Thursday, May 28, 2009

A Different Kind of Consent Form

The form all of mothers of repeat cesareans should have to sign...

I, the undersigned physician, have, in violation of the Consumer Bill of Rights and Responsibilities, the Emergency Medical Treatment and Active Labor Act, the Patient Self Determination Act, the ethical guidelines of the American Medical Association and the American College of Obstetricians and Gynecologists, Constitutional Law (the right to privacy and self determination protected by the 1st and 14th amendments), international tort law, and case law (of particular interest "In re A.C.", 1987, "In re Fetus Brown, 689 N.E.2d 397, 400 (Ill. App. Ct. 1997)", and "In re Baby Boy Doe, 632 N.E.2d 326 (Ill. App. Ct. 1994)") and the Patient Rights as determined by this institution, deprived my client,________________, of her right to self determination and her right to bodily integrity by ignoring her repeated refusal for delivery by repeat cesarean section. I acknowledge that by refusing to honor my client's denial of consent, I have not only violated the above laws, but I also affirm that I have used unwarranted and unethical pressure including emotional threats to my client's and her unborn child's life and safety, in my attempts to obtain such consent. I further affirm that I have stressed the risks of vaginal birth after cesarean, but neglected to inform my patient of the risks of delivery by repeat cesarean section. I further affirm that I understand, that should I resort to physical force, including but not limited to physical or chemical restraints to compel my client's cooperation, I will be guilty of criminal battery, which is defined as "any form of non-consensual touching or treatment that occurs in a medical setting".

In compensation for the above violations of my client's rights, I hereby guarantee the following:

a healthy baby, born in perfect condition, with no physical, mental or developmental deficits whatsoever, whether arising from surgery or any other cause

no complications for the infant, including but not limited to: persistent pulmonary hypertension, transient tachypnea of the newborn, respiratory distress syndrome, iatrogenic prematurity, lacerations, or hematoma

a speedy, uncomplicated post-operative recovery for my client. Specifically, I guarantee that my client shall not experience nerve damage, organ damage, hemorrhage (whether sufficient to require transfusion or not), disability or disfigurement, intraoperative or postoperative infection of the wound or surrounding skin and tissues, post partum depression and postpartum post traumatic stress disorder (PTSD), and other conditions not listed here.


Great job!!

Saturday, May 9, 2009

The Road to Recovery from Birth Trauma

A person with PTSD (post traumatic stress disorder) does not have to look forward to a life-time of unrelieved suffering and maintenance therapy.

Unlike many mental illnesses, most people can gain permanent, significant, if not substantial relief and freedom from PTSD through a variety of non-chemical options. What follows covers some of these options - how you can help yourself, and what sort of professional help has been found to be of assistance. Even as a scar will seldom completely disappear, neither will the effects of your trauma, however, you can enjoy life again in a meaningful and fulfilling way.

These measures are not an alternative to professional treatment but they will assist with how well you are able to cope before, during and after treatment.

Create your own support network of friends, family and professionals. Use people to help you in the way that they can eg. a family member may not understand your illness but is only too willing to offer babysitting whenever it's needed. Avoid spending time with people who are critical or unsympathetic or those who have a negative outlook on life.

Be aware of your limitations: Don't try to do too much and don't blame yourself for not coping. Accept help when it is offered no matter how small. If you don’t like to ask for help try leaving a list of “jobs” on the fridge that you can refer to when someone asks if there’s anything they can do to help. Prioritize tasks and on bad days stick to only what must happen on the day eg. caring for baby, preparing meals. Leave any non-urgent tasks such as vacuuming the hall or folding the laundry, for your keen volunteers, or for another day.

Take care of yourself.
Tend to your own needs and don’t feel guilty for doing so. Making use of a volunteer to mind a grizzly baby so you can shower in peace or eat a meal while it’s hot can make a huge difference to your day. Make time for some “time-out.” Use aromatherapy, homoeopathy, yoga, exercise, relaxation techniques; anything that works for you to soothe the mind, body and soul. And don’t neglect your spiritual needs either.

Establish some normal routines.
Sometimes, sticking to a routine involves less thought and planning. Along with the routine of feeding and bathing baby in the morning, include time for brushing your teeth, combing your hair, getting dressed and eating a nutritious breakfast. These may seem like obvious and insignificant tasks when we are well but during the bad times they can seem like insurmountable chores to add to an already overloaded day and yet they will help you greatly in your sense of well-being.

