Friday, March 28, 2014

Canadian Healthcare: Not as Universal as Some Might Think

In Canada, every baby born in Canada, is Canadian (*with the exception of some babies who might be born to diplomats). It doesn't matter where that baby's parents are from - and as a Canadian every baby born in Canada is entitled to access to the publically funded Canadian healthcare system. But, when should that baby's right to publically funded healthcare begin? Should that baby have different access, because of the origin of one or both of it's parents than another baby also born in Canada? Should it matter if that baby's mother is Canadian or if it's father is Canadian? Should it make a difference if, at some future point, that baby's mother will be eligible for publically funded Canadian healthcare?

It may come as a surprise - but, access to publically funded healthcare in Canada is not universally available to all pregnant women in Canada.

There are pregnant women in Canada who are uninsured and must pay out of pocket for healthcare services related to pregnancy and childbirth - many of whom intend on making Canada their home, many of whom are carrying the children of Canadians, many of whom will ultimately have access to publically funded health services.

The fact that these women will bear Canadians, and might well become Canadians or otherwise entitled to access to publically funded healthcare seems a fact that has gone unrecognized by whoever thought it was a good idea to exclude access to publically funded health services from these women.

I imagine the intent was to save healthcare resources for the Canadians who pay for the system - but I will argue that this policy is not only cruel, it is short-sighted and might well cost the very same healthcare resources it was intended to save.

Pregnancy and childbirth are exceptional times in a woman's life - at no other point is the health of both woman and child more vulnerable. At no other time is the health of the child so intertwined with the health of its mother. Care during pregnancy and childbirth matters - a lot. What is done or not done - echoes for the rest of that woman and that child's life. If access to high quality care is delayed or denied, there are consequences - both physical and psychological. Access to that care should not depend on the mother's ability to pay for it.

Right now, the policy is that unless you are Canadian or a landed immigrant you are not entitled to publically funded health care, and if you happen to be in either British Columbia or Ontario there is a three-month waiting period for eligibility - so if you were a Canadian living abroad who recently returned, you might also find yourself excluded from publically funded health services. It doesn't matter that there is a massive back log that impedes the processing of immigration applications. It doesn't matter that you may be married to a Canadian or that the baby's father is a Canadian. It doesn't matter that you would ultimately become eligible for publically funded health insurance or that the services that you are seeking to access are considered "basic care".

So what does this mean?

This means that the health and well-being of mothers and children in Canada might be at risk. This means that basic care might be foregone if the mother cannot afford to pay for it or if doctors and charities are inadequately resourced to provide it. This means that conditions that can be managed or diagnosed prenatally might go undiagnosed and unmanaged. This means that a mother might decide to give birth unassisted or at home, even though a hospital based birth might be better suited to her needs and those of her child. This means that some of the truly adverse consequences of pregnancy and childbirth - some of which might be avoided with better care - will be realized.

Who will pay for those left disabled as a result of inadequate care during pregnancy and childbirth?

Here's a hint, pregnancy and childbirth is far more dangerous for babies than it is for mothers. Those babies are Canadians. They are likely to pay with their lives or their health - and if they pay with their health, guess who is on the hook? Guess which resources will be used? Further, if the mothers eventually become eligible for access to publically funded healthcare - who will pay for the longer run consequences of inadequate care during pregnancy and childbirth?

Is it not better, to pay for an ounce of prevention? Is it not more fair to give every baby born in Canada the same access to healthcare - even before their births - regardless of whether it happens to be their mothers who are Canadian or their fathers who are Canadian?

Pregnancy and childbirth are exceptional - and are deserving of an exceptional policy response that recogizes the need to meet these health needs for these women and these children.

I encourage my reader's to sign the following petition demanding change to this shameful policy.

Background information:

- Uninsured mother's likely to have inadequate prenatal care.

- Tyee article on uninsured mothers in Canada.

- Mother gives birth in Hotel due to uninsured status.

- Canadian doctors call for action on uninsured.

Wednesday, March 26, 2014

Guest Post: Maternal Choice Cesarean, One Mom's Story

The following is a guest post from a brave cesarean by choice mother who is willing to share her experience in the hopes that others might be better able to understand and support cesarean by choice. She is now 3 months post-partum and enjoying motherhood the second time around. I thank her for her submission to Awaiting Juno and for the permission to post her story on my blog.

I had a c-section with the birth of my second child. It was elective, by my request. The first birth I experienced was an extremely unpleasant experience that I preferred not to repeat.

I'm not the type of person who shares my life choices all over the Internet, but I want to share my experience for the knowledge of those considering the same choice. I’ve heard about 1% of childbearing women opt for a maternal request c-section. My experience was very positive; everything I had hoped. After a less than ideal vaginal birth, it felt good for things to finally go in a way that was ideal for me.

There is stigma against choosing to have a c-section. The phrase “too posh to push” comes to mind. There’s also some confusion about women being happy with the procedure. “Why would anyone choose that?” Well, the answer to that question is highly personal! And trying to insult women by calling them too posh to push isn’t going to make us feel obliged to answer.

Still, there’s the stigma. I chose to avoid it, along with the demand for an explanation by simply not telling anyone who was not close with me. Since before I conceived my second baby, I knew a MRCS was my preference. I would even say that it was my plan. My husband witnessed the vaginal birth of his first son, and to say that he was on board with my plan would be an understatement. Next, I told my mom. She was on board. My family was on board. My husband's mom also was on board. She had four precipitous labors (that means she labored and birthed extremely fast). She told me she never understood why anyone would want a natural birth. She had four and she hated all of them. She never had any other choice, because her labors were literally that fast. And, kudos to her, she was the only woman who was honest about this with me during my first pregnancy. Since I ended up laboring for 24 hours, an unfathomable amount of time to her, she thought a c/s was a totally reasonable option.

