Postnatal Depression: My devastating midwife experience…

truth

Me:  (almost in tears) “Um, what did you just put down the sink?”

Horrible Midwife:  (haughtily) “Got rid of the left over milk from the feed, why?”

Me:  (crying uncontrollably) “That was the colostrum I just expressed for his next feed.”

Horrible Midwife:   “Oh.”  (and abruptly leaves the SCN)

It was 3 days after the birth of our LM and we were not in a good way.  That morning, our gorgeous baby boy had been diagnosed with severe jaundice as a result of the bruising and hematoma he experienced during birth and now required phototherapy for a minimum of 24 hours in the Special Care Nursery (SCN).  After that time, more blood tests would be done to determine if his TcB level (the level of bilirubens in his blood) was low enough for him to be discharged with me.  I was a wreck!  Whilst I could hold him every 3 hours to feed (expressed bottles of colostrum, then top-ups of formula, as he was too weak to breastfeed), he was otherwise left in the phototherapy crib with a little blindfold over his eyes and all I could do was watch him or sit alone in my room.   I was suffering the normal “baby blues” hormonal impact and could rationalise everything that was happening in my mind, however it didn’t stop the tears or the intense guilt I was experiencing with regard to his condition.  I wasn’t coping, I knew that… but this woman… I just could NOT believe she was doing this to me again!

Perhaps let me start at the very beginning…

It was not a good birth.  Indeed, I will go as far as to say it was a horrible, very traumatic birth.  People ask me “Was it a natural delivery?” and my response is usually, “Well… it was a vaginal delivery, but not what I’d particularly call natural”.    It was a truly challenging and intense 72 hours of pre-labour and labour that I most definitely could have done without.   The end result, of course, was our gorgeous little boy, but honestly… the getting there was something I would never want to repeat in my lifetime – not physically or emotionally.  And the whole experience was made even worse by one particular midwife I was unfortunate enough to have “care” for me from the mid-morning shift (I was admitted to hospital at 8am) until 11pm, half an hour before my LM’s birth.  I will be eternally grateful I did NOT have that woman present at the actual birth of my baby.   The lovely midwife who replaced her literally at the 11th hour will go down forever as the one saving grace in this terrible story, and I am so incredibly thankful every day for her gentleness, support, and empathy.  She was everything I had hoped all midwives would be, however the scars had already been administered and they were deep… so deep they continued to hurt me right up until the birth of my little girl a year ago.

It’s been 3 and a half years since I came face-to-face with THAT woman, yet I still remember her name, her face, her accent, the colour of her hair, the indifference in her eyes, the tone of her voice.  I remember EVERY single thing about her.  After the LM’s birth, I did my best to move on from the worst of my feelings, but when I fell pregnant again I started having recurring nightmares sparked from my previous experience.  In my dreams I was screaming at Dr B, yelling at him to “get her away from me”, “don’t let her near me”, “get her hands off my baby”!  My anxiety was real.  My intense fear was real.  The feelings of worthlessness, powerlessness, and helplessness were REAL.   I would wake with a heaving chest, breathless, and crying.  It soon became apparent I had not moved passed these feelings at all.  Just before I was diagnosed with PND (when LM was 8 months old), I had attended a counselling session and we had discussed my birthing experience in great detail.  I had never cried so much in my life.  Whilst sharing my thoughts with Mrs D at the time was a huge relief, my feelings had remained unresolved.  Hidden from view, I simply hoped they would slowly fade over time… Clearly, they had not.