Good nutrition is vital.
You need to eat well in order to care for others, especially if you are breastfeeding too. Adjust your shopping list to include healthy, easy snacks like fresh fruit and vegetables, dried fruit, nuts and cheese and simple to prepare meals including tinned and frozen foods. If you cook a dish that can be easily frozen, cook it in bulk and freeze it in meal-size portions for tougher days. Fill a thermos with a hot drink and set it aside with a snack to have in the early hours when you are breastfeeding. Also have a water bottle on hand to keep you hydrated, as breastfeeding is thirsty work.

Eat a well balanced diet.
Eat to maintain your optimum energy, which means keeping your blood sugar levels constant. A low blood sugar level leaves you feeling tired, listless and shaky while a high blood sugar level gives you a short-lived buzz. Avoid simple carbohydrates like sugar and refined white flour which are easily digested and metabolised rapidly, giving an almost immediate energy high, followed later by a significant energy slump. Avoid also caffeine, which is found in tea, coffee, chocolate and some fizzy drinks; also avoid smoking, alcohol and added salt.

B vitamins are essential for effective sugar metabolism and energy release. Alcohol, caffeine, smoking, oral contraceptives and stress can all deplete your body of them. As B vitamins are not stored in the body it will probably be necessary to use a supplement during these times of stress especially vitamins B9 and Bl2. Feelings of depression, irritability and tiredness can be symptoms of a B vitamin deficiency. Fresh fruit and vegetables, wholegrain cereals, wholemeal bread, yeast extract, liver, beans, lentils and tofu are all excellent sources.

An iron deficient diet will also leave you feeling tired. Good sources are cereals, liver, kidneys, dried apricots, eggs, watercress, beef, lamb and wholemeal bread. Vitamin C improves the way your body absorbs iron so combine this in your meals.

Consult your pharmacist, health shop rep, a nutritionist or dietitian, etc. for specific advice concerning your particular nutritional needs.

Allow yourself some simple pleasures.
Try to do at least one thing each day that isn’t a “should”; something that you get some enjoyment from such as reading a magazine in the morning sunshine for 10 undisturbed minutes or going for a leisurely walk around the block while listening to your favorite music. If necessary, plan it into your day but don’t berate yourself if it doesn’t happen. Try not to feel that the minute that you put the baby down for a sleep, you need to race around catching up on all the jobs that need doing. Prioritize and be willing to let some things go.

Be adaptable. New babies invariably mean a lack of sleep and sleep deprivation can make you feel like your going crazy some days. When the going gets tough, accept that it’s not forever and ease up on your expectations of what “needs” to be done each day. Conserve your energy, sleep when and where you can and put off anything that’s not essential.

Be unsociable when you need to be. Don’t feel that you have to always answer the door or the phone. Put a note on the door that says “Mother and baby sleeping, please do not disturb” and put the answer phone on or leave the phone off the hook if the ringing will wake you. Chances are that the minute you get your unsettled baby to sleep and you dive for your pillow, the phone will ring!

Forget trying to keep up to your previous schedule at the gym or worrying about if you are “pushing play” for the required time each day. Simply, a little fresh air, sunshine and gentle exercise, no matter how small will do wonders for your stress levels and to help you to feel connected to the world outside your four walls. Include your exercise as one of your simple pleasures.

Find a trusted person(s) to talk to about the trauma. They need to be empathetic, non-judgmental, and attentive listeners. Your partner may be this person. Be aware, however, that he is likely to be affected by the trauma too and may feel blamed or at fault for things that happened. He may also need to have his feelings heard. Speaking with someone who isn't emotionally involved may be a better option.

The need to debrief. After any highly emotional event, good or bad, there is a strong need to share the experience and to have one's emotions acknowledged. Having a baby is a monumental experience in any woman's life.

Every woman needs to debrief; even after the most normal of births. Those who had a stressful experience will need to talk it through many times. Friends and family may be initially sympathetic but may not understand the continuing need to talk.

Debriefing has been shown to reduce the occurrence of PND. It is also effective in reducing the severity of PTSD.

We believe all women should have the chance to talk over their birth experience in the early postnatal days, preferably with a health professional who was present for the labor and the birth.


Solace for Mothers with Birth Trauma

Birth can be beautiful for some women. And for some women, difficult deliveries bring fear, pain, grief, isolation, anger, and shame for months or even years.

Talking by phone to a trained and sympathetic peer counselor can help a mother to come to terms with the feelings and thoughts she is afraid to say aloud to anyone else. Calls are free and confidential. Monthly in-person facilitated support meetings allow women to come together to cry and to laugh. Call 877-SOLACE4 – sharing, understanding, and healing.

Please browse our web site to learn more about Solace for Mothers. If you work with birthing women, please offer us as a resource. We are please to have launched two online communities where women and those who support them can connect around birth trauma concerns.


Pregnant in America

Very informative movie. Available on netflix for rental