One night I went out with one of my best girl friends. I was craving some crepes, so we went to a diner. I decided to tell her about my plans. With her being a feminist and also generally extremely supportive of any choice her friends would make, I was shocked and hurt when she said, looking bewildered, "Why?! You're so young! C-sections are terrible! (She has no kids.) My aunt had a c-section and all of her staples flew out of her when she puked!"

So, don’t expect support from everyone. Also, take no shit from anyone. That’s my advice. It doesn't matter why you want a c-section. You don't owe the world an explanation. You especially don’t owe them a polite explanation. After all, people who think they deserve any say in what you do and do not do with your vagina are also not polite. And those who think that you are going to damage your offspring and rob them of gut flora and IQ points by choosing this are also wrong and not polite. They also tend to believe everything they read on the internet. You’re better than them!

At the time of my first pregnancy I was coming from a religious and homebirth-affiliated background. My friends who were mothers were all pretty smug, proud, and touted all things natural, so that was the route I chose to go down, too. It was scary to be pregnant so young. I was 19. I almost home-birthed, but my mom talked me out of it, so I ended up having a vaginal birth in the hospital. The staff was overall great and really kind to me, even though I was a horrid patient to have. Still, the birth was just terrible, physically and mentally: 24 hours of labor, three hours of pushing, 8lbs 13oz of baby on my (previously) small frame… It just wasn’t good. I tore externally (but not all the way to the back) and I also tore internally. I did have an epidural, but I decided to let it wear off while I was pushing, so I felt the tearing, and I felt my baby being born. I had vowed to myself that I’d never forget (like my friends who said they did), but now I wish I could forget.

My internal tearing was the main problem. It happened because my baby was big and stuck in the birth canal. We couldn’t get him past a certain point without forceps. It was the posterior wall of my vagina that tore, into the wall of my rectum, almost all of the way through. I still remember what it felt like when my doctor began to stitch it up. Sexual intercourse stopped being so painful around nine months later. It was a disturbing thing to work through. Not to mention the stress incontinence. I couldn’t cough, sneeze, laugh hard, jump, or run without peeing myself. Despite wanting a second kid, I couldn’t agree to the idea of another vaginal birth. I got dizzy and faint thinking about my first one. Plus, I didn’t want my unpleasant symptoms to worsen. My psyche and my body thanked me for my c-section. A vaginal birth was so undesirable to me, that if it were my only option, I’d never have had another baby.

One day my mother ended up randomly joining me for my OB appointment. I hadn’t brought up the issue yet. My mom spontaneously did. "If she wanted to have a c-section," she said, "would she be able to?" My OB said that would be okay and she asked me why I wanted to. I told her I didn't want to relive my vaginal birth and cried. She was really kind. She comforted me and read the dictation she wrote after my first birth. She said between that, and my emotions, my request was totally fine with her. She even scheduled the surgery for the exact day that I wanted, even though she was planning on having it off. She came into the hospital early that morning for my family and I, and then went home.

The rest of the story is short in comparison to what I’ve already written because it was a breeze after that. It was simple, easy, relatively pain-free, happy, and everything that I wanted to happen. That isn’t the reality for some surgeries, but for mine, it was.

We went to the hospital early in the morning in December to check in. Our check in time was 5am and the surgery was scheduled to start at 6am. No food or drink from midnight until after the surgery. The nurse directed us into a brand new comfortable hospital room. She asked some questions, got an IV started, and basically told me what to expect and what she would be doing for me. Two anesthesiologists came to my hospital room and explained to me the spinal I was going to get for the surgery. Pretty straight-forward, a lot like the epidural I’d had before.

My husband and I waited around in the hospital room. We felt pretty calm. We just chatted and had a good time until the OR was ready. When it was time to go down, my husband and I parted ways for a moment. He had to get his scrub outfit on. While he did that, I got my spinal. It was a good arrangement because he is phobic of needles. I hugged a pillow and curled my torso forward around it the best I could with my huge pregnant stomach being there. There was a nurse smiling at me, hands on my shoulders, talking to me. The spinal was actually not as easy as my first epidural. The anesthesiologist was placing… what I assume was a needle… and he hit a spinal nerve. That sounds terrible, but it really was not so bad. I said, "There's a weird feeling." They asked where. I gestured towards it and tried to explain. It was about a foot long vertical stretch, just a tad to the right of my spine. It felt like a weird minor pain I get sometimes on a tooth I have where it's chipped. That's the only way I know how to describe it. It lasted maybe thirty seconds total, and then it faded and the numbing started to happen.

My husband came back. They were monitoring my oxygen and blood pressure. A catheter was put in (SOO glad they did that after the anesthesia, not before). My OB asked if I could feel her touching me. I couldn't, so I said no. She felt different parts of my abdomen and body to see if I could feel anything. The answer was always a no. So, they started the surgery.

I still didn't feel anything. I had a bit of adrenaline, and the occasional chill. When the blood pressure cuff would squeeze my arm, it made my right hand clench uncontrollably. My husband made the mistake of holding my hand while that happened. That was a funny moment for me.

Anyways, my baby was born after not too long. The OB said something along the lines of, here he is, he is beautiful! Then he cried. I looked over and watched as they cleaned him up nearby, as per my request, before I held him. 8lbs, 3oz, 20.5" long! If I carried him to his due date he would have rivaled my first baby in size. Some people who have c-sections say they feel a huge amount of pressure as the baby gets pulled out of them, but I didn't feel that different or weird. Or anything. They wrapped Baby Andrew up and we got to hold him, cuddle him, look at his face. I didn't feel any pain and so I felt like I could be entirely mentally present. I was just so giddy and happy. I did not feel that way with my first birth. With this birth, I was just ecstatic and completely without pain.

While that happened, my OB performed my tubal ligation. She found out that I only had one ovary and one fallopian tube. Interesting. I asked the team if I could take a picture of my placenta and show my best friend, the one I had went out to the diner with, because she had always wanted to see a placenta. They let me, and then they asked what I wanted to do with it next. I didn't want it. And then we made fun of lotus birth together.

