Sunday, April 25, 2010

Birth Trauma Round Up

I've been meaning to get around to this for awhile. Each day when I read news articles and blogs, I'll bookmark it if its something I want to come back to or if I have something to say about it, or agree its important and needs to be said again and again until the right people listen. Generally, the articles that stand out to me are on the topic of birth trauma. So here is an anthology of birth trauma related articles over the past few months. On analogies: Keyboard Revolutionary: An Interesting Parallel
So what does it mean when another wielder of authority says, "Do what I say or your baby will die"? Are they looking out for your best interest....or are they a bully, a rapist, an abuser, deliberately playing on your unignorable instinct to protect the ones you love in order to get what they want from you?
And when its seen like this, how obvious is it that a mother can come away from her birth experience with PTSD?

Raising My Boychick: Just Like Athletics: Exploring a Childbirth Analogy
Rather than coerce with stick or carrot, what we do in athletics (again, thinking especially of charity racing; a particularly apt comparison to birth as it is physical effort that benefits another) is cheer, support, encourage, commiserate. No one stands at the sidelines of a charity marathon yelling “give up! it’s not worth it! stop trying to be a martyr! you’re not going to win a medal!” Nobody whispers in their ear when they’re doubting, “take these drugs [that will actually make running harder], let us drive you to the finish [we'll tie you behind the car], finish in five minutes or we’ll whisk you away for surgery [for a torn ligament you don't actually have].” No one tells an athlete she can only have a “trial” of running if she has no food or drink, if she’s hooked up to machines that purport to measure how hard her muscles are working, that take her blood pressure and heart rate and temperature and send it all to the medics’ station and meanwhile are hindering her movement and reminding her she’s on a clock and she’s not running fast enough (or running too fast and they’ll “have to” stop her “for her own good”.
The analogy works well. What would happen if hospital birth attendants had this analogy called to their attention? It seems so simple, yet a strong paradigm shift is engendered in it.

On feminist activism:
Courtroom Mama: Feminism Behind the Veil
[How many women] suddenly realized that grown-ass people in a medical office were calling them “mommy” and telling them what to do as though they themselves were children. And the fact is, for a number of women of relative privilege (cis-gendered, heterosexual, middle-class, etc.), the journey into motherhood might very well be the first point of friction with patriarchy. Many of us lucky enough to not feel the weight of oppression can manage to skate by with just our carryon baggage, but add a pregnancy or a child to the mix, and suddenly you’re “actually” a woman, or rather “just” a woman.
Fertile Feminism: Mainstream Feminism and Motherhood
That’s why I’m so pleased to have discovered all the feminist mother blogs that have been springing up recently, and why I want to work with feminist mothers to help bring your voices and battles and mainstream feminism together. It’s been all too easy for childless feminists to ignore motherhood, and it really, really shouldn’t be. We need to listen, learn and become allies to mothers by not only centring your voices but using our own to advocate for mothers everywhere.
The previous two articles both discuss how stereotypical feminists (or rather the dominant cultural idea of feminism) doesn't understand the issues facing mothers in dealing with injustice in maternity care. It now appears that some "majority" feminists are becoming aware of what us feminists in the minority are facing. Like Courtroom Mama, my first run-in with patriarchy may very well have been in my first birth experience and it certainly played a large part in coming to self-identify as feminist. I too felt, before birth trauma, that feminist history afforded me a "post-feminist" spot in my world.

On cruelty:
Henci Goer: Still Cruel Maternity Wards
We have a culture of impunity in maternity wards. Once pregnant, a woman effectively cedes her right to autonomy and bodily integrity to obstetric staff who sometimes—on grounds of fetal welfare, self-protection from malpractice suits, or mere convenience—manipulate women into compliance in ways that would be considered fraud in any other venue. Without fear of being called to account for it, they can bully, coerce, humiliate, and threaten. And, yes, they can physically mistreat or even sexually assault them
It is this that needs to be exposed. In her article, Henci links to recent news stories that highlight some of these abuses. Its starting to be uncovered but it still seems to far-fetched so far from the norm, but then what is normal seems irrelevant because of its normalcy. It seems the media has not just captured the sameness of these outrageous cases with the outrageousness of the "normal" cases. The whole history of hospital birthing has been this way and its just sick.

The Unnecesarean: Women Have Right to Complain about Mistreatment During Birth
I really believe that someday, our daughters or granddaughters will be amazed that any woman was ever arrested for refusing a c/section, or operated on against her will, or prevented from moving or eating or making noise while she labored to birth her baby. They’ll regard much of what is still considered normal today as cruel, and uninformed, and backwards. And they’ll be right. But only if we keep refusing to be silenced.
It exactly this that I could not and would not believe before I contemplated becoming mother. It seemed so blatantly wrong that it seemed impossible that it could be indicative of systematic injustice. It really did feel like just being pregnant and giving birth that I was going into a dark and dirty underground system. ACOG has been labeled a cartel and for good reason.

