Episode 27: How did We Get our Current Culture around Pregnancy & Birth: Ask the Historians of Science
Episode 27SN: How did We Get our Current Culture around Pregnancy & Birth: Ask the Historians of Science
Talking to my mother and other women from previous generations it sounds like they got pregnant and gave birth in a culture that’s different from the one we face today. Based on these talks, I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common, we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment in which we find ourselves.
Lamaze method
https://www.healthline.com/health/pregnancy/lamaze-method-pain-relief
Audio Transcript
Paulette: Hi Welcome to War Stories from the Womb. I’m your host Paulette Kamenecka. I’m an economist and a writer, and a mother of two girls…I’m also a daughter…and from talking to my mother and other women from previous generations it sounds like they had a very different pregnancy and birth experience than I did. Talking to my mother I have often wondered how we got to the specific point we are at: where pregnancy is a very medical experience, C sections are so common, we seem to be just starting to talk more openly about miscarriages and the postpartum period, and women are trying to navigate the demands of breastfeeding and work. In today’s show I interview two historians of science to get a sense of how we arrived at this particular moment we find ourselves in….
First I’ll talk to Dr. Judith Leavitt from University of Wisconsin and then I’ll talk to Dr. Janet Golden from Rutgers university about maternal mortality, and miscarriage and hospital births and breastfeeding, among other things
Paulette: Hi, today I’m excited to welcome my guest, Dr. Judith Leavitt, who was the Ruth Blier Professor of History of Medicine history of science and Women’s Studies and the Associate Dean of Faculty at the medical school, University of Wisconsin Madison. She’s the author and editor of many books about women’s intersection with public health and medicine in America, and 2010 authored a book about changes over time and a father’s experience of birth. I feel lucky to get to talk to her today about how we find ourselves in the current birthing environment. Welcome Dr Leavitt.
Dr. Leavitt: Thank you very much.
P: So I’ve been reading your book brought to bed childbearing in America 1750 to 1950, which focuses on the experience of women mostly white middle class but it includes some details about immigrant women and women of color. These questions will all come from reading that which kind of blew my mind, in part because it’s shockingly relevant. Regrettably, so the first thing I want to ask is that in our not so distant past maternal mortality rates were super high, (accurately counting maternal deaths remains a tricky thing to do, even today, but according to dr leavitt’s book, she writes, “the statistics show that deaths from maternity related causes at eh turn of the twentieth century were approximately 65 times greater than they (were) in the 1980s”) and I’m wondering if women looked forward at all to start doing families like they do today or was the threat of their health, Overwhelming Do you have any sense of that.
Dr. L: I think women were very aware of the fact that childbirth was dangerous, and they were aware of it, not necessarily because they knew about national rates or any numbers around that but they did know and had experience with women who had difficulty, and had come close to death with childbirth and they also knew women who had died in childbirth or whose babies had died in childbirth, so they were certainly very aware and I’m talking now 18th century and 19th century, very aware that child birth was dangerous, I saw that worry very much in their writing. And let me say that I read women’s diaries and letters, for the most part to get their own point of view at the moment that it happened not and sometimes in the, in their memoirs and memories of past events but a lot of it was very current in their minds and they were very eager to have babies. They were scared, because they knew it was dangerous, and I think some of the choices that they made about what they wanted for their childbirth, had to do with that danger fright, that they had. But they were just enormously eager to have children. Also, and it didn’t seem to lessen that eagerness, the fact that it was dangerous, dangerous I think it did influence their choices, a lot, and one of the points of my book, I should say is that I think women’s choices is largely what drew changes in childbirth history over time, used to be thought that doctors kind of forced women into the changes that happen, and doctors certainly played an important role, especially in the 20th century, but my contention in my book is that it was women who made the choices that they made and they made them as you started out this conversation by saying because they were fearful that they might die or might get into some serious physical difficulty in childbirth. And those changes, you know, I always thought, unfortunately tended to medicalize childbirth more than it might have happened, traditional childbirth was an event that happened in women’s homes, and women were surrounded by women, other women who had had children, their mothers, their relatives, their aunts, their cousins, and their friends. And it was around that female birthing bed that male physicians started to enter the 18th century,In those situations, most frequently they were invited in when women were having a long and very difficult labor, and they thought that maybe physicians could help. And it was forceps that physicians first brought to that helping effort, and many physicians said all they had to do is rattle the forceps in their pockets to get the women’s labor to progress more without them.
P: A little adrenaline, sure…
Dr. L: And that’s right exactly, and that they were invited in for those difficult kinds of childbirth, normal obstetrics wasn’t called obstetrics The ticket was called childbirth was midwife assisted and friend assisted and it was a very female event, and the physicians that did come in the male physicians were those that could enter a female, environment, and survive many didn’t many got scared by all the women around the birthing bed and left. Really, not, not doing much,
P: that’s super interesting I guess I didn’t, it didn’t occur to me that there was selection in the types of births that doctors first attended. So I imagine their success rate was low in part because they’re at the most challenging births,
Dr. L: right, except that they did have some success, obviously, helping birth. But midwives had a lot of tools in their kits, walking women around keeping them, mobile and and vertical was very helpful to a lot of women as they tried to get thrugh labor so midwives, had a lot of things they could do did do successfully midwives, it was really among the most important medical practitioners in the colonial period in America, by far, and they did more than just deliver babies they did a lot of other things that, because they were the, often the nearest and the most familiar of the health people that a woman, or family could call, they did call midwives to do other things, midwives. There’s a wonderful book on a colonial midwife by Laurel. LAUREL Thatcher over, called the midwives tale, and in we get a lot of what we know about late 18th century, early 19th century. Midwives from that. One of the things that we learned that was, I think, something we didn’t necessarily expect to learn is that midwives kept very very full, gardens, a lot of herbs that they would use in their medical treatments and some, some having to do a childbirth with them having to do with other diseases as well. So they were, pharmacists, as well as healers, and they were really very important part of whole scene around health and disease in the 18th and 19th centuries,
P: as women moved to the hospital in the 20th century is that the death knell for midwives because I feel like midwives are not nearly as common today.