At some point, the anesthesiologist took pictures of my husband and I with the baby. I adore those photos. The anesthesiologists always stayed right by my husband and I, keeping us company, talking about life. We talked about our families together, and they answered all of the questions that I had in detail. They were absolutely amazing the whole entire time. My baby got to stay with us always.

Recovery was pretty easy. I threw up after my first birth, but not this time. I had occasional nausea but it stayed under control. The first thing I could have was chicken broth. Then, I believe I was eating snacks a few hours after the surgery. Those hours flew by, so it wasn't an issue for me. I started to feel just a bit sore, but it was nothing like how I felt with my first birth. Also, the pain was in a different location, and it felt less…disturbing.

I have no complaints about my recovery at all whatsoever. It was somewhere between day four and day five that I stopped taking pain medication. Again, sooner and better than my first birth. The only thing that was worse was standing up and walking for the first time after surgery. I had spent a lot of time lying in the hospital bed at an incline, so I hadn't had my torso straight for a while. Straightening it out was a bit painful and strange, but after the second or third time, it felt much more normal.

I haven't felt pain related to the delivery for a long while now. I'm a little over three months postpartum. Healing came so easily. I wonder if my mental preparedness played a part in that at all. I have had no issues at all whatsoever with intercourse. I felt “ready” 2-3 weeks after the surgery, but we were good and waited. My stress incontinence even seems to be gone… No more leaks, ever. I should mention that to my OB next time I see her to ask if she did something during the surgery to make that happen, or if it's just a happy coincidence. I know she was aware of the issue.

I can't think of anything else to say, except that I am SO happy with my choice, so happy I was supported and able to make that choice, and I have not even one iota of regret. My husband also had a much better experience. It was so much less traumatic for him. I’ve heard people say their surgeries hindered them from bonding with their babies, but we felt like it was easier to bond with our baby this time. We had a better idea of what to expect, nothing traumatic happened, and my pain was very controlled. No complaints! I’m just grateful and happy.

Wednesday, March 12, 2014

Not now but not, not ever

The last few months have been personally challenging – and a big part of that challenge was coming to the conclusion that I had gone as far as I could go with respect to holding my care providers, and the hospital to account for what happened to me. That – one of the tools that I saw as perhaps being the most effective in terms of preventing the same thing from happening to someone else (litigation), simply was not going to be available for me to use at this time. I had invested a lot of emotional and intellectual energy into pursuing it and it is heartbreaking. I still believe that litigating was and is the right thing to do, but that it just isn’t possible right now, not because it is without merit but because what is needed to succeed at this time just isn’t available and there was no amount of wishing or wanting or brainstorming that could take care of the barriers that stood in the way. Those barriers were both structural and systemic and personal.

It is particularly difficult because I know, now – nearly four years after I had my daughter, that women in Canada are still struggling to access the care they need, when they need it. They are still struggling to find doctors who listen to what they need, who provide informed consent and who respect their right to make a medical decision for themselves after considering the risks and benefits of their options.

It happened in Alliston the other week – and is happening again as I type in Ottawa to another mother, a mother who just wants to be heard. A mother who just wants her right to informed consent and the right to make medical decisions for herself respected.

And it will continue to happen until there is profound change and a shift in focus away from the things that do not really matter and towards the things that do.

Which is why, while I have had to discontinue the case – I refuse to discontinue with the cause. Because there will come a time, when the barriers will be mitigated and surmountable but only if those barriers continue to be dismantled.

It’s why this blog will continue. It’s why the maternity legal action fund needs to be supported. It’s why the Cesarean by Choice Awareness Network will continue to grow and remain a place for women who would choose cesarean and those who support them to connect with each other and advocate for change. It’s why Moms Forward will be established. It's why I'll continue to tweet (@AwaitingJuno) and continue to raise awareness and advocated for change.

Because some day being a Cesarean by Choice mom will be better - with a strong community, with better access to compassionate and competent care providers, and meaningful recourse and support. I have not given up – but have accepted that there are things I can do, and things I cannot do, and that not now does not mean not ever.

I apologize for letting down those who had hoped that the litigation would proceed, and would like to thank all my readers for their continued support.

Thursday, March 6, 2014

An Update from Alliston, Ontario

My last post focussed on the difficulty a mom in Alliston, Ontario was having in trouble accessing her preferred method of birth - a maternal request cesarean. This post is intended to provide an update.

The baby arrived the day before yesterday, after an induced labour that lead to a normal delivery. The mother agreed to be induced by her OB because then she would be the doctor on-call so that if there were any bumps the mother felt the doctor would "be more lenient" in proceeding to a cesarean. The mother was able to get an epidural, and the baby arrived without any complications.

Prior to the delivery, the mother did all she could to secure a cesarean.

But the reality in Canada, even in 2014, is that sometimes even when you do all you can - it simply isn't enough.

I am also aware that it is possible that in this case, the mother will accept how things unfolded and might even be happy with the ultimate result. I do not believe she changed her mind about what she wanted to do - rather, she gave up on thinking that anything other than a trial of labour was going to happen, and under those circumstances made the best of it by choosing to be induced when her doctor was on-call and ensuring access to an epidural. It is her birth, and her feelings around it are for her to determine - and how she feels about it now might not be the same as she feels about 6 months or a year from now. Just as many women who plan on vaginal deliveries and ultimately wind up with cesareans are accepting and even happy as a result.

On the same token - there are many women who are forced into trials of labour and vaginal deliveries they do not want and are ultimately left psychologically scarred.

In closing I'd like to wish this mother my deepest congratulations on the arrival of her child and I'd like to thank all of those who offered advice and tried their utmost to assist in this situation. I'd also like to lament the fact that yet another mother has had her right to make a reasonable medical decision taken from her, and has made decisions that were ultimately very different from the ones she would have made had she been adequately supported. The physical outcome might have been better in this case - but I am by no means convinced that the overall outcome, the one that includes psychological health and well-being is better than what would have happened had her choice been supported.

