A healing journey of empowerment – Birth after traumatic birth

[ 1 ] 14/04/2014 |

tree_of_life-01 jpgGuest writer Becky Gauci-Maistre*

 

On Tuesday 16th July 2012, in the water, after 19 hours of labour, 17 of which were at home, Louisa was born into a joyous and peaceful environment. Caught by a midwife and straight into mummy’s arms and breast, while daddy looked on proudly and the doula captured it all on video. Louisa only left mummy’s arms for a four minute paediatric check while mummy delivered the placenta. She then met her older sister and spent the rest of the night in mummy’s arms. They all went home as a family of four, 14 hours later, after getting a good nights’ sleep.

Two years four months earlier, her older sister Emily was born unnecessarily early, surgically, with no love, under harsh lights, in a freezing room. She never heard mummy’s voice or felt mummy’s touch. Mummy was asleep. Little preemie Emily was whisked away into an incubator with only the midwife’s calculating hands, and daddy’s voice for comfort. Two and a half hours later, Emily was bundled into several layers and taken to mummy’s room, where a drugged mummy got to hold her for barely 2 minutes. Mummy has no memory of this, or of the next 48 plus hours. Although not confined to the incubator, Emily was kept in the nursery most of the time, and fed formula against her parents’ wishes.

How could two births be so different?

 

The biggest difference in these two births is not so much the mode of delivery, but, much more, the mother-baby centric (or lack of) approaches. During the second birth, the mother had autonomy[1] over her body. She was an active participant throughout the pregnancy and was encouraged to have faith in her body and in nature. She was not a patient, but a client of the doctor and midwives who assisted her throughout the pregnancy and through the delivery. She was allowed to choose who to support her through the labour and delivery, every intervention was discussed and done with consent. When fears arose, the maternity team took the time to talk things through and work to release that fear. There were no scare tactics, no “fear-mongering”, no discouraging remarks. There was a constant reminder that she owned her body and that would be respected.

During the first birth, which ended in (what the mother maintains to be) an unnecessary surgical birth, it was a very different story. No midwives were involved. The pregnancy was considered a medical emergency that should be feared. She was a ticking time bomb waiting to explode from even before that positive pregnancy test. The pregnancy had to be managed with every possible intervention available. This fear became very ingrained, especially when every intervention led to more problems. When the mother was experiencing some strong Braxton Hicks, a series of events starting with a trip to the doctor’s office, led to the mother lying on an operating table at 35 weeks gestation in fear for her life and that of her first child’s, having just been told they were both in severe danger. Everything happened so fast, and nobody stopped to listen to the mother’s protests or assuage her worries. The husband was busy filling out copious insurance details and organising leave from work. The midwife who would assist the delivery had no time to stop and discuss anything with the mother. At no point was the mother made to feel like she was more than an incubator that was doing a very bad job.

Eight weeks postpartum, the mother was diagnosed with birth-related PTSD (post-traumatic stress disorder), and from that point on a long road to recovery began…

Following the experience, the mother, Joanna, embarked on a journey of healing and education. Having been told that all future children will likely be born premature, via c-section and, (she assumed), under general anesthesia, she firmly vowed to not have any more children. However, she was determined to make a good experience come of this by sharing her story. When she discovered she was 5 weeks pregnant in November 2011, she thought her world would crumble around her. She turned to her online support community. They supplied information on VBAC (vaginal birth after cesarean), CBAC (cesarean birth after cesarean), how to choose maternity care providers, how to deal with birth after a traumatic birth, and so on. By the time 12 weeks rolled along, Joanna felt prepared to start facing up to the pregnancy and start interviewing care providers.

At 14 weeks she visited a well-known gynecologist reputed to be pro-natural birth and VBAC. A quick ultrasound confirmed a healthy baby growing perfectly. However, the appointment with the gynecologist was not so pleasant. After a few minutes of chitchat, the gynecologist confirmed Joanna was a good VBAC candidate and that he would be very willing to let nature takes its course. Joanna decided to ask the tough questions: What were the limitations? What were the time frames? What about monitoring, drips, pitocin? Would he be on hand during the delivery? Are all his house doctors of the same mind frame? The answers were not pleasant.

The gynecologist replied that Joanna would need to go to hospital at the first contraction or as soon as waters break, whichever came first. Once in hospital, she would have a cannula inserted, just in case IV fluids or pitocin is needed, and monitoring would need to be constant. She would also have approximately six hours to deliver the baby, otherwise the risk of uterine rupture increases[2]. If within six hours there hasn’t been enough progress, the only option would be surgical birth. Joanna was reassured that it would not be so bad as there would be ample time to insert a spinal block or epidural, and she would be treated with respect. He also said that once a cervical stitch[3] had been placed in the first pregnancy, she would need to have one done as soon as possible regardless of whether it was needed. “Once a stitch, always a stitch,” he said. She stood up, thanked the doctor for explaining to her that she would be “humoured” with a trial of labour, but she understands that this was just a nice way of telling her the final outcome will be another cesarean. The stunned look on the doctor’s face as she left the room was little consolation.

Feeling very defeated, she decided to take advice from the two most natural birth advocates on the island. Both gave the same information with regards to who to contact for maternity care. She booked an appointment.

The appointment was a breathe of fresh air. She was called in to the midwife’s office and a detailed history was taken. There was no rush, no ignoring of little details, lots of light-hearted chatting and empathy for the traumatic experience. With a pretty little booklet filled in, she was ushered into the doctor’s office. He took a few minutes to introduce himself and read the booklet the midwife had filled out. He asked how she felt and asked her to repeat her history. He then asked if she would like an ultrasound, which she consented to. With an enormous screen in front of her, he took the time to explain everything she was seeing. When he was done, he printed out a series of photos and asked her to take a seat again.

