October: Trauma

Terrorized

The lights.

The smells.

The wide hallway.

I walk down

To jab a needle in my arm

Again.

Watch the numbers fall.

Unrelenting reminder

Of what almost was.

Everywhere

Is fear.

I wasn’t always this way.

A car –

It’s not where I expected.

I jump.

I see

My reflection

In a glass door.

My heart races

And then calms.

It is only me.

– Rebekah Miklusicak

I wrote those words a few years after my miscarriage in 2013. The memory, and the trauma, was still fresh. It isn’t so much now. But miscarriage is common, and trauma following a miscarriage is common too.

Different sources say that between 10% and 25% of confirmed pregnancies end in miscarriage.

A UK study that examined PTSD, anxiety, and depression following a miscarriage showed that the prevalence of these symptoms has been previously underestimated with miscarriage trauma lasting “longer than we realized.”

Those of us who experienced the trauma are probably not surprised by the statistics.

One month following a first trimester miscarriage, 29% of women had symptoms of PTSD, 24% had anxiety, and 11% had moderate to severe depression. A year later 1 in 6 still carried PTSD symptoms.

In miscarriage, we’re met with our own helplessness and often with feelings of guilt, shame, and inadequacy. We labor on our own with no support or knowledge of what to expect. Future pregnancies are met with fear. Our grief is often invalidated, so we are quiet.

Medical professionals tell us we have to have three miscarriages to do any tests, and they’ll let us miscarry “as a diagnostic tool” and refuse to test our progesterone. They refer to our babies as fetal tissue, biowaste, products of conception, and say things like, “Why were you even pregnant?”

Why am I sharing this?

Because the experience is lonely. If this is you, you’re not alone. Talk to someone who’s gone through it too. Even those of us who have experienced miscarriage won’t always have the right words to say, but sometimes we need to share the story and hear someone else’s just so we know we’re not crazy.

Because people are unaware. If this isn’t you, you almost undoubtedly know someone who has had this experience, and a friend to be present and patient in the midst of it all can be invaluable.

Because the terminology and the medical care should change. Care providers, take your cues from the parents. Talk about the baby and the loss the way the mother does. Save your clinical talk for other clinicians. You might not be able to make it better and that’s ok, but please try not to make it worse. Talk to mothers about their mental health. If you can’t help them or give them the care they’re requesting (like testing progesterone) send them to someone who can.

For so many women, their motherhood had traumatic beginnings, traumatic chapters, and holds lingering trauma. Please be gentle with us.

We might not ever go back to “normal”. Sometimes that’s a hard truth, but it’s because our babies mattered enough to change us.

Note: Because I know a lot of people who follow me know me in real life, I’m ok. I’m just sharing this, because some mothers aren’t.

Resources:

Still Birthday

For those who want to try again:

NaPro Technology

NaPro in West Michigan

FEMM Health

Dear Expectant Mama: What You Should Know About the Benefits of Vaginal Birth

I am not a medical professional. Please research your options and discuss them with your care provider when making health decisions. This post may contain affiliate links. This means that if you make a purchase, I may make a small commission at no additional cost to you. Thank you for supporting this free resource! See full disclosure here.

Dear Expectant Mama,

You might be wondering what the big deal is about having a c-section versus having a vaginal birth. Perhaps you’ve seen news articles, health organizations, or advocacy groups calling for lowering the cesarean rate, which is currently just over 30% in the US and globally is steadily climbing. Cesarean birth is so common now that on the one hand its relative safety and ready availability in an emergency is often taken for granted, and on the other hand its risks are often minimized. Some women are so fearful of vaginal birth that a cesarean seems like a desirable alternative.

So what ARE the benefits of a vaginal birth?

 

[Please note that in this post many of these benefits of vaginal birth are set in the context of risks of a cesarean birth, since cesarean birth is the other possibility. This is never meant as a criticism to mothers who have experienced cesarean birth, whether by choice or necessity.]

1 – A quicker, easier recovery for the mother.

Healing after birth is a big job for your body to complete, and so is caring for a brand new baby! Postpartum and adjusting to mothering a little human is challenging, and those few months following birth are especially significant to a mother and baby’s well-being. The better a mom is feeling physically, the easier it will be to focus on bonding, getting a good start to breastfeeding, and learning each other’s rhythms and patterns, which are all so important to your journey as a new mother.

After you give birth there is always healing to do. But if you give birth by cesarean, your body will have to heal the layers of skin and muscle where your incision was made, and, in all likelihood, this will simply take longer than healing vaginal stretching, tearing, or even an episiotomy. There may be pain or infection at the incision site, and there is also the possibility of other organs accidentally being injured during surgery. These circumstances may further prolong healing or require additional medical attention. Whether you give birth vaginally or surgically, the good news is that your body is designed to heal.

