When a bad birth haunts you - Sunday World June 14, 2009

[AIMSI Admin]

Sunday World's parenting supplement,
Zero to Seven
Publication Date: June 14th,2009
(reproduced with permission)

WHEN A BAD BIRTH HAUNTS YOU

HOW did you plan the birth of your baby? How do you feel about it now that you have your healthy baby in your arms? And just how many people have said to you ‘well as long as the baby is healthy, isn’t that all that matters’?

By BETH TYRRELL.

THE answer is, yes, the baby is the most important thing in the world to a new mother. But what if the process of giving birth to her baby has left that mother so undermined, physically wounded, and deeply shocked that her natural ability to mother her child is weakened?

“We see women who are so traumatised by their experience of labour that they are divorced from motherhood,” says Krysia Lynch, spokesperson for the Association for Improvements in the Maternity Services in Ireland (AIMS Ireland.) This is a terrible situation for the baby, yet the mother’s trauma is more often than not caused by a medical system whose catch-cry is ‘it’s best for the baby.’

Women who want happy birth experiences are regularly accused of being naive and selfish, demanding their own pleasure at the expense of the baby’s safety. But in reality, the safety and comfort of the mother and of the baby go hand in hand.

Research shows that one in twenty new mothers is diagnosed with traumatic stress after childbirth, says natural childbirth campaigner Sheila Kitzinger in her book Birth Crisis. Kitzinger is one of the world’s leading authorities on childbirth, and she says that the western hospital system of turning childbirth into a medical event rather than a natural process has resulted in pregnant and labouring women having all control taken from them.

Meanwhile, most Irish hospitals have a strict policy on how many birth partners a labouring woman may have with her – most often she is allowed only one. For most women this one allowable birth companion will be the father of the child, meaning the labouring woman is without the support of an experienced sister, friend or professional birth companion.

It is this combined loss of control and lack of support that results in many new mothers being deeply shocked and upset or even traumatised. The loss of control is not some wishy-washy feeling that women have – it is a fact. If you feel upset that control was taken from you, this is a valid feeling and you are not alone. AIMS Ireland conducted a survey into whether labouring women in Ireland are asked to consent to procedures in pregnancy, labour and childbirth. In the vast majority of cases the answer is no, they aren’t.

*During the birth of the baby, only 33.3 per cent of women surveyed said that their consent was fully sought and given for procedures carried out on them. Interventions at this stage of birth are very invasive, including episiotomy (the cutting of the perineum) and introduction of a vacuum extractor or forceps – and according to this survey are carried out on the labouring woman largely without her consent.

*During labour only 38.4 per cent of women surveyed said that their consent was fully sought and given for interventions. Common interventions in this stage are routine internal examinations – in some hospitals these are carried out hourly on first time mothers; the breaking of the waters to ‘speed things up’, and the giving of drugs to speed up labour.

*More than half the surveyed women, 57.6 per cent, were not given the option to refuse a procedure, test, or treatment.

Lynch tells Zero to Seven: “Very often consent is assumed and the woman is not even informed what is to be done to her. The doctor will say ‘I’m just going to give you a little check,’ and before you can ask what that means there’s a hand up inside you. Or after an internal examination you’ll be told, ‘I just broke your waters for you while I was at it,’ or ‘I’ve given you a membrane sweep.’ All the time we hear from women who have been given an episiotomy without even knowing it was about to happen; the doctor mentions it as he is carrying out the procedure – ‘I’m just giving you a little snip now.’”

Niamh Healy of Cuidiú, the Irish Childbirth Trust, tells Zero to Seven: “Birth is still totally over-medicalised in Ireland, and because that is what women hear from their sisters and friends, that’s what they expect. If all your friends have complicated births with a whole cascade of interventions, it undermines your confidence in your ability to birth your baby.

“What women need is emotional support, not medical intervention. It is well documented that a woman who is confident, calm, comfortable and receiving good support, is more likely to labour safely and efficiently.”

Cuidiú has recently done a study of the satisfaction of new mothers with their maternity care. Healy says: “It is remarkable the difference between women who gave birth in midwife led units and those who gave birth in the hospital system. In midwifery care, women feel listened to, respected, and supported. An overwhelming number of women in maternity hospitals felt they were uncared for, that they were wasting the doctor’s time if they asked questions, and that when they did express their wishes they were often totally ignored.

