in the complications, and all he saw was a problem. He forgot that I was a person, and only saw the complications.

Birth rape is real. Birth rape is evil, and eventually it will become prosecutable. Right now it’s impossible to get anyone to believe you.

Sometimes Surviving is Enough

2009-05-27T15:06:00.004-05:00

While we were on vacation last week, I listened to a song on the ipod – Alive off Meatloaf’s Bat Out of Hell 3 album. I don’t listen to it often, but it’s my favorite song off of that album. The album was released when I was pregnant. Every time Alive was playing, Peanut would dance in my belly. I don’t know why, but she really seemed to either love it or hate it. It’s an interesting song. It celebrates surviving.

My counselor asked me once if I was proud / gave myself credit for anything going well with Peanut’s birth. I’ve struggled with giving myself credit for anything that happened during Peanut’s delivery. As far as I’m concerned the whole experience was a failure. I failed, the doctor failed, the anesthesiologist failed, the nursing staff failed, and my support people failed. There’s nothing but failure from my point of view. However, when I listen to this song it makes me start to wonder if it isn’t enough to just survive.

The doctor’s didn’t kill me off that night.

I didn’t give up, and let myself die that night.

My husband didn’t walk away from our marriage after that night.

I'm a runaway train on a broken track
I'm a ticker on a bomb that you can't turn back
This time, that's right
I got away with it all and I'm still alive
Let the end of the world come tumbling down
I'll be the last man standing on the ground
As long as I got blood rush through my veins
I'm still alive
Holly Knight, Jon Bon Jovi, James Michael, Andreas Carlsson, Richard Samborra, Desmond Child, and Andrea Ramanda

I’m not quite ready to rejoice in my survival, but sometimes survival is reason enough to be proud.

ER - The Final Episode

2009-04-06T12:37:00.002-05:00

I bet you're thinking you stumbled across the wrong blog. I don't usually write about frivolous things like the latest TV show. However, it's pertinent in this case to my healing.

I remember watching the first episode of ER. I was hooked. I loved the interplay of Dr. Greene, Dr. Ross, Dr. Benton, and Dr. Carter. So many things in my life have changed since that day, but that has been one of the constants - Thursday night at 9 pm. I haven't watched consistently in a long time, but I decided to watch last night's episode.

It started off okay. They got to the twin labor and delivery, and I was okay. (I can finally watch re-enactments of the happy deliveries without freaking out.) I watched them deliver the second baby, and I was still okay. The first gush of blood came out of mom, and I started to get a little tense, but I was okay. The second gush came, and I'm starting to think maybe I should switch to something else, and then... gush number 3, uterine inversion, mom starts losing consciousness, call for blood, start IV's... I jump off the sofa, grab my daughter, and run for the stairs. I rush to get her put to bed, and run back downstairs to change channels before the commercial is over. I'm shaking, edgy, panicking, and trying desperately to calm myself. I was up half the night crying.

Right after Peanut was born, I kept asking my husband and best friend questions about my birth. I have no visual memories after the attempted manual removal of the placenta. I have some memories of sounds, but no pictures. My nightmares were terrifying to me because I didn't have the pictures, so I kept looking for them to give them to me. I'd ask, What did they do? What did it look like? Anything to get a description of what had gone on. I've accepted this lack of visual information. I've gotten used to the missing time frame. Having that visual experience last night totally has me freaked out.

I'm achy, hollow, anxious, edgy, and exhausted. I want to hide in a small dark place, and forget what I saw. I want to forget the fear, the anger, the panic. It was like they wrote MY story into the script. The baby was in the warmer, Dad standing to one side watching, and it all falls apart.

I haven't been this bad in a long time.

I HATE feeling like this. I HATE being this new person. What did I do to deserve this?

I wrote this on Friday morning. I'm glad to say that by noon, I was feeling better. Still edgy, but not jumping out of my own skin edgy. By the time I got home, the stranglehold was gone. I could think about other things, talk about other things, be myself.

I sometimes forget how far I've come. It came in such small, baby steps that you miss where things began to change. Despite my being triggered, I'm grateful to realize that this experience doesn't control me the way it did in the past. Within 36 hours most of the intrusive thoughts were gone. I didn't have another nightmare, and the flashback was only in the immediate time frame of being triggered.

My husband wants to delete the recording from the DVR, but I won't let him. I know I have to watch the entire thing. I won't watch it today, and probably not tomorrow, but in the future I need to see it. In order for me to be free, I have to face it.

This was my story. It may have a few tweaks, but it's the story I live with everyday.

De-Briefing Tool (Part 1 Question 2)

2009-03-24T10:08:00.007-05:00

What happened in the events leading up to the birth?

My pregnancy was never easy. It was unplanned. My husband didn't want to be a father. He sucked it up, and accepted it, but he was never supportive, excited, or happy about it. It was stressful knowing his feelings on the subject, but I just kept plodding along.

At 13 weeks, I had a scare. I had some spotting over the weekend. About the time I thought I should go get it checked out, it stopped. I went to the doctor right away on Monday morning. He did an ultrasound, figured that some blood got trapped behind the placenta, and put me back on the routine prenatal visit schedule.

At 19 weeks, I had my "big" ultrasound. They diagnosed me with partial placenta previa. Since it was still early, I knew there was a possibility that the placenta would move, but I started researching c-sections. I put off my childbirth classes until I could find out if it had moved. It seemed silly to spend all of that money only to end up with a c-section.

At 27 weeks, I went in for my partial placenta previa follow-up ultrasound and the one hour gestational diabetes screening. That night, the doctor called me at home. I had failed the one hour test, and had to schedule the three hour test. I failed that one too, so off to the dietitian I went. No candy, no cake, no ice cream, for Pete's sake I'm pregnant, but I can't eat anything but vegetables and meat. No more eating cereal for my bedtime snack. No more drinking OJ. Nothing. It sucked. The good news was that the placenta had moved, so I'm back to looking at a vaginal delivery. This is also the time when the doctor first mentioned that he "didn't think I'd make it to 40 weeks". What a crock, of course I was going to 40 weeks. I had been 3 weeks late, and I expected that peanut would be 2 weeks late as well.

Because of all of the GD issues, I started seeing the doctor weekly instead of bi-weekly. We finally got to week 33, and he told me that I could skip week 34's visit. Woohoo! I went to my family baby shower, and after I got home I noticed that I was really swollen. My legs were the size of watermelons. My husband hounded me to call the doctor, so Monday morning, I give him a call. I left a voicemail for the nurse, and not an hour later, she calls back. COME IN NOW! I'm thinking, it's just some swelling. Everybody swells up at the end of their pregnancy, what's the big freaking deal? But, as a dutiful, if resentful, patient, I trot my 34 week belly into the clinic. I walk in, and got on the scale. I gained weight. Finally, 34 weeks had gone by without me gaining any weight. I'm thinking I'm finally acting like a pregnant woman. I sit in the chair, they take my blood pressure, and it's high - too high. All of the sudden, he's telling me to go immediately to the hospital for an NST - what the heck is that? I drive up to the hospital parking lot, and call my husband in tears. I don't know what's wrong. I'm at the hospital. They're going to do some tests. I'm scared out of my mind. He tells me he's coming, and I head up to Labor and Delivery. I get to the desk. No one from the clinic has called, I'm trying to remember what the doctor said to have done. They get me into a room, hook me up to the monitors, and I just sit there alone, staring at the TV, crying, and hitting the joystick thing-a-ma-jig when peanut kicks. My husband calls, he's at the hospital, but can't find me. They didn't "admit" me as a patient, so the reception desk is useless. He finally makes it up to the floor, and into the room where I am. The doctor comes in, and says no more work, stay home, keep my feet up, no anything. Great - NOT. He says they'll induce, but they want me to make it to 37 weeks. He's kind of vague, and my husband hates him on sight. I'm frustrated because this wasn't part of my plan, but I'm a good girl, and head home.

My husband arranges for my in-laws to take the dogs for the remainder of my pregnancy. They're German short-hair pointers, so extremely energetic. There's no way for me to stay off my feet if they're at home.

I hang out at the house, watching Dr. Phil and Oprah. I'm bouncing off the walls with boredom. I feel like I have nothing to talk about. My husband keeps asking me for answers on when the baby is coming, but I don't know, and the doctor is vague. I only get out of the house twice a week. Once for the doctor appointment, and once for the NST.

A couple of weeks go by, and finally we get my induction date. My best friend comes to the house to help me with my "birth plan". What birth plan? This isn't the spontaneous experience that I wanted. I'm going to be hooked up to every monitor imaginable, there are no more choices to be made. I tell her that all I want is to walk out of the hospital as a healthy mom with a healthy baby. Whatever we have to do we'll do.

Memory of Pain linked to Childbirth Experience

2009-03-20T12:18:00.003-05:00

http://www.foxnews.com/story/0,2933,508961,00.html

I saw this article the other day. I found it interesting that women who have rotten birth experiences tend to remember their pain at the same or a worse intensity than women with positive birth experiences. It only takes me moments to remember the pain I experienced. It definitely hasn't diminished with time.

De-briefing tool (Part 1 Question 1)

2009-03-18T11:54:00.001-05:00

I found a link to a blog that defines some questions for de-briefing from your child's birth. I thought that they were pretty good, so I thought I'd answer them on here.

Part 1: How was your birth?

1. What was your birth like for you?

Well, my pregnancy wasn't easy. I felt isolated before I ever got to the delivery room. When I took my childbirth education class, I was the only person who hadn't gained any weight. I was the only person who had gestational diabetes. I was the only one who had been forced to consider a c-section. I knew then that my pregnancy was far from normal. The last four weeks leading up to my delivery were frustrating. I hated being stuck at home. I hated not working. I hated having my dogs shipped off to the in-laws because they were too much work for me to take care of them. I hated being trapped. I hated not being able to eat. I hated being pregnant. I hated knowing that I wasn't going to have the birth I wanted. Don't get me wrong, I was resigned to the complications. I acknowledged, and still acknowledge, that they were real. I was willing to do whatever it took to have a healthy baby, but it doesn't make it any easier to handle the emotions of watching your dreams fade before your eyes.

For me labor wasn't that bad. Since I had resigned myself to the induction, the tubes, the wires, the monitors, etc. I didn't find it to be very traumatizing. It went the way I was expecting it to happen. I was trapped in bed, but I knew that. I had lots of tubes, but I knew that too. There were monitors everywhere, but after having NST's for the four prior weeks I knew about those too. Truthfully, I really didn't find it very painful. That may piss some people off, but to me it wasn't that bad. I was frustrated that information didn't seem to be flowing smoothly between the nurses at the hospital and the doctor at the clinic. I was also frustrated about justifying, arguing, whatever you want to call it with the anesthesiologist over the epidural. However, neither of those things contributed to my PTSD. I was irritated that the nurse didn't believe me when I told her the epidural wasn't working. It's not like I wanted her to do anything about it other than mention it to the doctor. I remember the contractions piling one on top of the other. It seemed like there was no break from them, but I just concentrated on the fluorescent light fixture, and breathed through them. I remember one of the nurses offering to dim the lights, and I was pretty emphatic about wanting them left on. Other than the bathroom, the only thing I could see while lying on my right side was the light fixture. I needed the focal point to center my breathing to ride over the pain of the contractions. I remember feeling like it was time to push. It seems weird that everyone believed me when I said that, but no one believed that the epidural wasn't working. I pushed, and pushed, and Mel asked me if I wanted help. I told her yes, and she told the nurse the next time she came in. It seemed to take forever for the doctor to show up with his handy dandy vacuum. I remember him asking if I was okay with that, and I answered yes. I remember tearing and the feeling of relief when my daughter slid out. I remember being exhausted and collapsing on the bed. There were several frustrations and some irritations, but overall it was about what I had expected. Not what I wanted, but what I resigned myself to when I realized that the complications had derailed my plans.

The real problems started after my daughter was born. I remember thinking, wow, I'm a mom. I knew it was going to happen, but there's something kind of odd about having them place a new baby in your arms. I was relieved, anxious to spend time with her, and introduce myself. However, I was completely repulsed by all of the goo and blood covering her body. At that point, I really wanted them to clean her up. I started feeling woozy. Just a little bit off. I was about to ask a question about the way I was feeling when the nurse asked if I wanted to hold the baby. I said no. I knew something wasn't quite right, and I was afraid to hold her at that time. Mel brought her over to me, and I reached out my hand. PAIN! It shot through my whole body. I've never experienced anything like it. Everything went black. The pain consumed me. It was in me, around me, smothering me. I couldn't scream. I was trapped by it. I clawed at the sheets. I tried dragging myself away from it, but I lost the battle. The pain was inescapable. I heard snippets of conversations. We're going to need to go to surgery... Where the hell are they... What's taking so long... It's about time you got here... The sides of the bed snap up. I'm moving fast down the hallway. The lights were beaming down on my eyelids, they're moving me to a hard surface, they're poking me, and then nothing.

Some one's talking to me. I can't focus. I just go back to sleep. I hear people talking again. She won't be able to breastfeed. I can't stop shaking. They're piling blankets on top of me. What happened?

How do we change the culture of birth?

2009-03-17T15:05:00.002-05:00

Sunday morning, I got up early with Peanut and the dogs. We all settled down in the living room, and I turned on the TV. There's not much to watch on Sunday mornings, so I chose a re-run of 90210. It just happened that this episode focused on the birth of Steve's daughter. I found myself struggling to watch it because it hit too close to home.

Supposedly, Steve's wife needed an emergency c-section. The doctors come tearing in, ignoring Steve's requests for more information, and hustle his wife out to the operating room. A bit later, the doctors come out to tell him he has a baby girl who's in the NICU, and demanding that he signs some consent forms or his wife is going to die. He tries to ask questions, the doctor brushes them aside, and demands he sign the paperwork. They don't discuss options, diagnosis, or risks. Just sign the blankety-blank thing. One of the next scenes is in the hospital room. His wife's coming around, and is asking questions, but Steve doesn't really know. He just keeps giving her this vague answer, you lost a lot of blood.

There's so much wrong about this episode, but there was no outcry when it was first aired. No one yelled and screamed about informed consent. No one freaked out over women not being told exactly what had happened. Yes, it's a TV show. They're allowed some dramatic license, but our culture is so accepting of this type of treatment being okay.

It's not okay. Women aren't incubators. We're autonomous human beings choosing to reproduce. We're entitled to true informed consent. We're entitled to respectful, non-coercive information about the complications. We're entitled to time to process, and choose a course of action. However, that's not going to happen as long as we, as a culture, continue to allow doctors to get away with this type of treatment. We'll classify it as emergent, and batter everyone down until they submit.

So, how do we change it? The attitude is so pervasive, that it's like putting out a forest fire with a garden hose. How do we open up the minds of pregnant women, their support people, and the nurses, midwives, and doctors who are caring for them?

Anniversary Effect

2009-02-25T07:56:00.002-06:00

Anniversaries – I thought that my daughter’s birthday would be the hardest anniversary for me to deal with, but I’ve noticed that I’m not struggling as much with that specific day as I am in the 3 – 4 months leading up to it.

