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?

1 comment:

Anonymous said...

Backdoor inductions are unethical because they are dishonest and invasive to mothers, often resulting complications and the need for further augmentation, and even cesarean. This goes against the Hippocratic Oath as well as the principal precept of non-maleficence. If a mother is not in true labor, and is not experiencing any threatening circumstances, then it is unethical to lead her to believe that she needs to be induced.

I think women will need to become informed and will need to start filing class action law suits against hospitals for the systemic violations of rights in order to stimulate the massive overhauls needed to fix our maternity systems.