Teachable Moments

[trigger warning – birth trauma]

So much has been happening since my little FireChick was hatched last October that the original purpose of the blog has gotten lost. It’s been such a whirlwind dealing with her illness day to day that beyond a few tweets, I’ve not really talked much about her birth, working through the trauma of the first and my mental health afterwards.

I can honestly say that I think of her birth fondly, with that warm glow that I expect many are lucky enough to experience first time around. So much so I think the full story deserves its own post, at a later date.

I’d like to share a moment from the birth though, where unfortunately I did re-experience some trauma and flashbacks. It was a solitary moment in an otherwise good birth, which I share because I think sadly it could have been avoided, in much the same way that wonderful planning and support did avoid any more significant trauma throughout the rest of the birth.

Labour was pretty well established, and I felt like I was in my stride using gas and air and hanging off a knotted scarf for pain relief. Due to my risk of postpartum haemorrhage I’d agreed to be cannulated – in case I was in need of emergency medicines or a transfusion. I remember nothing of the junior doctor who came to cannulate me – barely even their gender. They were not particularly rude, condescending or cold, nor remarkably warm, understanding or patient. A routine doctor for a simple routine procedure. Yet unlike every other staff member I worked with during this labour, I don’t believe they were informed of my trauma history.

I was asked to sit still on the edge of the bed while the cannula was placed. Anyone who’s given birth or witnessed it knows that this is no mean feat. But I managed it, cannula in despite my position making things more painful. The only thing left was to tape it down. Except I felt a contraction coming. I needed to change position. I managed to communicate this but was told no, I had to stay sat where I was on the edge of the bed. I pleaded that they could just wait and do it once the contraction was past but again, no, it had to be now, this way. The midwife told me to use the gas and air for the pain.

I huffed long and deep, too much, and that horrifyingly familiar, greyed-out, floating feeling crept over me. A feeling I hadn’t had for three and a half years, a creeping horror that I was in fact still in my first labour and about to die. I let out a throat ripping scream as I felt my vision and my sensibilities fading. Yet through that fog, I felt my husband’s gentle hand on mine. I heard him explaining to the bewildered doctor that I was having a flashback, an explanation he repeated to me, quietly and calmly. He reminded me where and when I was and showed me a photo of our older daughter. “She’s grown up, look, you’re not there anymore”. Shaking, I came back in to the room. I trudged the soles of my feet against the floor. I took in my surroundings, naming boring objects I could see as I’d learnt in EMDR trauma therapy. I let out a few heaving, shaking sobs and got on with the business of birthing my second baby.

Now why was that necessary? I wasn’t in danger. I didn’t need urgent medication, fluids or blood. Perhaps the cannula may have needed to be placed again, but so what? A little patience, a little more explanation to the doctor and I don’t believe that moment needed to happen at all. It was a small moment in the middle of a very positive birth, it didn’t ruin the experience but I do believe it was avoidable. The clear trigger had been the high amount of pain, awkward position and being told I couldn’t move. All three could have been avoided with better positioning and better understanding.

I hope that doctor went away with more than a sense of bewilderment that night, perhaps with curiosity about birth trauma and how to prevent it. Perhaps they just moved on to the next patient without a second thought. If you’re a health professional, it’s these little teachable moments that can make all the difference in preventing trauma and re-traumatisation, don’t let them slip by.

For more information and support on birth trauma, contact The Birth Trauma Association @BirthTrauma or join the Twitter hashtag #birthtraumachat on Monday evenings UK time

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Crunch Time

I’m writing this the evening before my induction, at 40 weeks plus 10 days pregnant. Things haven’t quite worked out the way I’d hoped. 

Despite weeks of intense Brixton Hicks contractions and false starts, there is still no sign of baby. I can’t help but feel a little let down by all the reassurances I’ve had from health professionals, about second labours generally coming earlier and easier. I’m trying not to let it affect my trust in them as I prepare to hand over my vulnerability to them in the coming days. I know that nothing is certain and that we don’t get to pick and choose or control these things. 