I was talking to my husband the other weekend, and I made a comment about my co-worker saying that I was making a big deal out of her birthday. (I’ve been planning her party for a while now. I want the invitations to be just so. I want the food / menu to be planned out in advance, and I want it to fit the theme of her party. I’ve started buying the favors for the kids. I’ve researched the local parks, to try and pick a location.) My husband said that I’m getting a bit obsessive, and I did the same thing last year. However, he did say that I’m better than I was last year, so that’s good – right? To me, I’m not planning a monster party. I am planning to make all of the food ourselves. I’m planning to invite the same people who were there last year – grandparents, aunts & uncles, cousins, and close family friends who were there the night that peanut was born. To me, this isn’t a hire a clown, or face painter, or pony, over the top kind of party. I’m not inviting her entire class from daycare – 14 2 year olds running around – YIKES! I want to have it at a local park, but that’s because I want the kids to be able to play on the playground instead of having games. Since peanut is only going to be two, I think games are kind of pointless.

Anyhow, that conversation has been bothering me a little. It’s been hanging out in the back of my mind like a tickle in your throat that won’t go away. I realized that I started planning the party at the same time of the year that I started experiencing complications during my pregnancy. This obsession, compulsion, planning kick is completely the result of the anniversary of things starting to go to hell, and I’m trying to CONTROL what’s going to happen in the upcoming months since I was completely out of control during those months of my pregnancy.

Isn’t that kind of weird? Oh well, it’s “better than last year”, so I guess I’ll have to ride it out again. Her birthday doesn’t seem to be as horrible as the months leading up to it. I guess by that time, I’m emotionally exhausted from everything else. The good thing about that is that I can actually somewhat enjoy her party. I’m also not stressing about her party falling on Mother’s Day this year, so that’s a huge bonus. I guess I’m starting to be able to separate my experiences as a mom from my experience with her birth.

Besieged? You don't know the meaning of Besieged.

2009-02-20T14:08:00.003-06:00

I read a blog post the other day by a doctor talking about medical (doctor) writers. She happens to really like a specific author, and the quote that she included in her blog was about a doctor feeling besieged.

Besieged is kind of a triggering word for me. I felt besieged at the hospital. Therefore, it’s not a word I’m comfortable hearing in this context. I read through the entire post, and looked the word up in the dictionary. The specific meaning of the word in this context referred to being overwhelmed. I can understand a doctor feeling overwhelmed at times. There are times I feel overwhelmed at work. Everyone from the burger slinging cook at Mickey D’s to the President of the United States will feel overwhelmed from time to time. However, there’s a huge difference between feeling overwhelmed and feeling like your castle walls are being breeched.

I don’t think people really understand what being besieged feels like any more. When the army surrounds your castle, when the gates hang crookedly from the hinges, when the larders are empty, when the well has gone dry, when the foundation is cracked, when the attackers have you strapped to the rack, and your family, friends, and army are being slaughtered then you know the true meaning of being besieged.

This is the way I felt in the hospital. I was surrounded by medical personnel who were supposed to keep me safe, and instead I was nearly destroyed. My personal gates were violently breeched with no warning by the doctor. My soul was emptied, and my emotions had run dry. I felt like I was strapped to the rack with all of the tubes, monitors, and paraphernalia I was attached to, and being tortured by the pain between my thighs. My marriage was in tatters, and my brand new family was hanging together by a thread. I faced endless nights of nightmares. I faced flashbacks during the day. At that point in time you have to make the choice to pick up the pieces, or wallow in the pain, fear, anger, failure, shame, and rage.

I made the choice to reach my hand out for help. I had to rebuild the foundation of my being one stone at a time. I had to learn how to live again, how to love again, and how to have fun again. I had to learn to harness my anger and control my rage. I’ve had to face the reality of my fears, and build a tomorrow I believed was gone. I’ve learned to cope with the anxiety, and I’ve grown stronger.

I’ve been besieged. I’ve been betrayed. I’ve been violated. My new castle walls may not be pretty, they’re pitted and pocked by the previous battles, but they’re much stronger than they were.

In honor of Valentine's Day

2009-02-16T12:06:00.003-06:00

My husband has been really great during this journey. It's not one that either of us intentionally signed up for, but he's handled it far better than I expected. He's the one who recognized when things were spiraling out of control. He's the one that prodded, and poked, and harassed me into seeking help. He's the one who kept poking and prodding and harassing me into not accepting that medication was going to solve everything. He's been willing to do whatever it takes to get me healthy and happy again.

One night stands out for me. It was the first night that he was staying home with our daughter so that I could have a night out with the girls. He came home with a present. He sat me down on the couch, told me that he loved me, gave me the present, and told me that he wanted us to recommit ourselves to each other.

You see no matter what, he loves me. It doesn't matter to him if I'm fat or thin. If I'm damaged or normal. He accepts me the way that I am right now.

It's an amazing feeling. I can't begin to tell anyone how important or essential that has been to me over the last 21 months. Whatever it takes, he's there.

I wear the watch that he chose for me gladly. It's not my style. I'd never have picked it out myself, but it reminds me that I'm never alone. He got a matching one for himself, and it's just one more sign of our commitment to one another. We wear them like our wedding bands.

So, thanks for being there for me. I love you.

How Far I've come

2009-02-12T07:47:00.004-06:00

As you can see, I'm not posting as much. Things have been much better lately. I was talking about the journey that the PTSD has taken me on the other day. I don't often take the time to reflect on how far I've come in this journey. I get so caught up in what's happening each day, that I just don't take the time to think back to where I was. There are some days that I almost feel like the old me. I've resigned myself to the fact that I'll never be who I was, and I'm beginning to make peace with what I think I'm capable of becoming now. I really think that I'll end up being more than I ever would have been if I hadn't experienced this.

I had a uterine inversion in addition to several other post-partum complications. At first, I coped by running away from what happened. I believed that if I ignored it, it would go away. I took my daughter out of the house every day. I believed that if I acted like a "normal" mom that no one would know that I spent hours at home crying when my husband was gone. Also, when I was out of the house it was easier to pretend that I was "normal".

It wasn't until my six week post-partum appointment that I really started to notice that my head wasn't quite on straight. It wasn't until the doctor touched me again that I had the first flashback. The feeling of his gloved hands touching me down there sent me back to the hospital room with his hand / arm elbow deep in my hoo-ha. The exam, just a typical exam, nearly brought me to tears. When I was in the hospital, I didn't get a good explanation of what had happened to me, and given the extreme trauma my body and mind had gone through, I didn't push for answers. I was told my uterus turned inside out, the placenta came out in 20 pieces, and I lost a lot of blood. None of those things are helpful at explaining /understanding what had happened. At my six week appointment, I finally had the wherewithal to start asking questions about what had happened. It was the first time I was told I had a uterine inversion, placenta accreta, and post-partum hemorrhage. That information sent me on a spiral of obsessively researching the complications. Every chance I had, I'd be reading about it, researching it, looking for the rates of recurrence, etc. It became my life for the two weeks I had left of my maternity leave.

My husband couldn't take it. He hated the obsession, so he started pressuring me to see the doctor. I went back to my old family practice doctor, not my OB, because I thought I had PPD. Actually,he's the one who suggested the PTSD diagnosis. We tried medicine, but I was still too obsessive. My husband kept hounding me to get help. He believed I needed more than just the drugs, counseling would be more effective, and he was right. I went back to the doctor, and asked for a referral to a counselor. At that time, I was having nightmares every night. I was having flashbacks a couple of times a week. I was obsessed with what had happened. I did the bare minimum when it came to work, to taking care of my daughter, to being a wife, but every other moment was spent thinking about, re-living, or reading about the complications. The counseling helped. It took months of seeing someone.

The first thing I had to work on was my anger with my husband. I hated him for allowing the doctor to do that to me. He was supposed to rescue me, protect me, save me, and instead he allowed the doctor to violate me. It took quite a while before I got past that. The next thing was learning to like sex again. I never told my husband, but, for the first six or seven months, I had flashbacks during sex. (I found the procedures they had performed on me to get the placenta out and reinstallation of my uterus extremely violating since they didn't tell me what they were doing before they started the procedure.) The feeling of having his penis inside me reminded me of the doctor's hand being inside me. I hated it. I couldn't get into it, and it hurt as a result. The pain fed the flashbacks, so it took a while to get to the point where I could look at it as just being close to him and not as something I "had" to do to keep him happy. After that, I still struggled with flashbacks whenever I gave my daughter a bath. I struggle with going to doctor appointments at the clinic, and it took me 14 months before I could walk back into the hospital where she was born. I'm just now starting to feel like the "old" Me.

I'm just starting to regain my sense of purpose, my ability to focus at work, and my ability to work through problems at home. There are still triggers, things like a friend being induced or talking about what happened with medical personnel, can still have me struggling. I know how to monitor myself for problems now, and I go back to counseling for a tune-up when I need one. It took me a long time to realize / accept that the complications and the procedure didn't cause my trauma. Yes, it was painful. Yes, the procedures they performed are vile. However, it was the lack of communication when I was still capable of understanding what was happening that caused the trauma.

So, now I found a new doctor, one who really listens to me. This doctor is a family practice doctor, so both my daughter and I are treated by her. That way, I see her more often than once a year, and she knows how to handle my needs. I've been really up front about needing a lot of communication. She knows that I need her to tell me what she's doing when I have a pap smear. She knows that I need to be highly involved in medical decisions. It helps me to deal with the fall out of the poor care I received during my daughter's birth.

As for having more children, if the only complication I'd had was the inversion, I'd be pregnant again right now. All of my reading /searching has led me to believe that the odds are in my favor of that not happening again in a future pregnancy. There's a support group for uterine inversion survivors on Yahoo that has so many positive stories of having second children that I could get past it. The problem for my husband and me is the accreta. The only study I've found that talks about the recurrence rate puts it at40%. I just can't get past those odds. I've met with several doctors. All of them have told me that I can have another pregnancy. I've even been told that they'd prefer that I deliver vaginally. They tell me that they can make it safer in the future. They would make sure the surgical team is accessible immediately.They would make sure to talk to me. They'd make sure I was treated with kid gloves. But I keep coming back to the 40% odds of having it happen again. I just can't risk the daughter I have growing up with out a mother because I chose to give her a sibling. She needs a mom. She can have a great life with or without a sibling.

I've come a long way, baby!

Breastfeeding & PTSD after Chidlbirth

2009-01-30T12:29:00.005-06:00

I've been struggling with this for several weeks. I haven't written about it because I'm still not sure what to say. It all started with this article. I saw it on my SOLACE support forum. I fell into the 4 1/2% of women who chose formula feeding as a result of their birth trauma / PTSD. I was okay with that decision at the time, and throughout my daughter's time on formula. Why I'm looking for answers now, I don't know.

I started haunting a breastfeeding / formula feeding debate board. I know my counselor would be crawling up my butt about this, but I think my brain is trying to process something. I don't know quite what yet, but it's definitely working on something. I felt compelled to respond to a post on there about formula feeding being selfish. I get so frustrated that no one admits that the decision to breastfeed can be just as selfish as choosing formula feeding. That article cites that the other half of women who experience PTSD / birth trauma choose to breastfeed to "make it up to their babies" or "prove that they're a real woman". Those aren't exactly selfless reasons to breastfeed. Why are formula feeders labeled as selfish, while breastfeeders are labeled as being better? Anyhow, it got a lot of people's backs up. I'm not typically a stir the pot kind of gal, but I seem to be compelled lately to behave in this atypical manner. No one seems to know how to respond to my belief that mental health issues are a valid reason for making the decision to formula feed. I seem to post, and the thread just dies.

Do women really believe that birth is this hunky dory, happy go-lucky, joyful experience all of the time? Why can't we face the reality of birth? Most of the time it is flowers, sunshine, and joy, but sometimes it's like finding yourself in the pit of hell. At least that's where I found myself. I wish I could say it was a happy time for us, but my husband and I both had issues to work through. We both struggled in those early weeks. My husband didn't hold our daughter until she was almost 8 weeks old. I had problems with nightmares, flashbacks, and being touched. Those weeks were horrible.

Anyhow, I'm still trying to figure out what I'm looking for. Maybe I'll find it, maybe not, but I have to exhaust my options.

Surrender, part 2

2009-01-21T12:07:00.002-06:00

I don't know what's going on, but it seems like I'm getting bombarded with thoughts about surrender. Not two days after I posted my first post on this did I use it as an example for another mom, and since then I've used it another couple of times. Who knew that this concept would strike a chord with so many women?

Anyhow, I wanted to utilize another analogy for discussing the topic because it came to me on another forum.

I've had to work through my thoughts on this. I've learned to view my pregnancy and delivery as a castle under seige. Each time some complication was discovered, the enemy, I mean medical staff, advanced on my position. Each time, I lost a little bit more ground. By the time I arrived at the hospital, I had only a tiny square of land to fight on, and as the delivery grew to a close, I lost even that. You see I had to make peace with the concept of surrender. I surrendered to the medical professionals because it was the only way I could live. I surrendered to them because I was too compromised to continue fighting against the overwhelming forces.

What a way to think of the situation. My daughter's birth felt like I was under seige. Everyone taking away my choices leaving me with no or few options for protecting my people - daughter, husband, family, and friends- or myself. When surrounded by overwhelming forces, when your food stores run out, when your well runs dry, your choices are surrender or die. Is that a choice?

There's a certain amount of surrender that's inherent to pregnancy. Your body is not your own. Foods that you hated you suddenly crave. Foods that you craved suddenly make you ill. Your body changes astronomically from one day to the next. Your hormones take over, and you lose a small piece of yourself. It's not all bad. You become more than you were. You're ripening, filled, glowing, but you can't fight the changes.

At first, you believe the medical staff are your allies. You don't realize that they're lions in sheep's clothing until much later. They tell you that you have choices, that you're in control, that they work for you, but that first complication takes away a choice. The second complication takes away more choices. Pretty soon, you realize that it's all a lie. They've breached your castle gates, and the only choice you have left is surrender.

I still believe that there's power in surrendering. I still believe that choice holds the ultimate power. There are times to fight, and times to walk away. Birth was a time to walk away, and NOW is the time to fight.

The Power of Surrender

2009-01-08T11:14:00.000-06:00

One of the things I’ve worked on is seeing what I perceived as my failures during my daughter’s birth as surrendering to the medical professionals. Surrendering is choice. Surrendering is recognizing that you’re in a losing situation, and making the choice to cut your losses. It doesn’t require that you like it, enjoy it, or are at peace with it. It doesn’t give the people who forced you into the position as pass or a “get out of jail free” card. However, there’s great power in making the decision to surrender.

