Birthrites: Healing After Caesarean.

Liz and Cary's Birth.

By Liz Jones.

When the stick turned purple I started crying and didn't stop for a week. A lot of my negativity about my pregnancy stemmed from a poor relationship with my own mother which had caused me to have a complete lack of confidence in my own abilities to mother a child. Therefore having a successful, positive birth experience was of utmost importance to me on a psychological and spiritual level. A long-time believer in home-birth I planned to have my baby at home, maybe in water and in a calm and peaceful, loving and joyful environment.

Unfortunately at 40 weeks, my baby was high and posterior and no amount of exercises, sitting in weird positions etc. was going to make her move. And unfortunately, my due date came and went and no amount of naturopathics, homeopathics or castor oil (!) was going to make this baby come. My Midwife was great during this time, a constant source of support and even though I knew that after the 14 day mark had passed - she was outside her limits of 'normal'. Yet she continued to support me in my choice to avoid induction.

However three weeks after my due date had passed, family pressures became unbearable and I decided that I would have to go to hospital. I shed a few tears at abandoning my hopes of a home birth but still went to hospital with a positive outlook. Unfortunately for me the minute I walked through the door it seemed as if all choice was removed from me. I cannot stress enough how much the attitude of the obstetrician in outpatients affected me. At this stage I had zero confidence in my ability to give birth in the hospital environment and that combined with the baby still being, high, posterior and me with the beginnings of toxaemia I felt that an elective Caesarean section was my best option. I can honestly say that if she had discussed it properly with me, I would likely have chosen to be induced, key word there being "chosen". However, the obstetrician would not even discuss it seriously with me and from then on I felt as if everything done to me was an assault rather than something I was a willing participant in.

So it was with resentment and anger that I arrived at the delivery ward later that afternoon. I was also intensely fearful because my first contact with the hospital had been with some-one who did not respect me as a person and instead treated me like a statistic to be avoided.

I had the first lot of gel at 4pm. At about 9.30pm my membranes ruptured spontaneously. I was quite pleased to think that things were on the way as the previous plan had been for a second lot of gel at 10pm and AROM the next day. Unfortunately, the waters were stained with meconium. A registrar came in and told me that my baby was in distress and needed to come out ASAP therefore she wanted to put a drip up to get things moving. She said things like, "an hour has already gone by". My understanding of this was that my baby was in imminent danger and needed to be born within a few hours. I found out later that she had in fact given me 24 hours and the baby was not in distress at all. All I can say is, I was exhausted (I had slept 3 hours the previous night and it was late by this stage), anxious and some-one was telling me my baby was in distress. I would have agreed to anything.

After having agreed to the drip, I immediately asked for an epidural. My attitude at this stage was, OK, if you're going to do this to me, you can at least make sure I'm not in pain. My midwife arrived as the anaesthetist was putting the epidural in. I was so relieved to see her! She asked the anaesthetist if I could still walk around with the epidural and he assured her I could. However immediately after the epidural went in I felt very drowsy and said to her I needed to rest. After an hour I started to notice an increasing numbness in my left leg and pain in my right hip. The pain continued to get worse and I knew the epidural had dislodged and asked the hospital midwife (Jane) to get the anaesthetist. She rang him and he advised her to top the epidural up. And so began a vicious cycle which continued until 7am when he finally (after being rung 5 times) replaced the dislodged epidural. At 5am Jane examined me and found that I had not dilated at all. I knew that in my 'plan' the doctor in outpatients had written Caesarean section if I was not 5cm after 5 hours so I was very distressed when Jane checked with the obstetrician on duty (a different doctor yet again) and he wanted me to continue. I started to ask Stuart why they were doing this to me and completely lost control. I knew, like I knew night from day, that labour was futile and could not understand why no-one else could see that. I remember my Midwife trying to get me to centre myself but all I could do was turn my face into the pillow and scream hysterically. The pain was excruciating, I couldnt breathe properly and I couldnt move. My Midwife got the gas set up and I tried to knock myself out with it.

Eventually the epidural was replaced (after two attempts) but the pain just moved from the right side of my body to the left and my legs remained numb. It was an improvement however. Obviously, any good chance I had had of helping Carys turn and thus be born vaginally had been taken from me during those six hours of being paralysed. The emotional impact of being left helpless and in pain for so long is very traumatic made worse by the sense of outrage at being sedated so much that I couldnt complain. In addition to this I was physically restrained by being attached to the foetal monitor. I liken it to being tied up and abused. I still have nightmares about being in that bed.

Once the pain had abated somewhat I realised I was really hungry, I hadn't eaten since 2pm the day before. Of course, I wasn't allowed to eat.