Dr. L: Well, midwives started to be replaced in the 19th century, so it was well still in the homebirth period that doctors wouldn’t be called increasingly for normal deliveries as opposed to difficult deliveries, and then it depended on who you were, how much money you had who you knew who you might call so doctors when they started coming to normal deliveries in the 19th century, they often came with midwives, that is midwives came and midwives might even call them and they’d be both of them around the birthing doctors are very kind of gradually taking over some normal births, especially urban ones in the 19th century, but it’s really in the 20th century when childbirth, moves to the hospital that midwives are most replaced by doctors and it’s really the midwives still in the south, well into the 20th century, in rural areas and in some rural areas in the north, especially immigrant rural areas but immigrants in the cities also might have tried to find an immigrant midwife who spoke their language and call her in before calling in a doctor before going to the hospital so midwives have been involved in childbirth. Always in American history, and are still. But as you know, a very small part but I think a slightly growing part of childbirth today, and it’s mostly, I think among some immigrant groups, Hispanic immigrant groups, for example in Texas are very user friendly to midwives and other rural groups. There’s a big Midwife center in Washington state, and is catching on around the country, again I think somewhat urban, as well as rural by a lot of middle class women who feel they have voice and who don’t choose to go to the hospital. So, midwives and birthing centers which are often run by midwives are increasingly used it’s still a small percentage of total births, but it is an increasing number.
P: Yeah, on this podcast I’ve talked to a bunch of women, both from England and Australia, where it’s just a much more common practice to go to a midwife unless you have a complication and deliver birth there which I wonder if that contributes to their low C section or lower than ours.
Dr. L: Probably. Yeah, wonderful book, new book on the history of homebirths that deals with 20th century home births and Midwifery, which you may want to look at by Wendy Klein. It’s really a good entry into that question.
P: I’m wondering about all these journals that you read. If anybody talks about infertility, how that was handled.
Dr. L: If they did, I didn’t pay attention to it at the time I was looking at some I’m sorry, I think, I let me tell you that when I started this research, it was really very hard to find childbirth accounts everyone told me don’t even look, You’re not going to find anything people don’t write about it, it’s this kind of taboo subject even Well of course I knew that wasn’t true, but I, I had to find ways to find childbirth stories, and so what I did when I went to an archive for example is look at family papers, kind of scanning through family papers until it was a birth, and a child in the family. And then I would go back to the women of reproductive age in that family. Nine months or further to see their child birth experiences and when and how and when they got pregnant and so that’s when I found a lot of a lot of women writing about wanting to get pregnant about excitement about getting pregnant, and they wrote about, you know their excitement when they were getting married and their excitement that they would get pregnant and their excitement about getting pregnant. And those women I found because they had had babies so in terms of women who might have been infertile, I probably wouldn’t have found them in that way of searching, unless that same woman has some infertility issues in her, her own experience, Shannon Whitleycombhas written a wonderful book on the history of miscarriage and that is partly about insecurities
P: in brought to bed it says the women who did not lose any of her children either at birth, or in the early years of their lives was rare in 18th and 19th century, far more common to the woman’s experience was the necessity of accepting the deaths of numerous offspring. I was wondering if because that was such a reality if miscarriage didn’t get any attention. If it was you know relatively early like it does today because he was surrounded by the death of children.
Dr. L: No, absolutely, it did. In that sense it did but but the ones I was talking about were ones, women who had lost children they had live birth, yeah, yeah. So in that sense I was, I was not talking about those women and infant mortality was just spectacularly high. In those years, and women experienced that they sometimes didn’t name their babies until they were a year or two old because they were worried that that would be kind of Jinx, their success and raising them, and very often they named babies, after baby who had already died,
P: that’s interesting
Dr. L: or a child who had already died so there was Elizabeth who was in the grave and Elizabeth who had just been born or had been born a few months before, when they were finally named so a lot of families, you know, made one of my it was one of my difficulties in searching out experiences because you might have had three Elisabeth’s in a family, and trying to figure out which one was the one that I might get a birth story from,
P: yeah. Yeah
Dr. L: That’s hard.
P: Yeah, it’s hard to imagine that, I mean obviously we kind of know, we know that intellectually but it’s hard to imagine what life was like with those editions, and that threat.
Dr. L: Exactly. And there have been people have written about it as if women didn’t love their children until they were a certain age because they were afraid to emotionally commit. And I don’t think that was true at all. I think women committed. The incident of birth, most of them are certainly in the first year of life.
P: In my first pregnancy halfway through the pregnancy. Doctors found that I had an autoimmune condition that was attacking the fetal heart. And so for the last three months they kept saying she’s not going to survive, she’s not going to survive and I had this struggle, on the one hand, you might try not to get attached to the idea of this baby. Although you’re already very pregnant with her. On the other hand, I thought, That’s not realistic. I’m already attached, and there will be no way to dampen the pain by waiting to name her. I’m sympathetic to the idea that naming someone makes them more real and more embodied, not naming them doesn’t make them any less real For me, that idea I can connect to. I myself was not able to say, and she’s fine. By the way she’s so good 19 Freshman. Freshman in college.
Dr. L: Good for you for sticking it out. That must have been very difficult.
P: It was super stressful, but you know, not naming a child, you’re still in love with the child right there’s no, no getting around that.
Dr. L: Right.
P: so another thing you mentioned in your book is that, women moved to hospitals to deliver before the death rate in hospitals, actually dropped below the death rate in home births and you have that great graphic of urban versus rural death rates which will forever be emblazoned in my mind, and I’m wondering if that was an issue of failure to communicate information effectively, how was that gap created.
