Book Reaction: Cut, Stapled, and Mended

To be honest, I wasn't sure what to expect from Roanna Rosewood's memoir, Cut, Stapled, and Mended. After it arrived I actually wondered if I should have agreed to review it, because I have so many things to read, things to think about, and interests that are calling me---do I really need to read a memoir about someone's cesareans? I've already read so many books about birth, do I really want to read another one? Well...the answer was YES, I did need to read it. After I finished the book, I felt almost speechless at how deeply it had touched me. This book was a surprise all the way through, from the opening Orgasmic Amazon Queen sex scene, to a session with a psychic healer who tapped in to Roanna's past life abdominal wound, to her dogged quest to open herself to her own feminine wisdom, to her birth experiences---all soul-shattering in their own way---this book touched me profoundly. I was shocked to find myself with tears in my eyes at many different points and eventually truly unable to put it down.

Orgasmic Amazon Queen notwithstanding, Roanna comes across as a practical and down-to-earth narrator, who in her quest to understand herself, her body, her inner wisdom, and her birth experiences, makes a decidedly not down-to-earth personal journey through a variety of healing modalities and nontraditional experiences and perspectives. I really loved the balance she struck between the spiritual and metaphysical experiences she describes and the nitty-gritty reality of doing this thing, giving birth. In a perfect example of what I mean, she writes:

You think I would run out of poop but I don't. It's endless poop. 

My ego, having (literally) had enough of this shit, quits. It gets up and walks right out the door. What is left of me poops in the tub. Looking down, I say, 'ewwwww.' I say it as if it wasn't me who just shat in the tub. I say it as if I just happened to come across poop in my bath one day. 'Ewwww' or not, I'm never getting out of the tub ever again. If this tub were full of nothing but shit mud, I would still stay right here (p. 144).

And, just a few pages later, the experience I already quoted in a prior post:

Only then does the Divine come, taking my body as her own. I am no longer alone. There is no fear…I experience completeness. I find religion. Infinity is tangible. Generations of children, their dreams, passions, defeats and glories—they all pass through me, converging here, between my thighs… (p. 146-147).

via Thesis Tidbits: Cut, Stapled, and Mended | Talk Birth

Despite planning homebirths, Roanna experiences two cesareans and her journey towards VBAC is an arduous one:

Deep inside, I feel the screams of birth echoing off the sides of my skull. Softer and softer they fade, becoming a faint whisper, then disappearing completely.

I open my mouth. 'Please,' I whisper-scream-beg-cry, 'please come back.'

She does not.

I am, once again, mortal. (p. 155)

While I would likely proceed with some degree of caution if reading this memoir as a pregnant first-time mom, there is much to be learned from Roanna's experiences. Her narrative is rich, deep, compelling, scary, dramatic, poignant, and powerful. I highly recommend it!

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Disclosure: I received a complimentary copy of this book for review purposes. Crossposted at Talk Birth.

Book Review: Survivor Moms

Book Review: Survivor Moms: Women’s Stories of Birthing, Mothering and Healing after Sexual Abuse
By Mickey Sperlich & Julia Seng
Motherbaby Press, 2008
ISBN 978-1-89-044641-3
245 pages, softcover
http://www.midwiferytoday.com

Reviewed by Molly Remer, MSW, CCCE
http://talkbirth.wordpress.com

Past sexual abuse is an unfortunately common experience for women. Anyone who works with women of childbearing age should be mindful and informed of the effects of an abuse history on the woman’s experience of pregnancy, birthing, and mothering. Indeed, I consider this awareness to be a fundamental professional responsibility. Enter Survivor Moms, published by Motherbaby Press. This book is an incredibly in-depth look at the experiences and need of survivors of sexual abuse during the childbearing year.

One of the best and most unique features of the book is the “tab” format used for much of the clinical, research-based, or fact-based content in the book. Rather than lengthy chapters reviewing research and analyzing the phenomenon, textboxes containing quick facts and reference material are printed in the margins of many of the pages. The bulk of the narrative information in the main body of the text is then in the voices of mothers themselves, interspersed with commentary by the authors linking concepts, explaining ideas, and clarifying essentials. This is a powerful format that makes information readily and quickly available for reference as well as making the overall book very readable and approachable.

As someone with no personal abuse history who is currently pregnant, I did find the book to be a very emotionally difficult, intense, and almost overwhelming read at times. This is not a criticism in any way—sexual abuse is not a light or cheerful topic and it can be one that many people prefer to avoid. This is all the more reason for birth professionals to make a specific effort to be educated and informed.