So, when did my surrender occur? It happened when the pain consumed me. It happened when I realized that I was incapable of making decisions for myself. The initial moment of surrender came just seconds before the doctor tried to remove the placenta. It came in the moment where I told the nurse I didn’t want to hold my baby. At that point in time, I knew something was wrong, really wrong. I knew that I needed professional medical treatment. I couldn’t put my finger on what it was. I didn’t know the words to describe the way I was feeling. I didn’t have time to voice my concerns, but I recognized that without further intervention things were going to hell. While I recognize that I was surrendering to the medical personnel at this time, it doesn’t absolve my doctor of his decision. It doesn’t give him a pass on not communicating to me what he was going to do and why he was doing it. He still had a responsibility to communicate my diagnosis, propose a treatment option, and give me the opportunity to consent. Yes, things went to hell, but that doesn’t mean that he was free to do whatever he wanted to my body.

I also surrendered a second time. I surrendered to my fate, and that occurred when they rolled me into the operating room. I remember that moment, the feeling of giving up, of being willing to die, knowing that I’d given life to my daughter. I hate thinking back on it. It’s painful, scary, and hopeless, but it was surrendering. Even before I’d accepted this concept, I’d written about it. I wrote about the pain after my daughter’s birth just after she turned one,

The pain is all consuming. You can't think. You can't breathe. You can't hear what they're saying. You can't process what's happening. It wraps around you smothering you in a cloud of darkness and fear because you know it's not supposed to be like THIS. You can't form the words to question what's happening. You're sucked down into the black void of semi-consciousness not caring what they're doing to you because all you can focus on is the pain. It's the only thing that exists. They're pricking you with needles, people come running in and out, and someone straps a mask over your face. You feel the doctor's hand shoved all the way inside you. How the heck did it get there? The pain sucks you away. You struggle to breathe and continue to fight. Try to breathe through it, but you can't ride the waves. It's consuming your body. Don't quit. Don't abandon the baby. Keep fighting. Some comments break through. You can hear the anger and fear in the doctor's voice, and it scares you even more. But you're sucked back down into the depths of hell wondering what's happening. You feel the bed being wheeled down the hall. You sense the bright lights of the operating room beaming down on your eyelids, but the pain pulls seductively at you. Just give up. Stop fighting. Surrender to your death. Abandon your baby. Just let go. And then the anesthesia sucks all your thoughts away.

In the fourth sentence from the end, I wrote, “Surrender to your death.” Even then, I was recognizing that I had a choice to make. Even senseless, strapped to the operating room table, in agonizing pain, I had the power to surrender. It was my choice to give them, the medical personnel, the power to save me. It was my choice to submit to their will, it was my choice to accept the treatment that would ultimately save my life. Even when I was at my weakest, I had the power. When I felt like the biggest failure, I surrendered. When I believed all was lost, I submitted.

There’s nothing more powerful than making that decision. I surrendered to live. I surrendered to support other new moms. I surrendered to fight for patient-centered maternity care. I surrendered to share my story with others, so that we can all learn from the mistakes of the past. I surrendered to care for my newborn daughter. I surrendered to raise her, God willing, into adulthood. It was always my choice.

A New Start

2009-01-06T12:42:00.002-06:00

2009 has finally arrived, and with it I'm hoping for a new start. I'm feeling pretty strong again. When things get overwhelming, when I'm sinking into the PTSD hell, I can never remember what I typically feel like. It's so easy to get bogged down in the sadness, the anger, the fear, and the despair. I'm used to feeling edgy, like a strong wind could tip me over, like I'm a step away from the mental hospital, but today I feel like a million bucks.

My daughter said, "I love you" for the very first time. She's reached such a fun age. I'm glad I took the time, money and energy to keep fighting for healing, so that I have the opportunity to enjoy her now. I'm finally strong enough to want a memento of what I've been through, so my husband bought me a Mother's ring for Christmas. I wouldn't have been able to put it on everyday during the last year, but now I am. I can finally see that there's more to being a mom than just giving birth, unfortunately, last year that was all I could see.

I'm hoping these feelings continue. I hope to keep living. I hope to keep being me.

Finally feeling better

2008-12-31T10:12:00.002-06:00

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.

Uterine Inversion

2008-12-09T13:04:00.001-06:00

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.

Giving up my Power?

2008-12-05T10:04:00.002-06:00

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.

Am I an advocate or a wimp?

2008-12-03T12:46:00.002-06:00

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.

I'm Thankful for:

2008-12-01T09:14:00.003-06:00

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.

Getting Better

2008-11-21T12:47:00.004-06:00

Since cancelling my meeting last week, I've started feeling a bit lighter. I'm finding myself being less annoyed with everyone. I'm less edgy. I'm still not sleeping well, but the actual sleep I'm getting is better.

I'm still struggling with anger. I'm angry with myself. I'm angry with the old doctor. I'm angry with the nurse. I'm angry with my new doctor for dredging this up.

My counselor suggested that I sometimes feel like I'm crazy. She might be right. Maybe that's why I'm fighting this so hard instead of submitting to it. Someone once told me that there's great power in submission, but I struggle with that concept. I guess to me, fighting is ingrained. I don't like to give up. I don't like to quit. I'm used to making things happen, but I can't make the PTSD go away.

I keep going over the letter I wrote in my head. It's like a loop that keeps replaying. I know that it's not the most graphic representation / version of my daughter's birth, but it's a pretty strong description. There's no hiding the pain, fear, or anger from the reader. I'm not sure if I'm okay about the new doctor letting other people read it. I know that hiding from this doesn't help. I know that I NEED to talk about it. I'm not quite sure I'm ready to face the censure, judgement, and scrutiny. Up until now, I've really only discussed it in "safe" places. I don't open myself up to the judgement often, and if I pick up a negative vibe from someone I don't bring it up again. I'm still trying to find a way to discuss it while protecting myself.

Maybe I need to re-write the story.

I just want to feel like the "old" me again. I don't like the new Traumatized Mom.

Meeting w/ Hospital Cancelled

2008-11-13T14:54:00.003-06:00

So, I'm cancelling the meeting with the hospital. I met with my counselor yesterday, and she noticed that my PTSD is nasty bad again. We started trying to track it back to the trigger, and I realized that I've been spiraling out of control since my doctor asked me to talk to the hospital. The easiest solution to getting myself feeling better is to cancel the appointment.

However, I don't want to ignore the request. Therefore, I typed up a copy of my birth plan, and wrote down my reasons for why I included each line. It was hard to do, but I feel much better now. Some of the items are really difficult to admit.

Here's a copy below.

Hi, I’m Traumatized Mom, and I’m writing this to explain how communication could have made my daughter’s birth a better experience. I developed PTSD that night, and I’ve been struggling with it for 18 months. I know it sounds weird to say that childbirth, a normal physiological event for most women, caused PTSD. After all, I wasn’t a victim of the I-35 bridge collapse or a soldier returning from duty in Iraq, but PTSD can occur during any event where the person experiencing it feels out of control and like their life is at risk. The National Center for PTSD defines it like this:

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

So, how does my situation fit the criteria for PTSD? I experienced a lot of complications after my daughter’s birth. I had a PPH, placenta accreta, and partial uterine inversion. My daughter’s birth was induced for PIH, but after her birth, I became hypotensive. I was in massive amounts of pain. I didn’t understand what was happening, or why. I felt like I had no control over what was happening within my body or to my body by the medical staff. I was thought I was dying. I thought I was going to abandon my new baby girl. I never expected to wake up the next day.

The effects of that night have rippled throughout my life. I’m now scared to go to the doctor. I do it, but I have nightmares for a week or so leading up to a well-baby checkup or annual physical. I struggle with flashbacks every time I give my daughter a bath. I’ve struggled with finding a new form of birth control since that night. Condoms give me flashbacks, and I can’t stand the thought of putting anything like a diaphram or IUD inside of myself. I also have to watch out for things that can trigger my temper. Something as simple as a co-worker not listening to me can send me into a rage. It sends me back to the hospital room where I felt like I was not listened to, dismissed, or ignored.

The PTSD drives me to do things that some people would consider a little screwed up. Before my annual physical this year, I was driven by this demon to write out what I called a “birth plan” even though I’m not pregnant or planning to become pregnant in the future.

So, please let me explain to you why I wrote what I did.

Introduction:

This isn’t the typical birth plan. I know that things can go wrong very quickly. I don’t care about IVs, pitocin, dim lights, or vaginal exams. I expect that I’ll be trapped in the bed by a multitude of cords coming out of nearly every orifice. I expect that things will go crazy wrong, all hell will break loose, locusts will descend upon the earth, and the plague will rage throughout the land.

I don’t know if any of you have had the opportunity to see a birth plan recently. Most of them harp on not wanting an IV, wanting the lights to be dimmed, not wanting vaginal exams unless requested, and believing that pitocin is evil. Those are the least of my worries if I have another child. Those things to me are minor inconveniences. Is it fun to be tethered to the bed, no, but I know that I’d do anything to have a healthy baby. So, if my blood pressure is skyrocketing, and lying on my left side lowers it, I’ll do it. If having an epidural reduces my blood pressure to a point that the doctors are comfortable letting me continue working towards a vaginal delivery instead of being shipped off for a c-section, no problem. Vaginal exams are not a big deal as long as they ask before doing them. As for the rest, well after the last birth, I have no expectation that things will go well. I know I’ll be waiting for the shoe to fall. Keeping me calm and in the “labor zone” will be the only goal. Everything else is easily ignored.

Item number 1:

Please talk to me constantly, especially when I can’t see what you are doing.

This is because of the PTSD. Information and education reduce anxiety. I cope with medical procedures much better when I know what’s happening, when people are talking to me, and when I understand why things are being done. I would prefer to have the noisiest room in the hospital – not because I’m screaming or yelling, but simply because I don’t want peace and quiet. Talking, information, and education calm me.

Item number 2:

Please follow this protocol when explaining interventions to me because I may not ask the appropriate questions.

Get my attention! Call me by name, grab my hand, look into my eyes, and talk to my face - not my cervix or anyone else in the room.

Why do you want to intervene?
What intervention do you want to implement?
Are there any long-lasting side effects or consequences of this intervention?
Write it down for me before you discharge me from the hospital.

When things were going wrong, I retreated into myself. I focused on what was happening inside of me. I focused on the pain. Nothing got through to me unless it was an emotionally charged statement like, “where the hell are they”, or “what took so long”. Things spoken in a calm manner didn’t register, so getting my attention was essential to understanding what’s happening. For me, the pain I experienced after my daughter was born was 1,000 times worse than the pain of labor. I described it to a friend this way:

The pain is all consuming. You can't think. You can't breathe. You can't hear what they're saying. You can't process what's happening. It wraps around you smothering you in a cloud of darkness and fear because you know it's not supposed to be like THIS. You can't form the words to question what's happening. You're sucked down into the black void of semi-consciousness not caring what they're doing to you because all you can focus on is the pain. It's the only thing that exists. They're pricking you with needles, people come running in and out, and someone straps a mask over your face. You feel the doctor's hand shoved all the way inside you. How the heck did it get there? The pain sucks you away. You struggle to breathe and continue to fight. Try to breathe through it, but you can't ride the waves. It's consuming your body. Don't quit. Don't abandon the baby. Keep fighting. Some comments break through. You can hear the anger and fear in the doctor's voice, and it scares you even more. But you're sucked back down into the depths of hell wondering what's happening. You feel the bed being wheeled down the hall. You sense the bright lights of the operating room beaming down on your eyelids, but the pain pulls seductively at you. Just give up. Stop fighting. Surrender to your death. Abandon your baby. Just let go. And then the anesthesia sucks all your thoughts away.

That’s a lot to overcome when you’re trying to get a patient to understand what’s happening and be a participant in their own care. I’ve been told that the doctor did a “really good job” of explaining what was happening, but I was already sucked into this hell.

My husband didn’t get it either. He was watching the doctor. He remembers the doctor having a slightly puzzled look on his face, but then he did a little fiddling. He remembers the expression changing to a more this isn’t quite right look, and then he did a little more fiddling. Finally, he remembers the “oh, shit, I’m fucked” look on the doctor’s face. My husband checked out then. Once he realized that it was all falling apart, he wasn’t listening. He was too scared.

The other reason for this being included is after I got out of surgery, and recovery, and I tried to ask about what had happened, I only got ½ answers. The first answer I received, was that “I had a lot of bleeding”. As you can see by the list at the beginning of this document, a whole lot more went wrong than a lot of bleeding. Everyone made the assumption that I had understood in the delivery room what had happened, and I never really got a full explanation until my 6 week post-partum appointment when I was more capable of asking questions. Even then, I didn’t know that surgery itself was called a D & C until I interviewed a new doctor 6 months later. Also, no one ever used the clinical diagnostic names with me. I was told my uterus turned inside out, the placenta was stuck, and my blood pressure crashed. This information was inadequate when it came to researching the complications after I got home. I didn’t know if the search results were returning the correct information or not. So, here again, information and education reduce anxiety. The more information that the patient has available, the less anxious they should feel.

Good communication requires that one person is listening or receiving the information that the other person is trying to give them. The message that the doctor tried to send couldn’t get through the fear, anger, or pain that we were experiencing. You have to pull the patient out of that mode for them to understand what’s happening.

Item number 3:

If there is any disagreement between caregivers over what treatment option is appropriate, please work it out between yourselves. I don’t wish to take sides, or argue with either of you. If there is a legitimate choice for me to make, please present me with both options in a non-confrontational manner, and allow me a few moments to reflect upon my options prior to making a decision.

When the anesthesiologist came in to perform the epidural, I made the mistake of telling him that the doctor wanted the epidural to decrease my blood pressure. The anesthesiologist felt very strongly that epidurals should only be used for pain relief, and he argued with me about whether I should or shouldn’t be given the epidural. From my standpoint, I knew that having a vaginal delivery was at risk. From moments after I showed up for the induction, we’d been trying to bring down my blood pressure. We tried different positions, and, without my knowledge, they’d tried IV blood pressure medication. I knew that if it didn’t level off, that I could be headed for the operating room. As far as I was concerned, I’d need the epidural if I got forced into the c-section, so why not try it for the blood pressure? The last thing my blood pressure needed was an argument over whether I was in pain or not. I was in labor. Last time I checked, labor is painful, so it seemed ridiculous to be arguing over this issue. Also, I’d never seen the anesthesiologist before this time. I didn’t know if he knew “my” medical history, if he’d seen the blood pressure readings, or if he knew that they’d already tried IV blood pressure medication. It seemed like he was not in the best position to be making decisions about what treatment methods I should be following. The last thing I needed was more stress / anxiety in that delivery room. There was enough stress in being induced for complications instead of having the spontaneous, un-medicated vaginal delivery I desired.

Item number 4:

If I tell you that something isn’t right or isn’t working, please believe me instead of dismissing my comment as a fallacy because I’m not acting the way YOU believe I should be acting to make that comment a truth.