“We’d love to get this message across to women: generally speaking you’ll be happier in a midwifery led unit.”

Lynch says: “Women are manipulated into compliance with the system by being accused of not caring for the safety of their babies if they refuse a procedure. But many times the procedure is being pushed for no better reason than it being hospital policy. The problem with hospital policy is that current clinical practice may be based on research that is forty years old. It needs to be updated.”

So we are told that every intervention, every speeding up, slowing down, and monitoring of our labours is for the safety of the baby. This isn’t a lie as such, because it is most likely what the doctor believes. But there are other considerations; the priority isn’t actually always the baby. It certainly isn’t always the mother. There is something far more important that must be served and protected as your baby is born: Hospital Policy.

Lynch explains: “Practically speaking, hospital policy tends to be more about the management of a huge institution than the care of the individual. The doctors and nurses have a tight schedule and must process the woman in a set amount of time”

This ‘clock-watched birth’ means that if a woman’s labour is not progressing as quickly as hospital policy dictates it should, she will be presented with an array of interventions designed to speed things up, and told she should accept them for the baby’s safety.

When a labouring woman is supported and allowed to take her own time the intensity of her contractions will build gradually and she is more likely to cope with the pain without needing drugs. When a labour is artificially speeded up the contractions can become very powerful very suddenly, leaving the woman with little option but to accept pain relief drugs. These in turn can lead to further interventions.

Healy tells Zero to Seven: “We hear stories from women: she was overdue so she was induced, and then needed an epidural. That slowed down the labour so she was given a drip. That distressed the baby so she had an emergency forceps delivery or a caesarean. The woman tells the story that the doctors saved her baby from a crisis situation. But the fact is that crisis could have been avoided.”

PANEL 1: GET HELP
Sheila Kitzinger describes the gradual process a woman goes through in coming to acknowledge that she has had a traumatic birth experience: “Immediately after birth they are stunned, relieved that an ordeal is over. They may even be euphoric and thank the obstetrician who, they are told, rescued the baby from disaster. But after a few weeks or months this is followed by inner turmoil, with flashbacks, nightmares and panic attacks. They put off getting pregnant again because they can’t face going through the same ordeal.”

If you feel like this, even if your emotions are not this extreme, you must get emotional support and healing for yourself, says Krysia Lynch. She says: “Many women get support on online communities such as EUmum or rollercoaster. It is very useful to talk to women with similar experiences. Homeopathy can help. You can call AIMS if you want; we have someone dedicated to listening to women’s birth experiences and supporting them. When you feel up to it, write a formal letter of complaint or request a meeting with the master of the hospital. These requests are usually taken very seriously and can help a woman cope and move on from her bad experience.”

PANEL 2: PLAN AHEAD
This is an article for women who have had bad birth experiences. If you are pregnant and reading this, be confident. Childbirth can be an amazingly positive experience, and not just for hippies and cranks – for all women.

*Educate yourself about your choices so you clearly know what you want. The AIMS survey showed that much information given by hospitals and doctors was heavily biased, so look elsewhere so that you have a balanced understanding. Make sure your birth partner understands your choices and why you have made them so that he or she can fully support you. Sheila Kitzinger’s book, Pregnancy and Childbirth, Choices and Challenges, gives very balanced information on the whole range of labour interventions and pain relief.

*Consider where you would like to give birth. Cuidiú has a Consumer Guide to Maternity Services which clearly explains the different kinds of maternity care available to women in Ireland. It also reveals statistics from each of the maternity hospitals, so you can see what the rates of certain procedures such as episiotomy are in each hospital. The rates are dramatically different in different hospitals. Go to www.cuidiu-ict.ie and click on ‘Consumer Guide’.

*Home Birth with an experienced independent midwife is a safe option for women who do not want to go through the hospital system and want to receive all their care from one caregiver. The Homebirth Association have advice for women considering this option: www.homebirth.ie/whychoosehomebirth.htm.
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Thank You,
AIMS Ireland Admin