Written both for mothers themselves and for the professionals who work with them, Survivor Moms is an essential part of any birth professional’s library. As noted in the book’s introduction, “We need to understand the impact of childhood abuse on birthing and mothering deeply, from hearing women’s stories. We also need to understand it broadly—from looking at the impact on samples and populations, on the body and on the culture.” Survivor Moms offers an accessible way of hearing those critically important stories and developing the necessary understanding to care compassionately for birthing women.

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Disclosure: I received a complimentary copy of this book for review purposes.

Birth Plan Item #1: Leave My Cervix Inside My Body!

Last night I finished reading several articles in Midwifery Today about birth in the Ukraine. Apparently, it is a routine practice immediately postpartum to use two "shoe horn" shaped devices to pull the cervix out of the woman's body to examine. Yes, I think that warrants repeating--manually pulling out the cervix to look at! (no pain medications). This is so patently horrible and unnecessary that I had a visceral response to reading about it--my uterus hurt.

However, as I reflected on my reaction, I began to wonder if the practice is any more strange or disturbing that some U.S. maternity care routines? I still feel like cervix-pulling-out ranks pretty high on the horrible factor, but I also recognize that is is filtered through my cultural lens of what I'm used to--"normal" (i.e. culturally acceptable) birth practices in the U.S. (such as Pitocin injection immediately following most normal births regardless of indication and so on and so forth). We have any number of questionnable medical care practices in this country too, but because I'm used to them they register as "normal." Of course, this doesn't mean I approve of them or fail to notice that they are not evidence-based, but I accept them as possible occurrences and I'm certainly not surprised to read about them over and over again.

One of the articles was about birth in a Ukrainian "birth house" and the other was a composite of observations about birth in the Ukraine in general. Sometimes there is a tendency amongst midwifery supporters to romanticize birth and midwifery care in other countries and to vilify the U.S.--if you are a Ukrainian woman, this is clearly misplaced!

My first thought when reading the essays was, "Wow! The U.S. system isn't so terrible after all!" But then, I tried to imagine the U.S. birth culture seen through completely fresh eyes, as I had just viewed the cervix-pulling technique. How would facets of hospital birth care in the U.S. appear to me if I was just hearing about them for the first time? As gross human rights violations?

Though I cannot make it have the same raw emotional and physical shock to me as cervix-pulling-out, I can only imagine how an episiotomy might sound to my imaginary fresh eyes: "then the doctor took some scissors and cut through the skin and muscles at the base of the woman's vagina." Or, the same with the not uncommon addition of, "as she begged 'please don't cut me! No!'"

I also read with sadness and dismay about the emotional maltreatment of Ukrainian women in labor and how (in hospitals) they are frequently denied the companionship of their husbands. Is this really more awful than women being coerced into unnecessary cesareans or even more basic, being denied food and drink throughout their labors? No, not really, just less familiar.

While it is nice to recognize that there are things that women birthing in U.S. hospitals can be very grateful for, there is not an official continuum or hierarchy of "better" bad things to happen to birthing women regardless of country of residence. Humanized care is humanized care. Women worldwide deserve a safe environment, a respectful caregiver, continuous emotional support, physically responsive care, evidence-based medicine, and to have their cervixes and uteruses left inside their bodies.

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Molly
CfM Blogger

P.S. In case anyone is interested, "cervices" or "cervixes" and "uteri" or "uteruses" are both acceptable plurals ;-)

August 15th is Birth Trauma Awareness Day

I wanted to pass along the information I received about Birth Trauma Awareness Day:

Press release:

http://www.birthtraumaassociation.org.uk/PDFs/BTA_day_2009.pdf

Read more at :

http://www.birthtraumaassociation.org.uk

From the website.....

Post Traumatic Stress Disorder (PTSD)

When we talk of birth trauma, we mean Post Traumatic Stress Disorder (PTSD) that occurs after childbirth. We also include those women who may not meet the clinical criteria for PTSD but who have some of the symptoms of the disorder.

PTSD is the term for a set of normal reactions to a traumatic, scary or bad experience. It is a disorder that can occur following the experience or witnessing of life-threatening events. We usually recognize these as things like military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. However, a traumatic experience can be any experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby) so it is now understood that Post Traumatic Stress Disorder can be a consequence of a traumatic birth.

