A couple of weeks ago I wrote a post encouraging women to get the facts about the “Mother’s Act.” In the post I raised the questions… “How many cases of Post Partum Depression (PPD) could be avoided by helping women have birth experiences free of unnecessary trauma, and intervention? … Is it a hormonal imbalance that is causing the PPD or is it the result of an unfulfilled disempowering birth experience?”
During the recent ICAN conference, I had an opportunity to talk, share and bond with other women about birth, pregnancy, parenting, and unnecessary cesarean sections.
As I listened to some of the women talk about their painful memories, I couldn’t help but acknowledge that the childbirth experience has a far greater impact on a women’s wellbeing than we can ever imagine. Turns out, the birth experience itself, and PPD may be more connected than we care to admit.
About a year ago I read Pushed…The Painful Truth about Childbirth in America. In the book there are a few accounts of women who share horror stories of their birth experiences that ended in cesarean section. I read those stories in amazement. Though I have been a labor nurse for 15 years, it had never occurred to me that women could have that much psychological pain and trauma following a cesarean section. I thought to myself “WOW….they always seem happy.” I remember sharing some of the stories with my then co-workers only to hear them say things like “What ever…I had 3 cesarean sections, and did FINE…it is not that bad” or “I have never heard of a woman feeling like that, I am sure that is exaggerated.” I argued the point that everyone has their own experience, and that the women who shared their experiences should be respected for them. I too had never personally heard stories so full of emotions, but I had to admit, I had never really asked the right questions. And based on some of the things I had seen, I knew it was more than possible.
As a labor nurse, things are often moving so fast unless a patient is in tears, while you may briefly ask her how she feels, there is usually little time left for processing. Not to mention, after being drugged up on so many medications following a c/section a mother is really in no position to process what just happened especially if it was a “crash” cesarean.
As a midwife, I have seen patients at their follow up appointments and asked them about their birth experience. It was rare that a woman said she was anything but happy. I have now learned that though I may have asked one or two questions, I may not have asked the right question. And if I asked the right question did I honestly allow women TIME to share and decompress. Another issue is the timing of the question. Perhaps when the question is asked, the new mother IS “fine” but later she begins to feel the disappointment of her c/section.
A mama’s blog talks about this in a wonderful series where she gives an account of her feelings about her personal cesarean experience five years after the surgery. She goes on to give other women an opportunity to share some of their memories YEARS after their experiences. The insight I gained from reading this has been priceless.
A mother I spoke to at ICAN told me how she initially felt fine about her c/section. She was happy about the way things turned out and had full faith and confidence that her doctor had treated her with respect and had done all the right things. She said it wasn’t until MONTHS later when she visited a good friend in the hospital, who had had a vaginal delivery, that she felt the psychological pain of her own experience. This mom told me after that hospital visit, she got into her car and wept. All of sudden she had feelings of inadequacy. Suddenly she felt cheated; like something had been taken away from her. She was proud to say she is now an HBAC mom (Home Birth After Cesarean).
During the conference I was not only able to hear stories, I was able to look into the faces of women who felt abused, lost, cheated, lied to and alone as it related to their c/section and child birth experience. In some I saw continued sadness. In others I could see triumph as they were able to say they were a VBAC, HBAC, or VBAMC (Vaginal Birth After Multiple Cesareans) mom.
While this conference offered a lot of general birth information, one of the biggest lessons I learned was how devalued some women feel when they have a c/section, especially one they deem as unnecessary.
Like most of the women in this profession, I became a labor nurse and midwife to be a helper of women. It pains me to think that instead of helping, I have in some ways been a part of the problem, and in some ways helped to create stories similar to the ones I heard. So with that being said as we close out cesarean section awareness month, I want to pay homage to and honor the survivors of c/sections. I want to honor your strength, your fortitude and your survival.
I want to apologize to any women I may have mis-educated or did not support during my early career. I didn’t know any better, and I am sure my lack of knowledge contributed to some c/sections.
As a night nurse I’ve seen it all too any times. If a doctor is called in the middle of the night and the patient is NOT ready for a vaginal delivery no further assessment is made. Forget he was called in by a new nurse who misinterpreted a fetal monitor strip. If it’s three in the morning, and he is awake, a baby is coming out, and this often means performing a c/section. Does the patient know that the c/section is unnecessary at this time? Of course not, her doctor, who she has grown to trust, tells her it is needed and she concedes.