Dr. L: No, it was the same thing I had talked about for the earlier period women were always seeking out something that was going to make their childbirth experience better. And they always thought that paying attention to what was the most advanced in medicine was going to help them the most. So that’s why they got doctors involved in the first place with with difficult births, it’s why they have kept doctors involved for normal births, so called normal verse in the 19th century. What was interesting, it wasn’t just give me everything you have, I’ll take it with the doctors, the women always remained very critical of what doctors would do they were, they wanted the forceps, but they didn’t want the forcepts.
P: Yeah,
Dr. L: they wanted something that anesthesia for example, women really really wanted anesthesia after the middle of the 19th century, and yet, they wanted to be the ones in control of it not necessarily give that control to doctors. So there’s constant push and pull between women and physicians, even though it’s women who wanted the physicians and what they had to offer. You can’t really think of this as something kind of straightforward, so the move to the hospital was part of that, that women thought that the hospitals would have something to offer and one of the things that hospitals had to offer was around the clock care, which women were having a harder and harder time finding at home, it used to be that relatives would come they’d move in for, you know, maybe months to help you around childbirth and early childhood for the babies and your sister would come and it would be easy, relatively easy to have somebody with you all the time for all the help that you needed. Well that became harder and harder as the 19th century wore on, as women were in the workforce more as families who are more mobile and moved away from their original family. So women had that real drive to look for some place that they could go and have care that they didn’t have to worry about. So that was a big part of it. Another part of it was the physicians once surgery was getting established in hospitals, physicians themselves were moving into hospitals, instead of doing office care and home care. So it was harder to get physicians to attend you if you wanted a physician. If you stay at home so that that was part of what women wanted and it was also that part of it was something physicians wanted it was a lot easier for them to have nurses on call and everybody ready and they just run in and hold out their hands and deliver the baby, where everyone else had done all the work so that was easier for them they didn’t have to worry about the horse and buggy, they didn’t have to worry about cranking up their early automobile they were set in the hospital and had a much easier time too, so it was really a push and pull from physicians and then from women’s end wanting to move birth into the hospital, they didn’t, I think realize as you put it about that mortality might still have been high in the hospital that infection was still an issue in fact is a bigger issue in the hospital than it was home. If they knew about it, it wasn’t the predominant thing in their minds they were looking for what they hoped would be a safe experience with people who knew what they were doing around them. What they didn’t realize that first generation that went into the hospital and it wasn’t the whole generation obviously all at once. The first women who went into that school didn’t realize consciously, what they were leaving behind. They didn’t realize the female world that they had created at home, which had been such a comfort to them and had eased the birth transition so well. They didn’t realize they were losing that if they went to the hospital, hospitals, they labored, if you can imagine this we don’t do this anymore they labored alone delivery room obviously there are people around them, the physician and probably the anesthesiologists and nurses in the labor room they were mostly alone nurses would come in from time to time to check if they were dilating, how far dilated, they were to check that they were okay maybe offer them some ice cubes, maybe not even that. Otherwise they’d be alone. And that was really, really hard to make that transition from being in the comfort of your family and friends to being alone as they put it, alone among strangers that’s why I named my book brought to bear because in the early period women were brought to bed by their friends by their relatives by people they loved and who loved them. In the hospital, they were alone among strangers, women in labor rooms would talk about listening to doctors and nurses talking outside in the corridor. they might come to the door and look at you, but they wouldn’t really come in and hold your hand and give you the kind of comfort that you wanted and needed if you if labor was going to progress. Well, so it was a very difficult transition in that sense, but as I say women didn’t know they missed it until they missed it, and then they missed it badly.
P: Yeah, no kidding that that sounds really dramatic I talked to a woman yesterday who was born in Britain but her family’s from Nigeria. And she was saying when she got home from the hospital, her mother was with her for living with her for a month and you know that her mother in law came and she was saying in Nigeria that is the common practice that exactly what you described, which is that someone moves in with you to take care of everything, and the mother’s feet are not to hit the ground and, which sounds kind of amazing and she herself was saying, it’s much harder to do you know that we live in England because everyone has a job. So, you know, my mom can’t live with me anymore because she has to go to work.
Dr. L: so I recreated that a little bit when I had my first child, I’ll tell you this experience, it was on the delivery table, literally the delivery table when I was pushing, I’m working so hard that I realized the birthing mother is the most important person in that room, and, of course, working the hardest of anybody in the room. And the story historically from her point of view had not been told we knew about the doctors we knew about the nurses we knew about the midwives, you know less about the nurses and midwives and we have since come to know but we knew about childbirth from the medical point of view and we did not know it from the birthing woman’s point of view. And that’s right there is where my book was conceived as my child was pushing her way into the world, I knew I had to tell, try to tell the story from my point of view my working hard point of view. And the other thing that happened which was totally inadvertent but quite wonderful. In my first birthing experience was that I was doing a Lamaze delivery which was in, in my day a little unusual,
P: the lamaze method was developed in 1950 by a french obstetrician and it was a natural birthing technique that focused on regimented breathing for each stage of labor
Dr. L: and the nursing student class heard about it and wanted to come in and see it. And so I had about 10 nursing students around my bed, all female. So, other than my husband who was there, I had recreated without knowing it, the female part of the experience, and it did help they all saying happy birthday when Sarah came out and it was, you know, it was quite a party in that sense in the same way as it had been what we used to call social childbirth, it was a social childbirth and a female social childbirth.
P: That seems fitting.
Dr.L: Yeah, it was but I didn’t know it at the time.
P: Let’s talk a little bit about Twilight sleep if it seemed as though, women were edging away from that social circle that was so helpful. It sounds like Twilight sleep was just the end of that.