Characteristic features of PTSD include:

• An experience involving the threat of death or serious injury to an individual or another person close to them (e.g. their baby).
• A response of intense fear, helplessness or horror to that experience.
• The persistent re-experiencing of the event by way of recurrent intrusive memories, flashbacks and nightmares. The individual will usually feel distressed, anxious or panicky when exposed to things which remind them of the event.
• Avoidance of anything that reminds them of the trauma. This can include talking about it, although sometimes women may go through a stage of talking of their traumatic experience a lot so that it obsesses them at times.
• Bad memories and the need to avoid any reminders of the trauma, will often result in difficulties with sleeping and concentrating. Sufferers may also feel angry, irritable and be hyper vigilant (feel jumpy or on their guard all the time).

It is important to remember that PTSD is a normal response to a traumatic experience. The re-experiencing of the event with flashbacks accompanied by genuine anxiety and fear are beyond the sufferer's control. They are the mind's way of trying to make sense of an extremely scary experience and are not a sign individual 'weakness' or inability to cope.

Who gets Birth Trauma?

Birth trauma is in the eye of the beholder’
Cheryl Beck (Nursing Research January/February 2004 Vol 53, No.1)

It is clear that some women experience events during childbirth (as well as in pregnancy or immediately after birth) that would traumatise any normal person.
For other women, it is not always the sensational or dramatic events that trigger childbirth trauma but other factors such as loss of control, loss of dignity, the hostile or difficult attitudes of the people around them, feelings of not being heard or the absence of informed consent to medical procedures.

Research into the area is limited and, to date, it has largely focused on the importance of the type of delivery. It is clear however, that there are risk factors for Post Natal PTSD which include a very complicated mix of objective (e.g. the type of delivery) and subjective (e.g. feelings of loss of control) factors. They include:

• Lengthy labour or short and very painful labour
• Induction
• Poor pain relief
• Feelings of loss of control
• High levels of medical intervention
• Traumatic or emergency deliveries, e.g. emergency caesarean section
• Impersonal treatment or problems with the staff attitudes
• Not being listened to
• Lack of information or explanation
• Lack of privacy and dignity
• Fear for baby's safety
• Baby’s stay in SCBU/NICU
• Poor postnatal care
• Previous trauma (for example, in childhood, with a previous birth or domestic violence)

In addition, many women who do not have PTSD, suffer from some of the symptoms of PTSD after undergoing difficult birth experiences and this can cause them genuine and long-lasting distress. These women are also in need of support.

Finally, men who witness their partner’s traumatic childbirth experience may also feel traumatised as a result. Please see our ‘partners’ section

What is different about Post Natal PTSD?

It is, perhaps, difficult to understand how a process as seemingly ‘natural’ as childbirth can be traumatising but it has been clear for many years that women can suffer extreme psychological distress as a consequence of their childbirth experience for a complex variety of reasons which are frequently related to the nature of delivery. Unfortunately, the difference between the common perception of childbirth and some women’s experience of it means that women who suffer Post Natal PTSD symptoms frequently find themselves very isolated and detached from other mothers. They also find themselves without a voice in a society which fails to understand the psychology of childbirth and which therefore expects mothers to get over their birth experience very quickly.

Consequently, women affected by Postnatal PTSD often find that there is nowhere to turn for support because even other mothers, who have not had traumatising births, can find it hard to understand how affecting a bad birth can be. This can make sufferers lonely and depressed as they often feel they are somehow ‘weaker’ than other women because they are unable to forget their birth experience, despite being told by others to ‘put it behind them’. They may feel incredibly guilty as a result.

This is a terrible burden for women to shoulder and one which profoundly affects their lives. The nature of PTSD means that constant ruminating on the birth experience is beyond the sufferer's control but this is constantly misunderstood, even by health care professionals. Unfortunately, for women suffering from Postnatal PTSD, their detachment from others and the lack of support provided to them can mean that relationships with friends and family may deteriorate. For example, many women end up feeling torn between their desire for more children and their determination to avoid another pregnancy. They may also lose interest in sex and these problems can place a great strain on relationships.

Worryingly, it is suggested that women may also try and avoid medical treatments like smear tests.

For many women, their greatest concern is the day to day difficulties they encounter bonding with their baby who may be viewed as a constant reminder of the trauma they have experienced.

The BTA aims to tackle this isolation by offering women much needed support and showing them that they are far from alone. By working together and providing women with a voice, we hope that we can help change those practices which contribute to Postnatal PTSD.

Isn't this just Post Natal Depression?

No. PTSD can overlap with Post Natal Depression (PND) as some of the symptoms are the same, but, the two illnesses are distinct and need to be treated individually.

