“You’ve got a healthy baby and that’s what matters.” I heard this over and over again after I had Elliot. It’s a terrible statement to make, because it sounds like the mother’s health doesn’t matter, just the baby’s. Of course we all want the baby to be healthy, but don’t we want that for the mother as well? And when we say ‘healthy mum’, it ought to be about her whole person: physical, emotional and spiritual are all tied up together.
I’ve been reflecting on three aspects of my maternal health since Callum’s birth almost two months ago.
One of the most overwhelming aspects of giving birth for me is the sensation of feeling well again. Whatever the recovery from birth and the sleep deprivation, I am no longer throwing up some of the time and nauseous the rest. For me, pregnancy is demoralising and debilitating. But when the baby comes out, I suddenly feel like myself again. That’s significant, because I have not been myself for nine long months. Since Callum was born, people have been saying to me how well I look in myself, how my smile is different. For me, just getting the baby out and no longer being pregnant brings a sense of healing, of finding something that was lost. Added to this, I now also feel intense relief I feel that I won’t ever be pregnant again.
Even as I physically recovered from Elliot’s birth, the way it unfolded meant my post-natal period was marked by trauma reactions. During Elliot’s birth, I experienced a medical system so obsessed with policy that they took a one-size-fits-all approach and did not consult with me. Though I was laboring well and calmly, and things were slowly progressing, the arbitrary time window had passed and so began a series of interventions that saw me end up with an unplanned c-section. Caesareans can be wonderful, saving lives or saving trauma, but my c-section was the culmination of having my autonomy stripped away.
This isn’t about individual doctors and midwives, but about a system, and I didn’t know how to navigate it. I didn’t know what or how much I was allowed to refuse or request. After all, I was on the hospital’s turf. I remember thinking at one point, however irrationally, ‘I’d better do what they say — I don’t want to have my baby out in the street.’ I’m someone who has had to struggle to get to the point of seeing my body as good, and believing that I ought to be able to consent to what happens to me. Having that needlessly stripped away was therefore not only disempowering but downright traumatic.
So with Callum’s birth I was looking for a completely different experience. The second time around, I wanted a ‘do-over’. If I ended up with a c-section because it was necessary, I would thank God for the medical intervention, but in the meantime I wanted to give a natural birth a red hot go. I wanted the chances that were taken away from me last time. I knew I’d need a lot of support to do that.
Our fantastic sending organisation came on board in a big way. They recognise the importance of mental health for their workers’ longevity on location, so when I told them I needed some counselling, they hooked me up to skype with a psychologist I’d seen before. They agreed to bring me back to Australia early so I could qualify for a midwifery group practice. Red Twin shifted her holidays so she could come back from Central Asia to be there for me and for Elliot during the birth. Others supported me as well. My friends Katie and Annie (who is also a midwife) talked me through a stack of things to do with vbac and were an emotional support, and Annie attended the birth and was wonderfully reassuring.
And it all paid off. Callum’s birth was a triumphant experience, and a healing one. I’m astounded at how well I’ve recovered — because not having the emotional trauma means the body can do what it needs to. Through therapy, I had worked on much of what was broken in me because of Elliot’s birth, but Callum’s brought a sense not only of being ‘fixed’ but of completion.
Before Callum was born, I was worried about whether I would love him as much as I love Elliot. The waves of emotion in the weeks after Elliot’s birth were so intense – was my heart big enough to do that twice? Everyone assured me I would love my second child as much as my first, but what they didn’t say was that the quality of the love is different, or at least it has been for me. Loving Elliot was an entirely new experience and the sensations of mother love completely new to me. I haven’t re-experienced that newness. Instead, I’ve felt like that same kind of love that I have for Elliot has expanded to now include Callum as well. It’s beautiful and happy, and perhaps the settledness of it is also because I am in a better post-natal place. It’s less like waves crashing over me, and more like feeling my heart go up a dress size.
Giving birth is about so much more than the gorgeous child you meet and who becomes yours. When I gave birth to Elliot, my motherhood was birthed as well, and the second time around more has been added to that, just as a new child has been added to our family. This time I feel: like I’ve found myself again; a sense of completion of a process begun 3.5 years before when I went into labor with Elliot; and a new expanded version of ‘Mama’.
Categories: Uncategorized Woman Written by Tamie
Tamie Davis is an Aussie living in Tanzania, writing at meetjesusatuni.com.