In hindsight, I honestly don’t think my expectations around the quality of midwifery care I would receive were unreasonable.  The majority of what we see and hear from family and friends about their personal care during birth  is warm, kind, giving, and supportive.  Indeed, our private hospitals and specialists pride themselves on the quality of their midwifery care.  And really, whilst I had “ideas” around what I would “like” for my birth experience, I certainly was not inflexible to the advice of midwives and specialists.  I ask questions.  I do.  I like to know what my options are and be informed before making a decision.  So was it unreasonable to expect this woman to speak gently, inform me of my options, and generally treat me with compassion and understanding?  Surely not.  I had been having contractions for over 24 hours, and with no sleep was downright exhausted.  Perhaps I could understand if her attitude progressively worsened with her shift as she became tired and run-down due to the over-burden of care required of midwives these days.  But she walked into her shift with me that morning projecting a coldness I had never before experienced.  To have to endure 10 hours of such blatant indifference and patronsing behaviour left me feeling beyond powerless.  In my time of need, I had been let down by the very person I had hoped would simply hold my hand, put my fears at bay, and provide me the strength and information I would need to get me through until the end.  It was instead a nightmare.   I could go into so many examples of her behaviour that day, but instead I think I’ll leave it with the one I began with at the start…

So there we were, my HF and I, sitting in the SCN nursery doing what we had to do to ensure the health of our baby and in the awful midwife from my labour walks.  Straight away, as the regular SCN nurse left to take her break, she began telling me how it was my own expectations that had let me down as “they were way too high”… Of myself, my birth, my general experience.  And all the while she was nursing our LM instead of placing him in the arms of my HF as the regular nurse would have done.  That’s right.  That’s what she said whilst refusing to let my HF feed our tiny boy (which he would do whilst I sat and expressed for the next feed) because “this is the only chance I get to cuddle babies on my break”.  That’s what she said as she ignored the advice from the SCN nurse as to which teat our LM was to use on his bottle (“Oh, don’t be stupid, he’ll be fine.  He’ll take this from me.”).  And again it was this arrogant, condescending tone of voice that was ringing in my ears as she threw the 30mls of colostrum I had just pain-stakingly spent half an hour expressing down the sink.  By accident, of course.  You see, she had been so busy patronising my perceived high expectations, she hadn’t realised it was my colostrum (not left-over milk) she was throwing away.

She did apologise as I sat sobbing hysterically, trying to deal with the reality of my baby being in the SCN,  hormonal “baby blues”, the pain in my breasts from pumping, in addition to her abhorrent treatment.  But in hindsight, even her apology left me cold.  After she had walked out of the SCN upon realising her mistake, I remember my HF holding me in his arms shaking with anger as the regular SCN nurse came back into the nursery to comfort me, saying how awful the other midwife felt and how sometimes these things “just happen”.  Then SHE reappeared.  That horrible woman walked back into the nursery, came over to where we were sitting and awkwardly tapped me on the shoulder in what I can only assume was an attempt at comfort.  But it was the haughtily addressed “I’m sorry.. but you know it’s not the end of the world if he has to be formula fed” that finally broke me.  I couldn’t speak.  I couldn’t stop crying.  I couldn’t lift my head to even look at her.  I was physically and emotionally exhausted.  I was done.  And with that she simply walked away and I didn’t see her again.  It was a moment in time both my HF and I will never forget… for all the wrong reasons.

Her behaviour was atrocious.  Her actions were unfathomable.  Her overall impact on my birth experience was devastating.  And I hope to goodness no other mother EVER has to experience such helplessness and powerlessness at the hands of such an awful person.  Maybe she was just having a bad day.  Maybe she had her own things going on that I didn’t know about.  Maybe… maybe… maybe!  I have tried so hard to be understanding of her behaviour, but nothing seems to justify nor will ever take away how she made me feel.  I know they say we choose how we feel about any given situation, but giving birth is such a vulnerable experience.  It doesn’t matter your personality, your age, your profession.  You are at your most vulnerable!  And that is the power of midwifery care… a power I know the majority of midwives would use only for the absolute good of their patients, not to their detriment.  Unfortunately,  I was one of the unlucky ones that time around.

I can say though without any hesitation that Dr B ensured my second birthing experience was the best it could possibly be… and the quality of midwifery care I received was amazingly warm and still makes me smile when I think back to my time in hospital with MH.  A very stark contrast, and one for which I will be forever thankful!   It’s incredible how healing a good experience can be on the back of something so traumatic and unexpected.  It’s been a huge relief to finally get this experience all down in writing!  I am always surprised at how much “feeling” I still have with regard to this issue and want to thank-you for allowing me to feel safe enough to share it with you here.