Amy Romano @ Science and Sensibility: Patient safety, disciplinary action, and the marginalization of midwives
But whether disciplinary action is against midwives or physicians, is punishment the best way to deal with breaches in patient safety?
When this question is posed to someone who has experienced birth rape, the answer is: They have to held accountable somehow. If its not through a hefty check from their administrators, then it needs to be some censuring from their superiors. If not that, then it needs to be criminal charges. When a woman is feeling like her OB or midwife is entering her body with the same force and skillful manipulation of a rapist, yes, the provider must be held accountable. RH REality Check: The Cure for An Ailing Maternity Care System
The idea that maternity care should be evidence-based, safe, and efficient seems like a no-brainer but one key goal to note is how these imperatives lay the groundwork to minimize “overuse, underuse, and misuse of care practices and services.” We need to make sure we’re providing optimal care to all women by guaranteeing women are able to access the services they need if they need them. However (this is a big one), let’s also start from a place of understanding that pregnancy is a healthy state of being – not an inherently sick state – and so let’s also minimize the amount of unnecessary interventions that now drive up costs and place women and newborns at risk for poorer health outcomes.
It must be said: the "overuse, underuse and misuse of care practices and services" are causing trauma to new mothers, rendering it exponentially more difficult to care for their babies in their early years. Its not yet known what sort of long term effects can be had from a traumatized mother in early life, but there are studies that show that children of depressed mothers are more likely to experience depression, children whose parents experienced PTSD are more likely to experience PTSD after a potentially traumatic event. Are our children being hardwired to face life's challenges with disorder? Its not just about health care costs, its about a mother's sense of confidence in her ability to care for her children. Its about the baby's sense of being cared for and loved. Michel Odent equates these early unnecessary challenges to a threat to humankind. He even poses the question "Can humanity survive?"

Its starting to sound pretty melodramatic and that's exactly what I would have labelled it before my experience, and before I learned that I was not alone. I find its a coping mechanism to write in this manner and that I cannot be objective and unemotional when I read the stories of birth trauma at Solace for Mothers and the MDC birth trauma board. Some of it seems so fundamentally, viscerally wrong that I struggle to articulate how and why it is so wrong. So instead, I try, though my blog to illustrate, highlight and show case examples so it can become clear to others without my feeble attempts to spell it out.

Monday, April 12, 2010

Healthy Home Checklist

Environmental Working Group has put together a checklist for removing from our homes environmental contaminants such as BPA to flame retardants, mercury to phthalates.

For a preview, the checklist for the kitchen looks like this:
It then has sections for Bathroom, Laundry and Cleaning Closet, and All Around the House.

Like all things, its a process to undertake to get known contaminants that pose mounting threats to our long-term health and well-being. Its daunting and can contribute to panic and fear. I have to remind myself that a little at a time is going to have to be good enough. One area at a time, one thing at a time. Little by little, I'll get to where I want to be. I remind myself that a few months ago, I didn't know about all these hidden dangers. If I could be content in my ignorance, I can be Zen in my awareness.

To learn more about why these efforts matter, visit the Environmental Working Group's website or, I recommend, Having Faith: An Ecologist Guide to Motherhood which chronicles, in a flowing narrative, the presence and effects of biocontamiiants on the most vulnerable in our worlds: our babies.

Tuesday, April 6, 2010

Vitriol Over Breastfeeding Research

The recent study from the Journal Pediatrics is getting a lot of coverage. In response there have also been a lot of public comment on it. Feminist Breeder summarizes the vitriol that is being expressed in response to it.

Most breastfeeding advocates, and moms who don't advocate but breastfeed happily or even ever comment on the good side of breastfeeding has heard the defensiveness that is sparked immediately from a mother who has used formula with her baby for whatever reason. (Can you tell that I have?)

A friend recently described what this is like to be on the receiving end of the defensiveness, and since she captured it so well, I'll link to her it (hope you don't mind Aimee!). Though she was talking about fertility, its very similar to discussions regarding breastfeeding and formula usage.

When speaking about breastfeeding or giving encouragement or advice to help someone continue breastfeeding, it is not condemning those who do not, yet it it stating what is factual: breastfeeding is better. Its the norm. It is right in the vast majority of circumstances. Stating fact is not a reflection on a person. Defensiveness is not necessary. There is compassion for those who struggle or regret or do not regret and feel comfort in knowing it was the right decision for their family, or who have "the serenity to accept the things [they] cannot change."

For whatever reason that is faced that leads a mother to supplement or to turn entirely to formula, the fact does not change that breastfeeding would be better. Its not said to make anyone feel guilty. Like a quote shared by a friend, "Ideals are stars to be guided by not sticks to beat ourselves with."

