Thursday, May 27, 2010

Does Low Self-worth Make For A More Satisfying Birth Experience?

I wonder, does a woman's image of self-worth make her more or less susceptible to birth trauma? If she truly believes that she is worthy of being listened to, that her body is sacred and worthy of respect, would she be more outraged by mistreatment in a birthing ward? Would she feel more violated than a woman with little to no self-worth? If a woman was raised to believe that she was unable to make decisions for herself, her feelings didn't matter and that her body was any one's to touch, grope, hurt why would she expect any better from her care providers? Next time a mother shrugs and says "that's just the way it is, at least I have a healthy baby." after describing what should have been a traumatic birth experience. Ask yourself, ask her "aren't you worth more than that?" Ask how many times in her life she has shrugged and told herself that. Truth is, it does hurt more to have self-worth when someone does something to make you feel worthless. It is shocking to us, LISTEN TO ME, I AM AS IMPORTANT AS A HUMAN BEING AS YOU ARE. I always wondered angrily why some women put up with such horrible treatment in the labour room. It's probably because they've been putting up with for years, maybe their whole lives. Today, teach your friends, daughters, nieces, sisters, mothers that they are full of worth. Break the cycle of violence that perpetuates silence and submission in the labour room. Love yourself openly, pat yourself on the back and do not be quiet when you've been mistreated. By giving yourself permission to be worth-full you may be giving another woman courage to not feel so worthless.

Smoke Screens

Recently, I read a blog written by a birth expert, http://momotics.com/avoiding-common-interventions-in-childbirth , (I know, what else is new). It was about how to avoid unnecessary interventions while in labour. I remember a couple of years ago listing these intervention avoidance strategies to a client. My first client. But several births later, I have come to realize that no matter how much knowledge you have before going into a birth about the risks of certain interventions, no matter what you have written on a birth plan, it is ultimately in the hands of the caregiver. Often (not always) a woman in labour feels out of control and is looking for reassurance and guidance. If a caregiver suggests an intervention to her while she is in this state, chances are, she's going to agree. Dads/birth partners are also in a state of stress looking for ways they can help mom and eagerly accept (and urge the mom to accept as well) suggestions from care providers. An experienced doula is less susceptible, being as she has witnessed women in labour and is comfortable with movements, sounds and occasional bouts of fear of a woman hard at work birthing a baby. That is why choosing a caregiver that is right for you is so important, right? No, it's not. Type of caregiver, yes. But when it comes to GPs and OBGYNs if you choose one you are potentially choosing them all. There are some fabulous MDs out there, and many women I have talked to have told me, "Oh I thought about having a midwife, but I love my family Dr." Then after their birth: "My Dr. wasn't the one on call, I had some guy I hadn't met before." Also, your Dr. isn't the one taking care of you during your labour, a nurse is, maybe 2 if there's a shift change. If s/he is busy (which happens a lot because nurses are often understaffed and overworked) you may only see them every 15 minutes for a 2 minute interval. Dr.s get all the recognition, but the nurses are the ones responsible for you the majority of your labour and birth. Your Dr. wants to be at your birth, but it's just not the way the system is set up. So some women get their Dr. who knows what is important to them. They get a Dr. that they are comfortable with, with whom they've built a mutual respect. That is wonderful, but there is a chance that when you get to the hospital you will be taken care of by strangers. It is a well known fact that the adrenaline/epinephrine that is released when a woman is stressed, inhibits the production of oxytocin, the hormone responsible for uterine contractions. So in essence, labour complications can be caused by being uncomfortable with your caregivers and surroundings. Where I live, the only way to guarantee that you will know the caregiver that will take care of you during your birth is to acquire a midwife. Midwives do homebirths and hospital births and should a complication arise that necessitates a surgical birth, the midwife simply calls in the Dr. and remains by your side (even in the OR) until a few hours after the birth. Where I am midwives are free, though if you live in an area where they are not, ask yourself this: How much money was/am I willing to spend on my wedding? How important is the birth of my child compared to my wedding day? Midwives cost much less than your average wedding.

Back to my original train of thought. Are the popular suggestions of : Hire a doula (which I recommend highly, but do not expect that in doing so you will avoid interventions) Write a birth plan, Share the birth plan with your caregiver, take a hospital tour and look at the birthing facilities intervention statistics (each MD will have a different intervention rate, so it all goes back to not knowing who your caregiver will be) , just smoke screens? Do these suggestions just (falsely) give women the impression that they are in control of their births? Is writing a birth plan going to change hospital policy? Is asking a hospital statistic going to lower the incidence of unnecessary Cesarean sections? No, it is not, especially if you live rurally and you don't really have a choice about which birthing facility you are going to. Childbirth education can help, but only if it is a course based on building confidence in a woman's ability to birth, not a course on this is what is done in a hospital.