Towards the end of my labor, I told the nurse that I didn’t think the epidural was working properly. She responded in a very snotty manner that, “epidurals don’t take away ALL of the pain”. First off, I didn’t want her to do anything with this information other than mention it to the doctor. I was handling it not working. I didn’t need her to go find the anesthesiologist, and have him fix it. I just wanted the information passed up the chain of command. Second, everyone deals with pain in different ways. For me, I was focused and breathing through the contractions. I didn’t yell, scream, curse, etc. I was in control. My best friend was there to support me, and she told me that I was boring because I didn’t need her to do anything to help me cope. I was self-sufficient. This became incredibly important later. I know there’s no way anyone could have predicted the way things happened, but the doctor made the choice to try manually removing the placenta without telling me because he believed I was anesthetized. Please reference my description of pain under item number 2

Item number 5:

Please tell me the name of every medication that you are giving me whether it is given orally or through an IV at the time you administer it, and write it down for me before I am discharged.

Here again, I had no clue what was being pumped into my body. When my daughter was born, I had one IV. When I woke up, I had 7 or 8 IV’s. I knew something wasn’t right. But, I couldn’t formulate the questions. I had no clue what was running through the IV’s it was so odd to me that each time they brought me a medication to be taken orally, they told me exactly what it was, but no one ever told me what I was hooked up to. The only things I knew about were the pitocin for the induction and the blood transfusions. So, here again, information and education reduce anxiety. The more information that the patient has available, the less anxious they should feel.

Procedures:

My uterus has a history of flipping inside out, so please don’t pull on the umbilical cord.
I only consent to manually removing the placenta if I’m fully anesthetized. Please verify this with me prior to proceeding with the procedure.
If I’m hemorrhaging, have another accreta, and my uterus has inverted again, then don’t take extreme measures to save my uterus. I won’t be using it again.

Well, I did term this a birth plan, so adding a few things that are really specific to my desires / experiences seemed appropriate.

Suggestions:

After my experience, I do have a few suggestions for how you can improve your patients’ experiences.

I have problems dealing with the level of violation I feel about the attempted manual removal of the placenta being performed without my knowledge or consent. I know in my head that this was a medical procedure, but my body and my heart don’t believe that to be a truth. To me, this was a procedure that shouldn’t be covered under the blanket consent form everyone signs upon admission. I can understand that there wasn’t time to go dig a form out of a cabinet, but I do think that it should require specific verbal consent from the patient.

I’d like to see you create a support group for moms with post-natal mood disorders like PPD, PTSD, PPA, etc. I know that I’m not the only mom who has walked out of your hospital feeling isolated. New moms are isolated enough without having mental health issues that isolate them even more.

I’d like to see you start giving patients an opportunity to de-brief from their experience. They say that this de-briefing can help patients assimilate their experiences more effectively than by trying to handle it themselves. This would also allow the patients to have their feelings validated.

I’d like to see some training offered to the doctors, nurses, and other caregivers on the maternity floor on how to handle moms with traumatic births. One of the things I found difficult was having everyone tell me that this was “normal”. I’ve visited dozens of friends after their babies were born. I knew it wasn’t normal to not care that the baby was in the nursery. I knew it wasn’t normal to still be hooked up to machines. I knew it wasn’t normal to be sleeping with those goofy massaging socks / leg warmers. These women need their feelings to be validated. They need to be told its okay to be sad, angry, or disappointed. They don’t need to here, “all that matters is a healthy baby”, “at least you had a healthy baby”, or “you’ll change your mind in a year”. They need to know that their experience was difficult.

Don’t avoid the hard questions. I was so angry that I didn’t get real answers that I wanted to sue the hospital / doctor. Ignoring the questions isn’t going to get a patient to not file a lawsuit, but giving them answers and apologizing for things that shouldn’t have happened might. As for why I didn’t sue, I re-live this event every day. I still can’t bring myself to discuss it without tears. I blame myself for choosing a caregiver that didn’t treat me respectfully, and I’m ashamed that I can’t get past this. I didn’t want to sit on the stand, and bare myself to the world. It’s hard enough to live with this every day.

“It is often easier to ask for forgiveness than to ask for permission.” Grace Murray Hopper

2008-11-10T14:58:00.005-06:00

That quote makes me crazy. It’s what happened the night my daughter was born. People, well doctors really, seem to think that they don’t need to ask for permission. They seem to think that once you’re in their place / hospital / care / etc. that they can take charge and do what ever they wish. Once you’re on their turf, the game is over, the power is stolen. A birthing woman is less than nothing. She’s an incubator. Her wishes can be ignored or over-ruled if she’s even given the opportunity to participate in her own care.

I need to add a comment about this quote to my birth plan. It’s fundamental to why I was so traumatized. There was so much rationalization on the doctor’s hand that night. “She had an epidural, she’ll never feel it”, “I’m the doctor, and I know what’s best”, or my favorite, “it’s just a medical procedure” to having a hand shoved elbow deep in your uterus with no communication. It sure didn’t feel like a medical procedure to me. I didn’t grant permission. I didn’t say, “yes. Go ahead”. I didn’t say, “I understand the placenta is stuck, and you need to try to get it out”. I wasn’t given the option to say yes or no. Permission? What’s that? Those consent forms cover it, right? Yep, just like a marriage certificate guarantees that my husband can have sex anytime he wants. I wonder what my doctor will think about the addition?

Here’s my revised birth plan:

This isn’t the typical birth plan. I know that things can go wrong very quickly. I don’t care about IVs, pitocin, dim lights, or vaginal exams. I expect that I’ll be trapped in the bed by a multitude of cords coming out of nearly every orifice. I expect that things will go wrong, all hell will break loose, locusts will descend upon the earth, and the plague will rage throughout the land.

However, I would like this experience to be better than my last birth.

Communication

Please talk to me constantly, especially when I can’t see what you are doing.

Please follow this protocol when explaining interventions to me because I may not ask the appropriate questions.

Get my attention! Call me by name, grab my hand, look into my eyes, and talk to my face - not my cervix or anyone else in the room.
Why do you want to intervene?
What intervention do you want to implement?
Are there any long-lasting side effects or consequences of this intervention?

While, “it is often easier to ask for forgiveness than to ask for permission”, it is not the right choice to make when it comes to breaching my reproductive organs. Ask before placing anything inside / through my cervix, hands, electrodes, amniohooks, etc.

If there is any disagreement between caregivers over what treatment option is appropriate, please work it out between yourselves. I don’t wish to take sides, or argue with either of you. If there is a legitimate choice for me to make, please present me with both options in a non-confrontational manner, and allow me a few moments to reflect upon my options prior to making a decision.

If I tell you that something isn’t right or isn’t working, please believe me instead of dismissing my comment as a fallacy because I’m not acting the way YOU believe I should be acting to make that comment a truth.

Please tell me the name of every medication that you are giving me whether it is given orally or through an IV at the time you administer it, and write it down for me before I am discharged.
Please write down any complications you diagnose prior to my discharge, so that I can research them after I get home if I have any questions about them.

Procedures

My uterus has a history of flipping inside out, so please don’t pull on the umbilical cord.

I only consent to manually removing the placenta if I’m fully anesthetized. Please verify this with me prior to proceeding with the procedure.

If I’m hemorrhaging, have another accreta, and my uterus has inverted again, then don’t take extreme measures to save my uterus. I won’t be using it again.

Meeting at the Hospital

2008-11-10T12:28:00.002-06:00

December 4, 2008 at 7:30 am I meet with the doctors at the hospital to discuss communication. I think it will be good to get this behind me. My doctor has asked me to talk about the "birth plan" I wrote before my annual physical this year. It ended up being a pretty atypical plan. I'm not sure if I'll print copies off, or do a powerpoint presentation.

I guess I need to think about it more.

NIGHTMARES - Continued

2008-11-07T12:59:00.003-06:00

So, that helped. Admitting that I'm stressed. Recognizing the anxiety. I slept okay most of the night.

I'm still nervous about this appointment. I don't want to go. I don't want to admit that we have a problem I can't figure out. However, I will go. I will be strong. I will advocate for my child.

If I run into the other doctor, so be it. I have choices. I can walk away. I can ignore him. I can give him a piece of my mind. I can scream at him. I can be strong.

I'm not the same person I was when my daughter was born. Yes, some things have changed for the worse. I'm more on edge. I have to be careful of my temper. I have to be alert to triggers. However, I've gained some things too. I know I'm stronger than I believed. I know that I won't give up. I know I won't quit, and I know that I can be a good advocate. I know that communication is essential to me, and I can find doctors that respect that choice.

NIGHTMARES!!!!!

2008-11-06T09:55:00.004-06:00

ARGGGGH!!!!

The nightmares just keep coming. At times there is a long enough gap between them that I forget about what they're like, but like a bad penny, they keep showing up. My daughter's 18 month well baby check is coming up. I know this is what is triggering them this week. Her doctor works out of the same clinic and the same set of waiting rooms that my former OB utilizes. I know that I'm more on edge this week because I caught a glimpse of him through the check-in window the last time I was there.

I just want to be better. I don't want to be haunted. I want my dreams to be safe again.

Passing information / educating patients?

2008-10-28T12:47:00.006-05:00

This is my response to a nurse's blog post:

This is a very touchy subject for me, and I appreciate you blogging about it. I didn't write a birth plan for my daughter's birth. I had gestational diabetes, and I was being induced for PIH. I knew that what I wanted, an unmedicated birth, wasn't a possibility. I accepted that I was going to have an IV. I knew I was going to have the blood pressure monitor strapped around my arm and the fetal monitors around my belly. I knew that it would be nigh onto impossible to move around. With every complication, I knew that my choices were being reduced to the point that I was determined to go with the flow to get this baby out safely.

Where the lack of information / education / understanding about my birth came in was after my daughter was born. Everything fell apart 30 minutes after her birth. I was hemorrhaging, the placenta didn't detach, and my uterus began to flip inside out. I was in so much pain and my body was going haywire from blood loss and a plummeting blood pressure that I couldn't understand what was happening. I couldn't participate in the decision-making process. I didn't understand the explanations my doctor was trying to provide. I knew that they were taking me into surgery, but I didn't know why I was going there or what they were going to do.

The lack of information continued after I was out of recovery. I knew something wasn't right. I had 8 IV's, and I was still in the labor / delivery room. When I asked what was wrong, all they told me initially was that I'd had lost a lot of blood. While this was somewhat true, it wasn't the whole story. I was at the point where I didn’t have the energy to fight for answers, and in all reality, my brain wasn’t producing the right questions to ask. When the doctor came to do rounds, he told me that the placenta came out in 20 pieces, the uterus flipped inside out, and my blood pressure plummeted from 190 / 120 to 50 / 30. However, he did not tell me that he had done a D & C after his attempt to manually remove the placenta failed. He did not tell me that the placenta not detaching was called placenta accreta. He did not tell me that my uterus flipping inside out was called a uterine inversion. He didn’t tell me that I’d lost 50 percent of my blood. He didn’t tell me what was running through the 8 IV’s that were still in my hands. Did he give me an explanation? Yes. Was it complete? No. There was no discussion of the consequences of these actions. Could I have asked? Yes. Should I have asked? Yes. Was I capable of formulating the questions? Not at that time. The trauma had taken too much of a toll on my body, and while I recognized that I wasn’t getting the full story, I wasn’t in an emotional or physical position to fight the battle to find out what had happened. I just wanted to go home. I wanted to lick my wounds in private, and pretend that it had never happened.

It wasn’t until my 6 week postpartum checkup that I found out the clinical diagnosis. At that time, I only found out because I asked if a c-section would have been a better choice than the induction. The doctor definitely wasn’t the one to initiate the conversation. Even then, it wasn’t until I was interviewing a new OB to find out what the risks were of having more children before I found out that my old OB had done a D & C.

I don’t think that my experience was all that unusual from an educational / informational standpoint. I think sometimes that the bare minimum of information is presented to the patient. Just enough information is passed on to keep them from being a pest.

This is a pretty complicated topic. There are a lot of things that are required for women to be educated about birth.

1. They have to want to be educated.

2. The information has to be accessible.

I wanted to be educated. I wanted to know about normal, typical birth. I wasn't into researching complications just to worry myself about them. I wanted to know the basic physiological aspects of childbirth. How your cervix changes to allow the baby to be born. How to handle the pain without drugs. How to move to make it easier for the baby to descend. When complications arose, I did research the specifics of those complications. I knew that high blood pressure presented all kinds of problems. I knew what to watch for as far as signals that it was getting too high. I learned about watching out for pre-term labor symptoms.

The problem was that I didn't end up with a normal typical birth. I don't think there's a single childbirth class that really explains clearly all of the complications I ended up experiencing. I could have done Bradley, Lamaze, or Hypnobabies, but would they really have educated me about having my uterus turn inside out? They talk about complications they consider "preventable", but I don't know that mine really were. If under anesthesia, the placenta comes out in 20 pieces it's pretty darn stuck. It's not just a little bit attached. As for the inversion, is it possible that the attempted cord traction caused this? Yes, but I'll never know for sure if this was directly the fault of that procedure, or if it was simply something that happened spontaneously.

I think too many of these classes assume that everything will happen normally, in which case interventions aren't necessary. The problem is that things don't always happen normally. There are situations where interventions really are necessary. When these classes teach you, don't trust your doctor or midwife, aren't they doing a disservice to the women who truly are at risk? They teach you to obsess over the procedures instead of creating a relationship with your caregiver. When things to wrong, they leave you dangling. You're the screw up. You didn't follow their teachings. You never should have listened to the doctor. They're all out to get you. Their only goal is to get everyone out alive, and on and on and on...

Some childbirth books have sections on complications. Few of them give as much information as I ended searching out once I knew what had happened. Was the information accessible to me? Yes, if I searched medical journal articles and medical school powerpoint presentations. Does that mean the average mom needs to research birth at this level? I certainly hope not. It seems ridiculous to have every woman searching out the most rare pregnancy complications for absolutely no reason. There are enough concerns when you're pregnant without looking for trouble.

I also think that caregivers need to think about their role in educating women. I really think that they need to step up to the plate a little bit in making sure that their patients really understand what happened. Did my doctor's explanation meet that criteria? I didn't know how to look it up or research it, but I did have a pretty good grasp of the complications from a layman's perspective.

It just wasn't enough for me. I needed more.

Birth Rape?

2008-10-26T20:44:00.006-05:00

Birth Rape

Isn’t that an ugly term? The first time I heard it, I thought a bunch of radical feminists were making a big deal out of nothing. How can those two words possibly be spoken together? Birth is about innocence. Is there anyone more innocent than a newborn baby? Rape is so ugly, so violent, so brutal. It offended me at the core of my being. However, I think there may be something to it.

Some people believe that birth rape can only occur if a woman has been previously assaulted. They believe that the birth itself isn’t a rape, but that the woman is experiencing a flashback to a prior criminal act. This flashback is so real, that they transfer their feelings about the original assault to the act of giving birth.

This experience impacted me the night my daughter was born:

I’d met this guy six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the bed while we were talking. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Doesn’t this sound like a date rape experience? I trusted this person. I invited them into my personal space. I didn’t give permission for this to happen. I tried to get away. I was violated. I must have had a flashback to this prior crime during my birth if I think birth rape is a valid term.

