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|At my 22 week appointment: "I suggest that all my type 1 patients have their hospital bag packed by 30 weeks. You're likely to end up hospitalized, and (chortling) most women don't want their husbands packing for them."
"You know, often WE'RE the ones telling the OBs what to do."
At my 30 week appointment: "About a third of women in your situation go before 35 weeks."
Me: "Is that spontaneous, or due to complications that require getting the baby out ASAP?" (Type 1 diabetics have a 20% rate of pre-eclampsia.)
Her: "A little of both."
Me: "On what are you basing those numbers?"
Her (clearly surprised that I would even ask): "Uh, there were some cohort studies."
Afterwards, I went to my lab and did a thorough search of the medical databases. I found no such cohort studies. I emailed her to ask where I might find them. She never responded.
"Our job is so much harder with pump patients." (Note: Insulin pumps make life much more flexible and provide better control for type 1 diabetics.)
"What's a correlation?" (Note: both endos are principal investigators for grants and primary authors for journal articles. In those roles, you don't have to be a statistician, but you should certainly understand one of the most basic concepts in statistics.)
Re: availability bias, a *psychological* term having to with the fact that if you've seen/experienced an event, you are likely to overestimate its probability (physicians have been shown to have high levels of availability bias that affect their decision-making): "Well, that's a mathematical term."
"You're going to have train your husband to change diapers!" (wink, wink) (Those of you who know DH and know how involved a parent he is can appreciate how offensive a statement that was.)
To DH (at an appointment she had requested that he attend): "You know, a lot of diabetic moms have trouble bonding with their babies."
In response to my statement that one of the reasons I was refusing the 38 week induction was that they raise the risk of c-section: (astonished) "No they don't!" This endo later told me -- and I was clearly supposed to be impressed -- that she originally trained in obstetrics.
|Woman: “LOOK at that baby!! He is so cute! How old is he?”
Us: “Three days.”
Woman: “THREE DAYS?!!”
Woman (gesturing to friends to come over): “This baby is only THREE DAYS OLD!”
|The hardest thing I’ve ever done is nothing. During the birth I had a role, so even when Maria was having a hard time, I had things to do to make her feel supported and loved. After we finally got DS out of the NICU, stinky and gorged on formula (the formula made him stinky) we got the chance to do demand breast-feeding. Except, Maria’s milk hadn’t had a chance to come in yet, both DS and Maria had to learn how to nurse, and the little man was hungry.
He’d fret, and cry piteously, and pull off the breast because he wasn’t finding the huge quantities of fluid that he had been accustomed to in the NICU. Maria, exhausted from the surgery and sleepless nights in labour, would wrestle with his strong, sweaty little body and try to get him to suck, to stimulate the milk he wanted so much… and I’d sit there, heart bursting with love for these two precious people, unable to do anything, no role to play, trying not to cry, which would only be distracting and upsetting to Maria. It is the hardest thing I’ve ever had to do.
Because of that experience, the happiest sound in the whole world is the contented little gulps DS makes when he nurses now.
|“[I]t was a very weird experience.
For one thing, there was a vaginal birth going on in the room next to me. I could hear them all yelling “PUSH PUSH PUSH” and the woman was really screaming, and even so, I kept thinking enviously, “She’s going through that, and I’m not.”
They got the baby out very quickly, in just three or four minutes. But for some reason, my arms were shaking uncontrollably, so I couldn’t hold him immediately. My husband did, and that was nice. But I’d had this whole image of giving birth to the baby and holding him immediately.
I feel almost like a failure, because I couldn’t deliver this baby myself. I know rationally that’s silly. I know that if this had been a hundred years ago, the baby probably would have died unless he’d been lucky enough to get himself untangled. Yet, I still have a nagging sense that if I’d done something differently, I could have had this baby the regular way. And when I hear other women describe the pushing stage, I feel like I missed something because I didn’t go through that. I know it’s crazy, But I feel like I didn’t quite *do* it.”
|For many women, one of the most difficult parts of cesarean birth is the lack of bonding time with their newborn. Many women worry deeply about the newborn while separated because they usually cannot physically see and touch the baby for some time. Many also deeply grieve that while they should have been the first to hold their babies, they were actually among the last to snuggle their baby; that virtually every staff member and family member got to hold and know their baby intimately before they did. This is a deep and very primal loss, and should not be underestimated by others. Biologically and emotionally, women are strongly programmed to interact with their children right after birth, to make sure baby is all right, and to cement their prenatal bond in a new and special way. Losing this period after birth is a deep emotional wound, one which is difficult to heal. Bonding can of course take place later, but that doesn't replace the precious time right after birth that can never be restored.