When breastfeeders are saying these facts, we are not disrespecting you. We are not dismissing your experiences. To quote Aimee from above:
I just ask for the same respect. I invite you to share with me your struggles and feelings about trials you have to endure. We can build understanding even through our differing challenges and being dismissive of each other's circumstances will only erect barriers between us.
But beyond all that, there is more to the issue. For many women it is not about choices, but its about making the best out of the circumstances they are faced with. On the Feminist Breeder's post, I responded in support of Shannon Drury, a member of the Mothers & Caregivers Rights’ Committee of National NOW, who said this:
They pretended to care about why more women don’t breastfeed, but they never mentioned the totally [expletive removed] obvious: THIS COUNTRY LACKS THE POLITICAL WILL TO ENACT FEDERALLY MANDATED MATERNITY LEAVE. Forget pumping stations. Forget “some women just can’t,” which as you pointed out is crap. GET ON THE STREETS AND DEMAND MATERNITY LEAVE FOR EVERYONE. Everyone. Everyone. Everyone.
I added to her comments by saying, what I discovered when studying family policy in my master's program. I'm sharing here what I posted there highlighting the policies I feel are necessary to provide the level of social support needed to acheive a 90% exclusive to 6 months breastfeeding rate:

"Beyond choice, and physical difficulties is the need for public policies that are designed to respect a woman’s ability to breastfeed and care for her baby exclusively. Paid, extended maternity leave is necessary to establish the breastfeeding relationship. At home subsidies for stay a home mothers would also be appropriate here (Sweden is essentially doing this for up to 1 year). After that requiring employers to allow mothers to pump milk at work and NOT making them clock out to do so, providing on site childcare, and flextime/telecommuting options are important steps in maintaining the breastfeeding relationship beyond 6 months. Insurance paid for lactation consultants, public health campaigns on the ease of increasing milk supply via oatmeal and herbal tea, expanding the WIC give-aways of breastpumps are all ways to assist mothers in having success breastfeeding.

I’m sick of the partisan politics that maintain that parents are expected to “pull themselves up by their boot straps” and “do the best they can with what they’ve been given” and “suck it up.” That does not a healthy nation make. Charity, benevolence, compassion and kindness need a more central part in our public discourse."

Two weeks of Facebook updates

March 15:
* successfully replicated Mimi's corn chowder without a recipe! Peter is so proud, especially since he didn't think he liked corn chowder.

March 16:
* Willem has decided that he wants to let his pink eye "heal on its own and not use medicine" instead of letting me put the antibiotic drops in his eyes. The drawback is that he will not be attending preschool until it resolves. Its a valid choice and one that I believe he is capable of making for himself, but I'm very surprised that he's sticking to it.

* couldn't go back to sleep after the baby woke because my mind is busy brainstorming areas of life that LDS women might be interested in advocating for. I know better than to wait when I have time to write my ideas; I'm writing them now so I don't forget.

* I was hoping to go back to sleep when I got home from yoga, but there's an awake baby...

March 17 (I hope you had a festive St. Patrick's Day!)
* is celebrating St. Patrick's Day with corned beef and cabbage and ceili dancing tonight! But before, I'm speaking live video streaming about The Birth Survey on Bellies To Booties Web TV at 2 pm Pacific.

March 18:
* thinks I had a cool, but not so good idea: use the pattern for my Ren dress to make a temple dress. White brocade skirt and vest over a white chemise, with white braided cording...March 19:

* laughed and laughed when I heard Willem say to Belle, "Leave my train station alone, you naughty kitten!"

March 20:
* won an ERGObaby organic baby carrier today, with backpack and front pack at the Healthy Kids and Green Parenting Fair!! I'm so excited!!!

March 21:
* totally scored a rain water collection barrel today because If there's a Water Shortage, Why Isn't Anybody Collecting Rain? Thanks to my neighbor for enabling me!

March 22:
* 's joy at health care reform is tempered by all the revisions that will be needed over time. Its a start, which is a relief, but there will be much more fighting. I'm kind of exhausted at the prospect.

March 24:
* wants some energy back. How about a nap today children?

* thinks its a travesty to pipe fake buttercream frosting on to a delicious cheesecake.

* if there's such a thing as cabbage chowder, I made it tonight. And then put it in a breadbowl.

March 26:

* is struggling to write my personal experiences into an article on childbirth.

*is listening to Peter tell me about travel warnings throughout the world and I misheard "terrorist concerns in India." I heard "terrorist insurance." Now that would a lucrative business... They would pay your ransom, extricate you from the hostage situation and pay any medical or therapy bills.

March 27:
has a baby that WILL NOT cuddle to sleep in bed with me. She spent an hour rolling around in the dark and only settled down to sleep when I put her in her bed, covered her with a blanket and walked away. Not cool, little girl.

March 28:
Belle climbed up on a box and now can't figure out the way down. Good for her that she's still trying.