I don’t like “You’ve got a healthy baby and that’s what matters” or “All that matters is that they are healthy” for a different reason. Sean was three weeks in intensive care after birth and he sufferes autism and epilepsy now. Is he somehow less special, less beautiful, less perfect because he was not healthy?
I love Sean not because he is healthy not because he is made in our image (though it is a part) but, more importantly, because he is made in the image of the God who gave him to us. Health does not matter in children as much as God’s image and his creation.
I am so pleased for you that labour and birth this time around were such a positive experience, and that you were so well supported to make it happen. Glad you can enjoy your strength and feel proud of your efforts!
P.S. I like the idea of ‘going up a dress size.’ That’s the way Tom and I have always talked about it. You don’t run out of love – you get more!
Hannah Craven email@example.com 0413 660 936
Thanks for sharing Tamie, it’s nice to come across a sensible exploration of these issues that isn’t filled with the vitriol that I usually encounter.
I often wonder if women feel that their autonomy is reduced/removed in a hospital birth environment because the medical staff have had their ability to respond differently to different women stripped away by previous legal actions. Obstetric legal cases were one of the big drivers of medical indemnity reform in Australia (a reform that is incomplete in the eyes of some people, myself included). If doctors (who bear far more medicolegal and financial risk than midwives do) are petrified of lawyers and lawsuits (most of us are), aren’t they going to act in the most medicolegally defensible manner? In the obstetric world this translates to “if in doubt, get the baby out” as there is no definitive way to assess the baby in utero.
Any thoughts on this interaction?
No one’s previously articulated the thing about being sued to me, but I assumed that was what was going on. It seemed to me like there were policies in place for the tiniest possibility of something going wrong.
I can see how from the doctor’s point of view, it’s best to play it on the ultra safe side, perhaps without discussion or consultation with the patient (which was how it played out in my case). They’re not thinking, ‘This is OK without intervention in 99% of cases’, they’re thinking, ‘What if this is the 1%?’, and fair enough too with the threat of being sued looming. But ‘safe side’ is not quite right either I feel – it seems like some of the interventions in obstetric care can actually hamper natural labor, making other interventions more likely. As in, they might save some problems but create others.
I wonder whether you think it’s too strong to say that doctors are unable to offer a patient the best individual care because of the threat of being sued? (which is not to indict doctors, but to recognise the weaknesses of a system, and to validate the pressure doctors feel they are under.)
Tamie, I don’t think it is as simple as one doctor thinking “I must do X because I don’t want to be sued”. Rather it is a significant driver (along with the government or hospital’s financial concerns) of what the system produces. So it probably is a bit too strong to blame it purely on the threat of being sued. There are obviously a lot of other contributors.
For instance we live in a society that simple does NOT tolerate any form of adverse outcome in childbirth. Doctors aren’t sued by their employer or the system, they are sued by women (and sometimes by or on behalf of the children). This same society doesn’t have a no fault system for funding care for those who have suffered these adverse outcomes, so suing is the way that you get money to bring up the baby or pay for equipment/care (as well as obtaining recognition of what has happened to you). These lawsuits happen regardless of whether the adverse outcome actually had anything to do with the delivery or perinatal care (eg there were a series of very large payouts for children who suffer from cerebral palsy where the obstetricians were sued for “birth asphyxia” causing the CP…it was subsequently discovered that CP changes in the brain exist before labour so how labour was managed had nothing to do with it, this doesn’t reverse those previous judgements).
Furthermore this is seriously high stakes territory. Where else in medicine can you so easily kill two human beings at once? Two previously healthy human beings even! We have made things so remarkably safe (from a physical perspective, we certainly don’t have the psychosocial side right yet as you’ve illustrated very clearly) that people forget that bad things do happen to women and babies. As an anaesthetist I almost always only see the things that go wrong, but even when these things are uncommon, they are not uncommon for the people they happen to. A population risk of ~3% of major haemorrhage post partum (>1L of blood loss), is as meaningless after the fact to the woman who suffered one (her individual outcome in that pregnancy was 100%) as it is to the woman who didn’t (whose outcome was 0%). Same thing applies to risks to the baby/babies. And even though we can risk stratify for some complications being high risk doesn’t guarantee the complication will happen, but neither does being low risk mean the complication won’t occur. The only way to know for sure is to get to the end of the process and look back.