Many women who have experienced a difficult birth report afterwards that hearing about other women's births is very hard for them. It's very common to feel envy, anger, sadness, or depression. All the old feelings about your own birth experience may resurface again too. Even when you have done a great deal of work processing your feelings, it's still not unusual to be broadsided by the intensity of your feelings about someone else's birth story.
Many women experience the opposite problem-------becoming upset by other women's good birth experiences. If your own birth experience was long, painful, and traumatic, it can be very hard to listen to the experience of someone who gave birth in two hours and found labor to be 'no big deal.' It's often especially difficult for women who experienced problems from interventions like epidurals or inductions to listen to the stories of women who chose these interventions without thought and sailed through without problems. It's hard to hear someone else rave about how fabulous their epidural was when complications from your own epidural is what led to your cesarean.
Finding it difficult to listen to other women's easy birth experiences is only human. It's certainly not that we want our neighbor or our sister-in-law to have a difficult birth---of course we don't wish them any ill! But it's hard when the thing we want most, some women have so easily and treat so carelessly. And to add insult to injury, these are often the very women who find it so difficult to empathize with our feelings, as they cannot seem to understand how traumatic birth can be sometimes. Although we don't actively wish ill will on anyone else, it is only natural to want for other people to truly understand our pain and what we have gone through. When they can't or won't, it's only natural to feel isolated, sad, and burdened by our feelings.
from Emotional Recovery From A Cesarean
|It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person.
For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.
Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD [Post Traumatic Stress Disorder] which include a very complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors. They include:
* Lengthy labour or short and very painful labour
* Poor pain relief
* Feelings of loss of control
* High levels of medical intervention
* Traumatic or emergency deliveries, e.g. emergency caesarean section
* Impersonal treatment or problems with the staff attitudes
* Not being listened to
* Lack of information or explanation
* Lack of privacy and dignity
* Fear for baby's safety
* Baby’s stay in SCBU/NICU
* Poor postnatal care
* Previous trauma (for example, in childhood, with a previous birth or domestic violence)
In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support. […]
It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as childbirth can be traumatising but it has been clear for many years that women can suffer extreme psychological distress as a consequence of their childbirth experience for a complex variety of reasons which are frequently related to the nature of delivery. Unfortunately, the difference between the common perception of childbirth and some women’s experience of it means that women who suffer Post Natal PTSD symptoms frequently find themselves very isolated and detached from other mothers. They also find themselves without a voice in a society which fails to understand the psychology of childbirth and which therefore expects mothers to get over their birth experience very quickly.
Consequently, women affected by Postnatal PTSD often find that there is nowhere to turn for support because even other mothers, who have not had traumatising births, can find it hard to understand how affecting a bad birth can be. This can make sufferers lonely and depressed as they often feel they are somehow ‘weaker’ than other women because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’. They may feel incredibly guilty as a result.
from Birth Trauma Association
|There is great understanding for a man who is unable to get an erection or ejaculate; most people understand that this is part of his total identity as a male. There is support for feelings of inadequacy, frustration, failure, sadness, and guilt. But there is very little understanding for cesarean women who have feelings of disappointment, sadness, failure, and frustration at not being able to complete the normal womanly physiological process of giving birth. For many women, being pregnant and giving birth are intricately linked to feelings of self-worth and identity.
from Silent Knife by Nancy Wainer Cohen & Lois J. Estner
|You Should Be Grateful - by Gretchen Humphries
You should be grateful, after all, you have a healthy baby.
How many times have we heard those words? How many times have we said them? It seems so obvious, you wanted a child and now you have a healthy child. You are alive to enjoy that child. You should be grateful. Right?
That phrase (or the similar, "All that matters is a healthy baby") did more damage to me than anything else said to me after my cesarean section. Because on the face of it, it seems so true. My husband and I had struggled with infertility for several years. My pregnancy came after at least 2 miscarriages and drugs to make me ovulate and then to maintain the pregnancy. I had beautiful twin boys. Why was I so upset? Wasn't I grateful? They were apparently healthy and so was I, if you discount the physical devastation of major abdominal surgery on top of the exhaustion taking care of newborn twins brings with it. My recovery was, after all, uncomplicated by medical standards. Physically, I was healing well. Wasn't I grateful?