* and the sickness goes on. Willem has a fever and has spent the day cuddled under blankets sleeping on Peter.

March 29:
And thus begins Belle's 10th month of life outside the womb. Let the toddling commence.

* Willem just pointed to the plushie for Gonorrhea and just said "I want to see that S T B."

March 30:

* Carla Hartley is tempting me again. Her offers for enrolling in AAMI (Ancient Arts Midwifery Institute) are always so very appealing...

First half of the day: I was pleased to find that "children are a joy and blessing" applied to the happiness in our home. Second half of the day: I had to remind myself that "children are a joy and a blessing."

March 31:
was taken on a hike by her 10 month old. Who knew a 10 month would actually hike? The Cascade mountains are beautiful and I'm so glad that Peter was willing to take a day away from studying to spend time with the family in nature.

April 1:

is CRANKY today. Any ideas to help a mama chill out?

April 2:
* had a reminder that trauma resurfaces unexpedectly and can suck you back into it. Given that its 2 am now, I don't think I'll be waking up in 4 hours to go to my early morning yoga class. When you see my blog post, you'll know what I'm talking about.

* loves seeing the simple joy that comes from playing with a box. Belle's new carseat came yesterday and Willem now gets what boxes are all about. We got a big package when he was Belle's age and he did not understand why we put him in the box at all. Belle gets it though because she sees her brother playing in it. They ...turned it into a slide until it became too squished for that.

April 3 (General Conference of the Church of Jesus Christ of Latter-day Saints):

has been appreciating the words spoken at General Conference this morning. I especially like the promptings I've gotten from what i've heard. What did you think of the quote from Eliza R Snow that Julie Beck used?

Me to Belle: "You are such a silly child." Willem to me: "You are just a silly mama."

April 4:
is watching Emma: Her Story on BYU TV (internet streaming) right now. I'm excited to see it. The first few minutes are boding well.

is making bone broth for the first time tonight. Out of the bones from the lamb rack we had for Easter dinner. We'll see how it turns out.

April 5:
For some reason I do not understand, Willem is calling all soldiers and knights "Lamanites" today.

Quote from Willem: "Do not kill me before you ask my permission!"

* And another "Lightning (McQueen) has blue eyes like Belle!"

Quotes from Famous People:

"Her baby constitutes for her a powerful symbol of her motherhood, her individuality, her new family, the beauty and wonder of nature, and the perfection of her own body and her procreative powers." Robbie Davis Floyd

"It is intriguing this [those born between 1935-1975 who were separated from their mothers after birth for several hours or even days] is the age group that has experienced spiralling divorce rates, increased incidence of child abuse, and greater extent of familial alienation than that seen in previous generations, and... the temptation to associate this with US birth practices is hard to resist." Wenda Trevathan

We do not ask you to give up any good you have, but we invite you to come and get more." Joseph Smith in talking about the gospel of Jesus Christ

Links to Articles:
Obama's Out of Control Health Care Costs (my comment: Peter and I had a good conversation about this article today. "Obama's Out of Control Health Care Costs" because we can all see this happening: The federal gov't promises to pay all health care costs, and doctors then jack up their prices just because they can. Regulating health care costs is essential to health care reform.)
You Probably Are A Feminist
Top 5 Myths About Having a Homebirth
Path to Freedom: the Original Urban Homestead
Family and Home Network (a new volunteer organization I'm excited to work with)
Calling for Integrative Medicine to be Written into Health Care Reform
Women are Saving the World Now: a new advocacy organization that featured Rikki Lake for BOBB
The Onion: Increasing Number of Parents Opting to Have Children School-Homed
Woman Catches Baby During Own Cesarean Section
Fertile Feminism: Mainstream Feminism and Motherhood
Breastfeeding Saves Money and Saves Lives: Analysis Says
Citizen Commentary on Health Care Reform: Written by my husband's mission president

Links to Products (in the crunchy vein):
Selling My Fuzzi Bunz Perfect Size Stash
Baby had a shocking deal on Ergo's on the 25th
Chemical of Concerns in Car Seats: Healthy Stuff's Ratings for 2009
Organic Cotton Mattress Toppers
The Femivore's Dilemma (article links to the book Radical Homemakers)

Links to Advocacy Opportunities:
Make Animal Abuse a Felony
Take Action: Tell the EPA to Protect Americans from Dioxin
Requesting Greater Transparency in Health Care: soliticed by Health and Human Services
Play an Online Game and Give Rice
Petition to ACOG: Increase Women's Access to VBAC
Switch to Kijiji to Protest Human Trafficking on Craigslist

Monday, April 5, 2010

What Trauma Looks Like

Warning: this post will be triggering for birth trauma survivors

When watching this video, I was reminded of the pictures taken of me holding my babies for the first time after their births. They are starkly different. I've pondered over the differences before and now that I've seen this video, I feel like posting the photos to illustrate to others what trauma looks like.