2 – A healthier microbiome for the baby.

Every human is colonized with a variety of microbes (mostly bacteria, along with fungi, viruses, protozoa, and archaea) that either helps or hinders the health and function of the body. Before your baby is born, she is for the most part protected from bacteria by the amniotic sac, but once your water breaks, your baby starts being exposed to bacteria from your vagina. Your own microbiome is passed on to her as she is “seeded” with the first bacteria she comes into contact with. As your baby is born and hopefully handed straight to your arms, she comes into contact with more bacteria from your skin. As you nurse your baby she is being fed with the perfect food to feed the right kind of bacteria in her gut, the seat of her immune system.

When a baby is born by cesarean, she doesn’t get the chance to pass through the vagina and be seeded with your bacteria. Instead she first comes into contact with the hospital environment and medical staff, so she is seeded by different bacteria. The method of birth isn’t the only factor to microbiome health, but babies born by cesarean generally have a less diverse microbiome with a less healthy balance of good and bad bacteria.

Higher rates of autoimmune and allergic diseases like asthma, type 1 diabetes, and celiac disease are correlated with cesarean birth, and microbiome health may very well be a contributing factor to these higher rates. It should be noted that correlation does not equal causation. There may perhaps be other factors that lead to an increased risk of both cesarean birth and autoimmune diseases, causing their increases rates to correlate. We simply do not know with certainty the exact factors involved in a child’s development of certain diseases.

If you have a cesarean birth…

At times, having a cesarean is due to factors completely outside your control, or you may have very personal reasons for wanting a cesarean birth. So if you do need or want a c-section, you can talk to your care provider about taking measures to help support a healthy microbiome in your baby. Vaginal swabbing, a procedure in which sponges are placed in your vagina prior to the birth and then are swabbed all over the baby, is a practice that helps to partially restore the microbiome. You may also be able to have immediate skin-to-skin in the operating room, and breastfeeding will also help create a healthier microbiome in your baby.

If you want to learn more about the microbiome…

Check out these resources:

“Your Baby’s Microbiome” by Toni Harman

“Microbirth” a documentary based on the book

microbirth.com, the corresponding website. They frequently offer a free webinar, “Understanding the Infant Microbiome”

3 – Better respiratory health for the baby.

As your baby passes through the birth canal, the pressure squeezes amniotic fluid from the lungs. As already mentioned, your baby’s microbiome may play an important part in her risk of developing asthma, but this process of squeezing during birth along with exposure to hormones during labor are also thought to play an important part in respiratory health, as they ready the lungs for breathing.

Some studies have shown that vaginally born babies have a decreased risk of transient tachypnea, which is abnormally fast breathing during the first few days of life. If a baby is born by cesarean before 39 weeks and without proof of adequate lung maturity, she has an increased risk of respiratory distress syndrome. Vaginally born babies are also less likely to be admitted to the NICU, but this could be due to factors that make both cesarean and NICU care more likely.  So if a baby has a known health concern that makes cesarean birth safer, that health concern may also mean the baby is more likely to need NICU care.

Here is my own experience with having a child with respiratory issues.

4 – Safer future pregnancies.

Perhaps you’ve heard “once a cesarean, always a cesarean”. The reality is in many cases if you’ve had a cesarean, a VBAC (vaginal birth after cesarean) may be a totally legitimate option for you, but finding a care provider who is truly supportive (and not just tolerant, or worse, actually opposed to VBAC) can be a challenge! On the other hand, depending on your individual circumstances a repeat cesarean may be the only safe option for you, or you may look at the risks and benefits of both VBAC and repeat cesarean and decide you are more comfortable with those of a repeat cesarean.

If you have a cesarean and still want more children you might want to think more seriously about trying for a VBAC (chances are you’ll be successful). Complications like placenta previa or placenta accreta that are more common after a cesarean also increase with each additional c-section, while the risk of uterine rupture, which is an increased risk during a VBAC, decreases with each additional VBAC. Both VBAC and repeat cesarean carry more risk than a second vaginal birth, and some studies have shown an increased risk of stillbirth after a cesarean while other studies have shown the increase to be only very slight. So if you can avoid a primary cesarean your future pregnancies simply carry fewer risks.

 

Cesarean and VBAC Resources:

ICAN International Cesarean Awareness Network

The VBAC Education Project This is a resource offered by ICAN. It contains a wealth of information about your options for subsequent births after a cesarean.

VBACfacts.com An organization dedicated to sharing evidence-based information on  VBAC and making VBAC more accesible

“The VBAC Companion” by Diana Korte

“10 Steps to Finding a VBAC Supportive Provider” by ImprovingBirth.com

5 – Less risk to future fertility.