What will reduce the use of unnecessary intervention? Get a care provider who is guaranteed to be at your birth (midwives are the only caregivers where I live that can guarantee that). Encourage your friends and family who have had poor hospital experiences to speak up and out, to write the Hospital Administration and the local Physician's College. Write to your government, demand that you have more access to continuous prenatal, perinatal and postnatal care providers. But most importantly, tell everyone you know; No. Getting a healthy baby is not all that matters!

Monday, May 17, 2010

A Sexual Abuse Survivor in the ER

I'm going to start it like this: This post may make people squeamish. Why? because my vagina is the topic. Some people may think that this stuff is suppose to be private, that the content is too personal. I am a firm believer that the personal is political, if It has happened to me, then it is happening to others as well. I am not going to let the social ideal of "hush-hush" if the organ is covered by underclothes stop me from speaking out. For too long men women and children have suffered in silence while perpetrators of abuse are protected by this shield of their victim's shame. There is nothing to hide about our genitals, there is nothing dirty about them. They are organs for reproduction that are filled with nerve endings that stimulate the production of oxytocin and endorphins. Though who could use that explanation to sell cologne, huh?

So, last Friday I wake up to one of my Bartholin glands being the size of a golf ball. For those who don't know, the Bartholin glands are the ones located on either side of the vaginal opening. They are responsible for the production of lubrication of the vaginal opening and canal. Immediately I go on the net to find out what this is and how I fix it. What I saw was scary, the surgical procedure diagrams made me nauseous. Apparently for little to no reason a duct in the bartholin gland can become blocked and an abscess can develop, but sometimes with many sitz baths and comfrey compresses the abcess can be drained by oneself. Well that wasn't the case for me. 24 hours and 4 sitz baths later my gland is now the size of 2 golf balls. This is when panic set in. I hate pelvic exams. I don't mean they make me uncomfortable, I mean they make me vomit with anxiety. I don't have flashbacks to my childhood abuse, it's more like I have feelbacks. It's the feeling of having to be exposed and vulnerable while someone in a position of authority who "knows whats best for me" poke and prods, like I could say no, but it wouldn't matter. I pushed on for another 8 hours before I agreeing to go to the hospital.

The drive to the hospital was hell. Make no mistake, Bartholinitis hurts. You can not sit, stand or walk. If only one of the glands is swollen you may be able to lie on one side. Still idling in front of the hospital entrance I sat (with a crescent shaped pillow under my bum) crying in the front seat. I knew that I would have to be seen by a Dr. I didn't know, I knew he would touch me and I knew they would cut me open. I felt so trapped. Amidst my sobs, my partner told me that a woman was at my window. It was my midwife, Dianne. She asked me if I was okay. I explained the situation and my fears. I told her I wished she could perform the procedure. She said she was capable, but unfortunately it was beyond her scope of practise (politics). Seeing her face during a time of stress gave me so much strength, it was like God had sent me an angel. I gathered myself and limped into the hospital.

I didn't have to wait for long before getting into the ER. I lied on my side on the bed and my partner read a childbirth education textbook to keep my mind off of things. I felt relieved, I had already taken a big step, I entered the hospital. It was also promising that they gave me the room with the least windows into the hallway. The nurse was great, he said, "This is one of the worst things that can happen to a perfectly healthy person." There was so much compassion in his voice I felt myself accepting what was to come, believing that I was in good hands.

The Dr. who came to see me had good bedside manner, too good. So good, in fact, that when he told me that the surgeon had gone home and he was going to perform the procedure right there in the ER, I didn't second guess him. I was so happy to have a Dr. that I was comfortable with that I agreed to let him do the procedure, he wouldn't offer if he didn't know what he was doing would he? He asked me how I was with pain. I told him it was not about pain, it was about anxiety. I explained that I had a past of abuse and pelvis exams give me anxiety attacks. He ordered me Larazipan then explained that he was going to freeze the area with gel then with a needle. He told me I would feel pressure but not much pain. I believed him.