Now, let me change six words:

I’d met this doctor six months before that night. At first, I saw him only occasionally, but over time I’d started seeing him once a week. I invited him into my room. After 6 months, I trusted him enough to let him come inside. I was sitting on the bed, and he was sitting in a chair at the foot of the hospital bed while we were talking after my daughter’s birth. All of the sudden, he shoved his hand inside me. I tried to push him away with my legs, but I couldn’t move them. I tried clawing at the sheets to drag my body away from him, but he wouldn’t get his hand out. I was in massive amounts of pain… This couldn’t be happening to me.

Does that change you opinion of my experience? Do you believe this behavior is suddenly acceptable? Why is it that behavior that is unacceptable every where else in society suddenly becomes acceptable in a delivery room? Before my daughter was born, I’d never been the victim of a violent crime. I’d always been treated respectfully by the men in my life. No one had ever touched me in an inappropriate manner. This wasn’t a flashback. It’s my reality.

Birth is an incredibly intimate act. It requires you opening parts of yourself that you keep hidden from the world in order for it to happen. It’s deserving of the same respect that women expect when giving themselves to their lover. It’s something to be treasured. If consent is so essential to a healthy sexual experience, consent is also necessary to healthy birthing experience.

It took several months before I admitted that my daughter’s birth had resulted in my birth rape. I didn’t want to admit it had happened. I tried hiding from it. I tried ignoring it. I didn’t report it. I blamed myself for it. But I’ve learned that this doesn’t help, so now I’m talking about it. I’m not sure yet if I’ll discuss this when I meet with the doctors at the hospital, but I’m thinking about it. I know they don’t want to admit that this happens. I know they want to bury their heads in the sand, but someone has to speak out. There was a time when people didn’t believe that one spouse could rape the other, but now we recognize this as a truth. In this time we live in, people believe that a woman in labor cannot be raped, but a time will come when we will believe in this truth also.

PTSD after Childbirth?

2008-10-17T12:35:00.005-05:00

I know a lot of people can't understand how a woman can develop PTSD, post-traumatic stress disorder, after giving birth. After all, it's supposed to be one of the best days of your life. It's a day that's supposed to be filled with joy, sunshine, and flowers. The angels in heaven are supposed to rejoice alongside the new family. Most of the time childbirth works that way. It's painful, but the women put it in the past. They might develop PPD, but that usually goes away.

I was so overwhelmed in the first 6 weeks of my daughter's life, that I didn't realize anything was going on emotionally. It was all I could do to get through those first few days and nights. Yes, I was tired, but all new moms are tired. Yes, I was struggling to physically recover, but all new moms struggle with that too. It wasn't until I saw my doctor again for my 6 week postpartum checkup that I realized things weren't quite right.

I got undressed, and laid down on the table for him to do the exam, and I found myself squirming to get away from the doctor. I didn't want him to touch me. I was terrified. I fought myself into submitting to the exam. I stared at my baby girl sitting in the carseat on the other side of the room praying for the exam to be over. He finally finished up, and I sat up on the table. I asked the one question that had been in the back of my mind for the last 6 weeks, "would a c-section have been safer for me?" It opened up the door for a pretty frank discussion about what had happened. I had never heard the terms uterine inversion, retained placenta, postpartum hemorrhage or D & C until then. Can you believe it took 6 weeks to get the clinical names of the complications I had experienced? I took that information home, and started googling the living daylights out of those terms. I read everything I could get my hands on - journal articles, medical school presentations, and any other reference I could find. I was obsessed. My husband would walk in the door, I'd hand him our daughter, and I'd race to the computer to start researching. I went back to work two weeks later, and at every break or over lunch I'd be googling those terms. I was an expert, but I still felt like I didn't really know what had happened. I finally broke down, and requested my medical records.

So 2 1/2 months after my daughter was born, I realized I had to do something about my mental health. My husband was frustrated with what he called my "OCD tendencies". He didn't like the person I was becoming, and I realized that my behaviour was impacting our daughter. I saw my family practice doctor thinking I had PPD, and I did score high enough on the screening test that it could have been the cause. However, when discussing it, he mentioned that it might be PTSD instead. But, it couldn't be PTSD, right? Soldiers in Iraq get PTSD. The I-35 bridge collapse victims developed PTSD. Childbirth is normal. It's a common part of life, so it couldn't be PTSD. I tried anti-anxiety pills, but they didn't help. After a few weeks of my husband pressuring me to do more than take pills, I finally asked for a referral to a mental health professional.

My husband went with me to the first counseling appointment. Imagine my surprise when the counselor begins introducing herself, and tells us that she's married to Dr. XXXX at XXXX clinic. The doctor who delivered our baby. I was so betrayed that my family practice doctor had referred me to someone that was closely related to my former OB. Since I was paying for the visit anyhow at this point, my husband and I gave her the abbreviated version of the story. She confirmed that it was PTSD, and told us that she could help me even though her relationship did bring up questions. After the visit, I made the choice that I would try to find someone else to help me since I knew I'd always have questions in the back of my mind.

It took several weeks to find someone else. I tried the counseling service through my employer, but that was a fiasco. I finally started googling counselors with EMDR experience. I found the new counselor 3 1/2 - 4 months after my daughter's birth. Once again, my husband went to the first visit with me. We told the story, going into a bit more detail this time, and once again I was diagnosed with PTSD.

I struggled with this diagnosis. I just couldn't figure out how it could be correct, so here's the criteria from the National Center for PTSD:

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

So, how does this apply to me? I was absolutely terrified that night. I thought I was dying, and so did my husband. The doctor made decisions and performed procedures based on inaccurate information that caused me great pain. I wasn't notified of his intention to perform these procedures prior to his performing them, so I had no control, choice, or opportunity to understand what was happening. I was objectified to the point that my husband and I both felt that I was treated like a vessel, and not like a competent woman. With all of the physical complications, I retreated inside myself, and was for the most part unaware of anything else happening in the room. Some things made it through, but for the most part, I was locked in my mind scared, in massive amounts of pain, and consumed by everything that was going wrong. Those feelings continued throughout my stay at the hospital. Questions were given half-answers. The nurses continued to trivialize the experience when I desperately needed validation that the event hadn't been typical. I was weak, and incapable of voicing my true needs. I finally just gave up trying to get answers, and focused on getting discharged. I wanted away from all of the people who were supposed to be taking care of me. I wanted out of the place that had failed to keep me safe. I was traumatized.

I didn't want a PTSD diagnosis. I grew up in a house where my father had PTSD from the Vietnam War. I know that while the symptoms fade over time, this never really goes away. PPD would have been easier - take drugs for a year, and you're all better. This was a gut shot. It never goes away. The nightmares have tapered off, and the flashbacks are becoming less frequent. However, I always have to watch out for triggers. Things like people not listening to me can send me into a rage. A call from the hospital, or catching sight of my former OB at the clinic can send my blood pressure screaming high. I have to remind myself to stay in the present when I'm talking to mom's with new babies. I avoid telling the story of my daughter's birth because my feelings are still to raw. It's a lot better than it was. I'm not as obsessed, but this is the new me that I'm learning to live with.

The Power of Words

2008-10-15T12:26:00.002-05:00

I picked up the mail yesterday, and found a flyer from the hospital foundation. On the exterior of the envelope, along the bottom, left-hand side was their new motto: Transforming Lives. It made me start thinking about all of the comments that have really struck me to the core in the last 17 months. Most of the time, the comments were meant to be reassuring or innocuous, but they weren’t either of those things to me.

The first one was, “do you want to hold your baby?”, and my subsequent response, “No”. Doesn’t that seem like an innocuous question and response? The only problem was that question was asked just as I was realizing that things were going really wrong. I didn’t know what, but I was starting to feel dizzy, spacey, and a little woozy. Holding my daughter would have been a huge mistake, but I couldn’t get past my feelings of failure that I didn’t “want” to hold my baby. It would have been easier to say no to “Are you ready to hold your baby?” There’s a huge difference in the connotation of ready and want. One implies ability while the other implies desire. I desired holding my child, but I recognized that physically that wouldn’t have been smart.

When I went back to work, one of my co-workers asked me when I was going to have another child, “after all, popping out another one is no big deal”. Wow, what I experienced was “no big deal”! Everyone sure thought it was a pretty big deal that night. People were in and out of the room, trying to find the anesthesiologist, and shoving needles in my hands. So, just for the record:

hemorrhaging 60% of the blood in your body, no big deal
attempting to delivery your uterus, no big deal
needing the placenta to be surgically removed, no big deal
doctors debating if you should go to the ICU, no big deal
blood pressure crashing from 200 / 120 to 50 / 30, no big deal
needing 8 IV’s to pump all of the drugs into you, no big deal
believing that you’re dying as they roll you into the operating room, not a big deal

It’s amazing the things people assume about birth. They have no clue what your experience was, and yet they make the assumption that it was just like their sister’s or wife’s or friend’s experience. Even my parents and in-laws were guilty of this. They were too caught up in the moment to see beyond the baby.

The first time I interviewed a new OB, he told me, “The worst OB in the world can give you a better birth experience than you had the last time.” I know it was meant to be reassuring. I was supposed to be comforted by that statement, but to me it was a condemnation of my skills in finding and choosing my previous doctor. After all, if the “worst OB in the world” is more competent than my previous OB was, what does that say about my choice? It was patronizing, and I never went back to him. The last thing I needed was someone else patting me on the head like a child.

What about, “you didn’t advocate for yourself” and “you didn’t educate yourself”. I love these ones, because it puts all of the blame on mom for the poor outcome. No one else has any responsibility because she “didn’t advocate or educate” herself. So, moms are supposed to read the doctor’s minds. We’re supposed to be more educated than the caregivers we hire. We’re supposed to argue, refuse, or question every time a medication is adjusted, a tool is picked up, or a twinge is felt. We’re supposed to have eyes in the back of our heads, and no matter what our physical and emotional condition we’re supposed to be able to force medical personnel to answer questions truthfully. We’re supposed to know if a homebirth is a better option than a hospital birth or a water birth. We’re supposed to know if we should take Hypnobirthing, Bradley, Lamaze, or the hospital childbirth education class. We’re supposed to know which books are the proper ones to read. Wow! Did you know that pregnant women have superhuman, omniscient, god-like powers? What a crock! Advocacy requires open and honest communication between caregivers and patients. Without that free-flowing information a patient cannot be an effective advocate for themselves. As for education, there’s no way for any one person to know absolutely everything about birth. Most of the time it works just fine, but sometimes interventions are necessary. We all make the best decisions at the time with the information we have at hand. All these statements do is blame the mom for her experience, and sometimes mom’s not the one who should be blamed.

“Transforming lives”, the hospital certainly transformed my life. They didn’t just make me a new mom; they traumatized me in the process. I became a victim of medical assault. I was trivialized, de-humanized, and objectified. They dismissed my attempts to advocate for myself. They ran roughshod over me and my husband. We didn’t leave as a happy family of three. We left broken. I had a husband who hated his child because she “caused” mom to be so sick. I left unable to give my daughter a bath without triggering a flashback. I was weak from blood loss, and emotionally destroyed by the experience. Then they re-traumatized me by asking me to fund their initiative to create a hotel-like atmosphere in the birthing center so they can “transform lives” when what they really need is to make sure they’re properly staffed for an emergency. Private rooms, rugs on the floors, pretty drapes at the windows, and sofa beds for dad to sleep on aren’t going to help the mom who needs immediate surgical care, and there’s no anesthesiologist on the premises.

Finally, my two favorites that always seem to come together. “You should be grateful that you have a healthy child”, and “all that matters is a healthy child”. Why do people believe that being grateful it all turned out okay doesn’t mean that you can’t be angry about how it was achieved. The two feelings aren’t mutually exclusive, and the co-existence of those two emotions is part of what makes recovering difficult. I’m grateful that the OB I chose was competent. I’m grateful that he held everything together until the CNA and the anesthesiologist got back to the hospital. I’m grateful that he was capable of resolving the issues without resorting to a hysterectomy. However, that doesn’t mean I’m not angry that he failed to communicate what was going wrong to me while I was capable of understanding it. It doesn’t mean I’m not angry that I was treated like a vessel, and not like a human being. It doesn’t mean I’m not angry that he didn’t ask if the epidural was working before he tried to pry the placenta out of me. There’s this dichotomy of emotions that I struggle with everyday. As for the “all that matters is a healthy baby” statement, does mom not count? Does dad not count? A healthy baby needs a healthy home. They need parents who care for them. When a parent can’t stand the thought of holding their own child, they’re broken. The home is broken, the family is broken, and the baby will eventually grow to be broken too.

Words have amazing power. Choosing the right ones can be difficult. For moms with PTSD or other post-partum mood disorders, the wrong words can wreak havoc on their recovery. They cut us to the bone, instead of building us up. I know it’s not intentional, but words can cause damage too.

Blindsided, continued

2008-10-15T10:11:00.002-05:00

Well, I decided what to do. I tracked down an e-mail address for the hospital foundation. I wrote a brief, polite e-mail to them asking to be removed from their call list. Letting them know that I could no longer support their organization after the poor quality of care I had received as a patient 17 months ago. I've spent thousands of dollars in counseling costs, time off work, and gas costs to learn how to cope with the PTSD. Funding my tormentors is simply not going to happen.

They've responded to the e-mail, so hopefully this issue is now resolved.

Blindsided

2008-10-14T12:54:00.001-05:00

Why is it that just when I think I'm getting better something blindsides me again?

Several years ago, my co-worker's wife died. My co-worker asked that donations be made in his wife's name to the hospital where I ended up delivering my daughter. I chose to make a donation, so I ended up on the fundraiser mailing list.

Last night, I received a phone call from the hospital foundation. The volunteer was expounding on the great things the hospital provides to the area, but all I could think about was the damage they had caused me. I clammed up, and let her ramble through her spiel. Obviously, I didn't respond in the typical manner because she suddenly stopped mid-sentence and asked if another time would be better. To give myself time to think about what to say, I told her that she could call back another day.

There's no way that I can donate money to this organization. They're more concerned with their expansion plans than providing good care to their patients. They're more concerned with the aesthetics of the birth center than the safety of the women birthing there. I've spend thousands of dollars on counseling. I've taken tons of time off work without pay to go to the counseling sessions. I nearly lost my marriage because they didn't care enough to make sure their patients were treated well.

Obviously this volunteer doesn't need me to go off on her about the poor care I received, but how do I get the point across that their "care" is lacking? I know I can "just say no", but I'd like to give them an explanation why without really delving into the details.

Does anyone have any suggestions?

Building Relationships

2008-10-13T15:04:00.001-05:00

If having a relationship with your physician is essential to building trust, who should initiate the relationship? The patient? The physician?

I didn't form a relationship with my former OB. I went to my appointments. I was honest. I took his advice. I asked questions when I had them, but being the last of my friends to become a parent left me with most of my questions answered. I read books. I searched the internet. I didn't write a birth plan because I recognized that each complication eliminated choices, and there was no point in getting myself hung up on a specific vision of the birth when I knew how quickly things could change. Was it my fault we didn't form that relationship?