While secondary infertility can happen to anyone, some studies have shown that having a c-section may place you at higher risk of future infertility, and unplanned hysterectomy, and adhesions that may cause long-term pelvic pain are also increased risks for women who have had c-sections.

If you’re a cesarean mama struggling to conceive or struggling with pelvic pain, I highly recommend exploring NaPro technology to try to help address your concerns. NaPro used specialized surgery and works with a woman’s cycle to try to get to the root cause of a problem and is less invasive than many traditional fertility treatments. I wish I had known about it when I was struggling with infertility!

6- Easier breastfeeding and bonding.

For years the norm has been to whisk baby away to be cleaned, weighed, and monitored after a c-section. In fact, for many years that was even the norm after a vaginal birth. Many hospitals are now encouraging more “baby-friendlypractices, and unless there is some complication you can usually hold and breastfeed your baby immediately after a vaginal birth.

Oxytocin produced during labor makes you and your baby ready to bond, so even if your labor ends in a cesarean, being in labor beforehand still provides you and your baby with some of the benefits of labor hormones. If you have skin-to-skin immediately or quickly after birth, yourbaby can start smelling and exploring and may even latch on by herself. 

After a vaginal birth you’re more able to sit in a more upright position that makes it easier to hold the baby, and your baby won’t be pressing against an incision while she’s nursing. There’s more to bonding than hormones and immediate skin-to-skin, and you absolutely can breastfeed after a c-section, but it may take more work and perseverance from you.

Gentle Cesarean

If you do need a cesarean, talk to your care provider (preferably during pregnancy) about gentle cesarean options. While it’s certainly not mainstream yet, many care providers are willing to support your wishes to have quick skin-to-skin and initiate breastfeeding without delay and without separating you and the baby while you’re in recovery. Because of the strong medications needed during a cesarean, you’ll need your partner, a doula, or a nurse to help you hold the baby securely, and you may feel too sick to hold the baby right away, but as long as you’re feeling up to it, you don’t have to miss out on those early moments of bonding immediately after birth. Whether you’re planning a cesarean or just want to be prepared in the case that a cesarean becomes necessary, you do need to make sure your care provider is supportive of this plan before your baby arrives!

References:

de la Cruz, C., Thompson, E., O’Rourke, K., & Nembhard, W. (2015). Cesarean section and the risk of emergency peripartum hysterectomy in high-income countries: A systematic review. Archives of Gynecology and Obstetrics, 292(6), 1201-15;

Donovan S, M, Comstock S, S, Human Milk Oligosaccharides Influence Neonatal Mucosal and Systemic Immunity. Ann Nutr Metab 2016;69(suppl2):41-51

I. Gurol-Urganci, S. Bou-Antoun, C.P. Lim, D.A. Cromwell, T.A. Mahmood, A. Templeton, J.H. van der Meulen; Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis, Human Reproduction, Volume 28, Issue 7, 1 July 2013, Pages 1943–1952

Keag, Oonagh E., Jane E. Norman, and Sarah J. Stock. “Long-Term Risks and Benefits Associated with Cesarean Delivery for Mother, Baby, and Subsequent Pregnancies: Systematic Review and Meta-Analysis.” Ed. Jenny E. Myers. PLoS Medicine 15.1 (2018): e1002494. PMC. Web. 18 May 2018.

Magnus, Maria C. et al. “Delivery by Cesarean Section and Early Childhood Respiratory Symptoms and Disorders: The Norwegian Mother and Child Cohort Study.” American Journal of Epidemiology 174.11 (2011): 1275–1285. PMC. Web. 17 May 2018.

Metz, Torri D. et al. “Simple, Validated Vaginal Birth After Cesarean Delivery Prediction Model for Use at the Time of Admission.” Obstetrics and gynecology 122.3 (2013): 571–578. PMC. Web. 17 May 2018.

Neu, Josef, and Jona Rushing. “Cesarean versus Vaginal Delivery: Long Term Infant Outcomes and the Hygiene Hypothesis.” Clinics in perinatology 38.2 (2011): 321–331. PMC. Web. 21 May 2018.

Prior E1, Santhakumaran S, Gale C, Philipps LH, Modi N, Hyde MJ. (2012). Breastfeeding after cesarean delivery: a systematic review and meta-analysis of world literature. The American Journal of Clinical Nutrition, Volume 95, Issue 5, 1 May 2012, 1113–1135.

Rossi, A., Lee, R., & Chmait, R. (2010). Emergency Postpartum Hysterectomy for Uncontrolled Postpartum Bleeding: A Systematic Review. Obstetrics & Gynecology, 115(3), 1453-1454.

Van der Woude, D.A., Pijnenborg, J.M., & de Vries, J. (2015). Health status and quality of life in postpartum women: A systematic review of associated factors. European Journal of Obstetrics & Gynecology and Reproductive Biology, 185, 45-52.