The needle hurt a lot. Then came the pulling and the gritty cutting. Apparently his scalpel didn't make 1 solid cut, he cut, pulled open, cut, pulled open and cut again. Then he pushed down and squeezed then again harder. I did not see this for myself, But I felt it. Not the sharp searing pain of the slice, just everything else. I cried. I held onto my partners hands and cried while he told me to breath. I used my "contraction tricks" I counted ceiling tiles, bounced my eyes around the room. Nothing could distract me from what was happening between my legs. At one point I almost threw up but the thought of his scalpel doing damage from my heaving managed to stay the nausea. At one point the Dr. asked, "what's the problem?" like having surgery done on your vagina in an ER isn't enough reason to cry. When he was done, I curled up as much in a ball as the pain would allow and I cried even harder. The nurse put her hand on my shoulder and said she felt the same way after she goes to the dentist. Strangely enough, that was a comforting statement. When I had calmed down, the Dr. told me there was no infection or abscess just blood clots. He said he stuffed the incision with gauze and that I was to come back tomorrow to have it removed. I asked him if I should have antibiotics, he said no since he did not find an infection there is no need. I asked him if I could have a sitz bath (one of the few things that soothed the pain) No. Ice Packs? No. Do nothing, come back tomorrow.

That night was reminiscent of labour. I paced through the pain, I rocked through it. I leaned over chairs and breathed through it. Like back-labour, there was no escape, no position that could fully relieve the pain. I remember asking my partner, "why does it hurt more? Some thing's wrong." Two ibuprofen every four hours wasn't touching it. We dropped off the kids and headed straight for the hospital. I couldn't take steps larger than 3 inches at a time and every three steps I had to stop lean on my partner and breath. I didn't have to wait for long to get into the ER. Having that "pale pasty complexion" square checked on the triage paperwork can get you in pretty fast.

The nurse took one look at me and said, I'm getting you something for that pain right now. He tried to hook up an iv but he "blew up" my vein. He had to find one at my elbow (this is important for later) Then I got a shot of fentanyl , oh blessed fentanyl. I felt a lot of relief. The narcotic was starting to wear off when the Dr. (a different one) and the nurse entered the room. He introduced himself quickly and held out his hand in a way that I would have to twist my body to shake it. I tried and gasped in pain. He then pulled up my sheet and said "now what do we have here?" So abrupt were his words and movements. I immediately felt threatened, I grabbed my partner's hand and looked at him with fear in my eyes. "So, I'm just going to pull this gauze out now ok?" He grabbed the loose end of the gauze that stuffed my vaginal wound. "Right now?" I asked "Just like that?" I looked at my partner for help, pleading with my eyes, Don't let him do this. "Don't worry,"He said as he started pulling. "I'll stop if you tell me to." Gauze sticks to flesh when it is dry, less than 5 seconds later I was screaming "Stop!" Tears streaming down my face, I asked for more fentanyl. The nurse put a saline pad on my incision to wet it down and soothe it. The Dr. was agitated and asked me what my incision looked like last night. I answered that I didn't know.
Dr.-"You didn't look?"
Me-"No."
Dr-exasperated "Well can you look now?"
I looked around the room for a mirror all the while frightened I might see one and actually pass out from the sight of my vagina with a half gauze-stuffed gaping hole in it. Seeing as I couldn't even sit up from the pain let alone do the yoga moves involved in seeing my own vagina and there was no mirror in sight, I answered "No."
"Well can you guess at how big the swelling was?" I showed him with my fingers. He nodded and said it was about the same. The Dr. turned to leave and my partner stood and said he needed to talk to them. The Dr. left anyways but the nurse stayed and asked what he wanted to talk to them about.
"She's had some bad experiences, and you guys just come walking in here..."
"-don't you lump me in with him,"The nurse cut him off angrily "I was raped as a child and I don't appreciate you including me in that statement." My partner apologized to her. I told him not to. I was furious with that nurse, this was not about her. I turned to her and said. "please don't chide him he's just trying to protect me." She told me to "Relax." with a nasty tone in her voice. To which I asked her her name for future reference. She became much nicer after that. After another shot of fentanyl and a good soaking of the gauze I allowed her to pull out the rest. "That was in there very tight," she commented. "Now we're going to have to swab the wound, so we can determine the infection."
More painful procedures. NO WAY.
"No." I said.
"But we need to, to determine what infection you have. The Dr. from yesterday ordered it."
"The Dr. from yesterday said there was no infection."
She shrugged.
"Can't you numb me with some of that gel they used yesterday?" I asked.
"It doesn't work very well on inflamed tissue"
"Well it worked a little yesterday"
"No." she said shaking her head patronizingly. This may work on some patients but not me.
"No then. No swab."
My partner pointed out that my pad and the gauze could probably be swabbed. The nurse shook her head "No."
"If the Dr. from yesterday wanted me swabbed, why didn't he do it while I was numbed?" I asked. She didn't have an answer for me.
The nurse left for a while. I told my partner that this whole experience has been horrible. I was shaking uncontrollably. I thanked him for sticking up for me and that that nurse never should have made it about her. When the nurse and Dr. returned the Dr. seemed different. I think the nurse explained my abuse to him. He talked a little softer, moved a little slower. When he went to examine me again, I asked him to explain everything that he was doing and to tell me before he was going to touch me "Oh," He paused, as if he had never thought of doing that before, "Okay." He touched gently. Things start to get fuzzy time-line wise around now. Remember when I mentioned that my IV was at my elbow? That's called a positional iv, which means that when my arm is not straight, I am not getting my iv fluids including my pain relief. Unfortunately I didn't find that out until later. I began to relax a bit more, no longer clutching my partner's hand to my chest. The Dr. had left once again and when he returned he told us I was being transferred to an OBGYN in another hospital. "I don't know what this is, it really should not hurt so much. You can drive there or wait 4 hours for an ambulance transfer"

