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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Let’s Play the Real/Not Real Game

I’ll start this post with a mild spoiler alert for Mockingjay Part 2, if you intend to see it and haven’t yet. I don’t think I’m really giving much away about the plot that wasn’t in Part 1, but if you’re super keen not to hear a thing, maybe come back after you’ve seen the film. Go ahead, I’ll wait.

Oh hey, welcome back. So, The Hunger Games. What have they got to do with perinatal mental health? More than you think, if you’ve had a traumatic birth. I’m a fan of the books and the films, and so far I’ve been impressed with how they’ve depicted post traumatic stress. Katniss’ sleeplessness, flashbacks, hyper vigilance and nightmares following the atrocities of the Games are depicted accurately enough for me to feel a lot of empathy with her. When she ran off, hid and drank herself into a stupor when they said she had to go back? Eesh, that could have been me if you’d told me I had to go through labour again in the early days of my recovery.

But they really upped their game with this film. Peeta arrives in the rebel camp tortured and traumatised by his time as a prisoner in the enemy Capitol. He’s so messed up, he doesn’t really know where he is or what’s real. Oh man, I did not expect to cry at this film. Suddenly I’m right back in my parents’ kitchen, not knowing where I am, if I’m alive or dead, if I’m still in labour, or whether I killed my daughter. Far from being horrified by his attack on Katniss, I really feel for the guy and the mental torment he is experiencing.

Later in the film, we see him crouching and sobbing, shielding his head to try and block out reminders of what he’s been through. He asks his friends to kill him he feels so unsafe. I know that feeling, like someone just snatched the floor from your world and you’re dangling over an abyss, with nothing and no one to catch you and no end to the terror in sight.  He doesn’t trust himself to be around anyone, and says they’re safer if he’s dead. I remember myself, wild eyed and pleading with the psychiatrist in A & E NOT to send me home where my baby was, to lock me away from everyone and sedate me until I couldn’t move so I couldn’t hurt anyone. Thankfully, Peeta and I, we both had people to tell us that they trusted us, that we were safe.

His allies encourage him to ask any time he wants to know which of his memories are real. My partner and I did this whilst I was in the mother and baby unit. 

I kicked you in the chest whilst you were trying to restrain me, real/not real? Real. I screamed a string of expletives til my throat went raw and I couldn’t talk anymore, real/not real? Real. You held me close and swayed me and asked me if I remembered Paris, and that we used to dance, real/not real? Real. You made me feel so safe at times that I thought I’d died and gone to heaven, real/not real? Real.

Watching the compassion, trust and dedication of Peeta’s loved ones as they support him through the worst time in his life, made me think ‘wow, we’re lucky’. The film’s depiction of what it’s like to live through PTSD is done so well I can’t even be mad at them for showing someone with mental health problems as violent and unpredictable. You just can’t help but have sympathy for this man when you watch it.

“Sometimes I have nightmares. Maybe someday I’ll tell you about them.”

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