Dr. L: it was, but one of many things in the hospital that ended that Twilight sleep was seemed very very attractive to women women, as I found out who call themselves feminists who wanted to imbibe that they men, choosing the way they wanted to have birth. When I was a feminist writing this book, I was thinking of feminism as something that meant I controlled the birth itself and that was a slightly different use of the word feminist but they were feminist and they wanted to choose and they had heard about this method this we’re talking about the second decade of the 20th century, in the 19 teens, and they had heard about this childbirth technique in Germany and wanted to bring it to America, and basically it was giving the laboring woman, a combination of scopolamine and morphine which would morphine to dull the pain and scopolamine to help you forget it, and it would kind of put you into this totally relaxed state of sedation and not really knowing what’s happening to you, and you would deliver your baby and then you would wake up and some women who did that. I remember having had a baby they didn’t know they had had a baby, so he missed the whole thing, which for me was really terrible because I loved the whole thing, I loved it, not in the kind of romantic, fuzzy pink way.
P: Yeah,
Dr. L: but in a way that helped that I understood the power of my body in a way that I hadn’t understood it before I had a baby. And that was incredible to me that a body, a woman’s body can do that, and I wanted every minute of that experience I wanted to be awake and alert for it, which is why I didn’t want medications but in, in the twilight sleep. Example women wanted that medication wanting to forget it wanted to wake up with a baby and not knowing it and not having felt it, and they did that until they realized that the dosages in those early years of using scopolamine and morphine the doses weren’t well regulated were, weren’t well understood and some of the babies were very lethargic after being born and the women not necessarily in great shape themselves so it was something that fell by the wayside pretty quickly in that form, but was continued to you be used once they understood dose medication, well into the 1960s. You may be still being used in places, my sister in law had a scopolamine Birth in the 70s but it was a way to medicate women without them, understanding it as medication per se. I think anyway they liked it and they came to the hospital for it so yeah they ended up one of the things you did under the effects of it was thrash about a lot and so they would put women into these into bed, high Canvas sheets so they couldn’t see and they couldn’t fall out, which also, you know freaked me out because you’re really alone in that environment, and I didn’t like that but they loved it, so.
P: Yeah, it sounds like horse blinders I’m not for that. And do you have any insight on abortion was it handled by midwives, was it a political issue, or the 18th The 19th
Dr. L: well, yes and no. I mean, in traditional societies and including our own life was not seen to exist before quickening between the 16th and 20th week of pregnancy. So until a woman felt movement, you didn’t worry about that and yes women tried to get abortions if they didn’t want to have their babies and they helped each other do that. Midwives sometimes helped some, some absolutely refused to help, and doctors got into the act and helped, and then some also absolutely refused to help, until the late 19th century was seen as perfectly fine for quickening because it wasn’t seen as you had life yet. Technically, so people did it and, and the problem was finding a way to do it successfully. And of course, there weren’t a lot of very successful remedies. Then, and the same with birth control, you know, they tried all sorts of things for birth control and weren’t necessarily successful,
P: that is super interesting to see how many historical lines from the past are still totally relevant today.
Dr. L: I do think that we are re experiencing many of the things we as individual women are really experiencing many of the things that women in the past have and we have some of the same concerns they may be manifesting slightly differently today but they are. There’s a lot of a lot we can learn from women in the past.
P: Yeah, the issue of control is so, fundamental to every woman who talks about her story about control over her bodyand almost everyone universally says, when they feel a loss of that sense when things are being done to them, it feels terrible and not natural and, and that seems true forever and I can see why women fought so hard to have people with them.
Dr. L: People with them and to make birth plans, even though a lot of women know that the birth plans can get thrown out…maybe too easily. They make them and they, they put a lot of stake in them, because they really do think about what they want in a childbirth experience, and of course many doctors really try to give them that. And pay attention to their birth plans and help them with that. And others just say dear, dear, I know more about this than you do, don’t worry just put it in my hands. So, you know we have those experiences, right away first in the hospital in the early 20th century and we still have today. You know, it’s something that we can look back on and see how did women, those women who kept control how did they do it. Yeah, and we can learn from that.
P: Oh, thank you so much for taking us on this tour of where we’ve been and hopefully where we’re going.
Dr.L: Well thank you for asking me. I hope that was useful.
P: Yeah, it was great. Thank you
P: and now a little bit more on where breastfeeding fits into the current day picture:
A special welcome to Dr Janet golden, a professor at Rutgers who specializes in the history of medicine, history of childhood, women’s history, and the American social history. She’s the author of several books, including most recently, babies made us modern how infants brought America into the 20th century, which is a very intriguing title, thank you so much for coming on Dr. Rosen.
Dr. Golden: Oh, thank you for inviting me.
P: One thing I want to talk about today is breastfeeding and sort of how we got where we are now culturally, I think there was no push to get my mother to breastfeed, as opposed to my kids when I, when they were born, there was an enormous push to breastfeed. So I’m wondering if you could kind of walk us through how we got here.
Dr. G: All right, that’s it, that’s a great question and I think we can say that there’s a very long history of forces, promoting breastfeeding and forces opposing breastfeeding, it’s very different in the United States than in other places, of course, where, just as an example. The French were very concerned to promote breastfeeding and for reasons of health because they were being outnumbered by the Germans and they wanted to build a strong healthy population that can then it becomes out of fashion to breastfeed everybody wants to have a wet nurse or send a baby out to a wet nurse so there are constant changes in this history
In the United States, you know for most women in the early centuries of what we will call United States history, you pretty much had a choice of breastfeeding or using animal milks which weren’t as well formulated as they might be today, and most people simply didn’t have the means to purchase them out to maintain it properly if they did purchase it, they didn’t have refrigeration so breastfeeding was really the way to go until these canned formulas developed and then the formula companies jumped in and said get rid of wet nurses. Feed your baby the scientific way and go with melons, baby food or go with Borden’s condensed milk in a formula. So there was pressure in the other direction
P: is that like 1950s When is that?