Time is a major issue too. As you experienced, once labour starts people rarely have the time to go away, seek additional information, think things through etc. And when we do ask women to consent for things they may be in huge amounts of pain (yes, I can do something about this….but I need consent before I can!) and terrified – hardly an optimal situation for consent, but we can’t say “go home, think about whether you’d like the caesarean, knowing that we can’t say for certain whether your baby is OK now but it seems like they are, although the risks are going up because…”!
To complicate this more, women are unfortunately also getting older and sicker when they have their babies. A 45yo woman who comes to her first antenatal visit morbidly obese and with pre existing and untreated health problems is no longer a rare event. So much so that these women are not being sent to specialist tertiary centres, because this is the new normal for obstetrics and obstetric anaesthesia. The risks here are high. I thought the last lady like this whom I looked after (she needed an emergency caesarean section) was going to die in front of me, on the operating table. Then her baby was delivered and things got worse. I have never seen a baby look that colour and survive. I know that she does not understand just how close both she and her baby came to dying that night (but my heart rate has gone up just writing about it!).
So in short, when we add underlying fear to an extremely high stakes situation with significant time pressure, where the only way of knowing for sure whether the baby is OK is to get it out, in a society that simply does not tolerate any form of adverse outcome….we get the system you experienced.
[Or at least that’s the viewpoint of someone who works in the system, sees the bad stuff, and yet knows that we need to prevent the first caesarean and do better for women’s mental health without ending up with more dead people]
As an aside, sometimes the time factor is even more critical with clear reasons to need to proceed to caesarean. To take an extreme example – cord prolapse (cord comes out before baby’s head – problem is that the head squashes the cord so baby stops getting oxygen from the placenta, but hasn’t been born yet so can’t breathe either). What happens? An emergency is declared (alarms ring, people rush in), a midwife grabs a glove, checks the cord is pulsing and then puts a hand into the vagina to push the head up and off the cord. The woman might be told to kneel on the bed with her bottom up and head down (midwife’s hand still in the vagina). There will be a big rush to push the bed (complete with woman and midwife) to the operating theatre. At some point in this process she will be told that the only way to have her baby alive is to have an emergency caesarean. There is no consent form to sign. There is no time. When she arrives in theatre there will be 8-20 people in the room. One will be the anaesthetist (although she’ll often not remember them). The anaesthetist won’t be able to take 10minutes to take a history slowly, explain what is happening and help her to calm down. Rather the anaesthetist will ask a couple of questions of the woman and several of the midwives/obstetricians that came with the lady. These are often rapid fire “Are you allergic to anything? What medications are you on? Any past problems with your health? Any problems with the pregnancy? When did you last eat? What’s happened? Open your mouth. Stick out your tongue. Close your mouth. Tilt your head back as far as you can.” She’ll have a drip put in her arm (if not already in) an oxygen mask put on her face and sealed firmly, be rolled over onto her back with her arms out either side. Monitoring will go on, the gown will be pulled all the way up to prep the abdomen for surgery (midwife still has her hand pushing the head up through all of this). Drapes will be placed over her abdomen. It is just now that the anaesthetist will induce anaesthesia.
How long does all of that take? Maybe as little as 5-7minutes, maybe as long as 20minutes.
The time pressure, fear and loss of autonomy in these sorts of caesarean sections (“category 1” where the situation is so urgent that the time between deciding to deliver the baby and delivering the baby is supposed to be less than 30minutes, sometimes it is as little as 10minutes) is so significant that around 30% of these women develop PTSD! I find this figure absolutely devastating (although I am also astounded that it isn’t higher). So I come back to your opening line: yes, she may have a healthy baby, but in those 10 minutes between disaster befalling them and anaesthesia being induced have we given her the message that the baby is ALL that matters? That is, she is irrelevant?
Thanks for explaining all that Suz. I think you’re right about the system and how it’s produced – the risk aversion in Australian society has really come home to us since living in Tanzania too. There’s nothing simple about this issue. It’s so valuable to have your perspective.
btw I had an allergic reaction to some kind of drug they gave me during my caesarean. The anaesthetist was very responsive and got me fixed up in no time – pretty scary though. I hadn’t had surgery before so when they asked me if I was allergic to anything I said no!