I dozed for a few hours and by 9am I was 10cm dilated, but devastatingly I was unable to move her. The disappointment of being so close only to fail is acute. After starting off pushing when I was told to it wasnt long before the desire to push became overwhelming. My Midwife held one leg and Stuart held the other but all I wanted to do was squat or get into a better position as the midwife was suggesting. I kept touching my numb leg to see if I could possibly weight bear to move into a better position but it remained numb and the more I touched it the more distressed I became. With my legs numb, I felt like I was falling off the bed and then to make matters worse I started to vomit. By this time the contractions were almost one on top of the other and I was becoming exhausted. I couldn't feel the baby moving at all and it just seemed like every-one was prolonging the agony. I started to beg people to intervene, telling my Midwife, "No more". In hindsight I realise that I was exercising the last little bit of control I had over the situation.

The doctor was called and she said she thought I needed a Caesarean. I think she thought I would be devastated. I lay there and thought, "no kidding, I thought that 24 hours ago". I ended up yelling at her, "I dont care what you do, just do it now". She seemed flustered by that. I thought that was fairly mild considering what I had been forced to endure thus far! The anaesthetist came in to discuss anaesthesia. I chose a spinal block as I knew the epidural wasnt being that effective. A few minutes later he returned and topped up the epidural. Despite Stuart, myself and my Midwife reminding him about the spinal block, he just shrugged and walked out the room. I was too drugged to protest more.

By the time I got to theatre I was desperately worried about the epidural as I still had sensation. When I mentioned it to the anaesthetist he made a joke. I was reassured, thinking if he wasn't worried, neither should I be. The theatre staff were busy arranging the drapes and by the time the doctors had scrubbed up they had set up the screen in front of my face. I was really unsure as to who would be performing the caesarean, and I was unable to see anything past the screen. It is one of the most harrowing memories I have - that of not knowing who was cutting into my intimate parts

What happened next is still very hard for me to talk about. The epidural was not working properly at all and as the doctor began to manipulate the baby the pain became intense. I started to moan and some-one told me to take deep breaths. I was at my limit of endurance and horrified and panic stricken that the pain was so bad. Next thing there was a heaviness on my chest. I couldn't quite believe that a baby would feel so heavy so I asked my Midwife something non-sensical like, "Is that it?". She was smiling and nodding and crying at the same time. I cling onto that memory as it was the only acknowledgment that anybody in the room made that something miraculous had happened.

The feeling of disassociation was heightened by the fact I had been told to keep my hands above the screen and when they showed the baby to me, she was on the other side of the screen, so I didn't feel like I was allowed to touch her. Incredibly they removed her from my stomach straight away and placed her on a trolley behind my head where I couldn't see her. How insensitive to not put that trolley where I could see it.

Suddenly, I felt a gush between my legs and the pain soared way out of control as I felt the doctor's hands in me attempting to stop the bleeding from the haemorrhage I was having. I use the term 'pain' loosely, as there are really no words to describe what I experienced. I was out of my mind with agony and even though one half of my brain knew what she was doing, the other part was yelling at any-one and every-one to make her stop. At that stage bleeding to death was preferable to the pain. Through this I was trying very hard to keep my legs pressed onto the table, scared that I would knee some-one. It seemed an eternity before the IV pain relief was organised.

Apparently I was out for about 20 minutes and came round as they were almost finishing suturing. The anaesthetist attempted to give me some prophylactic IV antibiotics. As I have anaphylactic reactions to three major groups of antibiotics, I told him no, which he refused to accept. He actually wanted me to explain what I meant by anaphylactic. If I'd had my wits about me I would have told him to go look it up in Mosby's (sarcasm gets you nowhere in these situations but it would have been satisfying now). There I was, still in pain, exhausted, panicked and just had a living being pulled out of my stomach and he wanted to argue with me?! He then insisted on doing a scratch test on my arm, which he did twice (like I hadn't had enough pain already) by which time he had me so ticked off he wouldn't have got the antibiotic into me for a million dollars. Eventually, he backed off (which part of 'no' he didn't understand, I'll never know) saying that it was no problem really, they were only prophylactic antibiotics and any infection could be treated later, on the ward. For crying out loud, if it wasn't a problem, why force me to argue? All this was before I had even seen Carys properly, a complete lack of respect for the fact that I had just given birth. It should have been a time devoted to allowing me to quietly see and touch my baby, make sure she had all her toes, perhaps see who she looked likeso much for being allowed to bond with your baby, I was busy arguing a point with some-one who refused to acknowledge my right to refusal of treatment.

Eventually, I made it to the recovery room where the pain was once again intense, with a ruptured, freshly sutured uterus still contracting strongly from the synto being poured into me to control the bleeding, it was like being in labour all over again. A morphine pump was set up and after a dose, my Midwife brought Carys over so I could have some skin to skin contact. Finally, I thought, I get to see and hold the baby and do some of the stuff I had missed out on so far. She put the baby to my breast and although Carys wasn't interested in a feed at least she was next to me. How disappointing to have even this moment ruined by the sight of the hospital midwife tutting and rolling her eyes behind my Midwife's back.