Dr. G: that really gets going in the end the first formula is get going in the late 1860s 70s 80s
P: Oh, Wow,
Dr. G: so they start pushing that only a few people can afford it, of course, the breast, but breastfeeding begins to look unscientific and so there’s, you know, we start selling the, the sugar formulas that go into the milk formulas, and of course once you have running water clean water indoors, you have electricity or gas heat to boil things, it just becomes a lot safer to do that. Now obviously, there is some controversy when formula companies are promoting these powdered formulas in countries where people don’t have access to clean water, low income they have to dilute the formulas so they’re not healthy for babies but we’re not, we’re not going to talk about that so we’re really gonna say that by the post war period 1950s Breastfeeding is just out of fashion it seems primitive It seems something that poor women do. The modern scientific ways is to bottle feed, and then it’s very precise you can measure how many ounces did my baby, drink some baby books had you weigh the baby before you fed the baby and then feed the baby and see how many ounces, they took in, and then people began to push back against that and saying no. Why should this commercialized enterprise these be in charge, why should medical authority dictate over what’s natural for women, let’s go back to breastfeeding and of course there is good scientific literature that says it’s, it’s a better alternative, you know, cows make milk for calves women make milk for babies, you know it’s it’s a natural correctly designed product, but of course not everybody can do it and not everybody wants to do it so we live in a world now where two things are true. One is that I think we can stipulate that scientifically medically speaking babies are better off drinking milk, designed for babies, which is from human females, But we can also say that. Secondly, we live in a world where we get clean water, we can properly prepare our formulas the formulas are well designed, and not everybody can or wants to breastfeed their baby so both things are true, and we’ve gone in the direction of making it easier to promote breastfeeding in hospitals, maybe a little too pushy on that as you can explain, and we’ve also reformulated to use a bad pun there are our WIC program and other things to support breastfeeding and we’ve put in, in places that employ large numbers of people we put in stations where women can pump their milk store their milk etc so we’ve made it certainly made it easier to be a breast feeding person, but that that has, I think shaded over for some people to be almost a command, and making people very resentful and unhappy with that, you know, I guess we live in a world where everything is polarized nowadays even taking care of infants.
P: yeah, That seems to be the case and a lot of women describe how they expected breastfeeding to be easy, because it is natural, but I don’t know that those two things go hand in hand, and once it is difficult, then there, then they think it’s something that’s wrong with them and all of a sudden it’s a comment about their ability to be a mother…after you give birth, that is the first thing that you’re doing. So, it’s challenging to have the first thing be something that’s not necessarily super easy. Do you have any sense of how common it is to have trouble breastfeeding.
Dr. G: I really don’t know because I think I’m sure there are studies on that I’m sure it’s difficult in the beginning I believe it’s harder for women who’ve had cesarean sections and have had some anaesthesia in their system, I believe it gets easier with second and third and fourth. So on children. But certainly, initiating breastfeeding it’s often better done if you have a mom or a support person who can get you through it it’s, it can be, you know it can be painful. Problems do develop you need support breastfeeding may be natural, your body may be designed to do it but that doesn’t mean you necessarily know how to do it. Some infants have trouble sucking latching on, you know it’s not, it’s not a perfect and easy thing to do, but I think what makes it so hard for people is the, the weight of expectations and judgment, you know, we live in a culture, I think it’s fair to say that the easiest people in the world to pass judgment on are either people like us who we feel we can do better than other moms in the, in the hospital with us or in the birthing center with us, and then people who are different from us and who behave differently from us and we can say oh they’re different and there’s something wrong with them. And oftentimes that judgment is really about women and about mothers and about child rearing. And that I think makes it all the harder, all that judgment that goes on and, and political divisiveness,
P: Yeah, and what I find, talking to people is that it’s not always on the surface, sometimes it is a it is a buried expectation that you don’t realize until you don’t meet it. Many women have come on the show and talked about how breastfeeding is the super painful and difficult thing and the latch didn’t quite work and the baby wasn’t getting enough milk, but it was still hard to give up, Because her expectation was, you know, good moms breastfeed.
Dr. G: Right. Just like when other women wanting to breastfeed and the 50s and the expectation was you’re a bad mom. Because you’re not buying the most up to date formulas and the fancy bottles that go with it. So, if we took the judgment, out of it. I think it would be easier for people to breastfeed it would be easier for people who didn’t want to breastfeed to bottle feed, it will be easier for people who want to partially breastfeed and partially bottle feed to be comfortable with that, but there’s the idea that we, that we have to pass judgment on this and make people uncomfortable about their choices. It’s always been that way, but it doesn’t have to be that way.
P: Well that’s interesting to hear that that is always the case so even when the pendulum swung the other way and people were being discouraged from breastfeeding, you were made to feel bad if you breastfed.
Dr. G: You were made to feel bad and there are many many stories of women who said I want to breastfeed my babies and the nurses would would only would start the babies on bottles without telling you so it was hard for them to latch on and then they would only bring you the babies every four hours even if babies were hungry and they’d cry themselves to sleep, and then they start wiping down your breasts with alcohol and other antiseptics. Oh they made it, you know, because it seemed like you were doing it seemed dirty if I can put it that way to put your baby on a breast and when you could have a scientific bottle that was you know had been sterilized to the right degree and gotten out all the germs so. As difficult as women today have it who choose not to breastfeed and get judged by nurses or by their friends or their doctors, it was a different way, maybe 50 6070 years ago.
P: That’s sort of shocking and I guess I don’t know whether I would call that marketing exceedingly creative because suggests that the scientific way is to do something that’s made in a lab, as opposed to what your body has produced, that’s sort of amazing.
Dr. G: Well, that you know we were very into measurement. So, how much is your baby weigh how much did How big was your baby how fast is it growing so if you can measure how many ounces your baby drank and write that down, which a lot of moms had charts to do that that just seemed like a very scientific thing to do.
P: Yeah, that that’s fair and I’m sympathetic to that and actually I don’t know if you’ve heard of a company called hatch. No, they have a very special changing pad with really sensitive monitors in it so that you can weigh your Baby and breastfeed and weigh them again, and it’s there’s an app on your phone and you can check it out and and it is for that purpose explicitly because so many women who breastfeed say I have no idea how much they got or if they drink anything or you know what’s going on so it’s funny that science has come to meet that demand another way.
