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.

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