After a traumatic birth, described as birth rape:

The joy at meeting my baby comes through (and a sense of my victory over the system's efforts to control me), but look at that far away stare showing the disconnect between me and my baby. And do you see the timidity and the reservation with which I'm holding my baby boy? And how the smile doesn't make it to my eyes?

When my son looks at pictures from his birth, this is what he is going to see. I hope he never questions because of these pictures, "Why is my mama sad? Did she want me? Does she love me? Is she mad at me because of how I was born?"

And then compare, to this:

From this, and another example from a friend's blog, I see that birth experience matters. Not to the mom's hedonistic desire for self-satisfaction, but to the baby that the mother greets. I feel my babies deserve to be greeted by a mother who feels victorious, respected, capable and empowered; not one who has been victimized, disrespected, dehumanized and demeaned.

Friday, April 2, 2010

Not Letting it Happen to You Can Lead to PTSD

The blogger at Nursing Birth posted last year a series called "Don't Let This Happen to You: The Injustice in Maternity Care Series" and in one of the posts, she described a phenomenon that I had never heard about, but recognized it immediately as what was attempted on me when I was pregnant with Willem.

In my prequel, I described how at 37 weeks 6 days, contractions started at 11 pm. At 11 am the next day, I was 3 cm dilated having contractions every 6-15 minutes. The midwife at a prenatal appointment that day told me that I was in labor and should check in with Labor and Delivery to be admitted to the hospital. The midwife on call at Labor and Delivery called failed to progress and, after performing cervical exams every hour for 4 hours ,started advocating for pitocin/AROM augmentation as she called it. It was 9 pm, 3 to 3 1/2 centimeters dilated with contractions between 6-10 minutes apart.

In the prequel, I asked if this sounded like a phenomenon that you've heard of before. Do you know?

Nursing Birth taught me that this is called a backdoor induction and she defined it this way:
If a woman is 4cm dilated but is not having regular, noticeable, and painful contractions that are causing cervical change she is NOT in labor. If said woman is sent into the hospital and any interventions to stimulate contractions are started, then it is by definition considered an induction NOT an augmentation. And if said patient was not scheduled to be admitted on such day, then it is considered a backdoor induction. I knew it as soon as I read it. This is what happened to me. It is unethical and just as Nursing Birth calls it, an injustice perpetrated on a birthing woman.
Even at the time, I knew it was inappropriate for labor to be stimulated artificially and I refused. This is where my story and Nursing Birth's patient's story begins to differ. I did not go along with it with the recommendation for induction. If I had been more savvy to manipulative tactics such as this, I would have known to not trust the midwife who referred me to L&D. But then again, if I had been more savvy, I would have known that hospitals are not the appropriate place for low-risk mothers to give birth in the first place. Even then, we weren't understanding why the midwife would make the recommendation to check into the hospital obviously in early, non-progressing labor but in our excitement, we decided to trust her. To our detriment.

Because in my experience, I then learned what PTSD is like. I'm not faulting Nursing Birth for leaving the story off as she did, but I have something to add to it. If you fight the system, even if you win, which is not likely or common, you will still lose. You will lose a sense of being human, the feeling of being respected and treated like the person deserving of dignity that you are. Such dehumanization can have indelible impact on the psyche.

The converse is true, letting it happen to you, can lead to PTSD. But not knowing it is happening to you seems to be a protection. It appears to me that the mother, Jessica, in the story was unaware at the unsavory practice that she was being subjected to. So what is worse? Not knowing you've been victimized, or knowing the feeling of violation because you do know you've been victimized?


After I had begun to process my birth experience, I wrote an email to the referring midwife telling her the outcome from her recommendation. To my surprise, I received a conciliatory email in response.

After I learned the term backdoor induction, I was upset for a couple of days. I talked through it with my colleague from Solace for Mothers and felt better sharing the stress with someone else. Since, I've intended to blog about it, but I'm only finding myself able to do so after writing the prequel and being triggered by the previous article I wrote about.

Sharon with Solace for Mothers asked me the question, "What are you now going to do with that knowledge?" I answered that I would write a letter to the hospital saying I knew what they did and emphasize how distasteful and unethical the practice is. I have not done that yet, because I'm struggling to find the words to express how and why that is so wrong.

So, I'll ask my readers, after telling my story in a letter to the hospital and midwifery supervisor, how do I support my claim that practicing backdoor inductions is an unethical practice?

