Where I'm starting

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.

Here we go again, but I see improvement

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.

A Trip to the ER

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 do we change the culture of birth?

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?

Breastfeeding & PTSD after Chidlbirth

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.

Giving up my Power?

I was reading a Birth Trauma forum the other day, and the question posed to their site was, “When did you give up your power?” There were some interesting answers. Some women said they gave it up in their childhood. Some said the medical establishment slowly eroded it. Some women blamed their spouses for not agreeing with or supporting their vision of their birth.

Personally, I’m struggling with the question. I think there’s a bit of shame associated with it. It blames the woman by assuming that “she gave up her power”, like it’s always in our ability to have a great birth experience. That no one else or nothing else can violate us if “we just don’t give up our power”. I don’t see choosing to see an OB or choosing to see a midwife is “giving up our power”. I don’t see choosing a hospital or choosing a homebirth is “giving up our power”. You don’t automatically lose your power by making a choice.

I don’t think that’s the way they mean the question. I think they’re assuming that the women responding had typical, uncomplicated pregnancies. They’re assuming that there are no complications that can or should be taken into consideration when making the decision.

However, complications, while sometimes over-diagnosed, can be real. There are times, not all the time, when having your child in the hospital is the safest place for mom to be. There are times when having a birth attendant is the safest situation to be in for both mom and baby.

I have to say the question’s been bugging me. You see, I don’t think I gave up my power by choosing an OB. I didn’t give up my power by choosing to listen to him when complications arose. I didn’t give up my power by choosing to have my baby in a hospital. I didn’t give up my power by choosing an epidural. Let’s face it, I argued myself into an epidural despite the anesthesiologist’s objections to providing it. The doctor stole my power when he chose to perform a procedure without my consent. I didn’t give it up, it was STOLEN.

There’s a huge difference between those two concepts. I have to admit that I didn’t fight to get it back during the remainder of my stay, but that was my choice. I chose to focus on healing. I chose to focus on getting out of that hospital as soon as I could. I chose to focus on me. I didn’t want anything to get in my way, but there again; I guess that is taking back my power. It was my choice; therefore, the power was mine. I didn’t fight for answers; I chose to save my energy to fight for healing.

Maybe having a choice is having the power. Except for the procedures after my daughter was born, I made the choices. They might not popular in the home birthing community, but they were my choices.

Am I an advocate or a wimp?

So, I feel like I wimped out by choosing to not speak to the doctors tomorrow. I know that it's not so much a matter of wimping out, so much as it's a matter of choosing to focus on fixing myself. However, I tend to use negative phrases or comments to describe myself instead of positive ones, so it's easier for me to say I wimped out.

My counselor told me that I'm becoming an advocate because I chose to provide my doctor with my writings instead of just cancelling. I'm not sure how I feel about that. I don't want to be an advocate. I don't want to be an activist. I just don't want anyone else to feel the way that I do right now. I don't want another woman to feel like she's powerless. I don't want another woman to feel like she's been coerced into procedures that she doesn't want. I don't want another woman to feel as isolated as I do. I don't want another woman to feel like she has no one to talk to, or no one who understands her. I don't want another woman to feel like the nurses are re-traumatizing her by their dismissive attitude. I don't want another woman to believe that she's worthless, like she's a vessel, like she's nothing. It's a horrible feeling to know that no one believes you count for anything.

I'm tempted to show up at the hospital tomorrow even though they're not expecting me. I'm tempted to see if I can make it through the discussion without breaking down. I don't know. I know that it would be incredibly hard for me to be strong enough in my beliefs that I don't feel like I'm being judged as worthless, ignorant, or unreasonable in my expectations.

In 37 years, I've learned that problems don't go away by themselves. Ignoring a problem won't make it go away. Not talking about a problem doesn't get it resolved. There's a problem in our maternity system. When 10% of women test positive for PTSD after their children's birth there's a systemic problem with the maternity care in the US.

I don't know how we fix it. If there's anyone that understands that complications can be real, that some women need more care or interventions than others, it's me. I know that homebirths aren't the answer to the problem. I know turning care over to midwives isn't the answer to the problem. I know that birth abuse can happen at home, in the hospital, or in a freestanding birth center. I know that midwives, doulas, and doctors can all be perpetrators. I guess that's why I cringe at being called an activist / advocate. Too many people see the solution as being so simple as making homebirths the norm, or midwives the norm.

Maybe it's a simple as making sure that doctors, nurses, midwives, and doulas are making the decision to provide patient centered care. Maybe if we had a more open dialogue between caregivers and their patients on their childbirth philosophies we'd have better outcomes. Maybe if caregivers were more open about how they really practice their craft patients would be able to find a caregiver that provides them with the type of care they desire. Instead we get blind-sided. The on-call caregiver delivers your baby instead of the person you've developed a relationship with. We get stuck with a nurse who's having a bad night, and doesn't want to be at work, so she takes it out on her patient.

It's so hard to make the right choices. No matter what we choose, someone says we're being too inflexible. We're taking risks by having the baby at home. We're taking risks by having the baby in a hospital. We're taking risks by breastfeeding, or we're taking risks by formula feeding. It's enough to make your head spin. Why don't we support each other instead of questioning each other? Why don't we bond together as a team instead of looking for the saboteur?

Advocate or wimp? I don't know. I know I won't let this drop.

Meeting w/ Hospital Cancelled

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

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.

Birth Rape?

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?

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.

Blindsided

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?

Trust

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

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

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?

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?

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

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?

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