Wednesday, February 12, 2014

Like Watching a Movie When You've Already Read the Book

I am blogging about this with the permission of the mother involved.

There’s a caesarean by choice mom in Ontario (Alliston) who has contacted me – and unfortunately her story seems to be unfolding pretty much as my story unfolded with the birth of my daughter. Except, her OB told her at 33/34 weeks that she would not do a caesarean unless there was a medical indication for one, but if a medical indication presented itself that they would move to a caesarean as soon as possible. The doctor implied that the “Ministry of Health” would have a problem with her undertaking a maternal request caesarean (I call BS!). My doctor failed to refer me until 32 weeks, and I did not know if my request would be granted until I was 36 weeks.

The woman was upfront about what she wanted with her care provider from the start of her pregnancy (as was I). Had the doctor been upfront with the woman at that time, she could have moved on to an alternate provider that might have facilitated her request (as might I have). Instead, she was treated paternalistically (as was I) by a doctor who seemed sympathetic, who seemed to listen and to understand – but who ultimately frustrates what is desired by the patient by ensuring that what is wanted cannot be realized.

After being informed by her doctor that her care plan is unlikely to be realized – this woman has been left scrambling. She’s gone back to her family doctor hoping that if he advocated for her that her plan would be facilitated. No luck. She’s written a letter to her doctor that says she does not really consent to a vaginal birth and that she is worried about the potential harms of vaginal birth for both herself and her daughter. She’s pointed out the NICE guidelines on caesarean by choice (she’s Canadian so they don’t really apply). She tried to give her doctor Pauline McDonaugh-Hull and Magnus Murphy’s book “Choosing Cesarean: A Natural Birth Plan”. Her doctor declined reading it. She is currently left hoping something goes wrong so that she can have the caesarean she wants. Her OB wants to begin performing “stretch and sweep” procedures at her 37 week appointment next week.

I’m saddened that nobody has seen fit to refer this woman for a psychological assessment – as the idea of a vaginal delivery causes her a considerable amount of anxiety, they are declaring they won’t do the caesarean without a medical need – without recognizing that the mental health impact of an unwanted vaginal delivery IS a medical need. Rather than investigate that, they just out-rightly have denied this woman access to the care she needs and are doing so in a rather unethical way, by having delayed referral to the point where alternate care is not possible. The lack of understanding and compassion is appalling – as is the lack of recognition that a woman has a right to decide what to do with her own body and she should not be unreasonably prevented from doing so. This woman has not fallen through the cracks, so much as she has been shoved into a crevice.

So what would I do if I were faced with that situation?

I might start contacting lawyers and legal aid to figure out if there was some way to avoid having my rights violated. I might write a letter to the College of Physicians and Surgeons of Ontario calling out the behaviour of the physician. I might contact the media about my plight. I would contact Birth Trauma Canada for advice. I might contact the Office of the Ombudsman and file a complaint. I might contact patient rights organizations with my story. I might go to a different hospital with a reputation for being more “woman friendly” at 39 weeks and beg for a caesarean. I might hire a psychologist to try and advocate on my behalf – or maybe contact a perinatal social worker to see if she could help. I might ask the doctor to provide me with a medical reason not to perform the caesarean. I would go to another care provider – even if it meant the on-call OBGYN at the hospital and I would continue to make my wishes known in as clear of a way as possible.

And ultimately, if all that failed and I was still subjected to a vaginal delivery I did not want. I’d do what I’ve done – try to handle it as best I can, to try and cope with what has happened, to try and not let it impact my life more than it needs to because you can’t change the past – you can only do what you can to make the future a better place.

I’m really sorry that I cannot do more for this mother – it is like watching a movie when you’ve already read the book. Sometimes you can only hope for a different ending.

P.S. If anyone can help make a different ending happen - please drop me an email at qualitycareforbcmothers@gmail.com. - Thanks.

Monday, February 3, 2014

Tragedy and Hope - Heartache, Death and Birth

At Victoria General Hospital right now there is a man who is waiting for a caesarean section, he waits because his wife, unlike every other mother-to-be is no longer able to wait as she is brain dead. She suffered a fatal cerebral hemorrhage on December 28, 2013. Her husband left to get her some Tylenol for a headache she had, and came home to find her unresponsive. He called 9-1-1, and while they were able to sustain her on life support, the damage was too severe and there is no hope for her recovery. She was 22 weeks pregnant at the time. She has been kept on life support since, in the hopes that her unborn son might be born safely at 35 weeks (in about 7-8 weeks time), or emergently if her body begins to fail her before then. Given his current gestational age – the baby already has an excellent chance of surviving the birth (80 percent).

The arrival of Iver Cohen Benson is expected to be bittersweet – a miracle born out of a terrible tragedy. Shortly after his arrival, his mother will take her final breaths and his father (Dylan Benson) will have to say his final farewells to the body of his life partner. He will embark on a new life then – the life of a new father, the life of a single parent, the life of a widower.

I applaud Mr. Benson for having the courage to take it on – he appears to determined to give his son the best life that he can. He has taken leave from his work to be at the side of his unborn son. After his arrival he will need to be by his son’s side for any required stay in the NICU, and after that the hard work will begin. The job of being both mother and father to a very small child while attempting to grieve and heal from a tremendous loss in his life.

Mr. Benson is going to need an incredible amount of support. Not just from his family and friends but also from his community. He is going to need all of the support he can get – all the support that most new mothers need, he will need. All the support that single parents need – he will need. All the support that widows/widowers need, he will need.

It warms my heart to see the outpouring of support that has begun for Mr. Benson and little Iver, but it needs to be understood that the support that has been given so far is just that. A start. This is the beginning of a very long (and potentially very expensive) road ahead, a road that will be navigated alone.