What Triggered the Prequel

My post from last night, The Prequel of my Traumatic Birth Experience, was prompted by a friend posting this article on facebook. Though it is reporting a study saying that that anxiety in pregnancy can predict developmental delays in the baby once born, my attention was drawn to this paragraph:
"Contrary to old beliefs, however, research shows that ordinary day-to-day job and home stress isn't likely to cause low birth weight or other problems for most women. Traffic delays, work deadlines and other everyday hassles aren't likely to pose a threat to unborn babies, researchers say, and pregnant women who feel they are coping well tend to do just fine."
I disagree with this statement based on my experience (copied from the prequel):
When I was in week 34 of my pregnancy, I was working part-time at a preschool (9am-1:00 pm each day). I had a commute and prep time before class started so I was waking up at 7 am. I'm not a morning person (if you ever notice when most of my blog entries are posted you'll know that I'm a night owl). I was constantly tired in my pregnancy. I'd get home from work and have to take a long nap each afternoon just so I could function the next day. One day, I had to rush away from work for a prenatal appointment, but that day had already been a struggle. I was fighting nausea the whole day (strange for the third trimester) and had thrown up 3 times, once as I was getting into the car to head to the appointment. Already feeling tired and sick, I encountered unexpected traffic which was making me late to the appointment. I generally get very stressed when I am late to something so the combination of being impatient, stressed sick and tired was not boding well for that appointment. I then parked rather far away from the clinic and had to walk (more like jog since I was worried about being so late).
I also remember there was a journal article that linked maternal employment in late pregnancy to increased blood pressure. The researchers of the study being discussed in The Wall Street Journal either were unaware of this study published in American Family Physician in 2001 (Increased Blood Pressure and Working in Late Pregnancy. American Family Physician Oct 2001), not considering increased blood pressure as a "problem" for women, or had reviewed the findings of that study and disagreed with its findings.

To me, my experience leads me to support the findings of the 2001 study. Even though, I was incorrectly diagnosed with pregnancy induced hypertension at that appointment, it is true that my blood pressure was elevated from my baseline (diastolic at 88 after that stressful day, but its 60 when not pregnant, and at 70 when pregnant).

Reading the Wall Street Journal report last night brought that all back. Even at the time, my husband and I ascribed my working, the stressful commute and the brisk walk to the increase in blood pressure. I still do not understand why the midwife was not willing to accept that as a possibility. We felt it was lunacy to then think that rechecking my blood pressure later in the appointment, AFTER diagnosing me with gestational diabetes, putting my on bed rest and leading me to believe I was experiencing PIH, was going to result in a lower blood pressure reading, because I had time to "relax" during the appointment!?!

That was precisely the time when I stopped feeling like I could enjoy my pregnancy. Up until that point, I had felt very excited and happy as the birth approached. After that appointment, that happiness was clouded by the specter of the dead baby and dead mother card, as well as an induction that I knew made a cesarean more likely, which increases the chances of complications and death. All of this then caused greater confusion in my mind because at the beginning of my pregnancy, I was given a priesthood blessing by my husband and adopted father in the gospel which told me that I would give birth and go through the pregnancy without complications. Given what my husband and I knew, we believed the blessing was still true because the midwife was mistaken in her diagnosis. But how to handle a situation with a maternity care provider where our version of reality didn't mesh with hers? It all added up to a great deal of stress in our minds and just paved the way for the trauma I experienced as a result.

I often think that if the birth experience had happened in isolation of the prior stress, I wouldn't have experienced PTSD to the degree that I had. As it is, I felt there was so much manipulation and lies that I knew I wasn't safe going into labor so my stress response to what was happening in the hospital was amplified.

The Prequel: My Traumatic Birth Experience

Although my birth story is often cited on my blog, I have never written out the prequel to the story. My traumatic birth didn't start in early labor, it actually started weeks before.

When I was in week 34 of my pregnancy, I was working part-time at a preschool (9am-1:00 pm each day). I had a commute and prep time before class started so I was waking up at 7 am. I'm not a morning person (if you ever notice when most of my blog entries are posted you'll know that I'm a night owl). I was constantly tired in my pregnancy. I'd get home from work and have to take a long nap each afternoon just so I could function the next day. One day, I had to rush away from work for a prenatal appointment, but that day had already been a struggle. I was fighting nausea the whole day (strange for the third trimester) and had thrown up 3 times, once as I was getting into the car to head to the appointment. Already feeling tired and sick, I encountered unexpected traffic which was making me late to the appointment. I generally get very stressed when I am late to something so the combination of being impatient, stressed sick and tired was not going well for that appointment. I then parked rather far away from the clinic and had to walk (more like jog since I was worried about being so late).

That sets the stage for what happened at the appointment. In typical technocratic style, once checked in, I was weighed, pee collected in a cup, blood pressure assessed. Would anyone like to guess what my blood pressure was after my previous hour?


The midwife comes in and goes over the results of the glucose intolerance test from the previous appointment. The values were higher than normal prompting a discussion regarding gestational diabetes.

As an aside, I knew the results were going to be skewed because I was unable to handle the glucola being the only nutrition in my body at the time. Rather than sweating it out since I felt very close to passing out, I snacked on my ever handy blood sugar stabilizing snacks I carried around with me. The good news is that I didn't pass out on the way to the lab, the bad news is the false result on the test.