If you are a mother who feels in any way slighted by your birth experience due to what you believe was an unnecessary cesarean section; if you are a mother who was happy with your overall birth outcome but felt your c/section was impersonal or rushed; if you felt mistreated or abused by your birth experience that ended in cesarean section; I want to apologize to you on behalf of all of the ill-informed labor nurses everywhere.
I want to honor you, your stories, and your experiences. I want you to know that many of us do hear you. Please continue to share your stories. You are NOT alone. You are NOT a failure. You are NOT less than a woman. You are strong and courageous. Courageous for surviving, and courageous for sharing. I thank you for your stores of truth and lessons learned in spite of the pain.
In Birth and Love,
Nicole
Nicole, I like your post. I believe I underwent an unnecessary C section 4 and a half months ago. I cried day and night ever since the surgery because I don’t want any surgery performed on me.
I worked hard during my pregnancy aiming for a happy outcome. I gained only 5 pounds and exercised a lot. I never had swollen legs or felt weak. I had a very small belly at full term. I could climb stairs for hours right before my labor.
My labor progressed rapidly as I wished. I didn’t feel much pain although I didn’t have any pain relief medication. But my doctor was very impatient. She wanted to break my water artificially. I refused many many times, but finally agreed when I was 9.7 centimeters dilated. It was about 9 hours after I was admitted to the hospital. She asked me to push. I wanted to rest for a while. She said no and ordered the vacuum extraction staff. It made me crazy as they tried to insert the vacuum cup into my vagina. It was painful. I refused the vacuum and they sent me for a C section. It was about one and a half hours after my doctor broke my water.This was the last chance that I could have said no. But I didn’t catch this chance. Both my baby and me had not even the slightest complications during all the process.
I was and I am confident that I could do a vaginal delivery without the distraction of my doctor. She tried her best to discourage me by claiming nonexistent bad situations. She said my baby’s head had not turned, so she thought I couldn’t do it. But it turned out that my baby’s face was in perfect position. My baby weighed 5 pounds and 12 ounces with a small head circumference. There was no reason for this surgery at all.
I could not accept the fact that I had a surgery. I kept blaming myself for not being strong enough in being against my doctor. Sometimes I even want to kill myself because I think I am inferior to others.
I never asked for a good Ob for my pregnancy, since I thought I could do all the things by myself and my Ob would have nothing to do with all this. But I underestimated the distractions she could put on me.
Hi K. Z. Frist please accept my apologies for the delay in responding to your comment. I am verey sorry to hear about your experience. It truly does break my heart. I have seen/heard of many situations like this. It is an unfortunate reality in our model of maternity care. I pray for you that you will be able to work through the dissappointment from this delivery and use it to strengthen your reserves. Share your story with other women so that perhaps they can use a different provider and avoid the same situation. When you have time, visit the Birth Survey website and share your experience. Also if you need help to work through your experience, find a local chapter of ICAN. There you will find women with stories similar to your own. Through ICAN you can heal yourself and help heal other women. It takes a village not only to raise a child but also to help bring our children into the world in a healthy way. Thank you for sharing your story.
Blessings
Nicole
The reason no moms say anything is because they’re afraid. Sometimes it hits you when you’re in the hospital, sometimes it doesn’t. But anyone with half a brain knows you don’t tell hospital people that you’re feeling down, insecure, or the tiniest bit depressed. Because everything you say gets written down. In your chart. Forever. And it colors how other medical professionals treat you in the future. Forever.
I had a TWO doctors write in my chart that I was very depressed. It just so happens that I was NOT AT ALL depressed. I was in the hospital, pregnant, with a serious heart condition, and they were treating me like total crap, like I was making my symptoms up. I was frustrated! I TOLD them I was frustrated, and why. These morons decided that because they saw tears, I was ready to jump off a building. They disregarded everything I said, and snuck out in the hall and wrote down “depressed”. (Have they never seen a pregnant woman before? Or heard of hormones?) So after that, my cardiologist, who previously had treated me with respect, began questioning every thing I said. He even went down a list of questions…you know, the “are you afraid you might hurt yourself…”. SHEESH! I wasn’t sad, I was MAD…at THEM! Tends to happen when you’re in serious pain and people laugh it off and treat you like a loony. (And they never did apologize when it turned out that I was right, of course.)
So will I ever tell a doctor or nurse that all my c-sections make me feel less like a woman, etc.? Ummm…I don’t think so.