So many people said it to me, I started to wonder. People I trusted, people I respected, people I loved. Women that had cesarean sections for their children and trumped the advantages of it. Maybe I wasn't grateful for my babies? Maybe I didn't love my babies as much as I should or as much as other mothers did? Maybe I was being selfish and petty to be so upset about the birth and not blissfully happy with my babies---after all, other women seemed to "get over it" so quickly---so quickly in fact that I had to wonder if I was really crazy to think there was anything to "get over." What was the big deal?
Part of the problem was that I actually didn't feel overwhelmingly grateful, nor did I feel overwhelmed with love for my boys. I knew that if anyone threatened them in any way that I'd do anything to protect them. I'd already proven that in negotiating a less traumatic cesarean than they would have normally experienced. I could protect my children but I didn't feel a lot about them. I was depressed. So for several months I wasn't feeling much of anything. It wasn't hard to believe that I wasn't grateful enough, that I didn't love them like I should. But I still had to wonder, even as the depression lifted, why hadn't I 'gotten over it?' What was wrong with me?
Then I began to realize how evil it is to tell a woman who's experienced a physically or emotionally traumatic birth that she should be grateful because when you say that, she hears that she isn't grateful enough for the precious baby she's been given. And that cuts to the quick. She may already be wondering what was wrong with her that she couldn't have a normal birth and now you've told her that she doesn't love her child enough. It is evil to say, "All that matters is a healthy baby," because you are saying that her pain, her damage, doesn't matter. You are telling her that not only is her body broken, but so is her mind. That if she is physically healthy, that's all that matters, and to be concerned with anything else is somehow wrong. That the means to the end doesn't matter, she is expendable.
The truth is a woman can be absolutely grateful and full of passionate mother love for her child and be enraged by how that child came into the world. Hating the birth, hating what happened in that cold impersonal operating room or delivery room has nothing to do with the child. It is possible to be both full of rage and full of love. When that rage is turned inward, a woman is depressed, and likely to believe you when she hears you tell her she's ungrateful and unloving toward her child. And if that rage turns back outward, it will spill over to you, because you told her a lie and she believed it because she trusted you. If that rage stays hidden, it will fester, and eventually there will be a place in that woman's heart where she no longer goes, because it just hurts too much and makes no sense. Good mothers just don't have those feelings, and she's already afraid she isn't a good enough mother. And so she loses something precious, and so do we all.
I discovered that there are a lot of women out there who hated the birth of their child; women who had bad surgeries, women who had good surgeries, rarely women who had necessary surgeries, women who didn't have surgery at all but did have horrible things done to them in the name of birth. I'm not the only one. There is a vast hidden ocean of pain in women who've had horrible births but do love their babies and continue to wonder, "What is wrong with me? If I just loved my baby enough, I wouldn't feel this way."
I was freed by the knowledge that there is nothing wrong with me! I underwent the surgical removal of my children from my body---a procedure that has nothing to do with birth, that completely circumvents what my woman's body is made to do. If it felt like an assault, then it was an assault, a very sexual assault. And if I'm not upset about being assaulted, then there really is something wrong with me. And that nothing that was done to me has the power to keep me from loving my children with passionate mother love.
I am grateful, grateful beyond words for the blessing of my children. They are miracles. The day they were taken out of me was one of the worst days of my life. Yet I am grateful for them, though not for what was done to me. My physical body might have recovered well enough to be called 'healthy' but my spirit was deeply wounded and then neglected. I was not healthy. I know my children suffered because of that. I have a lot to be grateful for but not for their birth, never for their birth. Understanding and accepting that makes me truly healthy. Admitting the horror of their birth frames the love I have for them in a way that astonishes me----amazed at what I went through because of my love for them, I now know I really would die for them if needed.
Now, when you tell me that I should be grateful, I realize that you are showing me how frightened you are. That you are afraid to look at my pain. That you are afraid to admit that maybe I have good reason to be angry, that maybe women are truly assaulted in the name of birth. You are telling me that it's okay for women to have birth ripped from them, that it isn't acceptable to look for a better way or to mourn what was lost. I know you now. You may not know yourself, but I do. And I pity you.
....I'm glad you survived to tell the story! Your baby is just beautiful and so are you. Many thanks for opening your heart and sharing that with the world.
Maybe I was just projecting, but if someone had asked me to articulate the baby's thoughts at that moment, I would have said, "Help me, mama. I'm scared and I don't feel good."
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