vbac pain (long)

[Dean & Jo Bainbridge]

I know this is going to be long, but this is one of my pet projects at the moment.  I certainly do not wish this to be taken negatively...I hope it might either confirm what you as midwives, see or maybe give a perspective that can sometimes be forgotten.  It is meant to be constructive.  I eagerly invite responces and or suggestions from any of you. I think the thing that care providers have to remember at all times is that unless they really know the labouring woman, they should NEVER make any sort of comment either in jest or off hand.  Some of the most damaging comments that we cs mums (and vbac mums) hear can be some off handed comment meant to cheers us up!  It is those sorts of comments that can make or break of our birth experince.  To say things like "at least you can wear a bikini still" is absolutley ludicrious and of no benefit to the woman.  Things that care providers must keep in mind that a woman having to have an emg. cs is in a hightend state of vunerablity and sensiivity.   The care provider must be extremely careful to treat the woman and her fears with the utmost respect. I have listed below some things that came from an interesting study called "Adverse psychological impact of operative obstetric interventions: a prospective longitudinal study" (Fisher, Astury,Smith.  A&NZ journal of Psychiatry 1997; 31:728-738)   (It is a summary that I have written and also contains anecdotal evidence I have found through personal experience and through CARES)    “…operative intervention in first child birth carries significant psychological risks rendering those who experience these procedures vulnerable to a grief reaction or to post traumatic   disorder.” (Fisher, J. “Adverse psychological impact of operative obstetric interventions: a prospective study”, A&NZ Journal of Psychiatry 1997;31:728-738   Emotional effects of caesarean birth can include: *depression, anger, grief *diminished clarity of thinking, efficiency & enthusiasm *marked decrease in self-esteem *belief that intervention was required due to personal inadequacy or failing (rather than factors beyond their control) *short term diminished responsiveness to external world, in particular to the child *diminished social and occupational functional capacity *less likely (even avoidance) of conceiving again  Lowered Self-Esteem resulted from: “…damage to feminine identity and body image and , because of heightened dependence following surgery, to diminished self-worth.” (Fisher) REASONS FOR DISTRESS Involvement in decision making Emotional stress of well being of child and self Less likely to have partner or support person present (VD 92% v’s CS 81%) Complete change of environment and care providers Less likely to see babies during first 5 minutes of life (VD 97% v’s CS 60%) Extremely less likely to hold baby immediately after birth (VD 90% v’s CS 12%) Increased likelihood of substantial separation (31% didn’t hold baby after birth for 8 hours or more) Unexpected obstetrical intervention at a time of heightened vulnerability  External Factors that can Influence a Birth Experience: *familiarity of care providers and trust in their care-continuity of care and information *mutual respect and understanding of perceptions of birth *involvement in decision making *full understanding of the necessity for intervention *intrapartum apprehension for well being of child and self *long and/or difficult labour  *having partner or support people present *complete change of physical location *introduction of strangers (other care providers) *conduct of personnel in operating theatre *initial contact with child; seeing, touching, holding etc *respect for the actual birth of child –not simply a ‘extraction’ *separation during recovery *post operative pain *post operative support Nearly all of the above listed things can be addressed with very little effort Those Who are Most at Risk of Depression: *expected a natural birth *inadequate help or support during labour, surgery, post operative recovery *general anaesthesia or combination of drugs that cloud memory or had unpleasant side effects *felt coerced by hospital and/or partner *felt that cs was a surgical procedure not a ‘birth’ *expected to breastfeed, but found difficult after surgery *isolation or lack of support at home *guilt over grief “…women who experienced caesarean child birth felt significantly worse in the postpartum period than they did in late pregnancy.  They reported increased symptoms of depression and irritability and a deterioration in efficiency and clarity of thinking.  Anxiety levels had reduced marginally from late pregnancy.  Their self-esteem was significantly diminished.” (Fisher) Emotional distress associated with traumatic birth does not become apparent for some weeks, months or even years.‘Healthy Mother, Healthy Baby’ extends past the six week check up!  “Because it is the one thing that will give me back my life, erase the feelings of abject failure and make me feel like a true mother, not one that can’t even accomplish the first task required of her, that is giving birth to her child.”Anonymous quote from a woman when asked why she wants a vbac What I stress to care providers is that your conduct and comments should only be of benefit to the woman in a supportive and caring manner.  Your sense of humour may be very different to the woman so dont try to 'cheer her up' or make light of the situation.  There  is little to no extra support for women who have cs in the post partum period.  I have had some wonderful midwives tell me that they dont treat their cs mums any different to the vd mums.  Sorry but us cs mums are different.  We might have just been through a long hard labour and then major surgery, coupled with stress of the welfare of the child and so forth.  Add to the mix the post operative pain, the drugs coursing through our bodies, trying to breast feed, being unable to reach over and pick baby up due to severe pain, and then you can add the rest of the hurdles faced by all new mums.  Perhaps a hug or a supportive chat with a cuppa might be of more help.  I know how busy most midwives are so I know that this might be hard, but who else is there for these women???  Also it is worth asking the woman if she really understands the reason for her section.  Most of us go home not quite understanding, or worse, going home thinking that because "bubby wouldnt come out" it is somehow their fault!  Remember the terms we are given "failure to progress".    I will get off my box now!  Thanks for listening!! Jo Bainbridge founding member CARES SA email: [EMAIL PROTECTED] phone: 08 8365 7059 birth with trust, faith & love...