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.

Acknowledging Irrational Thoughts

Wow!

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

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

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

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

Clogged, Stuck, Trapped

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

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

"It's a suite experience!"

All I can think is its dangerous.

Watch out.

Don't go there.

It's NOT SAFE!

Run!

Trapped!

Hide!

Fear!

Escape!

Pain!

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

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

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

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

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

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

I must not fail.

De-briefing tool (Part 1 Question 1)

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

Part 1: How was your birth?

1. What was your birth like for you?

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

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

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

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

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

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

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

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

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

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

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

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.

“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.

The Power of Words

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

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

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

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

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

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

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

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

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

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