I’m allowing myself some space to feel disappointed though, that feels important. I don’t do empty positive thinking – I think it’s at best ineffective and at worst invalidating, I prefer to honour my difficult feelings no matter how painful that might be. It really does feel important to acknowledge, this is not how I wanted things to be, not again. It makes me cringe slightly when the ‘It’ll all be fine’ brigade try to cheerlead me along. Because it might not. It’s already not. I’d rather you just sat beside me, gave me a hug, and maybe just said, I’m sorry it’s not how you want it to be.

So how did I get here? My whole birth plan has been about avoiding certain things – amongst those, induction and augmented Labour. However, the closer I’ve gotten to the point where the only real option left is an elective section, the less appealing that has seemed. I’ve spoken to friends, family and Twitter family about their various experiences with both sections and inductions and it just made me realise, no one method is guaranteed to make things easier. I’ve done a little more reading around both, and actually realised there was a lot I didn’t know. Like the fact that last time I had what’s known as an augmented labour, and that there are induction methods you try before you get near a syntocinon drip. Before I knew it I was sat in front of my obstetrician uttering words I never thought I’d hear myself say. I’m willing to try induction again. (I just read that back. Am I nuts??! Don’t answer that).

I tell myself that it IS different this time – there’s the option of mobile epidural so I don’t feel like a prisoner chained to a hospital bed. Ditto for intermittent monitoring or telemetry if more observation is needed. And one big mighty reassurance that at any time, short of being about to push, i can back out and opt for a section. 

It’s been a headfuck trying to manage all my various risks – pre-eclampsia, birth trauma, postpartum haemorrhage, then all the stuff that comes after – postpartum psychosis and postnatal depression- some choices just seem impossible because the options are good for mediating one risk but bad for another, or vice versa. 

When it comes down to it, I’d rather avoid major surgery if I can, and hopefully have a more straightforward recovery, so I am willing to give induction a go. I just have to keep my eye on my goals and the things I want to avoid – I do not want a vaginal birth at all costs. The forceps I had last time, although I don’t have any traumatic memories about their use, left me so bruised and sore that I’m not sure my recovery was any quicker or less painful than a section. I certainly still can’t get my head around the idea of being able to walk the same day as giving birth, let alone go home. I also need to keep my eye on how long it all takes – the main focus postpartum to minimise risk of psychosis is going to be  rest, and I don’t want to start off from a position of major sleep deprivation again. As for pain, well I think I’ll just have to roll with the punches on that one.

So here we are. Lunchtime tomorrow I’ll get one of the prostaglandin pessaries, with 24 hours to see what happens, followed by a 6hr one if there’s no movement. At my (two, unsuccessful) sweeps I was examined to be ‘favourable’ (a glowing review, if ever I heard one, haha!) with some dilation and effacement already. The first one did *ahem* dislodge a few things too so hopefully this will start something off. That’s better than the sweep in my first pregnancy, where the midwife couldn’t even reach my cervix let alone do anything with it. And after 24 hrs of labour I was still only 1-2cm. After the pessary  I’ll be able to go home so in theory I won’t get caught in the snare of the hospital and their cascade of ‘might as well’ interventions.

I’ve been trying to mentally prepare myself this evening – I’ve done some pregnancy yoga, and even some visualisation relaxation that helps with birth trauma. I have to say, it really helped me feel more positive about the whole thing and more excited to meet baby, rather than being weighed down by all the negatives. Husband is working late tonight, which is a shame as I could really do with an early night and I usually wait for him to come home before bed. 

There’s nothing left to do but wait – bag is packed, appointment is made, babysitters informed. Deep breath, here goes, see you on the other side.

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Birth Planning after Trauma (Part 1: The Debrief)

So, here’s what happened when I went to see an obstetric consultant to plan this next birth, following the horrible time I had last time. 

Twitter followers may remember FireBloke being in the dog house for quite a while after he forgot to book leave far enough in advance to come with me to the appointment. That certainly wasn’t a good start. At my booking appointment I’d had that weird, distant, spaced out feeling I used to get before dissociating/flash backs, something I haven’t experienced  since the tougher stages of therapy (well over a year ago). It made me really anxious about meeting the obstetrician in case I went in to full blown freak out, and the thought of doing this without my other half was just too much to bear. 

