Monday, April 11, 2011

Recovering from a traumatic birth

As a doula, I spend a lot of time talking to women about their labors.  Helping them work through what happened and why, show them the reasons why things were done, all that.  Whether it was last week or 40 years ago, labor is the kind of experience that stays with you. 

Sometimes you have to revisit those hours to figure out why the events took place in the way that they did.  You have to ask yourself questions, you have to try and understand the rationale of the doctors, nurses and midwives.  You have to find some level of peace with what you've been through.

This is essential for all women, but even more so for those who had a traumatic birth experience.  The fear of it happening again the way it did the first time leads many women to in turn fear the next pregnancy.  Some push it off for years.  Some never try again.

I'm always annoyed at the people who say things like as long as the baby is healthy, that's all that matters.  Not exactly.  While the health and safety of the mother and baby are obviously paramount concerns, they aren't the only ones.  And belittling everything else provides a great disservice to women in general. 

You should come out of labor feeling enriched and empowered, strong and feminine.  You should not exit the delivery room feeling violated and defeated, damaged and weak.  Yet it happens every day.

I was not surprised that my first question asked here was about a traumatic birth and the fear of a repeat.  Without having been there and knowing all the details, it is impossible for me to say exactly what happened and why, but I can venture guesses.

This mother labored 29 hours prior to having an "emergency" c-section.  I use the term loosely, and will explain below.  She then had several boluses of epidural medication delivered, so much that it actually impaired her ability to breathe.  Terrifying, and all too common.  She came out of the hospital with a baby, yes.  But she brought home fear too.  An assumption that she will need a repeat c-section and that her pain will not be manageable safely. 

All legitimate concerns.  And all those legitimate concerns are making her hesitant to try for the next baby. 
This mom is worried about a repeat.  I don't blame her. 

She thinks she will have to have another c-section.  Whether that is the case depends on a few things.  First, she would have to find a doctor and hospital that allow VBACs to even consider it.  Second, there would have to be no maternal factors prohibiting a VBAC, like a vertical incision, prior pelvic injury, or abnormally small pelvic outlet.  Most cases of failure to progress, the baby being too big, or fetal distress are more related to how the mother labored and with what interventions than anything else.  Most cases of failure to progress are either induced or just not given enough time.  Most babies fit through most pelvises.  She could very well be a candidate to attempt a VBAC.

She is afraid of the breathing issues she had repeating.  The trouble she experienced before is related to the way the medication is administered, and the lies that people tell about epidurals in the first place.  The truth is that they aren't as amazing as advertised.  Sometimes epidurals don't work at all, sometimes they only cover half your body, sometimes you feel like you can't breathe but can still feel pain.  They aren't perfect.  Epidural anesthesia carries with it a fair amount of risk, and interfering with breathing is one of them.  There is no way to really predict if she would have the same trouble next time around, but it is something that the anesthesiologist should be made aware of in advance, particularly if she needs a repeat section.

My best advice would be to hire a doula, attempt a VBAC and try to go without an epidural completely or put it off as long as possible.  Give gravity a chance to work, let your endorphins kick in as a natural pain reliever.

If it's impossible to find a doctor and hospital willing to allow VBACs, or if there are other legitimate reasons not to attempt one, realize that a scheduled c-section is a whole different experience than one that comes after a long labor.  You know what you are going in for, you can plan around it, you can have a sense of expectation about what will happen.  It is far less traumatic the second time around.

One of my favorite doula stories was about a friend of mine, completely defeated the first time she labored.  Induced, epidural, prolonged pushing stage, episiotomy, vacuum, long painful recovery.  She was afraid to go through it again.  I convinced her that it didn't need to be that way.

Second time around, she labored beautifully even though she did need to be induced, avoided pain medication, pushed for only a few minutes and was pretty sure she could conquer the world.  Which is how labor should be.

Recovering from birth trauma sometimes only comes after the next baby is born.

One thing that traumatic birth experiences does accomplish in a positive light is that it almost universally creates more educated moms the second time around.  Mothers who ask more questions, mothers who try alternatives, who seek second opinions.  Surviving birth trauma is in some ways empowering all on it's own in that regard. 

The desire to not let history repeat itself is strong, especially when it's your body.

I will be writing many posts in the future specific to induction, epidurals, VBACs and more, please check back.

And good luck.  Don't be so afraid that you refuse to try again.  It can be better.

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