Two "perks" and an icepack later we were on our way to a hospital 45 minutes away. The drive was painful but I was euphorically optimistic. when we entered the hospital, I could barely walk. Many helpful ladies offered me a wheel chair. There is a point in pain where you can no longer put together coherent sentences. "No" pause "wheelchair" was all I could manage. until a lovely paramedic spotted me and grabbed a stretcher for me to lie on my side on. It had been 4 hours since I had been given the perks. They were wearing off fast and I was in an emergency waiting room on a stretcher with an icepack between my legs. I started to cry. "This is the 3rd time I've been in this hospital post-op where they've let my pain meds wear off." I was in the presence of my OBGYN within 10 minutes of that statement.

This OBGYN was a get down to business kind of guy. I asked for pain relief before he examined me and he gave me morphine with a hint of gravol. My partner asked if the Dr, had read the chart (referring to the section on past sexual abuse) and asked him to explain what he was doing while he was doing it. He explained that he was going to examine with his hands the inflamed area. Morphine was a miracle. I could feel him touching the area, but there was no pain and very little anxiety. "There's still infection in there, I can feel it." He told me.
"The Dr. told us no infection came out" I told him, very confused.
"There's infection, I can feel it, I'm going to put you under general anesthetic then I am going to do another incision to drain the infection, then I am going to fill it with gauze, ok?"
"What are the risks?" I asked because last time I didn't.
"very little risk is involved in this procedure the risk of complication is less than 1%"
I signed the consent form but asked to speak with the anesthesiologist before the procedure.
I recognised the anaesthesiologist from the birth of my son and felt very relieved. He gave me the option of being awake for the procedure.
"Which carries more risks, the spinal or general?"
"About the same." he told me.
"I'll take general, I'm sick of being poked at while I'm awake."

I woke up in recovery and was taken care of by a lovely nurse. She let my partner in to come see me. I felt so much better, not only from the great drugs that I'm sure were coursing through my body, but because I trusted this OBGYN. I was proscribed T2's and at least a week off work.

I had a few rough nights, developed an allergy to my antibiotics (my face swelled). I took a look at myself in the mirror (I have to pull 5cm of gauze out of my incision everyday). When I saw the first incision, I was infuriated. It was nowhere near the duct that enters the Bartholin gland. The incision had been made in completely the wrong spot. No wonder he didn't find the infection he was nowhere near it! So not only was the surgery traumatic it was completely useless. All it did was add to the pain as the abscess swelled behind this fresh incision that was stuffed with gauze. No wonder I needed so much pain medication. I asked my GP to make copies of the surgical notes so I could read them. Turns out they call what the first Dr. did to me a "trial incision". When it comes to a vagina the word "trial" should never come before the word incision. Please do not cut into my genitals unless you are sure you know what you are doing. Is that too much to ask? I'm sure that Dr. wouldn't agree to a trial incision on his penis. I hated hospitals before. I always felt vulnerable and coerced. I feel like all of my rights are taken away when I enter one, that I am at the mercy of someones ego and schedule. How can a place that tries to be so efficient that it loses touch with the needs/fears of it's patients be a healing environment?

So, now starts the letter writing. Physician's College of Ontario, Nursing College of Ontario. The Hospital Administration. Sensitivity training would be an asset, considering that an estimated 1 in every 3 women has been sexually assaulted at least once in her lifetime. Let us not forget that many men have also suffered from sexual abuse. The Handbook on Sensitive Practice for Health Care Practitioners states: "Examination or treatment may trigger flashbacks or overwhelming emotions such as fear, anxiety, terror, grief, or anger." I think these health care providers need a reminder about "First, do no harm."