Dr. G: Right, well, you know, our medical world is always in part about marketing, They’re very much intertwined, because you can sell people on science, whether it’s the science of hygiene and cleanliness or it’s the science of measuring your baby for a time women, middle class, upper class women were encouraged to buy scales and weigh their baby every day and write it down you know because measuring is science. So, and then the marketers got very into this our department stores have infants departments, they used to have nurses who works there who would tell you the right things to buy and give you medical advice so you know that that the world of science which has brought us many, many wonderful advances is also about the world of marketing which has brought us many, many products and they do get tied up together and help to sell each other.
P: That’s shocking to hear that there were nurses at department stores, impossible to imagine, and I guess a great way to sell stuff.
So let’s talk for a little bit about these baby friendly designated hospitals, the impetus for this came from the WHO World Health Organization,
Dr. G: right, it’s a worldwide effort
P: in the 90s, and then I’m sure it looks different here than it does in other countries, in 2007, it says that less than 3% of United States births occurred in 60 Baby Friendly designated facilities, but by 2019 28% of births are in 600 Baby Friendly facilities and Baby Friendly is a designation you get if you follow this 10 step approach to encouraging breastfeeding, but it sounds like it’s almost aggressively to the exclusion of anything else.
Dr. G: Well, I would, I would say two things about that one is it’s fascinating to see how much it’s grown and I’m sure that has a lot to do with the marketing of the hospitals, right, if you have health insurance and you pick that hospital, because it’s a Baby Friendly Hospital and you like it, you’ll continue to bring your insurance cards when and go back to that hospital so that’s that’s good for the hospital. It is probably good for hospitals to move away from promoting bottle feeding to supporting breastfeeding, that how aggressively they do that, I would assume is to some degree determined by the, the nurses on the obstetrics floors, and how seriously they promote breastfeeding over bottle feeding, and if you think about it from the nurses perspective, if you have rooming in and a mom can pick up her baby and breastfeed on demand, then that’s a lot less work for the nurse taking the baby back to the baby part of the hospital and feeding the baby, him or herself. So there are all sorts of incentives built in for the hospitals for the staffing of the hospitals for the baby, certainly, you know if you’re going to support breastfeeding, which is a good thing overall, But how you handle that I’m sure it’s very idiosyncratic, and it may depend on whether you have the night nurses or the day nurses and are they new hires are they the older hires how they feel about it.
P: Yeah, it’s interesting to see sort of what’s developing and just so interesting to me that there’s this cultural shift that happens you know almost on its own cycle, where it goes back and forth. So, can you imagine at some point in the future where breastfeeding will be out of fashion.
Dr. G: It may well change because now, you know, now we’re beginning to see what uh what environmental pollutants are in women’s bodies and in breast milk so maybe they’ll have formulas that don’t have those pollutants and we’ll move away from it. When we talk about breastfeeding we’re talking about the health of a woman and a baby and a family and workplace issues and social issues and environmental issues, and it all gets encapsulated in this tiny realm of Will you or won’t you breastfeed, but there really so many bigger surrounding issues is breastfeeding supported by do we have six months of paid family leave in this country. No we do not, you know, that might be a better support for breastfeeding or partial breastfeeding, then what happens in a Baby Friendly Hospital or a baby unfriendly hospital if we want to label the other ones
P: that oh that sounds much more expensive, potentially, potentially much more helpful but much more expensive.
Dr. G: Right.
P: The other thing that seems tricky about maternal health and newborn health is that I feel like it has not received as much medical attention. You know all the issues that come with pregnancy, many of which remain a black box preeclampsia we’ve known about for hundreds of years, we’ll still know kind of how that works. So it’s, it’s tricky to see what will be the lever that will encourage a shift in one way or the other to change.
Dr. G: Right, I mean we still have many many women who’s who are uninsured.
P: Yeah,
Dr. G: even with our expanded Medicaid and programs there. We have undocumented women, who I believe if they call up a center, they can get prenatal care, and they’re supposed to not wait more than six weeks but in fact I think there is not enough services for them, their children are going to be Americans. They’re here. And yet we’re denying them a kind of Healthy Start There are so many complicated issues around pregnancy and birth that are much more expensive as you say, not necessarily harder to solve because the rest of the world seems to solve them. But if we don’t have those conversations then we bring it back to this individual well that mom didn’t breastfeed or that mom should breastfeed or why is she fully breastfeeding and leaving the baby formula when she goes to work We’re talking about individual decisions, but we’re not talking about the structure in which they’re made.
P: Well, so you bring up a good point other than vastly more generous medical supports that other countries give their women. Is there any do you have any sense a theory about, you know why culturally in America, you know postpartum care is one visit at six weeks, and I as far as I can tell, you know, after you’ve been through, almost 10 months of pregnancy and an exceedingly challenging delivery, you could, you could use care before then, but we, but we don’t do it that way. Do you have a sense of like, what else is driving those differences between US and other countries.
Dr. G: Well, you know we have a for profit healthcare system. So, I believe that if you’re an insurance company said, Is there any data to say you need continuing care that, you know, first year after giving birth. Well, no their baby will go to the pediatrician and you as the mom, you’ve had your one postpartum visit you’re done. Why do we have to pay for another visit for you. So we have that problem right there. Yeah. And, and I think that there’s just a sense of, you know you’re you’ve become. you go from being the vessel for the baby you deliver the baby then the baby is going to get that the S chips care the Medicaid care the private insurance care the clinic care, but you as the mom you’re kind of done to your next pregnancy I guess, Or your annual gynecological checkup. We don’t and so we have a very high maternal mortality rate in this country as a result of that, but we have a strong tradition, really, I would say from the post world war two period of saying, everything is a private matter, you know, It’s for you to go to your doctor. It’s for you to decide if you want to be pregnant or not pregnant, we don’t, we don’t have a system that says, we have some responsibility to our citizens and non citizens who are here and who should have good healthcare.