Thankfully I have a lovely friend who offered to come with me. She knows the story, down to the gory details, so I had no problem with her being there. She’s had her own perinatal struggles too so I knew she’d be supportive. But before we come to what happened in the appointment, let me explain what happened last time I met this consultant. 

I met this obstetrician for the first and only time 6 weeks after FireGirl was born. As hard as it is to believe, I had already been in and out of the mother and baby unit by then, and was on my way to recovering from postpartum psychosis. I was still incredibly anxious and traumatised, but  I at least knew a few things I didn’t know before (like the fact that I wasn’t dead, and what day of the week it was). I saw her for a ‘debrief’: a meeting where they explain to you what happened with your birth and you get the chance to ask questions. They are often run by midwives, but this consultant has a specialist interest in birth trauma. She wasn’t actually present at my delivery, but she’d spoken to the people involved. If you feel you have suffered a traumatic birth, I would really encourage you to try and push for a debrief. 

She started by explaining to me what had happened, and what they suspected had gone wrong. They think that the prolonged labour tired my uterus out, which may be why it had such problems contracting afterwards (hence the postpartum haemorrhage). They think I lost more blood than initial estimates, and didn’t give me a big enough transfusion, hence why I was so wiped out. They also suspected very late onset pre-eclampsia, a risk for next time. Then came my turn to ask questions. ‘Ask me anything you like. Anything, no matter how stupid you think it is’ she said. I took a deep breath. ‘Did I nearly die?’ I asked. I wasn’t sure I wanted to hear the answer. ‘No.’ She answered me calmly, without missing a beat, like she’d been expecting it. I was taken aback. What?? I felt like I had nearly bled to death, in my memory it played out like a medical drama where the transfusion doesn’t arrive in time and everyone is panicking. She explained further – ‘we were pretty worried about you, but everything was under control. And now here you are, with your lovely baby!’. 

Wow. It was like something slotted in to place in my brain. Like waking up in the present after a nightmare. I had been so locked in that memory, in that room, flat on my back and exhausted, feeling on the brink of death and thinking at least it might be a relief. I had been so stuck there, I couldn’t see the next part of the story; the part in which I survived. I still had a really long way to go in terms of recovery, but after that day is when I really started healing. The therapy that came later worked on this principle ; retell the story and update it with the stuff you now know to be true. 

She ended the appointment by giving me an open appointment for whenever I felt like coming back. She said she didn’t mind whether I wanted to hear the exact same information again, or ask new questions, or maybe even some day talk about planning another birth. She also said she gave me carte Blanche to have whatever kind of birth I wanted if I ever did feel ready to do it again, and she would go on to write that down in a letter for me to wave under anybody’s nose who disagreed. It was a huge relief and played a large part in me feeling able to come back, almost 3 years later, to see her again. 

I just can’t express how much this experience meant to me. It contributed massively to my recovery; to repairing my trust in maternity services, and to empowering me to face the beast and do it all again. I can honestly never thank this woman enough. 

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Just the basic facts, can you show me where it hurts 

I had a horrible labour. I had a horrible birth. I lost 3 litres of blood after days of back to back labour and a failed epidural. I believed I was going to die. I spent 5 days in hospital in total, and was discharged home with a bruised pelvis from the forceps, and a bucketload of medication. I started motherhood with a heavy dose of anxiety, exhaustion and confusion about what had happened.

At home my girl was instantly starving. She breastfed constantly, for hours at a time, including 8 hours straight that first night. I remembered the safe sleeping advice that said you should never fall asleep in a chair with a baby, and that bedsharing was dangerous, and I began to feel incredibly anxious about staying awake. I was terrified I would fall asleep and accidentally smother her. Yet it seemed imperitive that I continue. I willed the the sun to come up, and thought maybe if I could just make it through the night I’d  be alright. I cried; that seemed to be happening a lot lately.