To give some idea about the costs of being a widowed parent to a newborn infant/toddler/pre-schooler think about the following :

1. If Mrs. Benson had survived, she would have received maternity/parental benefits and as a result of her employment (provincial government) her wages would have been topped up while she was on leave (up to 85% during 17 weeks of maternity leave and 75% while on parental leave) – and Mr. Benson would have been able to continue to work. After a year of leave if Mrs. Benson returned to work – she would have earned her income as well as being enabled to contribute to the daycare expenses of the child. If she chose to become a stay at home parent, daycare expenses would be avoided. In Victoria the costs of a full-time infant space is about $1150 per month – nannies are more expensive with live-in nannies costing about $1500 per month and live-outs costing $15 per hour.

2. If Mrs. Benson had survived, her family would have benefited from extended health benefits that she receives as a result of her employment. Unless Mr. Benson also has extended health benefits through his employment, those expenses will be out-of-pocket ones in the years to come.

3. If Mrs. Benson had survived, she may have chosen to breastfeed her son. Given her death and her son’s likely prematurity, he will likely need donor breastmilk. If you are in a position of donating breastmilk, please consider doing so to a breastmilk bank where donor milk is appropriately screened and pasteurized) – in BC information on doing so can be found at www.breastfeedingmatter.ca/html/milk-bank.html - babies like baby Iver benefit immensely from these donations. Eventually, baby Iver will likely need formula – and this can be tremendously expensive, particularly if baby Iver has any sensitivities and is in need of a hypo-allergenic breastmilk. The costs of formula feeding can exceed $500 per month. An excellent resource for those who formula feed is the fearless formula feeder at www.fearlessformulafeeder.com .

4. Being a parent is a very hard job, and being one to a small child is a special challenge that frequently involves sleep deprivation. It’s hard enough when there are two parents able to take on the challenge – as one can often provide some respite for the other. As a result of Mrs. Benson’s death, that respite might be unavailable or might come at a cost – on average babysitters in Victoria charge between $10-$15 per hour.

5. Being a widow is no easy task either. Mr. Benson’s story reminds me of Matt Longelin’s in some ways (www.mattlogelin.com) – he too was thrust into new parenthood and widowerhood at the same time when his wife passed within 48 hours of the birth of their daughter, Madeline. Accessing psychological counselling can run about $160 per hour.

This is why I hope that Mr. Benson can far exceed his fundraising goals and succeed in being the dad he wants to be and giving little Iver the best life he can. I hope little Iver brings him joy. I hope Iver is able to meet his full potential and always knows how much he is loved by his father and his community. I hope the financial toll of losing Mrs. Benson is mitigated to the degree possible – because the loss of a mother is already tragic enough without it also imposing financial ruin on those left behind as they try to grapple with the void that is left.

I should add that I do not personally know the Bensons – but I wish them the best possible outcome under these horrible circumstances.

If you would like to consider donating to Dylan Benson and his son, Iver – they’ve established a donation page at http://www.youcaring.com/help-a-neighbor/baby-iver-fund/133560 entitled "Baby Iver Fund"

Monday, January 27, 2014

No, Dr. Maiman this might not be a cause for celebration...

I have a problem with automatically celebrating declines in rates of caesareans without understanding why the decline happened, and whether or not there was any significant repercussion from the change. I have a problem with the assumption that vaginal birth is good, and caesarean birth is bad. I have a problem with a very superficial understanding of what is a very important health issue for both women and their children.

In short, I think the focus on caesarean rates is wholly detrimental to the health of women and their children. Which is why – I get annoyed by articles like this http://www.nlm.nih.gov/medlineplus/news/fullstory_144198.html - that trumpet the decline of first time caesareans as some kind of public health success story. It might be, but the disservice to women and their children, comes from the assumption that the road to better health and well-being goes straight through the birth canal.

The issue of birth – and the issue of planned caesarean versus planned vaginal birth, is complex, incredibly complex, and the focus on rates of caesarean over-simplifies it. The focus on the rates of caesareans, ignores many things that matter a great deal and deserve greater attention.

There are so many things that I’d like to know before considering whether or not the movement in caesarean rates is a good thing and off the top of my head here’s just a few things:

1. Was the decline in the rate of urgent/emergent caesareans or in the rate of planned caesareans?

2. Was the decline a result of a change in the demographics of women giving birth – for example were the moms younger, more likely to be a healthy weight at the start of their pregnancies, were they less likely to be gestationally diabetic, were they planning on larger families?

3. Were there more 3rd and 4th degree tears?

4. Were more moms suffering from incontinence a year after the birth?

5. Were there more low APGAR scores?

6. Were there more deaths?

7. Did more or less moms consider the births traumatic?

8. What happened to rates of post-partum depression and/or PTSD?

9. Were any moms who would choose caesarean denied access to their delivery method of choice?

It’s true that the risks of caesareans mount with the number of caesareans that are had – and for women planning large families it is important that they pursue the birth plan that gives them the best odds of success. However, I must strenuously disagree with the assertions made by Dr. Maiman in this article that “The risks to mother and baby are much higher in a caesarean birth than in a vaginal birth” and “Vaginal delivery is the preferred method for having a baby, Cesareans should only be resorted to when its absolutely necessary.”

Vaginal delivery is not the preferred method for delivering a baby for many women – particularly those who suffered adverse consequences that could have been avoided had they been delivered by caesarean. Further, it is very debateable as to whether or not the risks of caesarean are “much” higher for both mother and baby than a planned vaginal birth. There is some evidence http://www.ncbi.nlm.gov/pubmed/19941705 - that looked at 40,000 term deliveries from 1994-2002 and compared planned cesarean for breech with planned vaginal for cephalic and found the maternal morbidity (life-threatening) was similar in each group but that life-threatening neonatal morbiditiy was decreased in the pre-labour cesarean group.

However, as long as we’re focused on the headline cesarean rate, and lowering it, at what might be tremendous cost – we will never get to what really matters: the health and well-being of mothers and their babies.

Wednesday, January 22, 2014

Yes, cesarean mothers also give birth...