P: Dr golden thanks so much for coming on and talking to us today. I feel like I’ve learned a ton.
Dr. G: Okay, well it’s been wonderful to talk to you.
P: Thank you again to Dr. Judith Leavitt and Dr. Janet Golden for giving us a sense of the factors over time that have come together to contribute to the pregnancy and birth culture we have today. Thank you for listening, and if you liked this episode, please consider sharing the podcast with your friends. The next episode is a return to a birth story…and this story is really, in some sense, a loveletter to becoming a parent–it showcases the many challenges that sometimes have to be overcome to get there…
Episode 26: The Press of the Postpartum Period: Dana’s story
Episode 26 SN: The Press of the Postpartum Period: Dana’s story
Today’s guest sailed pretty smoothly through the process of starting a family–she got pregnant relatively easily, carried her pregnancy without too many hiccups and gave birth in a way that wasn’t too far from her expectation–and then she hit a breastfeeding wall, which likely contributed to her experience with post partum depression. Now she’s focused on helping women build a better relationship with their bodies. She clearly articulates the mental and emotional struggle so many of us experience as this process transforms our bodies into something new we’ve not experienced before, and aims to guide women to a more compassionate understanding of all the amazing things our bodies do. Today’s episode is a little different from previous episodes because not only do we talk about my guest’s experience, but because of the work she does, we also discuss the press and pressure of postpartum expectations many women have, and talk briefly about one route out of what can be a really challenging fourth trimester.
You can find Dana, and more about her work, at wellnesslately.com
To find more about Dr. Golden‘s work, click here
Breastfeeding research
https://www.sciencedirect.com/science/article/pii/S0974694312000163
Audio Transcript:
Paulette: Hi Welcome to war stories from the womb. I’m your host, Paulette Kamenecka
I’m an economist and a writer and the mother of two girls who taught me very early on about my lack of control over the process of growing a family. Today’s guest sailed pretty smoothly through this process–getting pregnant easily, being pregnant without too many hiccups and giving birth in a way that wasn’t too far from her expectation–and then she hit a breastfeeding wall, which likely contributed to her experience with post partum depression. She’s focused her work on helping women build a better relationship with their bodies. she articulates the mental and emotional struggle so many of us experience as this process transforms our bodies into something new we’ve not experienced before, and aims to guide women to a more compassionate understanding of all the amazing things our bodies do.
In this episode, I include a brief clip from my interview of a professor of the history of science, because she provides some historical context for our current cultural understanding of breastfeeding.
Let’s get to the conversation.
Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you are.
Dana: Sure I am Dana Baron, I’m an intuitive eating and body image coach and I’m in exotic suburban New Jersey outside of New York City. Yeah and I help women to basically escape the diet mentality that keeps them trapped and cycling through restrictive diets and then binge eating and emotional eating and beating themselves up and really build body image resilience. So that’s the work I do
P: That sounds like we’ll have a lot to talk about. excellent.
D: Yeah.
P: So let’s talk a little bit about pregnancy, before you got pregnant, I’m sure you had the image of where it would be like, what did you imagine you were stepping into
D: I imagined I you know coming from the sort of, quote unquote wellness industry I imagined the pregnancy glow, and just feeling like a goddess of fertility. And, you know, just being absolutely enamored with my body and the miracle of life and all that kind of stuff it was not the case for me I’ve had two I’ve had two babies. My oldest is three and my youngest is 17 months so,
P: oh wow,
D: something fresh for me yeah,
P: good Lord well, people listen to you can’t see, but you don’t look like you have two babies in the morning.
D: Oh,
P: you look rested and you know there’s a lot of work at that age, so
D: yeah, I’m glad I look rested, we are. Everybody is sleeping through the night so
P: oh, nice
D: that is a huge, that’s, yeah so I do get regular sleep but yeah I mean in COVID preschool clothes, no babysitters coming running a business, so it has definitely been a wild ride over here so I’m glad I look rested.
P: Yeah, my kids are older, my kids are teenagers and you know my younger one just got her license so
D: Wow,
P: I’m Literally completely superfluous, which is, you know, he relatively easy and COVID, so yeah but my sister has young kids and so I think about your cohort, a lot like, oh my god imagine.
D: Yeah, I mean, on the one hand the physical like manual labor is endless. At this point you know even my three year old can barely get himself dressed just yet. We did potty training in COVID all of that but, so that is a lot but I also think about, you know, the older kids, all the things they’ve missed and all the things they are grieving right now and certainly being setback academically like I, I’m glad I didn’t have to teach my kids math that would have been a real issue for all of us. I think there’s different challenges and especially, you know, a teenager just getting their license I’m sure there’s a whole new world of emotional and anxious, navigating, you know, at that age because right now they’re just always kind of home with me and safe under my care but you know they go out in the world, it’s a different, a different type of exhaustion, I would assume.
P: Yeah, you know, I have two girls and they’re both extremely competent. And so, I’m not super worried, you know, they’re both really cautious so the real thing would be they get pulled over for going too slowly or something, you know,
D: that’s me.
P: Yeah, me too. That’s me a good problem to have. Yeah, so let’s talk about your experience did you get pregnant easily.
D: I did, I actually think in hindsight I don’t I don’t think I knew enough at the time but we started trying, maybe in November and I do think I had a very very very early, not even pregnancy detected yet miscarriage because of what had happened with my cycle that month and that was the first time we tried and then, you know, the, I think a month after that I was pregnant or, you know, six weeks or whatever it was so.
P: Oh good Lord I’m glad it happens that way for some people because we all have that story in our head and, and it seems like it may not be true but it is so yeah, thanks for that. Okay,
D: yeah.
P: And how was the pregnancy.