Thanks for reading as always and really hope everyone is doing well.

TSM… xx

Helpful Steps: Endometriosis, heavy bleeding, chronic pain, laparoscopy, and ablation… FUN!

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Okay… So I guess I don’t HATE my vagina, as opposed to just hating the reproductive organs that come along with it.  Okay…  I guess I don’t officially hate them either, considering they have assisted in the creation and birth of my two gorgeous children.  So really, I don’t HATE my “girly parts” at all… but I DO have serious issue with them!  I DO have issue with the chronic pain I have lived with since my period started at 13 years of age.  More particularly, with the severe pain I have experienced probably 50% of the time (for the past 15 years) with thanks to both the menstrual and ovulation cycles.  Similarly, I DO have issue with my fear of leaving the house, knowing the inevitable flood my heavy menstrual bleeding will create.  With the moodiness, the highs and lows of emotion, hormonal fluctuations, not to mention the self-doubt my periods have caused… and, of course, the age-old question, “Why is this happening to me?”  Damn you, Dysmenorrhea, EndometriosisMittelschmerz, and Menorrhagia!  😉  But, through all of this, what I am thankful for is I’ve FINALLY been able to do something proactive about it.  It’s been a long, long, road but it seems the light at the end of my tunnel has been reached.  

My menstrual journey began normally enough, however after the first year it was obvious something was not quite right with regard to the amount of period pain I was experiencing.  So off to the doctor we went (my mum and I), to be told – as all good doctors do – that my easiest solution would be to go on the contraceptive pill.  So at age 14 that’s what I did.  And then by age 16, I was told to skip the “sugar” pills and take the pill constantly so as to avoid having a period all together (as this apparently would ease my endometriosis symptoms/damage).  I learnt very quickly how to manage my period pain during those teenage years, but what  I didn’t manage very well were my hormonal moods swings and episodes of intense anger.  Interestingly, I thought this was simply who I was and resigned myself to living a life feeling and behaving this way.  So for 15 long years I rode an emotionally-charged, hormonal roller coaster until eventually (at age 29) I went off the pill and almost immediately felt like a different person.  Suddenly I was clamer, more emotionally grounded, able to walk away from emotionally heightened situations, and simply “be me” again.  Not that I even knew who “me” was because the pill had clouded this “peaceful” part of my personality for so long.  It pains me now to think about how my life may have been different through those teenage years if only I hadn’t taken the pill.  It’s not anyone’s fault of course.  Decisions were simply made based on the information we knew at that time.  All the girls were taking the pill for period pain and contraception – why would I react any differently to them?  Because I was one of the small percentage of girls who experienced adverse effects to the hormonal changes the pill creates in our system.  And as we already know… hormones and me, well… we just don’t seem to get along.

At age 29, after years of suspected endometriosis and trips to the specialist, I went in for a routine pap smear only to be called a week later to say I had to have emergency surgery the next day.  My pap smear results had shown a CIN3 level abnormal cervical cell change in the 12 months since my previous pap smear (which I was having regularly due to my ongoing issues).  I had put off having a laporoscopy for years to treat the endometriosis because of my fear of hospitals and needles.  Needless to say, now I simply did not have a choice in the matter.  So the day after said phone call, I was in hospital having a LLETZ Loop procedure performed for the abnormal cervical cells, a laporoscopy for the suspected endometriosis, and a hysteroscopy to determine any uterine damage or effects on my fertility.  Fortunately my results were good with successful removal of the CIN3 cells, with limited structural damage or impact on my cervix.  I had numerous endometrial scarring deposits (which were expected), with the worst being external to my uterus taking up residency and causing adhesion’s between my uterus and right ovary.  All endometriosis was removed and the hysteroscopy showed positive results with regard to my future fertility prognosis.  All in all, I guess you could say it was a very productive day at the office for my specialist (and for me too).  Whilst these procedures didn’t stop the pain and heavy bleeding I’d always had with my period, it was a relief to know exactly what was happening “down there” and the added emotional benefit of no longer being on the pill was the icing on the cake. 