Language is powerful. The words we use can convey ideas, foster understanding and create new ideas. Words can also be used to exclude and to inflict harm on others. Words, aren’t just words – they are filled with meaning and are the primary tool that human’s use in social interactions with others.

Recently, I came across a tweet, although I’ve heard the same sentiment expressed elsewhere: “Cesarean mothers did not give birth.”

My immediate reaction is that this might be the dumbest sentiment that I have ever heard expressed, but also a kind of anger at the ideas that are implied by this sentiment. The idea that caesarean mothers are somehow lesser mothers than those who both planned, and managed to have vaginal deliveries. The idea that the only “real” birth is a vaginal birth. In this statement is a kind of backhanded insult to every woman who ultimately became a mother via caesarean – a kind of one-up-womanship that should be called out for the kind of garbage that it is.

Birth marks the end of a pregnancy – it is the process by which a woman becomes a mother, and hopefully emerges physically and psychologically healthy from with (ideally) a baby whose health has not been compromised by the process. The definition of birth bears no mention of mode of delivery because, frankly, mode of delivery is irrelevant to the definition.

A caesarean birth is not a “fake” birth, they do not issue “caesarean certificates” instead of “birth certificates”, they do not ask for “date of caesarean” instead of “date of birth”, and my kids both celebrate “birthdays” – regardless of how they were born.

Sometimes the things people say go beyond being stupid – it’s a shame though, that such silliness can hurt so many and that such silliness is often in an over-abundant supply.

While we're at it - bottle fed babies are also "fed", adoptive mothers are also "mothers" and stay-at-home moms and working moms equally love their children.

Monday, January 13, 2014

When Nurses make Medical Decisions Instead of Doctors and Patients...

I think I know what really happened in my case. It is disturbing.

The head nurse at Victoria General decided that elective cesarean for whatever reason deserved to have the lowest priority and to never actually get on the slate.

A health professional who I had never met, who I had never discussed my pregnancy with, who decided in her judgement that I was not deserving of respect for my medical wishes.

Where have I come up with this theory?

From an OBGYN nurse who frequents an online discussion forum who decided to comment on a thread I started for Cesarean by Choice Mothers. She declared that there was no way that an elective cesarean was available in Victoria and then indicated why.

According to Tikitorch at Kids in Victoria:

oh yeah who? i am an obgyn nurse and yes i have been on mat leave for the last 4 months but im sure nothing has changed... even if there was elective c sections, theres no way they would make it onto the slate that the head nurse puts in order of priority for the OR, anyone with any medical condition would be above that person.

BC medical does not pay for an elective ceseran section (*unless you had a previous c section, or a medical reason for it, for example active herpes, diabetes, macrosoma etc), so if in fact you found a doctor to do it for you, and the moon and sun aligned and you got on the OR slate, you would be financial responsible for it,.,

This should provide as a warning to mothers planning cesareans by choice at Victoria General - the head nurse will substitute her judgement for yours and your doctors.

Sunday, January 5, 2014

Take Stock, Regroup, Just Keep Swimming

December was a personally rough month, as such it has been a while since I have blogged. Thankfully, there was a bit of a reprieve over the Christmas break and a few of the issues that were contributing to an overall feeling of being overwhelmed have been resolved and I have had some time to regain some perspective. Something that has been a channel for a lot of the anger I have over what happened and what I could do about it is looking untenable, and as a result I have been struggling. So I have needed to take stock, regroup, and move on.

On the stock front I have a lot to be immensely grateful for - I have a husband who I love. Between us we have four healthy children. We have stable jobs. We live in a beautiful city. I am immensely grateful that I have many good friends, and am immensely grateful to have met individuals who share a desire to change healthcare in British Columbia and Canada.

In terms of regrouping, I have made a commitment to myself to set aside an hour a day to exercise. I'm hopeful that it might be adequate to stave off some of the depression I seem to have developed. I'm hopeful it will give me time to think about how to move forward, and how to get closer to where I'd ultimately like to go. I'm hopeful that I can be a better wife and mother - and that I can find a better balance.

In terms of moving on - when one door closes, another may open. I'm hopeful I can do a decent job of identifying what those doors are and can have the courage and strength to walk through them.

All the best in 2014.

Monday, December 16, 2013

Patient Choice Cesarean, Urgent/Emergent Cesarean or Forced Vaginal Delivery - Is it Really That Hard to Choose?

There's a phrase I hear from healthcare providers and others who oppose patient choice cesarean, "No physician is obligated to perform a procedure that he or she thinks is not medically indicated."

They see the denial of choice as being justified. Perhaps they think that they are saving the healthcare system resources by denying the choice. Perhaps they worry that women are unable to make an informed decision in this regard. Perhaps they see performing a cesarean without medical indication as causing harm, to either the woman or the child.

For whatever reason, there are those, who when faced with performing a patient choice cesarean, will outrightly refuse to undertake the procedure.

This would not be problematic if timely access to an alternate provider who is willing and able to undertake the cesarean can be realized. Unfortunately, under the current system - this is often not possible.

So if a woman cannot access patient choice cesarean when it is needed (either planned at 39 weeks or done urgently after the commencement of labour) - what will happen to the patient?

Perhaps care providers simply haven't thought about this in full - what happens to the woman, pregnant and desiring of a cesarean who is not provided timely access to one? What really happens?

Nature is a cruel wench - she isn't particularly patient, and the woman cannot just delay delivery until she finds a provider and a facility who can accommodate. The woman will eventually go into labour - this is nearly guaranteed. Either a medical need will then arise for a cesarean - in which case an urgent/emergent one will hopefully be provided - or medical need won't arise and at some point the woman will be fully dilated, and given no choice as to what she will have to do whether she wants to or not. She will deliver vaginally. The experience of which is foreseeably traumatic - or at least should be - as the patient will have been subjected to what can only be considered a Forced Vaginal Delivery or an urgent/emergent cesarean where either her life or her baby's is put at risk.

