Re: [ozmidwifery] Post cs support

[Janet Fraser]

"Any suggestions. Should all women have a follow up appointment with the midwife who was at her birth, is this appropriate as they may have been part of the problem, should all women have a follow up appointment but the woman be allowed to choose who she wants the appointment with, at what stage would this be appropriate, 2 weeks, 8 weeks 3 months? How does this fit with the M&CH nurses who are now involved in the woman's on going care? How does her doctor, be it her own GP, obst or the one who attended (or not) her birth  be involved in this? "   Andrea these are definitely on track about post-trauma, but how about measures to prevent the trauma in the first place? PTSD is not inevitable as I've seen women experience very traumatic births either through staff mishandling or purely "no fault" as it were, stuff that just goes wrong but through the intervention of JUST ONE kind, loving staff member, the woman has suffered no lasting ill effects. It would also require so many changes of mindset on the part of those CPs too. People believe that birth is traumatic in itself and that drugs and interventions improve, not detract from, the experience. This is not the case for most women who had no need of those interventions in the first place. Real debriefing can only occur in a place with no vested interest in the outcome. Hospitals are keen to avoid what they see as potential lititgation and will refuse to listen to emotional pain as valid. I have a close friend who has written proof in her records of serious mistakes, outright lies, really shocking stuff that has left her gutted for years. She tried desparately to talk to the hospital but despite the lies being in black and white in her record the only response has been total denial, we were right, we know what we're doing, you're wrong. She had a barely qualified surgeon perform surgery she neither needed nor consented to, and he left a large chunk of placenta behind. Of course the massive infection was treated as malingering until she got a private u/s and had it confirmed. Hospital response? No, we didn't do that. It must be something else. She now has a lifelong battle with horrible scarring from the crap job that was done and the resulting infection, as well as chronic systemic candida from the months and months of antibs required. This was her second unnecessary surgery but most people around her, medical people included, view her as fortunate to have access to western medical care. Her ideal birth now is under a tree a long way from such care. She said no to the caesarean, she told every person she saw in the hospital that she didn't consent, she ran outside and smoked compulsively hoping this would stop her being given an epidural (which incidentally didn't work so she felt the whole surgery, something else the hospital deny happened. Hard to think she'd imagine that.). When she tried to talk about how traumatised she is, she was told that it was just leftover trauma from her first caesarean and nothing  to do with all these factors. She also had her baby taken to SCN and didn't meet him for 24 hours later by which time he'd been ff with thickened formula without her consent for perceived reflux. Major Melbourne hospital.   What we REALLY need is to prevent it in the first place. How can we do this? Well I offered to talk to students in the hospital where my birthrape occurred but have never been taken up on it. I'mnot really surprised even though my offer was entirely genuine.    We need to impress upon those involved in care that "informed consent" does not mean massaging the truth, telling outright lies, manipulating women "You want the best for your baby don't you? Take this drug." We need NO to mean no, so that when a woman says no she is respected. I'm not sure that all the people who see vaginas every day for a living necessarily respect the sanctity of women's bodies. I certainly received no respect for my body in my hospital experience. If a woman screams when you touch her, STOP TOUCHING HER. Leave the room if you've scared her, make sure someone else takes over from you. Apologise as soon as possible. Just a few quick hints but I can provide a lot more.   We also only have funding and recognition of PND in this country. PND is a great diagnosis which puts all the blame on the defective woman and recognises no possibility that she may actually have PTSD. I've spoken to numerous PND support groups, and women who attend them, and most are rubbish. There is no discussion of birth although most of the women are traumatised by their experience or at the very least require intensive debriefing. Most of them involve exhortations to get more sleep, generally by weaning and ff, and do nice things for yourself. Wildly inappropriate and unhelpful. When I was suicidal from PTSD I saw my GP who insisted on booking me into a PND unit. I kept repeating over and over that I didn't have PND. He ignored me. I just cancelled the appt later. He also tried to tell me that there were positives about my experience. What were they? I was alive and so was my baby. Well, I expected that from a major tertiary hospital and a baby never in distress in utero so why should I be grateful for it? Do they normally kill women? (Ok facetious, but do you know what I mean?)   To diagnose or recognise PTSD requires that our hospital system faces up to the conveyor belt happening within it. PTSD implies that something was done to that woman in some way which has led to this. It puts the focus back on the perpetrator rather than the victim. This to me, is the biggest reason it doesn't happen. It also, in the minds of those legal persons on hospital boards, and insurance companies, opens up more places for women to sue. Given that most claims paid out against Obs are for emotional distress, by a very long shot, this is already happening.   