The next few days were a haze. I tried to rest. I became obsessive about sleeping enough, though I was actually sleeping very little even when I tried to. Husband would try and settle little one in the conservatory to blank out the noise of her cries, but I couldn’t sleep thinking that she was crying. Dark thoughts entered my mind that he would try and kill her to shut her up. I crept downstairs and convinced myself I saw murderous intent on his exhausted face. I couldn’t talk about the birth or the thought that I’d nearly died. My baby carried on feeding continuously, and I asked a breastfeeding support worker to visit for advice. She gave me the sympathetic head tilt and parroted the old stomach-the-size-of-a-marble bit, and said everyone likes a snack and I just needed to carry on, as my latch was fine. I tried to get across just how exhausted I was, how I wasn’t eating, or showering, or sleeping. I asked this stranger for permission to express milk and feed a bottle so I could rest. She reminded me that breast really is best and left. What did I know. I’d never done this before. 

My community midwife came to visit and was worried about me. I wasn’t keeping up with my various medications, my stitches weren’t healing and she thought I seemed different. She asked me directly if I’d felt depressed or suicidal. I cried and confessed that at a lowest point I had fleetingly thought I would rather die than be the kind of woman who couldn’t cope with feeding her child. Then I hastily tried to backtrack, and expended all my energy one day showering, dressing and conversing brightly to prove to her I was coping. She didn’t buy it and referred me to perinatal psychiatry without my consent. They called and I fobbed them off, wanting nothing to do with them. 

My parents took the baby for a walk one day so I could try and sleep. As I lay in bed, I realised it was exactly a week since she was born, coming up to the minute. A wave of sadness overcame me as I reflected that this was not at all where I expected to be at this point post birth. Days locked in the sweaty embrace of breastfeeding, struggling to find a bond with the closed eyes and swallowing jaw that were a source of dread and regret and terrifying memories.

I began to sob as dark thoughts of suicide as the only escape crept unbidden into my mind, taking root and spreading. I called out for someone. Anyone. Suddenly, the desperate feeling of needing help and nobody coming caused me to lose my grip on reality. I dissociated to that place of terror in surgical theatre when I thought I was going to die. I let out a raw, animal scream. 

Suddenly my husband was in front of me shouting my name like a short, sharp slap. I came round, but couldn’t put a coherent sentence together. I just managed to say Ambulance…now….999… he was confused but started dialling anyway. He asked what was wrong, and from the depths of my mental health knowledge I dredged up a phrase…puerperal psychosis. 

Somehow he got me dressed, with me talking terrified gibberish, and not understanding why no one seemed to see the urgency I did. There was no time. He guided me downstairs as I wouldn’t break eye contact with him. He asked if it was safe, and I roared NO I’M GOING TO KILL YOU, I’M GOING TO PUSH YOU DOWN THE STAIRS, then horrifyingly, the words I’M GOING TO KILL MY BABY. I felt animal and dangerous and I didn’t trust myself to do anything. The trip to A&E and the wait for a psychiatrist took an age. I couldn’t understand why they didn’t rush me there. Why did they think this could wait? I felt the entire time like I was on a precipice, about to slip off into oblivion. I had to keep talking whilst all the time my mind threatened to dissociate back to terrifying memories I felt would consume me. I screamed to be locked up, away from everyone and pumped full of drugs. I wanted oblivion, numbness, escape from this mental torture. 

During my psychiatric assessment I put my fingers in my ears so husband could explain my traumatic birth. The psychiatrist tried to persuade me I’d just had a panic attack and to go home with some sleeping tablets. She mentioned the mother and baby unit, but the thought of being around my daughter terrified me as I felt convinced I would harm her and she wasn’t safe with me. 

So I went home. Baby girl had been taken to my parents house with a bottle of formula. They’d gotten advice from a helpful checkout lady in ASDA, as the on call midwife wasn’t interested in giving bottle feeding advice. We went to my parents to get some more support as advised. I coiled up on their sofa, terrified to sleep in case of nightmares but knowing I desperately needed to. I felt despicable, disgusting and unworthy of motherhood. The sight of my daughter feeding from a bottle was pure anguish. I made a gut wrenching decision that I had to stop breastfeeding so that I could start to take care of my self. That was that, no follow up advice, the end of our breastfeeding journey. 