And the thing with traumatic experiences is that they don't just go away - and sometimes they don't ever go away. The physician will have avoided doing what he/she saw as a medically unneccessary procedure - but in so doing will have likely inflicted a rather large emotional toll on a woman as she is entering a very significant life transition.

I can speak to the experience of forced vaginal delivery as it is my own lived experience. I can speak to the toll it has taken on me, and how it has changed me and how having had that lived experience - I would not wish it on any other woman because it is it's own kind of hell.

That is the real choice facing health care providers when women come to them asking for a patient choice cesarean: Do you facilitate the request after having provided informed consent, or do you subject your patient to a Forced Vaginal Delivery or an urgent/emergent cesarean after medical need arises?

Wednesday, December 4, 2013

A Doctor who Listens: Worth Their Weight in Gold

I appreciate that my experience with the medical system has changed what I expect of it, and has sensitized me to certain things. In particular, I blame part of what happened with my pregnancy and birth of my daughter as a failure of my health care providers to listen and understand what my needs were as a patient, and to facilitate those needs as best they could. I communicated my wishes clearly, and expected them to be respected.

As I've blogged about before, also as a result of what happened, I needed to find a new family doctor. It took nearly a year, but I found one. It is a new relationship - and like any new realationship, it is particularly fragile. We've had a few encounters - and while I think the new Dr. is a good person, I think that it just is not going to work out.

Advocating for oneself in the health system is already a challenge. Recently (now a month ago), I had some female oddness happen - I emailed an OB I knew and asked what I should do about it. I made an appointment with the GP - and the GP's answer was basically to just do another appointment for a pap (no physical was done at that time). I asked for a referral to an OB and that it seemed like a good idea for a pelvic ultrasound to be done. He ordered the ultrasound but refused to do the referral at that time. We did the ultrasound, and I had another appointment with him to discuss the results. My Mirena is partially imbedded in my myometrium. I decided to ask for the referral to the OB I prefer to determine what should be done. My GP is refusing to refer and insists on removing the Mirena himself (a. I'm not sure removal is fully neccessary and I'd like a second opinion on that, and b. if it does need to be removed, I'd prefer to have an OB (and preferably the OB in Vancouver) remove it because if there are any complications the last place in the world, I want to go is Victoria General Hospital). Last Monday his receptionist called - and told me that he'd prefer to remove it - I reiterated the request for the referral. I called today (10 days later) to see if the referral had been put through. It hasn't. This is the last time I'm asking for it - and frankly, this experience has demonstrated that he is not listening to me and makes me question whether or not he would listen to me in the future with any issues that may arise. I am frustrated and annoyed.

I think the hunt for a family physician for the W family is back on - and I foresee going to a walk-in clinic in the interim to get the referral I need to access the care I need.

If anyone knows of (or is!) a family physician in Victoria who is accepting new patients and who listens to their patients - I promise a low-maintenance and grateful young family.

Friday, November 29, 2013

For Spouses of Women Struggling with Birth Trauma

Birth Trauma is hard on women - but its also hard on their spouses and on marriages and partnerships. A post done by the Good Men Project for spouses of those with depression has inspired me to think about what partners of women traumatized by birth can or should do for the women they love as many of the things mentioned in the post resonated with me and my experience. Nobody tells the partners of birth trauma victims how to cope or what to do - and for the most part how can they be expected to know what to do? This post is intended to try and offer some advice to those loved ones, who desperately want to do something, but just don't know what.

Birth Trauma is devastating for women - when a woman is traumatized by her birth, her entire notion of herself as a woman and her role as a mother have been shattered. It can be a massive struggle for a woman just to make it through the day - many moms continually relive their birth experience and accompanied with the demands of motherhood, they feel overwhelmed. Spouses of women might try a gentle approach, they might try a firm approach, they might try to get them to open up, they might suggest things they think will help, they might buy presents and say encouraging things, they might get frustrated and argue. It seems as nothing a spouse does for a birth traumatized woman makes any difference - she just will not move-on. She seems unable to be grateful for all the good that remains.

Spouses of those traumatized by birth need to know, that birth trauma is not about women being in a "bad mood", or being upset because things during the birth didn't go "their way". Birth trauma is serious and debilitating. It is not about women "playing the victim" - or being trapped in "pity parties" - or being "selfish". Having a traumatic birth experience is like being in a car accident, or having your home destroyed by a flood. There might have been things that could have been done (or there might not be anything that could have been done) to avoid what happened - but the traumatized woman never asked for what happened to happen. The circumstances were entirely beyond her control - and if she could go back in time and have things happen differently, she would.

If your wife was injured in a car accident and had several broken bones - you wouldn't tell her to brush it off and continue as though nothing happened. If your wife was car-jacked and assaulted - you wouldn't tell her that sometimes that happens, and she was just unlucky but that she should be grateful to be alive. You would be patient, you would understand that she might be shaken from the experience - that she will likely need time (maybe a lot of time) and rehabilitation. Depending on how bad the experience was you might even have to come to terms with the idea that your wife might never be the same again. She might have to find ways to cope with the lingering injuries, she might not be able to do the same things she used to do, she might not ever be as social or as unguarded as she once was.

This is what birth trauma is.

Just because your wife made it through the birth physically, doesn't mean she wasn't injured psychologically. And just because you can't see the injury, does not mean that it does not exist, does not mean she is not debilitated.

After my daughter's birth, I was left reeling. It has taken years and a lot of therapy and self-care to get where I am. Three and a half-years on and I am not the same as I was and I doubt I ever will be. I won't seek care from Victoria General Hospital if I can avoid it. I am sensitive to feeling like my care providers are not listening to me. I am far more territorial of my person. I avoid movies with birth scenes in them. I am far more critical of those who judge personal decisions. I am less tolerant of intolerance and injustice. I am more skeptical and cynical. I am more angry. There are friendships I have had to discontinue - and other ones that have begun because of what happened. Birth trauma completely changed my outlook on life and who I am as a person.

