----- Original Message -----
Sent: Friday, December 07, 2001 7:08
AM
Subject: vbac pain (long)
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...