Unfortunately, because awareness of this issue is generally poor, many women are wrongly diagnosed with Post Natal Depression and are prescribed medication that may do little, or nothing, to help their situation. Women tell us that they are frequently told by their health care professionals that they should try and 'move on' with their lives or that they should just be grateful that they have a healthy baby. Unfortunately, this type of reaction shows a gross misunderstanding of the nature of Post Natal PTSD and may actually exacerbate the feelings of guilt and isolation that women already feel. Women may then end up with prescriptions for anti-depressants, simply because doctors do not understand the disorder.

However, it is important to note that depression can go hand in hand with Postnatal PTSD, so not everyone is misdiagnosed and if you have been prescribed anti-depressants, this may well be an appropriate course of action for your particular circumstances. If you are concerned about this issue in any way, you must speak to your health professional (e.g. GP or Health Visitor) for further advice. Please show them a copy of our leaflet if they appear to be unaware of Post Natal PTSD or the fact that it requires specialised treatment.

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Also remember the wonderful resource Solace for Mothers which provides numerous services for people who have experienced birth trauma.

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Molly

CfM Blogger

Cesarean Awareness Month!

As the recent Grassroots Network message referenced, April is Cesarean Awareness Month. There is an article available from Associated Content about it here. There is also more at ICAN, the home of cesarean awareness, prevention, and advocacy.

Appropriately, articles about cesareans have been catching my eye this week. From a newspaper in Sydney, Australia we have: Caesarean beliefs 'misguided.'

From the article: "WOMEN who choose to have an elective caesarean in the belief that it will prevent incontinence and genital prolapse are 'misguided' and may be putting their health, and that of their baby, at unnecessary risk.

That is the view of Jenny King, a urogynaecologist at Westmead Hospital, who questions the right of women to choose surgical births to avoid pelvic floor problems.

Evidence is mounting that repeat caesareans cause harm and there are doubts that they provide the protection they were thought to provide, she said."

From a completely different perspective there is also a recent article called In praise of the c-section: I'm not sorry I didn't have a natural birth. There is a lot of food for thought within this article and I hope to have a chance to post about more it soon. There are fundamentally different worldviews among women when it comes to birth and birth issues (a medical model/view and a normal/health/holistic/midwifery model/view). Though it can be extremely difficult to read "the other side" and try to really "hear" what someone from that worldview is saying, I think it is really important to pay attention to differing perspectives. Having your "ideology" challenged causes you to deepen, refine, evaluate, and analyze your perspective and beliefs (and sometimes to change them).

There is also a cesarean awareness video called Frozen Smiles linked to from the Passion for Birth blog (this is one of my favorite blogs to check in with every week!).

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Molly
CfM Blogger

Solace for Mothers

We are pleased to announce the Solace for Mothers Friends and Advocates Online Community which provides a forum for those who support mothers who have experienced birth trauma, have been impacted by witnessing birth trauma, or want to connect with others to advocate for gentler birth practices.

Solace for Mothers is committed to providing resources and support to professionals and loved ones supporting women through the difficult emotions following a disappointing, hurtful, or violating birth experience. Spouses, family, and friends of mothers who have experienced traumatic births are offered a space to find information, support, and resources through participation in the Friends and Advocates Forum. Birth attendants are also provided with the opportunity to process their own emotions in response to births they have attended. Birth professionals and birth advocates are provided a space to discuss the causes of birth trauma, how policies and programs can be enacted to prevent trauma from occurring to childbearing mothers, and methods of treatment when trauma has occurred.

The Solace for Mothers Friends and Advocates Online Community welcomes birth activists, mothers, families, and professionals, all of whom are stakeholders in providing healthy, safe, and empowering births that enable families to successfully transition to parenthood. Users of the online community are invited to contemplate and discuss the current state of birth and what evidence based practices best support childbearing women, their babies and families. Advocates who are interested in becoming involved in organized efforts to promote these practices are encouraged to participate and share their thoughts.

The Friends and Advocates Online Community can be entered from here. The forum is made public for browsing and registration is required to post and respond to topics. To view the online community, go here.

Mothers are welcome to participate in the Friends and Advocates role but they are invited to register and participate in the Online Community for Healing Birth Trauma, which provides peer support to women who have had traumatic childbearing experiences. Birth professionals, family members, and friends please respect the privacy of the Community for Healing Birth Trauma and register only for the Friends and Advocates Community.

If you have something to say regarding childbirth and want to be a part of a larger conversation, please join us. We are interested to read your stories, thoughts, hopes and goals for the future! Please also feel free to pass this invitation on to organizations and individuals who would be interested in the topics of birth trauma and improving maternity care.

Warmly,
Sharon Storton, Founder of Solace for Mothers, Inc.
Jenne Alderks, Creator and Moderator of Online Communities
Jennifer Zimmerman, Creator and Moderator of Online Communities