Three months later

The first month after Carys was born was sheer hell. I was back to hospital five times with complications, uncontrolled pain, an infection, retained products. Stuart would bring the baby to me to feed and then take her away again. I was so completely exhausted I would cry and ask him to give her a bottle. I had no connection with the baby, I was totally convinced she was some-one else's and that is how I looked after her, like she was a patient of mine. I dealt with her basic needs, anything else was emotionally beyond me. I do have a connection with her now but I still feel like she is adopted. The pain and terror I felt during the whole experience and during the section in particular have left me feeling very vulnerable and lacking in confidence and this reflects in any decisions I have to make regarding her. Whereas before I was vehemently anti-immunisation, I had her immunised with barely an argument. I cannot bear to see the scar on her face. I feel I should have protected her from that.

I cannot relate anything that happened with giving birth. One day I was pregnant, the next I wasn't and I'm not really sure what happened in between. I do not say Carys was 'born' or that I 'gave birth'. Those terms have no relevance to my experience.

My relationship with my husband is on rocky ground. He was supposed to protect me, why didn't he help me? Why didn't he yell the place down until they got some-one, any-one to fix the epidural? He was so upset by the whole thing that he had a vasectomy. I hate him for that. The grief I feel is compounded by the knowledge that the healing experience of a second, joyful birth will never be mine. Sex is impossible due to the continuing pain from the incision.

Period pains cause a terrible panic to come over me. For a long time Tuesdays and Wednesdays were bad days for me (Carys was born on a Wednesday). Even people asking how old she is causes me to think each time of how many weeks since it is. I blame myself for being too passive, for being too assertive, for not being informed, for being informed, for not pushing hard or long enough, you name it, I blame myself. I have become very critical and unforgiving of myself.

I am incredibly angry at the doctors who made decisions about me which affect the rest of my and my child's life and then disappeared. Not once did either of the doctors involved bother to even put their head around my room door. The doctor who managed most of my labour actually refused to see me in outpatients. Both hospital midwives made the time to come and see me. I guess that's the reason why we choose midwives!

I still wake up and go to sleep thinking about it. Sometimes I cry, sometimes I get angry. Every day I wish I had died on the table. Anything not to have to live with these memories.

Five months later

I wake up every day wondering why I am still here. When Carys was first born I had a concrete plan that as soon as she was weaned I would kill myself. I really felt she didn't need me in any other way than that. Now I know that she needs me but instead of being happy about that I resent her for keeping me here. Maybe one day I'll thank her!

Asking the hospital for an explanation as to what happened has descended into a war of words. They now longer will speak to me except through their lawyer. I guess I should be happy I scared them enough to get their lawyer involved but it certainly doesn't help to have my pain and anger repeatedly denied.

The anger is still overwhelming. Some-one remarked how unemotional I was about it, I had to explain that the anger is the only thing I have left to hang on to.

I still suffer from terrible flashbacks. I opened a magazine the other day to see a picture of people in theatre garb and I vomited for hours. To lie on my back brought flashbacks of lying helpless in theatre, to lie on my left side brought memories of seeing the foetal monitor, to lie on my right side brought memories of the hospital locker. Nightmares of being attacked or in pain or both are a continual problem. The feeling of violation will not leave me, worsened by vague memories of VE's performed while I was disorientated from the gas and drugs. In fact, in the space of 24 hours I had had five different people perform VE's on me, some more than once. I counted 12 different people altogether.

I am beginning to resent the term 'post natal depression'. It is so easy for all my feelings to be dismissed as hormonal. I may be depressed and I may be post-natal but I do not have post-natal depression. Most people who went through the amount of pain, helplessness, fear and horror that I went through, whether having a baby or not, would be depressed too.

Stuart is still suffering also. The memory of his baby's birth is not a pleasant one for him either. The first time he held her, it was with me moaning in pain in the background. He thought I was going to die and was panic-stricken. He tells me I was moaning even after the IV pain relief. It must be harder for him in some ways as at least some of my memories are dulled by the drugs. He on the other hand was forced to watch while being fully aware.

I still feel as if I have no right to be making decisions about my baby. I bear a lot of responsibility for what happened and feel as if I have failed her by failing to give birth to her. Failure is still a big issue and finding 'failure to progess' written in my blue book was a stab right to the heart. Not "failed induction", not "obstructed labour". God forbid that any-one's judgement should be questioned. I didn't fail at anything, I was failed.

Seven months later

I gave up trying to think of Carys as mine and instead I accept that adoptive mothers love their kids just the same. It's a psychological ploy I use to avoid having to confront reality. I love her and enjoy her and refuse to let them take that away from me too.

A couple of weeks ago I took an overdose. I went to the doctor who said I didn't have PND but that I was grieving and angry. He gave me the pills anyway and they were the first things I reached for when I could no longer abide the memories tormenting me day and night.

I have come to the conclusion that I really would quite like another child (me, who didn't want even one!). As odd as it may sound, I would have an elective section. I would gladly go through three months of physical pain if it meant I could have just a few minutes of happiness at my baby's birth. After all, the physical stuff heals, it's the mental stuff that doesn't.