WOW Sarah, it frustrates me so much when I hear stories like this one. We have certainly got to change the way we deliver health care to women and their families. While depression can be a real thing for some people we certainly don’t do a good job at figuring out who. The questions we ask and the timing of those questions is so misguided. It is crazy. I recommend this site http://tinyurl.com/l94s38
for some great info about post partum depression, forced drugging of mothers, and forced hospitalization. You can get involved and help other women who may have an experience like yours. Thanks for stopping by and commenting.
You wrote “I want to apologize to any women I may have mis-educated or did not support during my early career.” I feel the same way. I know that technically I am still “early” in my career, but there are some times that I think back to when I was fresh off orientation and was still learning myself. I wonder if I knew then what I know now if things might have been different from some women if I had known how to advocate for them better. Thanks for your very moving post!
~Melissa
http://www.nursingbirth.com
Hi Melissa. Sometimes I find even with the experience I have things are often moving so fast short from pushing the doctor out of the way and onto the floor there is little we can do. (That just created a great visual hahaha). If we keep trying we will continue to help one woman at a time. BTW…. are you going to be at AWHONN this year. I am speaking on this very topic.. “Using the evidence to reclaim the role of patient advocate” If you will be there definitely look me up!
I had a C/S with my first which I profiled on my own blog. I wanted a natural childbirth, but ended up in the OR. I wasn’t officially diagnosed with PPD, but I sure came close. Don’t know if it was a combination of the C/S, lack of support, a colic baby, first time mom, hormones or what. But, sadly, recovering with my newborn was one of the worst times of my life. Fast forward 20 months later, had a VBAC with midwives for my second. This turned out to be the HAPPIEST time of my life. Coincidence? Who knows.
Its sounds like you had a LOT going on with your first birth. I am happy that you had great experience with the second. There are so many factors involved with PPD. While your c/section may not have been the CAUSE of it….it sure did not help the situation any. Thanks for sharing your story and thanks for using midwives!!
<i<How many cases of Post Partum Depression (PPD) could be avoided by helping women have birth experiences free of unnecessary trauma, and intervention? … Is it a hormonal imbalance that is causing the PPD or is it the result of an unfulfilled disempowering birth experience?”
amen!! I’ve been saying this everywhere too! thanks for visiting my blog and reading my wonderful co-authors piece today!!
Nicole- This is a beautiful, powerful post. I feel you have helped me realize that I may not have asked the right questions at the right time either. I wish to do better. I felt bad sometimes… years later after my 21yo was born by C/S. I feel comfortable about the reasons why it was done based on what we knew at the time. However I can relate to the feelings I hear from others, the delay in bonding etc….there were still some lingering thoughts of how it may have been. I experienced all that. Now- I feel I am closest to her now than I have ever been.
Thanks for visiting my blog and thanks for your compliment. I am glad that you and your daughter are close and you were able to move past the emotional ups and downs of a c/section. Keep sharing your story because it helps all of us.
Nicole
being a midwife, a lot of what you said hit home. I would like to hear more about how you initiate conversations about birth and what you feel are the right questions to ask. I’m looking for specifics here – not just providing time and an open space.
This is a great question and unfortunately I don’t think I have the “right” answer as there are many, but here are my 6 cents. I think every woman and her birthing experience is so different that there is no ONE right question. When I was practicing as a midwife, I would often ask a simple closed ended question like “How was your delivery?” and patients would simply say “Fine.” I didn’t know how to elicit a longer/bigger/more detailed response. I think a more open ended question/statement i.e. “Tell me about your birth experience.” is better and as the story unfolds with a good ear and attention to body language you can guage the next questions to ask. The old school “nursing 101″ communication is key here i.e. “Tell me more about that”, “What do you mean by that?”, “It sounds like you were ____________ (scared, concerned, happy, frustrated)” and then back to “Tell me more about that”
I do believe that the “time and open space” is critical. If a woman really senses that she CAN be open to talk she will be more willing. Everyone wants to tell their story. We all have to just learn to be better listeners and let the storyteller know through our attentiveness that we are genuinely interested in hearing their story. Closing the door, sitting down, putting down the pen and paper work and really let her know through your actions, “I am here, I am listening, I care about YOU and I am not asking this simply for documentation purposes”
I hope this is helpful. Thanks for reading and thanks for your question!! I would be happy to hear what other people think.
Nicole
Thank you for the kind words you have regarding my series on C-sections. I too, feel it is important for women to be able to share their experiences and not be judged because they have some things they were not happy about from their birth experience. I touch more on this in the final part of the series.
This is a great post too- don’t be surprised if you see me link back to it in the future.