The doctor asked Joanna if she had any questions, so she asked about the constraints of a VBAC. He replied that once there was no labour the first time, this labour would mimic a first-time mother, so there was no telling how long it could take. Monitoring would be to a minimum and she would be free to labour as she pleased. He suggested she visit the labour and recovery rooms before leaving. He suggested a healthy diet, free from white flour and refined sugars. Joanna asked about cervical stitches, to which the doctor replied it was an antiquated practice that showed more risk and little benefits, and there was no indication it was needed anyway. He also verified that he would not perform any vaginal exams during the pregnancy unless absolutely required. This was directly in line with all the research Joanna had done. Suddenly this pregnancy was looking brighter.

Having found the right support team, Joanna set to educating herself to extremes, reading medical journals, discussing in midwifery forums, speaking to women who had unassisted births and even watching videos of humans and animals giving birth. She started a HypnoBabies home course, and listened to the Affirmations track at every opportunity. She hired a birth doula, and attended more ante-natal and childbirth classes.

At 35 weeks, she was feeling very weepy, anxious and was getting very frequent Braxton Hicks that could be timed. Panic and fear set in. She called her doula.

I’ve been waiting for this to happen,” the doula chirped pleasantly. “I was worried you’d need to deal with this during labour and have been planning on how to tackle it for some time. I’m so pleased it’s hit you now.” Her relaxed demeanour was confusing but reassuring. After a very long telephone conversation, Joanna walked away with a new phrase “prodromal labour”[4]. She hit her online community and was inundated with information. Things fell into place. What she had felt, that fateful day just over two years ago was Prodromal Labour, and here it was again.

Every evening at 5pm, the prodromal labour would start, and promptly stop at approximately 5am the next day…for 5 weeks. Everyone was very pleased this was happening: “your body is preparing”, they said. You are doing the hard work now and labour will be easier.” “Your baby is doing a great job of getting into position, work with her, encourage her to move down into your pelvis.”

The birth story is a very exciting one, and deserves a dedicated article, that will help explore non-typical labour patterns, the value of a good birth support team, including a doula and much more.

At 9.50pm on the 16th of July, supported by her husband,  a doctor, two midwives, a doula and empowered by determination and knowledge, Joanna water birthed a 2.8kg, healthy, chubby baby into the world with little assistance. The baby suckled like a pro from the get go and the euphoria experienced by the whole family is still something they feel elated by almost two years later.

Whilst not everyone will VBAC after a traumatic birth, it is the feeling of empowerment, control and consent experienced by the family unit that is the crucial part. Whether a mother births by elective repeat cesarean birth, by trial of labour ending in a repeat cesarean birth or by vaginal birth, the decisions must lie with the family. They are entitled to all the facts and information from their care providers. They are entitled to informed consent. They are entitled to a trauma-free experience. They are entitled to a true outcome of healthy mother and healthy baby, because it is only when a woman is respected and treated with dignity that she can truly feel herself to be a confident mother. The events leading up to birth, birth itself and the early post-partum days are ever so delicate. It is up to every one of us to support women in achieving an experience that they will recount with pride, joy and a deep knowledge of self-worth.

 

VBAC vs RCS

 

*Becky Gauci-Maistre had a traumatic birth experience with her first baby. She embarked on a journey of knowledge and discovery, determined to help others avoid such an introduction to parenthood. Following a healing and empowering journey with her second child, Becky quit her PhD studies in Identity Management and decided to start training as a childbirth educator and post-partum doula instead. She also co-founded the Better Birth Coalition, which is now a member of The Positive Birth Movement. She is the local chapter leader for Momma Trauma’s Sacred Circle – an international peer-to-peer group set up to assist mothers who have experienced a traumatic birth experience. She is currently beginning to get her ante- and post-natal services of the ground under the umbrella name Tree of Life. She is particularly focused on assisting mothers who have had traumatic birth experiences, require information on birth after traumatic birth, be it natural or repeat cesarean, and raising awareness on how to have positive birth experiences. For more information, you can contact treeoflife@gmail.com and mtsc.malta@gmail.com for birth trauma support.

 

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[1] Autonomy is the the capacity of a rational individual to make an informed, un-coerced decision. To be in control.

[2] Facts regarding uterine rupture and more information on VBAC can be found at ICAN and at VBAC Facts.

[3] A cervical stitch is a means of helping the cervix stay closed during a pregnancy when it is suspected that the cervix may be damage and unable to bear the weight of the full pregnancy.  This is usually called cervical insufficiency or incompetent cervix. A healthy cervix will stay at a length of approximately 2.5cm, closed, facing backwards and be quite hard to touch (like the tip of your nose) for the duration of the pregnancy. After vaginal birth, the closed cervix may feel slightly open with a small slit. This is normal.

[4] Prodromal labour, also known as false labour, is a type of labour that can start anything from a few hours to a few weeks before “real” labour begins. The natural birth community consider prodromal labour to be the body’s way of preparing the body and baby for birth by toning the uterus, positioning the baby and encouraging to cervix to start effacing and dilating. Some further believe that prodromal labour reduces the length of active labour.

 

 

Category: Birth Stories, Guest posts

Comments (1)

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  1. 'Joanna decided to ask the tough questions: What were the limitations? What were the time frames? What about monitoring, drips, pitocin? Would he be on hand during the delivery? Are all his house doctors of the same mind frame? The answers were not pleasant. […] She stood up, thanked the doctor for explaining to her that she would be “humoured” with a trial of labour, but she understands that this was just a nice way of telling her the final outcome will be another cesarean. The stunned look on the doctor’s face as she left the room was little consolation.' – Although I didn't go through a c-section, I still wish I had been better prepared and had asked such questions. Lesson learned for next time.

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