It already was not a good day to hear news like that, coupled with the way the midwife said it. She seemed very unaware to my stress level and was not sensitive to how concerned I was regarding the way in which she stated it and my frustration with her for not consenting to the 3 hour fasting test as a follow-up. If I had had such a negative reaction to the 1 hour test, having eaten lunch just before that appointment, how in the world would I cope with a overnight, drink the glucola on an empty stomach after waking up even earlier than usual and then waiting 3 hours test?

So after that conversation, the midwife plunged right into, "...and your blood pressure measurement from earlier indicated that you have pregnancy induced hypertension." If you have a copy of William's Obstetrics handy, or any other prenatal care textbook nearby, you'll find that the minimum criteria for a diagnosis of PIH is a diastolic value of over 90. In the same paragraph in William's it states that some practitioners like to make the diagnosis when a woman's diastolic is elevated 15 points above her baseline, which would have been true in my case, but if one were to continue reading, one would see that William's states that is not a recommended procedure for diagnosis.

I was visibly upset by this time at the appointment and receiving no assurances, compassion or comfort from the midwife who was speaking to me. I called my husband and in tears told him what was happening. He at the time had been having a conversation with his advisor and when he heard my husband say, after looking at his phone, "Oh. Its a number from the medical center. It must be Jenne probably calling from her prenatal appointment right now," said, "That means something is wrong. Go. Now."

He ran over to the clinic (on campus) and we sat down with the midwife. My husband was surprised at how the midwife was handling the situation because based on what she was telling him, he didn't see that she was making a reasonable assessment. She counseled that I go on immediate bedrest and cut salt out of my diet entirely. Although we were not entirely trusting her judgement, we decided that bedrest was better safe than sorry. We spent the next week trying to get a better sense of the risks of PIH (by this time they had dropped the concern of GD) and we couldn't get a better sense of their concerns based on the information they had given us. We consulted with a number of the midwives and nurse's assistants on staff and we basically got, "PIH can lead to preeclampsia and preeclampsia can mean that the baby dies and the mother can stroke out and die."

We did our own homework and read up on what we were being told, and it didn't add up. I still stayed on bed rest and attended the non-stress test appointments that were scheduled twice weekly. But we knew that what was happening was not as serious as they made it out to be.

A couple of weeks later, at an appointment with another midwife in the practice, I was told, "In all my 20 years of being midwife, I've never see a woman with blood pressure like yours go into labor on her own without being induced." Not only does that say something about her practice style, it also says something about her knowledge.

Up until this point, in my prenatal care, I had tried on a number of occasions to discuss with the midwives policies relating to the birth. Each time I had been told that we would discuss it later. I had never had a satisfactory discussion about my desire to have an unmedicated birth using Hypnobirthing. The midwives did not seem interested in discussing it.

Now at this appointment where I'm being told, they'll basically pressure me into an induction whether I like it or not or whether its indicated or not, I felt like I needed to run away from that practice. But I was 35 weeks pregnant with my first baby, living in a big city that I wasn't familiar with having moved there less than 6 months before, and not very knowledgeable regarding birth options. I thought, if a midwifery practice is going to be this unpleasant to work with, how could working with an OB be any better? We considered and discussed transferring over care to the OBs in the practice, but I was scared of the medical mindset. I wanted midwifery care, but didn't know enough and felt that I didn't have even time to find out about out of hospital options.

So I stayed, like a domestic abuse victim in a violent, toxic relationship.

A friend volunteered to be my doula to help protect me from the unwanted advances of the hospital staff. Having made those arrangements, I told myself that I would hope for the best and pray that labor started on its own before the threat of induction became more real.

In week 37, after 3 weeks on bedrest, and having made it to "full-term" I asked my husband what the soonest time would be okay with his schedule as a first year graduate student for the baby to be born. He said that after Thursday Jan 25 all his tests would be done and that weekend would be an okay time.

Bedrest was, in some sense, a blessing. At the time I was enrolled in my M.Ed program and I had work to do. I spent the month of bedrest doing assignments and getting started on my thesis. It was helpful. But the drawbacks were also considerable. I felt myself getting weaker the longer I stayed inactive and immobile. I'm pretty sure the baby moved into an unfavorable position and further exacerbated the scoliosis in my spine. I started getting headaches and being dizzy, which just made the midwives want to say I told you so since those are indication of progressing preeclampsia, but its also a sign of weakness as a result of inactivity and a lack of salt in the diet. I believe these factors contributed to the long labor (38 hours) as well as the hours of back labor (17 hours worth). Add that to being a first time mom, going into labor earlier than it would have likely been otherwise at 38 weeks, its not surprising that I had a long early labor. It would have been very helpful to know of Ina May Gaskin's teachings for husbands and wives to; as she calls it, "cuddle and smooch" during labor.