I have also seen, and had expressed to me about my own experience, a perception that only previously damaged or traumatised women experience PTSD from birth. Again, let's blame the victim. Actually what happens to many women in hospitals is quite sufficient to cause massive PTSD after which we are then expected to go home grateful for our live baby even when what occurred was purely iatrogenic. For the record, I have never experienced child sexual asault but have had PTSD previously from an attempted rape in my 20s. Recovery was a lot easier however as no one told me to get over it and be grateful and I didn't have to care for another person at the same time. It was a societally sanctioned way to be traumatised. If we recontextualise what happens in birth, and put it outside of an institution, we might begin to reclaim come of our natural horror.   Picture this, you're walking along the street, someone comes up to you and without warning cuts open your vagina. Horrible right? Happens regularly in hospitals but because the perpetrator wears a gown and is invested with power in that setting, it's considered ok. No warning, no anaesthetic, no need, common hospital scenario.   You're in your home and someone is coming at you with a loaded syringe. You scream "Get away from me with that. What's in that?" They ignore you and jab you with it repeatedly over many hours. It makes you nauseous, dizzy, unable to think properly. During this time, the perpetrator asks you to make major life decisions all the while telling you your children are in danger. Could you do that?   You're lying paralysed in your bed, in the next room you can hear your baby screaming as unknown people do things to it about which you have no knowledge. What do you do? Eventually someone hands you a baby you've never seen, wrapped up in a blanket. What do you do? Do you take their word for it that the baby is yours?   These are entirely preventable and the scars they leave on women can last a lifetime. In the complaint letter I wrote to the hospital, I rewrote the scenarios I had experienced in an effort to give them an idea of how it ought to go. Instead of unnamed person who doesn't introduce themselves sticking a gloved hand inside my body and then announcing a course of action over my head while I scream, and with no prior discussion about the ramifications of those actions, how about a conversation first? Introduce yourself, look the CLIENT in the eye, talk about wanting to do a VE, talk about why, talk about how, talk about how she can say no at any time and to tell the CP if it hurts so they can help. Talk about possible courses of action if certain signs are present, talk about what those might mean. Ok in a true emergency this becomes more complex but in most cases it's not that urgent. This can still be done by a CP whom you have never met, and occur with a client never seen before.   And please please please, read some birth stories! Even a quick perusal of several stories is going to show you the same thing - women being treated like cadavers. There are research articles and books on birth trauma which all spell out the same thing. Having my baby is not a day at the office for me, please don't treat it like that. My body is sacrosanct, not to be handled harshly, not to be on view to those passing by. I can't tell you how many women have onlookers not needed when they're trying to push out a baby. Given how poor our midwife/client ratio is this always astounds me but it's sundry people passing who might like a look at this "case" who get invited in.   Many on this list are nonposting members of Joyous Birth and therefore have access to the birth stories section of our forums. Please read those stories, note how women describe what it's like to be last in the hierarchy, even behind your baby. There are countless birth trauma groups springing up around the world, all led and run by consumers with almost no input from the institutions where the trauma occurs. As a previous poster said, this is all too closely allied with the rampant sexism of the western world anyway so I for one, don't expect it to be much different from this. But for many of us, the perpetrators of our trauma are other women and that is very sad. I don't understand how the women who did what they did to me, can live with themselves. This isn't about obstetrics being a boys' club, it's about a whole system which does this to the consumer. Consumer, not patient!   This is a list of resources online that are helpful. Please ask for more. Please read with an open heart, hear the stories without feeling attacked personally.   Support, Advocacy and Recovery on the internet  http://health.groups.yahoo.com/group/accessingartemis A group for women recovering from birth trauma.   www.birthrites.org  Loads of useful links. Includes info on recovering from traumatic birth. Very empowering. Encouraging of a consumer-type attitude to your health care.    http://www.victoriousbirth.com/index.html  Caesarean and Traumatic Birth Support. A site for women who want to truly heal spiritually and emotionally after a difficult birth experience    http://www.eheart.com/cesarean/index.html  A site by, for and about those born by c-sec.    http://www.tabs.org.nz/  New Zealand site on traumatic birth and recovery – PTSD and PND.    http://www.sheilakitzinger.com/Birth%20Crisis.htm  Kitzinger on birth trauma.    http://www.birthlove.com/petition/womens_rights.html  Petition and declaration on the rights of birthing women.   http://www.birthlove.com/ A US site devoted to improving women’s experience in birth. Excellent for birth trauma.   http://www.yoni.com/healerf/templedoor.shtml Healing the Temple Door – a guided meditation on healing from rape which can also be excellently employed in recovering from birth trauma.   Leila's essay "Rape of the twentieth century" is vital reading. She and I are often accused of overdramatising. It's not true. Read the stories on BirthLove and see for yourself : )   With a spirit of co-operation, this has all been quick and off the top of my head! I'm happy to talk more any time : ) J