I walked into my first appointment with him scared because I'd spotted over the weekend. It stopped after an hour, so I didn't feel it was necessary to go into the ER to get it checked. I simply set up an appointment for right away Monday morning. Throughout my whole investigation into choosing a new doctor, it had never occurred to me that I would stay with this one. My thoughts from the get go were simply to find someone to help me get this baby out safely. I had every intention of going back to a family practitioner after the baby was born. Was that the "fatal" flaw in my thinking? Should I have been committed to this relationship before it started?

I saw the situation similar to that of needing any other specialist. The family practice doctor refers you to a specialist for a specific condition. The specialist helps you resolve that condition, and you go back to your original doctor. There's no need to see an ENT if you sprain your ankle, right? Was I wrong in considering my pregnancy to fit this model? Or, was he wrong in not instigating it? Should he have done more than ask the specific diagnostic questions that helped him guide me down the path. Was he responsible for bringing up his birth philosophy to me, his patient?

After I left his care, I interviewed several doctors around the metro. I checked out doctors at the large urban hospitals. I checked out doctors that my co-workers saw. I didn't "click" with any of them. Instead of being reassured, I felt devalued. Instead of being calm, I felt anxious. Instead of feeling autonomous, I felt trivialized. Even my family practice physician, someone I'd seen for 15 - 20 years, contributed to my feelings of betrayal. He made a huge mistake in referring me to my former OB's wife for counseling, and this destroyed our relationship. I felt uncomfortable seeing him. I was afraid to be betrayed again, so I kept trying to figure out what to do since I knew I couldn’t remain in that relationship.

I was surprised when I met Dr. B for the first time. She really initiated the beginning of our relationship. When I tried to trivialize my experience, she forced me to expound on it. When I tried to change the topic, she circled me back around to the problem. She made sure I was getting help. She offered different options for treatment based on my current issues like flashbacks, anxiety, and dissociation. She made sure I was comfortable. She didn’t rush me out the door. She made sure I was okay with my daughter. She made sure I was okay with my husband. She looked for emotional well-being as well as the physical which ended up being easily cured.

As for my old OB, well, I have to accept some portion of the responsibility for not building a relationship with him.

Maybe we failed each other.

Trust

2008-10-10T10:06:00.002-05:00

Do you trust your doctor?

Is trust essential to the doctor – patient relationship?

I’ve read several blog posts by healthcare providers talking about trust. In one, the author basically requires trust from her patients. She believes that she works hard to develop a trusting relationship throughout her client’s pregnancies, and in an emergency those clients should immediately acquiesce to her demands because she’s built a relationship on trust, and in an emergency she shouldn’t have to stop to explain the complications, the patients should simply react. In another blog, the caregiver demands that patients who don’t trust him should find other care. In a third blog, the caregiver wants to find a way to study a trusting relationship, and bring the concept into evidence based practice. However, is trust too strong a word for what they really want?

Trust is difficult for me to give. I don’t trust my parents. I sometimes trust my husband, but not always. I don’t trust my daughter. After all she’s only one, and she doesn’t have any concept of the long term consequences to her behavior. I don’t know that I’ve ever trusted a physician. I respect them. I’ve found most of them to be well-educated in matters that I’m not educated in. I’m willing to take their advice because I believe that they’re actually looking out for my best interests, although I have been willing to negotiate other treatment options with them when I believe it’s justified. Isn’t that enough?

I lost all trust I had in my former OB after my daughter’s birth. His lack of communication in an emergency destroyed my respect for him. Without communication, information, or knowledge there is no consent. Without consent, there is only anger, fear, and violation.

My husband lost his trust as well. His was lost due to non-verbal communication during the emergency. He recognized the "Oh shit, I'm fucked" look on the doctor's face before he started verbally communicating. At that point, my husband checked out of the room. It brought up all of his barriers, and he never heard anything the doctor said after that.

Communication, especially during an emergency, diminishes fear. It keeps the patient feeling like they’re still in control even though chaos may be swarming around them. It gives them something to cling to when they’re fading in and out of consciousness. Open and honest communication during an emergency, even if it’s not a full explanation, can keep a patient calm, focused, and rational enough to comply with the needs of the medical staff. Knowing what and why things are happening helps patients to process the event as medical procedures.

It took me several months to find a new caregiver after I left my former OB and my former family practice doctor. I found that I couldn’t stand the thought of having a man examine me. I just kept waiting for the other shoe to drop despite the 15 – 20 year relationship I had with my former family practice doctor. Our relationship wasn’t strong enough to withstand the distrust I now experience with male doctors. I even interviewed a new OB at a different hospital. He tried to sound positive and uplifting, but instead came off as patronizing. The last thing I needed was another doctor who believed that he is or was infallible.

It was a fluke that I found this new doctor. I called the clinic to make an appointment to see any female doctor, and this is the one that had an opening. It wasn’t well-researched, but she listened to me. She didn’t let me off with the dismissive practiced answers I had for my pregnancy. She ferreted out answers, and as a result I switched my and my daughter’s care to her. Patients need to develop a relationship with their doctors. I don’t know that it has to be built on trust. I do believe that respect is a strong enough bond. However, it’s difficult to build a relationship when you only see a physician once or twice a year. By having her care for my daughter I increased the number of times I see her in a year to almost once a month. I don’t trust her. I don’t trust any doctor, but I respect her knowledge. I respect her training. I respect her ability to listen to my concerns, and help steer me down a path that meets my needs.

Maybe it is trust, I don't know. Personally I think it's too strong a word, and yet when I researched this issue for the presentation I'm giving at the hospital, this is the word used in all of the articles I found on improving patient care. Patients who trust their doctors are more compliant. Patients who trust their doctors are less likely to file a malpractice claim. Patients who trust their doctors get better care. However, hospitals are adding patient advocates to help facilitate communication between doctors and patients. I wish my hospital had instigated this program before I was a patient.

If it is trust, I know it takes a long time to build, and only seconds to destroy. It's kind of like handing your sixteen year old the keys to the car for the first time only to have them call you 5 minutes later to tell you they've been in an accident. More than likely it will be a long time before you let them drive by themselves again. Eventually you might give them a second chance. I never let my doctor have one.

A letter to my doctor

2008-09-26T10:11:00.002-05:00

I wanted to take a few minutes to let you know why I decided to file a complaint against you this winter, and explain to you the lasting consequences of your actions the night of May 11, 2007.

I trusted and chose you to be a part of my transformation from a woman to a mom. I know for you it was just another delivery. It was just another series of complications to overcome, but for me it was a life changing event. For 32 minutes, I experienced the joy that comes with that transformation, and then you forced me into another transformation, a rape survivor. I know that wasn’t your intent. You were trying to avoid worrying me with another complication when you believed that you could easily and painlessly eliminate it. However, a yellow plastic gown, latex gloves, and a medical school diploma hanging in your office don’t make you God. It was my body that you violated. You humiliated and shamed me in front of my husband, daughter, best friend, and the nursing staff. I was vulnerable and trusting, and you betrayed me. Instead of treating me like an adult capable of making decisions, you treated me like an unfeeling object. Epidural or not, labor or not, my vagina is private. It’s up to me to decide who and what invades it. You abused your power, and denied me the opportunity to consent. You denied me the ability to process the event as a medical procedure. There was no warning, no understanding. The pain was indescribable. I know you tried to explain what was happening afterwards, but the pain was an incredible barrier to my understanding. The blood loss was too great, the change in blood pressure too rapid for me to process what was happening. I became legally incompetent so rapidly, that I can’t even figure out who signed the consent form for the D & C.

My primary care physician told me once that he really enjoyed delivering babies. It’s one of the few times that someone goes home with something after being in the hospital. I went home with a lot of things. I went home with a newborn. I went home with nightmares. I went home with flashbacks. I went home isolated because births like mine are not to be discussed. You don’t discuss birth rape over a cup of coffee at Caribou with an infant beside you.

Do you want to hear my version of Jennavive’s birth? I’m sure my version differs from yours?

“One more push to get the shoulders out.” I hear the doctor say. Despite not having any breath left, I try once again to push. I feel myself tear as the baby slides out, and they lay this gooey baby on my stomach. I’m in shock, she looks like an alien. There was nasty gooey mucus covering her whole body along with streaks of blood. I wish I could say I loved her at the point, but I was appalled by how she looked. I was relieved when the nurse took her away to be measured, weighed, tested, and cleaned up. At 11:45 pm, the doctor asked the nurse to tell him when 15 minutes had passed. I thought it was kind of odd at the time, but I was really starting to feel a sense of accomplishment and joy. I was watching the nurse cleaning her up while my friend took pictures. I was starting to feel a little odd, but I remember telling the doctor that “his 15 minutes was up”. The nurse asked me if I wanted to hold the baby, but I said no because I was feeling really woozy. My friend brings her over for me to touch. I reach my hand out to her. PAIN!!!! My hands are fisting in the sheets, and I’m fighting not to scream. My breathing is ragged, and I don’t know why the doctor’s hand is in my hoo-ha. I try to get away, I’m scrabbling with my hands trying to drag my body up the bed, but with the numbness in my legs I can’t escape. My vision is blurry, and I start seeing spots when I hear the doctor tell the nurse to get the surgical team. I’m struggling to stay conscious to focus on my daughter, but everything fades to black. Why do I need surgery? I don’t know what’s happening. The baby’s already here. I can’t leave her. I hear the angry voice of the doctor, “what took so long, where are they?” The nurse answers, “They left for the night. It will take an hour to get back to the hospital.” Why is he so angry? I don’t understand what’s happening. The pain is so intense it takes my breath away. They strap the oxygen mask over my face, and I feel the pricking of needles. Are they doing a hysterectomy? I still can’t see. Where’s my baby? I can’t abandon her. I hear fear in the doctor’s voice. “Where the hell are they”, he yells at the nurse. I’m so scared now. Am I dying? I can’t abandon my baby. My husband will never forgive her if something happens to me. I have to stay here to raise her. Do whatever it takes, but keep me here to raise her. Alarms are going off. What’s happening? I hear a new voice, and I feel the bed moving. They’re rolling me down the hallway to the operating room. I sense the bright lights, and feel myself being transferred to the operating table. The voices are frantic. I feel more needles pricking me, and everything fades to black…

This is what you left me with. Each year on her birthday, this is the story that I will remember. Do you remember your children’s births? Do you remember the joy you felt? I don’t. It was so fleeting. I remember the pain, anger and fear. I’m glad that you’re skilled enough to have kept me alive. I’m glad that I’m here every day to enjoy my daughter, but I can’t forgive you for the pain you caused.

I wrote the complaint to the state medical board because you crossed a line that should never be crossed. It’s my small attempt to remind the medical establishment that patients have rights. I wanted to remind you of the Hippocratic Oath. Isn’t there a line in there about “doing no harm”? You caused harm that night. It’s my small way of facing my attacker, and while you’ll probably get off scot-free at least I tried to change it for the women who will tread this path after me.

I wrote this several months ago, but I'm finding myself struggling again. My co-worker's induction is scheduled for next week, and I'm worried about how things will go for her. I just don't want to see her end up in the same place I am.

Reading this today made me realize just how much anger I still harbor towards the doctor. I guess the PTSD comes in waves. I feel strong for a while, but then something sucks me back down. I know part of the problem is a story on my SOLACE forum that really struck a nerve. A mom went through a post-birth experience similar to mine, and has never felt validated in her feelings. Reading her story, and feeling her pain, anger and fear radiating through it just smacked into me.

Sometimes criminal activities take place in the bright lights of a hospital. It's not intended to be that way. I know there's no intent, but the action itself is criminal. If a patient is fighting to get away from you, they're in pain. If they're screaming at you to STOP, stop. If you're more worried about what their family members are seeing there's something wrong with your morals. Patients are humans. We're autonomous. We have feelings. We're not objects. Treat us with the respect that you expect us to treat you with. Listen to us. Answer our questions. Allow us to trust you. Don't betray us in the heat of battle.

Choices

2008-09-26T09:41:00.004-05:00

Should patients be “allowed” to make their own choices about their care? Should they be entitled to make the final decision? There are some situations that are truly emergent. In those situations, does the patient lose their right to choose?

Obviously, each situation is unique. There are times when different doctors have different opinions about how to treat a patient. Isn’t that why we “get a second opinion”? We’re trying to decide what course of treatment to follow. Do we have surgery, take medicine, or ignore it and do nothing? In my case, the doctor tried three different treatments before he successfully corrected the problem. Shouldn’t it have been my choice which one to try? He tried applying cord traction, he tried to manually remove the placenta, and he finally performed a D & C before he got it out. Was this a reasonable course of treatment? He did start with the least invasive procedure, but if there was time to try three different treatments there was time to talk to me about it before he started performing them. He didn’t believe it was emergent when he started on the cord traction. He didn’t believe it was emergent when he tried prying it out. He didn’t label it as emergent until he needed surgical assistance, and even then it was HIS choice, not mine. Maybe if we’d discussed it right away it wouldn’t have been so chaotic. If he’d talked about it right away maybe we could have requested help BEFORE it became emergent. Maybe I would have processed the whole thing as a medical procedure instead of a rape, a violation, an abuse. Maybe if he’d discussed it, he would have known the anesthesia wasn’t working and recommended a different course of action. Would I have chosen going straight to surgery? I don’t know. I probably would have followed the course he thought was best, but at least I would have had the opportunity to ask questions, provide necessary information about pain relief, and OWN my decision. I would have understood, who, what, why, when and where. I wouldn’t have been locked in darkness, despair and fear.

We deserve to make our own choices. When we choose, we can accept our responsibility for what happened. We “own” the choice. It’s hard to own someone else’s choice. It’s hard to take responsibility for someone else’s actions. I wish I owned the choices that night, but I was nothing, a uterus, a vessel, a doll.

I didn’t deserve to be objectified. I didn’t deserve to be ignored. I didn’t deserve to be treated like a liar and an over-reactor. I didn’t deserve to be deceived.

I did deserve the opportunity to participate in making my own healthcare decisions. I did deserve them listening to me. I did deserve owning my decision. I am and was an autonomous, capable, intelligent woman who was more than able to make difficult decisions regarding my care. I didn’t need a protector, a god, or a physician dictating my choices. It should have been my choice. I paid him to guide me. I wanted his advice. I didn’t give him the right to take away my choice, my power, or my autonomy.

Why does the concept of advocacy haunt me?

2008-09-12T10:18:00.004-05:00

I don't know why, but I continue to struggle with the concept of advocacy. I just can't seem to find any peace. I know that advocating for yourself does not mean diagnosing yourself. It doesn't mean being more knowlegeable than the doctor. It has to do with knowing your limitations, and communicating your needs in an appropriate manner.

I came across this old, from 3 - 4 months ago, piece of writing, but I'm still struggling with it. Maybe putting it here will help.