We made it to that Thursday, and we decided that we would try out the strategy of starting labor via intercourse and what I've jokingly heard referred to as "prostaglandin application." And then we prayed. We prayed that labor would start and the baby would come, so that we would be protected from the providers that at this point we did not feel safe with. We then fell asleep and I was woken up 4 hours later by menstrual-like cramps coming every 15 minutes.

I let Peter sleep but I couldn't. I was so excited and so relieved that labor had started on its own. At six am, I couldn't keep my excitement to myself anymore and I woke Peter up. We talked, we were happy and we decided that it was just be stupid to go to the hospital at that point because we knew for sure that we were going to avoid going to the hospital too early. We then discussed if I should go to the scheduled non-stress test at 11 am. We decided to keep the appointment, if not to avoid the within 24 hour cancelation fee. But before, I wanted a big breakfast. So like a runner getting ready for a marathon, we went to IHOP and I throughly enjoyed my breakfast feeling exhilarated that not only had I thwarted the mid-witch, I was going to meet my baby.

At the appointment, we knew it was too early to go to the hospital, even though I had been contracting for close to 11 hours at that point (still 6-10, sometimes 15 minutes apart, easy to manage). The NST showed that I was having irregular contractions and my cervix was dilated 3 centimeters. We were surprised when the midwife at the clinic called up the Labor and Delivery and told us that we would be checking in. I thought it was still too early, but went with the recommendation.

Then we enter what I call the flight pattern period of my labor. Labor and Delivery said they were full, they could take me so I should go home. At home, I got a visit from my visiting teachers--they thought it was very strange that I was in labor and welcoming them over and how calm I was dealing with it, but it was early labor and it was easy to handle. After calling and checking with Labor and Delivery a couple of times, they were still busy. So I waited. All I wanted to do at that point was to go into my labor space and focus, turn inward--what I called at the time "holing-up." I couldn't do that at home knowing that I'd have to leave. (This is about the time that homebirth started sounding appealing but completely out of the question since it would have been completely unplanned). We went out to lunch, basically tried to distract ourselves and stay near by the house and the hospital in case we got the call saying we could come in.

At 4 pm, we were finally able to get into Labor and Delivery. No progress. Contractions still 6-10 minutes apart. Hourly vaginal examines commence. We walk the halls of the hospital. At the gift shop, we find a mini set of bowling pins with a marble to "bowl" with. We buy it in celebration of the anniversary of the day we met three years to the day before at the bowling alley in the BYU student services center. Looking back, we should have just gone to the bowling alley and bowled through early labor.

At 9pm, 1/2 centimeter progress and the midwife starts talking options. She offers 1) send me home with an Ambien to sleep, 2) give me morphine, move me to another room in the hospital (not L&D) and make sure I'm sleeping or 3) pitocin augmentation and breaking water.

Is this starting to sound like a phenomenon that you've heard of before?

As I sat on a birth bath and handle contractions as they come, we refused, refused, refused. My husband tried to talk to them but they refuse to talk with anyone other than me. We countered with, sure, its reasonable to clear the LDR room for another mother in labor, but we'd refuse the morphine and go to another room to let labor progress on its own. Its surprising how hostile the midwife was to that. The room was only offered if I accepted medicinal sedation. At the time, that felt so dehumanizing. Like I was being viewed as a dying horse that needed to be take out back and shot to be put out of its misery. Or that she wanted to make me the hospital's prisoner, but instead of using shackles, she was going to use drugs (hello, 24's use of medical torture?) An OB was called in and we were told, "You have no more options. Its time for you to leave. Get out."

As we pack up and get ready to leave, we look for a nurse, or a midwife or the receptionist at the check-in test to find out when they would like us to call back or at what point to return, and there's no one around. So we leave, feeling neglected and confused.

Go figure, that once at home, labor picks up pretty quickly and intensely. I started having a hard time finding a comfortable position. I could lay down comfortably and I had been upright for so long that my legs were tired. I started having back labor and it was difficult to support myself on the birth ball. My husband and doula tried to get some sleep. They gave up pretty quickly and then helped me into the bathtub. The water was too shallow, and not hot enough, the tub walls hard and uncomfortable. So I lay hurting, cold and shivering. I start to get frustrated and despondent. I call L&D and I'm told that I can come back in and get checked for progress but I might be turned away again. I'm gun-shy at this point and I'm too afraid to go back in, too upset with the insensitive way I was treated earlier, knowing that the same midwife would still be on the shift. I found that she was going to get off shift at 8 am, so I became determined to stick it out.

We get to the hospital at 8am and she's still there. She does the triage exam which I've blocked from my memory. All I remember from that is spots of blood on the floor of the triage room that did not belong to me.

That's a good point to stop and refer you to birth story that I wrote soon after Willem was born, and have edited slightly since then.

In the next few days, I'll post regarding some insights I've learned since experiencing this.