A common myth surrounding endometriosis is that it can be improved by having children… “It’ll get better once you have kids”, people would always say.  Um, unfortunately not.  After the birth of our LM, and then again after MH, my periods only worsened.  The ovulation pain (“Mittelschmerz”) was equally as intense as it was debilitating, lasting for nearly 4 days of every month.  My period pain would last over 24 hours (again, debilitating), and the heaviness of those first two menstrual days was hideous.  When I realised things were again getting worse after MH’s birth, I decided to go and see Dr B about putting a stop to this nonsense once and for all.  His question to me was very simple:  “Do you want to have any more children?”  Having always known MH would be our last, it was an easy reply:  “No.”   And with that, we discussed my options.  I knew I didn’t want a hysterectomy at this stage in life, so we talked through other procedures that may help ease the intensity of my symptoms.  After only half an hour of discussion, my mind was made up and we had scheduled my surgery date for the 1st of July.  I just needed this pain to be over and my quality of life back.  I was booked in for a diagnostic laparoscopy to remove any new deposits of endometriosis, an endometrial ablation (utilising the Novosure ablation method) to alleviate the heaviness of my bleeding, the insertion of a Mirena device to help ease the ovulation pain, and a pap smear (why not do everything!).  It was a full system overhaul!  Dr B stated if he could improve my symptoms even 50% that would return my life back to some degree of “normalcy”.  I crossed my fingers and hoped for the best.

Not surprisingly, my endometriosis had returned with a vengeance over the years and many more deposits were removed.  Dr B made note of two particular external deposits of scar tissue adhesion’s which were “quite unique”.  One deposit had adhered itself through my cesarean section scar, and the other behind my uterus (between my uterus and bladder).  He even provided photographs (see below)… The first image shows the scar tissue deposits as he found them (cesarean on the left, between uterus and bladder on the right), while the second shows the same sections now clear of the adhesion’s.   Sorry if this is a little too much information, but I actually find it all quite fascinating!

Endo-scar

Endo-clean

After the laparoscopy, Dr B proceeded with the endometrial ablation which involved burning the lining of my uterus away to prevent the blood from depositing as it normally would.  He predicted the procedure to be successful with “95%, a good coverage” of the uterine lining being treated.  Great news.  Next the Mirena was inserted, the pap smear completed, and the rest (as they say) is history.  Whilst my recovery was nothing to write home about, with considerable pain and discomfort for the next two weeks, the overall success of my surgery has been a godsend.

I’ve been through two menstrual cycles now since my surgery and have experienced only slight twinges of discomfort around ovulation time and then again when my period is due.  The good news is rather than lasting days on end as the pain normally would in both cases, the discomfort only lasts an hour or so.  My actual period is also considerably improved and virtually non-existent (save for perhaps a slighly brown-ish discharge lasting 3-4 days).  There is no bleeding at all!  My disbelief about this has me constantly waiting for something to give, something to happen, for the bleeding to start.  But it doesn’t.  On the success scale, Dr B assures me this result is right up there with regard to the best possible outcomes and is extremely pleased given it’s better than even he expected.  And whilst in 5 years time my Mirena will need to be removed, and a new one inserted, and there’s a chance my ablation will need repeating, I can comfortably say I would recommend this path of treatment to anyone experiencing severe endometriosis symptoms.  The downfall, however, is you have to be certain you no longer want to have children.  The endometrial ablation doesn’t prevent you from falling pregnant, but it does prevent you from carrying a baby full-term and this is something many people misunderstand.  Hence, the insertion of the Mirena.  Not only is it helpful in providing relief from ovulation pain, but also important as a form of contraception.
 
Thanks very much for taking the time to read this post, particularly if you are also struggling with endometriosis.  To be 95% pain-free after so many years of chronic pain is an incredibly liberating experience and one for which I’ll be forever grateful.  I feel very lucky to have had such a positive result when I am well aware many women are not as fortunate.  Endometriosis is a nasty and debilitating condition, and it’s something we as women should be speaking about more often.  As they say, awareness is key… March Into Yellow!