When a woman is battling Birth Trauma - it is like she is in the deepest, darkest ocean - being crushed by the pressure of the water, and unable to determine the direction in which she should swim to reach the surface. All a woman wants to do is not feel the way she does, to not feel as though the day their child was born was also the worst one of their lives. They want to reach the surface and breathe -they want to swim to shore.

The natural reaction is to throw them a rope and pull them up to safety - to make them "see" how wonderful things are, to not focus on what happened, but on all the good that is. To make them move forward.

The problem is, that trying to pull women from the depths of Birth Trauma - might make things worse. Telling her to be grateful for her healthy baby. Telling her that what happened to her has happened countless times to countless other women. Telling her that she can not let what happened impact her mothering. Telling her to snap out of it and move on. Telling her that she should be happy as other women have it far worse. All these things are just as likely to drive the woman deeper into the trauma - and might add a dose of depression to go with it. Not only will she be unable to swim to the surface for air, the pressure to deny her feelings and needs for the sake of others might well crush her as she becomes a means to an end, rather than an end in and of herself.

For mothers, there is already tremendous pressure to sacrifice and put aside your needs for those of your family. Mothers already fear harming their children in some way by failing to do things the "right way". Mothers fear being labelled, they fear being seen as ungrateful. Mothers fear being judged as being weak - motherhood and birth are a kind of female machismo - and to admit that birth defeated you in some ways, is almost like admitting you are a lesser woman. There is tremendous stigma attached to mothers who are not blissful in their births and motherhood. We have been told from the time we are little girls, that being mothers is what women do and that good mothers are self-sacrificing. It does not matter that by accepting the stereotype of the good mother, we restrict women to biological essentialism - and that the sentiment is decades out of date and harms many women. The instinctual reaction for a mother is to sacrifice herself and her needs - to insist on soldiering on as a good mother does, personal needs be damned! Mothers will revert into themselves, put emotional barriers up and they will shut down. Trying to force a woman to move on, at what is likely the most emotionally challenging time of her life creates far more problems than it solves.

What spouses of the birth traumatized need to do - is to be there for their wives. If and when they talk, listen - refrain from giving opinions, just really listen. Women who are traumatized by their experiences need to be heard - they don't need your opinion about why everything is or should be okay (your body did not give birth). The thing I wanted more than anything, and the times when I felt my husband was really there for me, are the times when I felt validated and heard and sometimes just held. Your wife needs you to not be angry with her. Your wife needs you to be patient while she finds her own way out of the awful - she needs to feel and be safe when talking about it with you. However awful, the things your wife has to say - listen, and when you are done listening reaffirm that you love them still, reaffirm that you will be there for them, however long it takes and wait until they are strong enough to swim to the surface and the shore. Tell her it is okay for her to do what she needs to do for herself. It probably will be hard, you might need some help, but do not give up on your wife. Support her, love her, and be there for her until she gets to shore - she's the mother of your child, it is the right thing to do.

Thursday, November 28, 2013

Forced Homebirth in a Hotel Takes BC Maternity Care to a New Low

I believe in access to adequate and timely healthcare to facilitate the needs of patients - and in particular the needs of mothers and their babies. I believe in informed consent. I believe in the prevention of birth trauma. I believe that when moms want access to medical care during pregnancy and childbirth - we owe it to them to provide that access.

Which is why I am scraping my jaw off my desk this today - I am shocked and appalled. I am also incredibly thankful, that for this mom and baby that the circumstances in which they were forced to give birth did not result in any physical harm.

A 17-year, first time mother was 8 days overdue and needed to be induced. They travelled to the Vernon Jubilee Hospital for the induction at 9 am on November 15. They needed to book a hotel room to wait for labour to begin - they returned to the hospital at 3:30 am and despite being unable to walk, the mother wasn't dilated enough and was turned away. They returned to the hotel and sometime after 4:30 am active labour began and progressed so quickly that they could not go back to the hospital. The aunt and grand-mother delivered the baby in the hotel room.

How is this acceptable care? How is this safe care? How does this respect the needs of pregnant women for informed consent and timely access to care?

This is wrong on so many levels. This apparently happened a year ago - I wonder if anything in Vernon has changed since it did?

Tuesday, November 26, 2013

On Causes

The other week we were flying back from a weekend vacation (a whole weekend of uninterrupted sleep and adult time with my husband) - and I did not have alot of reading material on my iPad and I was tired of scrabble, so I was reading the case law I had pulled sometime ago in support of my case. I was reading the Morgentaler decision - the decision that struck down Canada's abortion law in 1988 - there are so many striking parallels between a woman's access to abortion and a woman's access to planned cesarean. I was thinking how sad it is - how clear the law seems to be on the issues, yet at the same time - how insurmountable the challenge ahead is seeming. I was also thinking about how my experience changed me and mourning the loss of the wife and mother my husband and kids deserved to have - the woman who, had things unfolded differently, would be thinking and doing so many other things - a woman who would not be burdened by a cause.

Having a cause is a lot like having a chronic illness. A cause isn't something you give passing attention to - nor is it something you fully choose - it is the choice you make when the alternative is for whatever reason, unacceptable. It is what is done, when nothing else can be done and doing nothing is reprehensive.

The cause is also a life-preserver - a coping mechanism...it holds out hope that change is possible. That what is and what was, doesn't have to be what will be. Remaining committed to it, means that hope has not yet departed. It means that what happened to me does not have to happen to other women.

I have no doubt with respect to the right of women to expect the same rights as other patients with respect to their healthcare and their abilities to make medical decisions for themselves. There are tremendous barriers to exercising those rights and asserting those rights when they are violated - and those barriers need to be eliminated. That's not a small task - and it will require many who are committed to the changes that matter - mothers, doctors, OBGYN's, midwives, nurses, lawyers, judges and administrators. It will require a certain bravery and tenacity - and those who see the value beyond their own individual experience. It will require research and awareness. It will require resources and organizational capacity.

But none of these things should be seen as unattainable for far more has been found for things that matter far less.