One of the issues I've struggled with over the last year is the concept of advocacy. In other forums, I've been attacked on the issue of “properly” advocating for myself during the birth. My last two counseling sessions, we’ve worked on this issue. Trying to eliminate / mitigate the shame I feel when I’m reminded of this attack, but it’s left me with a lot of questions.

I've struggled to figure out where I failed, or even if I did fail to advocate for myself. Did I set myself up for the experience that I had? Is it now a requirement to become educated in the most obscure pregnancy complications before setting foot in a hospital? Are the doctors, midwifes, and nurses no longer responsible for educating their patients? Does a care giver only need to provide answers to the questions their patients ask, or should they offer up more information? Whose responsibility is it to initiate the communication between a doctor and a patient? Is it now the patient's job to ferret out the details of their own health? What about when a patient is unable to advocate for themselves? Does that mean that the doctor is free to do whatever they wish with no thought for the patient? Is it okay for the health care providers to intentionally avoid answering questions? Is it okay for them to sneak medications or perform procedures when the patient's view is completely blocked without notifying the patient of their intent? Is it now the responsibility of anyone supporting the patient to provide the patient with a blow-by-blow account of everything going on, so that the patient can effectively advocate for themselves?

Looking back, I did a pretty darn good job of advocating for myself when I was aware of what was going on. I was handling the pain really well, but my blood pressure was skyrocketing. I knew that we had to bring it down, or I’d end up with a c-section. When the doctor suggested the epidural, I thought okay. I can try it, hope that it lowers my blood pressure, and end up with a vaginal delivery, or I can choose not to have it, and end up needing it anyhow for the c-section. It seemed like a pretty smart move to try it, and see if it would work. However, the anesthesiologist disagreed with my doctor’s suggestion. When he asked if I wanted it I said, “Yes, the doctor wants to try it to bring down my blood pressure.” He gave me song and dance on the risks of epidurals. I was lectured on not using it for anything other than pain relief. I was unwavering in my insistence that he give it to me. I went toe to toe with him while the contractions were coming right on top of each other. They pass the stupid things out like candy, why on earth was he being so stubborn? I finally lied. He knew I was lying, but he caved. It’s kind of hard to dispute pain with a laboring woman. Ultimately, I was successful. I understood the severity of the situation, and I was willing to go to bat for my decision. I also successfully advocated for myself during the pushing stage. I knew there was something prohibiting my daughter from descending, and I asked for assistance. It turns out her head was crooked. I might have been able to do it myself in a few more hours, but I was exhausted. It was a relief to have them assist me with the vacuum, and have the pushing stage be over.

The problems arose when the medical staff chose not to provide information. I was surprised when I received my medical records to find that they had been giving me IV blood pressure medication during labor. It seemed so odd to me because they were very precise when giving me oral medication to tell me exactly what each pill was. They lined them up in the little paper cups. “This is your thyroid medicine. This is your allergy pill. This is the stool softener. This is…” You get the idea. Why is it okay to not tell a patient that you’re putting medicine in the IV if you have to tell them exactly what you’re giving them orally? Shouldn’t the same standard be applied? What about notifying patients before performing invasive procedures? The doctor chose not to tell me that the placenta was stuck. I was just the patient. Why would I need to know that there was a problem? He thought he could be a hero. I had a difficult pregnancy. I’d been plagued by complications. In some ways I can see where he thought he was “doing me a favor” by not having me face another one, but I probably wouldn’t be here today if he’d shared the information with me. Especially since his efforts failed, and in failing he exacerbated the situation. The rate of hemorrhaging increased because he tore the umbilical cord off the placenta, and we think this might have caused the uterine inversion. His attempt to manually remove the placenta caused so much pain because the epidural didn’t work that I couldn’t comprehend what was happening. I couldn’t advocate for myself through the pain because I couldn’t find my voice. Instead of screaming, I clammed up. My brain was compromised by the hemorrhaging. It was too busy keeping me alive to send the right signals to my mouth to form questions. It was like someone took hold of my throat, and wouldn’t let any air through it. Even when the doctor did try to explain what was going on, he spoke to the room in general while focusing on my hoo-ha. He didn’t try to get MY attention. He didn’t come up to my face, and speak to ME. There was no effort to have a nurse re-explaining it to me or my husband. There was no discussion of how to deal with the problem, he simply announced, “I need the surgical team.” I didn’t know why. I didn’t know the name of the procedure.

The secretiveness didn’t end there. When I came out of surgery after they re-installed my uterus, managed to remove the placenta, accomplished getting the uterus to contract back down which stopped the bleeding, and restored my blood pressure to a reasonable pressure, the first thing I asked was, “what happened?” I can understand my husband not being able to tell me. His fear was so great the he couldn’t comprehend the doctor any more than I could. He told me he’d get a nurse to explain it since the doctor had already left. The only thing she told me was, “you had a lot of bleeding”. They didn’t tell me what procedure they’d performed. They didn’t tell me why they’d performed it. They didn’t tell me how serious it was. They didn’t tell me it could happen again. I have to admit that while I attempted to advocate for myself at this time, I didn’t do a good job. I was so weak from the blood loss that I didn’t even think to ask all of the questions I should have, but they knew how severe the situation was. Why should the responsibility be placed on the patient to question them when they know how compromised the patient is? Should they really be able to fall back on the, “well you should have advocated for yourself” excuse? Where does the patients responsibility end and the medical community’s responsibility start?

I keep coming back to the need for good communication in order to be a successful advocate. There has to be a level of trust and honesty between the caregiver and the patient. The patient needs to answer questions honestly, listen to the recommendation, and ask questions if they don't understand or want more detail. However, the caregiver needs to do the SAME thing. They need to ask probing questions. They need to listen to the patient's verbal and non-verbal cues. They need to answer questions honestly. They need to explain why they're making this specific recommendation. They need to speak to their patient, and not the room in general. They need to recognize that their patients are autonomous, individual, and unique. They need to recognize that what works for patient number two won't work for patient number four. They need to realize that we each have different ways of analyzing risk, and they need to be honest about their doctoring philosophy. They need to be trustworthy.

Trust is difficult to build. It takes more than having a patient pee in a cup, get their blood pressure taken, measure a belly, and listen to a heartbeat. It comes from initiating difficult discussions. It comes from asking questions. It comes from giving honest answers. It comes from being open. It comes from not making assumptions. It requires open and honest communication. However, it helps everyone get through a difficult situation.

There was no good communication on the night of my daughter's birth, and this resulted in a failure on my part and their part for me to advocate for myself.

What's with the title?

2008-09-05T12:53:00.003-05:00

30 minutes

That's the length of time it took my blood pressure to fall from 180 - 190 / 110 - 120 to 50 / 30.

That's the length of time it took for my uterus to turn inside out after my daughter was born.

That's the length of time it took for the hemorrhaging to take it's toll on me.

That's the length of time I was allowed to expel the placenta before the doctor shoved his hand elbow deep in my hooha and tried to manually extract it without a working epidural.

That's the length of time it took for my doctor to forget that I was a capable, autonomous, intelligent, and educated woman who should have been allowed to remain an active participant in my own healthcare choices.

Why do they forget this? It's such a simply concept. We hire them to be our guide. We ask them for advice. We expect them to explain our choices, and guide us to the appropriate decision. They aren't our parent. They aren't our boss. They aren't our god. Ultimately the choice should be ours. Why do they forget that in the heat of battle? They are a consultant, and their words should be listened to, evaluated, and a decision rendered by us.

Choice is a difficult topic. We should be allowed to choose caregiver and location. We should be given enough information during our appointments to feel comfortable with the choice we have made. We should be given honest answers about their childbirth philosophy, instead of finding out when we arrive at our birth location. Childbirth doesn't render us mute or stupid. It doesn't negate our decisions. We are expected to make choices about our children's healthcare once they're born, why can't we be allowed this same right before they arrive? After all, we have to live with the decisions that are made.

I acquiesced to many interventions I didn't want. I gave in to the induction because I couldn't consistently control my blood pressure. When I gave into that intervention, I knew that I was giving in to the Pitocin and the amniotomy. I was giving in to the continuous fetal monitoring. I was giving in to an IV. I was giving in to being, for all intents and purposes, strapped to the bed. When I agreed to the epidural, I gave in to the catheter. I gave in to pushing on my back. None of these things traumatized me. I made a choice.

In some ways, I made great choices. It turns out that a hospital is the safest place for ME to birth. Having an OB was another good choice I made. I chose a doctor who truly believes in vaginal deliveries. As long as we kept my blood pressure under 200, he kept letting me labor.

I advocated for myself by fighting with the anesthesiologist for the epidural. I advocated for myself by telling the nurse that the epidural wasn't working even if she didn't listen to me. I tried advocating for myself throughout my stay by asking questions, although given my compromised state I wasn't very competent or successful during my stay.

Trauma came later. It came when I was dismissed, belittled, trivialized, scorned, and ignored. It came when questions were not asked. It came when questions were not answered. It came in a thousand little insults. Patients aren't stupid. They know it's not normal to have 7 IV's in your hands after having a baby. They know it's not normal to spend the first 36 hours in bed without getting up to shower, change a diaper, or give a baby a bath. They know it's not normal to not care where there baby is, or wonder about their care. They know it's not normal to be too weak to get out of the sitz bath on their own. They know it's not normal to still have 5 IV's in their hands on the day they're discharged.

We know when you're lying to us. We know when you're concealing things. We are smarter than you think, and one of these days you'll get your comeuppance.

Advocacy, smadvocacy

2008-09-02T12:08:00.002-05:00

I've been trying to figure out where the trauma actually came from. I keep circling around in whenever I try to figure out and work through my feelings about advocacy. In nearly every birth story, I keep seeing that no matter what procedure was performed, induction, vaginal assisted deliveries, cesarean sections, episiotomies, or NICU stays, over and over again there's a comment about being unfairly treated. Is it possible that if we changed the way women were treated during labor that the procedures themselves wouldn't matter?

If doctors and midwives took advantage of their 12 prenatal office calls with each patient to discuss what their theory on birth was, and referred women who wanted a different experience to other providers, would that help? If they treated us with respect, and allowed us the opportunity to be true advocates for ourselves by making choices about our care would that help? I've talked to women who attempted home births with a midwife, who had midwifery care at a birth center, had midwifery care at a hospital, had a family practice doctor, or had an OB that suffered trauma. It doesn't seem to matter if your at home, or a hospital, or a birth center. It doesn't matter if it's a midwife or a doctor. You can have few interventions or many, and still be traumatized.

It seems like sometimes we focus on trying to control the procedures because we can't control the way we're treated. That seems to be one of the many problems. For a long time I wanted to blame the doctor for attempting to manually remove the placenta. It was concrete, and didn't take much effort to blame that procedure. After all, it was painful, scary, and horrific. However, that wasn't really the cause of the trauma. The real trauma, for me, came from being treated like an object, a future mal-practice suit, an imbecile, an over-demanding patient, a failure. If the doctor had asked permission and I had consented, I don't think I would have been traumatized. I wouldn't have enjoyed the experience. I might have had a few rough nights, but I wouldn't have been traumatized.

Maybe we should be advocating for true informed consent. Maybe we should be advocating for patients being treated with respect. Maybe we should advocate for patients being allowed the right to make their own choices. Maybe we should advocate for patients and doctors developing a relationship built on trust that would see us all through the ups and downs of birth.

I'm not talking about blind trust. I'm not talking about women believing that their doctor is a god - a know all, be all, decision-maker. I'm talking about having an open and honest relationship with their caregiver. I'm talking about having a caregiver that helps a women refine and build their birth plan at each pre-natal appointment. I'm talking about a relationship where if the doctor cannot provide the patient with an experience that they want they'll refer the patient to someone whose birth philosophy more clearly aligns with their patient. I'm talking about a relationship where the doctor actually educates their patients about birth, instead of leaving us to ferret it out of medical texts, baby books, home birth books, internet sites, or any other resource we can find.

I don't know, maybe it's off the wall. It's far easier to argue for no epidural, no pitocin, no episiotomy than it is to argue to be an equal partner in the relationship. It's easier to change procedures than it is to change attitudes, but it's the attitudes that caused my trauma.

Meeting with the hospital?

2008-08-28T12:34:00.000-05:00

My new doctor has asked me to participate in a discussion at the hospital where my peanut was born about how they can improve care. I’ve been struggling to decide if I should participate. With my PTSD, I’m afraid I might experience some flashbacks during the presentation since it would be held at the hospital. I’m afraid I might break down into tears with little or no provocation. However, I also feel compelled to help them figure out a way to make giving birth in a hospital setting a safer more empowering experience.

I’ve been trying to figure out what they could change. In some ways this seems a bit redundant since I sent them a letter a few months after my peanut’s birth letting them know what I thought they could change. Don’t you think this is pretty specific?

My family has been utilizing your hospital and clinics since I was a child. We’ve always been pleased with the quality of care that they we have received as a patient in your facility. Several of my friends have had their babies in the Birth Center, and been very satisfied with their experiences as well. Therefore, when I became pregnant last September it never occurred to me to give birth anywhere except your facility. After all, in my home town, you advertise on the digital billboard about the extraordinary ratings that you’ve achieved in the Birth Center.

Allow me to begin by stating that I wasn’t expecting a perfect labor and delivery. I’d had far too many complications during my pregnancy to expect labor and delivery to go smoothly. I entered the hospital that morning with a verbal birth plan, discussed with my husband and labor coach, basically stating I would do whatever it took to walk out of the hospital as a healthy mom with a healthy baby. However, I walked out of your hospital as a mentally traumatized, physically healthy mom with a healthy baby.

Therefore, I just want to take a few minutes to let you know of some ways that you could improve care in the Birth Center after being a patient in May 2007.

1. Make sure Birth Center is adequately staffed for an obstetrical emergency even when no one is actively in labor on the premises.

Because of all of the complications I experienced during the third stage of labor, I ended up requiring emergency surgery. At the time the doctor notified the nurse of this need, the C-Section team had been sent home for the night. It took 45 minutes after the doctor requested help for them to arrive back at the hospital. During that time, the doctor was limited in his ability to stabilize me. My blood pressure plummeted. I hemorrhaged 1500 ml of blood, and my uterus began inverting. The situation could have been managed much more efficiently if the doctor could have obtained help from the members of the team immediately. Given your location, only 30 miles outside of Minneapolis, and the growth the community has experienced in recent years, it never occurred to me that you would not have a C-section team staffed 24 hours a day. Obviously the additional staff would cost the hospital money and possibly delay the expansion plans you’re currently implementing. But the cost of the additional staff is far less than the cost of losing a mother or baby to an obstetrical emergency that was not properly managed due to a lack of trained personnel available at the time of the emergency.