I began to suffer from panic attacks, intrusive thoughts about harming her, harming myself, SIDS, her overheating, her stopping breathing and dirt and contamination and I would frequently wake with a start looking for her, believing I had fallen asleep feeding and smothered her. I felt myself spiralling against a tide of trauma and exhaustion and expectation and I just couldn’t process it all. Above it all was a pervasive doubt, the psychiatrist had said it was just anxiety. It felt like so much more. I obsessed over diagnostic labels – did I have OCD? Anxiety? PTSD? Postpartum psychosis? Or just the baby blues? I flushed the rest of the sleeping tablets down the toilet and asked my husband to lie through his teeth to keep psychiatry away from me. 

Before I knew it it was the second week anniversary and the time of birth was coming up again. I couldn’t stop my thoughts from racing. I was staring at the clock in the kitchen and didn’t know how I got there. Time seemed to freeze. I was aware of husband asking me if I was ok, but he seemed to be talking to me from another planet. Another century. The time never seemed to get any closer to 2.51, the time of her birth, and I became convinced that time had frozen for me because I was actually dead. I had died in childbirth. I had bled all over the floor and everything that came after was my poor dying brain snuffing out. This must mean I was still there. I was still in that hospital room and still in labour and it was all still happening. Wild and terrified again, I began to hit out, shout, scream. I had to stop this, I had to change it, I had to wake up and fight fight fight not to die. I was convinced. This reality, in my parents kitchen, it was not mine, it was a fantasy. I had to wake up urgently or I would die. I began smacking my head against the wall, the floor, straining to open my eyes to a reality that never came, hallucinating nightmarish scenes from the birth. Perhaps I was wrong. Maybe it was my baby that was dead and this was my demented grief. Where was she? DID I KILL HER? I HAD to find her, run to her, husband stopped me, I hit him, he restrained me, I kicked him in the ribs and fell on the floor bruising my back. A hundred different abhorrent realities raced through my mind. I was dead. I was dying. I was still in labour. She was dead. I killed her. Where is she? End it all. Kill yourself. Somewhere in all this I realised I was desperately ill and needed urgent help. I pleaded with husband to get me help, then would dissociate again and beg him not to leave me. 

I didn’t quite know how, but now I was in a car on the way to A&E again. It felt ok. I was going to get help. The mother and baby unit wanted to see me. Then followed days of agonising waiting for a bed, sedated and curled up in self loathing and despair. Bursting in to tears of relief at finding my way to the mother and baby unit and being reunited with my darling baby girl. Kidding myself it was like a spa. I panicked during my admission assessment and tried to run away. Shit, I’ve gotten myself locked up, I must have dissociated in to another nightmare. Why is this door locked

Slowly, the terror was replaced by a numbness that pervaded for months after I was sent home. A nurse on the unit confided that she’d seen many women driven to the brink by pressure to breastfeed. I was ashamed of what had happened and felt that I should have been able to see it coming, prevent it. What if I’d been more assertive during the birth, cared less about breastfeeding, cared more about breastfeeding, slept more, tried harder. It became a shameful secret that hung over me at every mother and baby group, every coffee morning and I felt fraudulent and false.

Gradually, I forced myself to go out, stay active and connect with people. I connected with my daughter and delighted in her company. I started exercising, took up baby swimming lessons and made new friends. I had a six week follow up with an obstetrician, who re-explained what had happened and why, and answered all my questions. I took a deep breath and asked her if I’d nearly died. She didn’t miss a beat and said no, not a chance. They’d been worried about me, but I’d always been safe. I stopped having panic attacks that day. I pushed HARD to see a clinical psychologist and talk though my experiences, we even revisited the delivery suite and reprocessed my traumatic memories. She signposted me to a drop in support group that enabled me to start telling my story and find other women who’d shared similar experiences. I got braver, and told a few newer friends what I’d been through when I was able to talk about it without having flashbacks. They were compassionate and understanding and have been my salvation. Bit by bit, I came back to life.

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