2. Make sure the patient understands and consents to procedures being performed on them.

Procedures were performed on me after the delivery of my daughter without my consent or any explanation of why they needed to be performed. This was an emergency situation; however, that doesn’t negate the patient’s right to be informed prior to procedures being performed on their body. Even a cursory explanation would have been adequate. It only takes 30 seconds to tell a patient “Your bleeding is excessive, so I am going to apply traction to the umbilical cord to get the placenta to release”, or “That didn’t work. We need to try a manual removal of the placenta to stop the bleeding”, or “Neither procedure worked. We need to go to surgery to remove the placenta, and stop the bleeding.” During the aforementioned procedures, I was still conscious and capable of consenting to the procedures if I’d simply been given the chance. Even if the doctor was too busy handling the emergency, a nurse could have given me the basic information. It would have been much more reassuring to me if I had known why I needed surgery instead of just being rolled into the operating room with no explanation. Also, after I became unconscious, my husband should have been informed about my diagnosis before I was sent to the operating room. Since the doctor was preoccupied trying to save my life, a nurse should have taken on this responsibility.

While the doctor did discuss the procedures with my husband after the surgery, my husband did not understand what had happened. He needed my labor coach to re-explain everything to him after the doctor had left. Given the dismissive attitude of the doctor throughout my delivery my husband felt uncomfortable asking the doctor for more information, or to re-explain it until he achieved a full understanding of what had transpired and how it had been corrected.

3. Give patients all pertinent details about their condition. This should include but not be limited to what was done, why it was done, and how it was done.

When I first came out of recovery, no one gave me the full story on what had happened. I was originally told that I’d simply had a lot of bleeding. I wasn’t told until 12 hours later that my uterus had begun turning inside out and that the placenta came out in 20 different pieces. It wasn’t until I received my medical records that I found out that I also had uterine atony, hypotension, and two additional tears (one a vaginal tear). I was also never told how serious the emergency was, or told that they had considered transferring me to the ICU instead of leaving me at the Birth Center. I also discovered that my daughter had an asynclitic presentation, and that the umbilical cord had avulsed from the placenta. When I asked what had happened I deserved to be given every diagnosis and a detailed explanation of the procedures that were performed. The severity of the complications should have been explained to me at that time, and I should have been informed as to the possibilities of this happening again in future pregnancies. A printout of the clinical diagnosis should be given to patients, so that they can research the conditions at home since there is no internet access available at the hospital to patients.

4. Before being discharged, make sure patients know what medications were administered.

When I delivered my daughter, I had one IV in my hand. When I woke up in recovery, I had seven IV’s in my two hands. Other than the blood transfusions which I consented to, I didn’t know what was in the other IV’s. This information should have been given to me without my needing to track down my medical records. Upon receiving those records, I found out that I’d been given blood pressure medication during labor. I was completely unaware that this was being given to me along with the pitocin for the induction. I was also not told about the nitroglycerine that the anesthesiologist administered to relax my uterus, so it could be repositioned. I wasn’t informed about the IV antibiotics that I was given to prevent infection, the anti-shock medication, or the medication to help my uterus contract in addition to the pitocin I had already received. Since these medications were never discussed with me, I also wasn’t given any information about how they could impact my daughter if I chose to attempt breastfeeding. I had considered trying to breastfeed after I went home, and it’s a good thing my body didn’t produce any milk because the antibiotics administered to me should not be taken by a breastfeeding mother. It’s simply incongruous that the nursing staff went out of their way to tell me exactly what medication I was being given orally, but failed to tell me what I was being given intravenously. A printout should be provided to all patients prior to discharge with a list of medications they have received in addition to the discharge instructions with any medications to be continued listed.

5. Make sure that the doctors validate that their patient is actually experiencing pain relief prior to performing painful procedures.

The epidural did not provide any pain relief for me in the uterine area. I experienced numbness in my legs, but I experienced every contraction, and could feel myself tear as my daughter slid out. Because I chose to have the epidural to lower my blood pressure instead of for pain relief, I didn’t notify my doctor that the epidural had been unsuccessful. Apparently the nurses also failed to communicate to the doctor that I had total feeling in my uterus, so when he performed what I now know was the manual removal of the placenta the pain was excruciating. Even though I couldn’t move due to the numbness in my legs, I actually was fighting to get away from the doctor during this procedure. A little communication would have gone a long way in this situation.

6. Make sure that the staff members introduce themselves to patients when checking on their condition.

Someone from the C-Section team checked in on me the afternoon following my surgery. However, because I was unconscious when the team had arrived at the hospital, I had no clue who the person was. I had to ask if he had been there the night before, and even then he didn’t identify his role in treating me. It’s quite disconcerting as a patient to not know if the person speaking to you is actually on the medical staff.

7. Make sure that if doctors disagree on a course of treatment that they work it out between themselves instead of putting the patient in the middle.

Due to the high blood pressure I was suffering from during labor, my doctor suggested than an epidural be placed which would result in lowering my blood pressure. The doctor wanted to avoid giving me magnesium sulfate due to the side effects that it produces. I consented to this course of treatment. The anesthesiologist came to place the epidural, and apparently he was uncomfortable with my answer to his question about if I wanted it. I ended up needing to argue my doctor’s position with him instead of him talking to my doctor about it. I’d already read and signed the consent form, so all this did is increase the tension everyone in my delivery room was feeling.

8. From my and my husband’s memories of the event, there seemed to be communication problems between the doctor at the clinic and the nurses at the hospital. This should be addressed in a hospital-wide policy.

There were several times that the nurse would tell us that she would go contact the doctor, and it would take close to an hour before she would come back with a response. The nurses were quite concerned with the rate at which my blood pressure was climbing, and the stress it was putting on the baby. My husband has told me that the nursing staff actually considered sending someone down to the clinic to track down the doctor at one point. It also seemed to take a long time for the doctor to respond after asking for help in delivering my daughter. Due to my failure to progress with pushing, we requested help by either vacuum or forceps to deliver my daughter. It took an hour after we made this request for the doctor to present himself. I don’t know why this delay occurred, but it was very frustrating, and it didn’t foster a sense of calm in the delivery room.

9. Upon cleaning up my daughter, the nursed asked if “I wanted to hold my baby?” Please ask the nurses in the delivery wards to phrase this question “Are you ready to hold your baby?”

That question has haunted me for months. I feel like the world’s worst mother because my answer was no. I desperately wanted to hold my daughter. However, I was afraid that I would hurt her because I was feeling so funky. At the time I wasn’t aware that I was hemorrhaging, and that my blood pressure was transitioning from being hypertensive to hypotensive. I know in my head that this was the correct decision to make, but I still feel guilty about my answer. I’ve also heard other women commenting on not being able to hold their baby due to shaking from the epidural, so this isn’t something that is limited to women experiencing a traumatic birth.

After researching the complications I experienced by reading medical journals and watching medical school PowerPoint presentations on obstetrical emergencies, I know the course of action my doctor followed is the standard response to those emergencies. I also believe that my doctor performed these procedures in a well trained, competent manner. However, my doctor was also arrogant, dismissive, and uncommunicative. Those attributes don’t foster the positive experience that you advertise on billboards throughout the west metro. Perhaps the doctors at your facility could use a remedial course in bedside manners on a regular basis.

As a result of my experiences in your hospital, I’ve developed PTSD. I’m currently receiving medication through my primary care physician at your clinic, and receiving psychotherapy through a counselor. Your facility failed to provide me with the care I needed for my daughter’s birth to be a joy instead of a nightmare. Please review your policies to prevent this from happening to another family.

Apparently the letter I sent got buried instead of it being discussed by the hospital staff. I think that someone needs to wake the medical community up. Patients aren’t looking for their doctor to be a benevolent dictator. They want a doctor who is on their team. He guides them in achieving their goals – whether that’s a healthy pregnancy, labor and delivery, or the elimination of chronic pain.

Doctors have an amazing opportunity with pregnant women. They typical woman will have 12 – 15 appointments that the doctor can use to build trust. They can talk to the woman about their treatment philosophy. They can explain the procedures they can expect to perform. These prenatal appointments shouldn’t be an assembly line type of visit. They should have more meat to them than having your weight and blood pressure taken, belly measured, heart beat listened to, and then the big dismissal. They should be talking about the type of experience they typically provide; they should be directing patients to doctor’s whose treatment philosophies more clearly line up with what the patient wants. When complications arise, they should be discussing the impact of the specific complication on the birth experience that the woman may have.

The entire concept of writing a birth plan or taking a childbirth course should become unnecessary. They know what their doctor is going to do, how it’s done, and why they’re doing it. It would give them the opportunity to make an informed decision about who they’re choosing, and build a trusting relationship. When things go wrong, each party to the experience can rely on that strong foundation of trust to help them through. Feeling empowered shouldn’t be based on your ability to control the procedures being performed, it should come from the relationship you have with your caregiver. My trauma wasn’t caused the procedures they performed, but the way they treated me. It was caused by their not involving me in the decisions about my care. It was caused by their failure to tell me that things were going wrong. It was caused by their secretiveness after I started questioning what had happened. It was caused by the way they belittled and trivialized my feelings about the experience. Things happen that are outside of people’s control. Most of the time, birth is safe, but it can go really wrong really fast. Without trust the experience can become incredibly traumatizing.

Today, I read a couple of blogs by women who work in the healthcare industry. The first one was a labor and delivery nurse who feels like she has no control. She has no ability to change the system even though she recognizes the system is screwed up. The second was written by a midwife who believes that the doctors themselves need to initiate the change in how they work. They need to step up to the plate, declare the system dysfunctional, and take matters into their own hands.

As patients, our ability to truly advocate for ourselves is at a disadvantage. We don’t have the 8 years of medical school to back us up. We can’t diagnose ourselves, and we certainly don’t know how to define our own treatment plan. We can yell and scream about intervention rates. We can complain about the procedures, but we cannot change the procedures the doctors perform. We do need healthcare professionals to guide us, but every leader needs a follower. Our role as the patient puts us in the position of being the follower by default. We can’t lead the doctors down a new path. Change has to begin with one doctor who realizes that the system we have is broken, and them deciding to take a new path. It’s their choice to lead others down that same path, and ultimately their decision to train future doctors to walk that same road.

So, what am I going to talk about at this meeting?

Honesty
Communication
Building trust
Getting rid of the “assembly line” mentality
Treating us like patients instead of possible malpractice suits

And not one word about the procedures

The first request for help

2008-08-26T16:26:00.000-05:00

This is the first version of my peanut's birth story. It’s so weird to read such an emotionless, sanitized version of the story, but it was my first attempt to reach out for help, validation, and understanding. I hadn’t yet asked for and received my medical records, so I didn’t know how serious everything had been. I didn’t really know what had happened, why it had happened, or how it had happened. I knew that it wasn’t “normal”, but that’s the extent of the information I had. The anger and fear hadn’t really sunk in yet, and I hadn’t yet asked for help in coping with the PPD that I thought I had. I hadn’t yet spoken to a counselor, or tried drugs to help with the anxiety. I was so naive.

I posted this on a bulletin board for women who had difficult / traumatic birth experiences. I really didn't know that this happened. I honestly believed that there was no safer choice than having your baby in a hospital with an OB. In all reality, this probably was the safest place for me. The same complications would have existed at home, so location really was immaterial. If we'd transferred from home, it probably would have taken longer to receive a diagnosis. I would have waited for the ER doc to figure out what he needed, and waited for him to call in an OB and anesthesiologist.

I still have a lot of questions. I still struggle with the decisions that were made, but here's the story I knew at the time.

My daughter was born May 11th. I've never told the entire story of her birth to anyone, and until this week I never realized just how bothered I am by how it happened.

I had the easiest pregnancy until I reached my 24th week when I was diagnosed with Gestational Diabetes. Changing my eating habits was very difficult at first, but after a couple of weeks I had it down pat. At 34 weeks I began to experience pregnancy induced hypertension, and my doctor placed me on modified bed rest. By the time I reached 37 weeks it had progressed to pre-eclampsia, so I agreed to be induced the following Friday.

Things started in a pretty typical manner. The doctor broke my water, and they started me on pitocin. However, things started to change rapidly. My blood pressure started climbing, so they had me lay on my left side for what seemed like forever. Things didn't improve, so they tried to roll me over to the other side. However, as soon as I got to my back my blood pressure started to decrease. The contractions started to settle into a steady rhythm, but my blood pressure started to climb again. At this point, my doctor wanted me to have an epidural to reduce the blood pressure, so I complied with his wishes. Unfortunately, the epidural didn't really work. It resulted in slowing labor to a crawl and putting my leg to sleep, but I didn't receive any pain relief from it. Finally, around 9:00 pm I had the urge to push. I pushed for two hours before I came to the realization that after being on bed rest for a month I simply didn't have enough energy to push my peanut out on my own. The nurses finally tracked my doctor down, he wasn't responding to his pager, and he gave me a little help with the vacuum.

My daughter was born at 11:32 pm, but that's the beginning of the story. The placenta didn't detach right away, so the doctor was stitching me up while he gave my uterus time to work on expelling it and the nurses were cleaning up my daughter. At midnight, he once more gave the umbilical cord a tug. I nearly jumped off the bed the pain was so intense. Instead of the placenta detaching, my uterus flipped inside out and started to come out through my cervix. The doctor asked the nurse to call the c-section team. Unfortunately they had all gone home after I had delivered, so they had to be called back to the hospital. I started hemorrhaging and my blood pressure dropped as I started to go into shock. Things get pretty fuzzy about then, but I do remember my doctor once more asking for the c-section team with a hint of panic in his voice. People started streaming into the room, and they rolled me into the operating room.

When I came to, I was back in the delivery room with my husband, and I had the worst case of the shakes. I'm not sure what they were pumping into me at this point. I had one IV line in my hand when my peanut was born, but I had seven lines in my hand when I came to in the delivery room. (I found out later that they had left my husband alone in the delivery room with my daughter, and they didn't tell him what was happening. According to him, the room looked like the nastiest crime scene he'd ever seen on CSI.) At this point, my husband was so overwhelmed that he called a friend to come and sit with me so he could go home, get some sleep,and begin to deal with all of the emotions the day had brung. Finally at 5:00 am I was up to actually holding and naming my daughter. After some time with my peanut, our friend called the grandparents to tell them that my peanut had been born. When the doctor came to do rounds, he told me that he had managed to save my uterus and the placenta had to be manually removed. It turned out that the placenta didn't detach properly, and it came out in twenty pieces. It was also the first time my doctor had experienced a uterine inversion. Apparently it is a very rare complication.

While every decision was made with my and my daughter's best interest in mind, it was an amazingly difficult time. I'm struggling to focus on being grateful that I'm still alive and my body still has all its parts.

An introduction

2008-08-26T09:59:00.000-05:00

So, doesn't my title sound dramatic? It definitely matches the drama of my childbirth experience. My peanut was born 15 months, and 15 days ago. Unfortunately I'm still dealing with the PTSD that followed her arrival.

This blog is my space to work through my grief, fear, anger, rage, and questions. I'm hoping that I can find a way to climb out of the hell I've been living in, and make it to solid footing here on earth.

It's also a place to compile all of my writings about the birth trauma. Right now, I have posts scattered across the world-wide web, and this will bring them all under one roof.