D: It was very straightforward and no complications besides for sciatic stuff after you know after I guess that’s more postpartum but yeah it was really straightforward and I was really lucky to just both of us healthy, the whole time
P: Good
D: and I know she’s was your vision for the birth, something you experienced. It was, I come from a long line of nurses, half of my, you know, half of the women in my family are nurses two of them labor and delivery nurses. Wow, so I always just expected a hospital birth, an epidural, sort of the straightforward Western medicine so I didn’t have. I definitely run on the anxious side especially, I lost my father at 18 and it’s sort of very quickly and he wasn’t sick, it gave me a little bit of my girl syndrome so like a little hypochondria. So I always feel safe around medical establishment. So in my sort of anxious line of thinking I just wanted to get to the hospital and get the baby out safely. That was the sort of the only thing in my mind I didn’t have any expectations really
P: well that’s like a smooth way to do it. What was the birth like did you have contractions and did you know what they were like What was all that like,
D: yeah, so I never went into labor, my OB practice basically schedule you for an induction if you were eight days past your due date, that was just what you agreed to when you went to this practice essentially so it was, I never went into labor, my best friend came out of the city we watched the Office all day on my due date I was like wait, I had no idea what to expect, and I just never went into labor so I went in they scheduled me for a Monday evening, to go in and get, I don’t know cervadil or whatever the, yeah, yeah, well one of the first stage of it but when I went in, they realized that I was like a centimeter or two dilated, so they said we’re going to skip that just go to Pitocin. So, I was given Pitocin and about 930 at night, and then I by one I think I asked for the epidural. I didn’t know what to expect and I, my aunt had my aunt who is a labor and delivery nurse said that if you do have to be induced. You might want to just be able to walk around as long as possible because once you do get an epidural now you’re in the bed, and you don’t know what’s going to happen, you could be in that bed for 18 hours so
P: yeah,
D: so I just kind of had that in my mind and then at some point I just said, You know what, and they checked me and I was moving along pretty rapidly, so I just got it at that point and then I think I pushed for like an hour and a half, maybe, and he just kind of came right out by 7am So it was a very quick.
P: That’s awesome for a first birth
D: yeah, it was great. I think I got like one stitch it was, it was very straightforward. I was very relieved.
P: That’s awesome. And then, how long did you say the hospital? Just a day, or?
D: I think we got lucky, because here I don’t know if your audience is global, but here in the states you get like a certain amount,
P: Yeah,
D: from one. And we, oh I think it was like if you checked in. I forgot. Anyway, we got the longest amount possible so I think I was there two nights. Yeah and it was really interesting because my grandmother was actually upstairs at the same hospital like going through the process of the end of life.
P: Oh wow
D: So she got to come downstairs and like me so we were all, it was a very full circle moment because my entire extended family was coming in and out of the hospital to be with my grandmother and then to come, you know, check on me too, so it was very I mean this is obviously all pre COVID
P: yeah, yeah, yeah, Yeah, That is kind of special and unexpected. Huh. And so two days after the baby’s born, you’re sent home. And what does that feel like was the fourth trimester.
D: It was sort of bewildering, the first really the first change in the emotional space around it was that they very quickly realized that my son wasn’t getting enough nutrition. I was trying to breastfeed. And, you know, I was so out of it, it was sort of like an out of body but you know the pumping wasn’t working his latch wasn’t happening I wasn’t they didn’t seem to see any colostrum, what does that colostrum?
P: yeah, colostrum
D: So it was devastating to me sort of like 233 o’clock in the morning when the nurse comes in to check and he’s, you know, he’s not. He doesn’t have enough output, so they’re like we have to we need to give him formula he needs to eat this is too long and I was just like, I was beside myself I like just I never imagined that happening, I don’t know why, in hindsight is, feels ridiculous to me in hindsight but I just was so attached to breastfeeding, that was sort of all you hear when you’re pregnant is how good for the baby and my mom and my aunt and everybody my family breastfed it and I’m here I am like in the wellness industry, you know like, and it just wasn’t working so the first like that there was something so devastating about watching this nurse and stranger, give my son his first bottle in the middle of the night because the baby needed to eat and I was not doing well. And I just remember my husband and the nurse standing there with their backs to me like feeding my baby and I just was so like I felt like I had already failed.
P: well also in your case where everything else had gone smoothly, you think Oh I can I can trust this, this is a process that’s working right. So, do they give you like classes or have a have, lactation consultant
D: we did it all. We did it all they had the lactation consultants in and out my aunt, my mom everybody squeezing my boobs all day. I even went in and I was just so attached to this you know I went in. My mom and I brought him back in maybe like five or six days later for like a lactation specialist and this is like a big Regional Hospital. My mom worked out for 40 years, there’s plenty of support and care here right. They have a whole team there, I went in, they measured the baby, they we breastfed on both sides we measured the baby again like trying to figure out exactly how many ounces and I was basically producing like half an ounce from one of my breasts, and I had had a breast reduction when I was 20, which the work I do now it’s like a very interesting to have done. So they told me, but I was, you know, 20 years old I wasn’t thinking about breastfeeding and the surgeon was like I cannot guarantee like I have to tell you that this could interfere. For most women, it’s not an issue but it could prevent you from being able to produce enough. So I’m kind of assuming that that’s what happened. So all those things combined I don’t know why it was so shocking to me but, yeah, so it’s like coming home my husband having to Google the right formula we had no bottles. It was, yeah, it was a mess. So, yeah.
P: And then, it sounds like you got that sorted or what was that process like
D: yeah I mean, about three and a half, four weeks of doing the. Yeah, in hindsight it’s very interesting, doing the skin to skin breastfeeding. And then I’d have to give him a bottle, and then I’d have to pump. And this was around the clock because I was told that you know you got that first few weeks of a window to get a supply going, and it just wasn’t happening.
P: You want to get into the weeds on breastfeeding, you could argue that it starts in puberty when the breast is being formed and is subject to all kinds of influences, but let’s fast forward to birth. Once the placenta is birthed, a bunch of hormones shift your breasts gear up for breastfeeding on demand, but what’s required for successful breastfeeding is the coordination of physical and biological factors. Essentially, you need to breastfeed, to be able to breastfeed because the process releases more hormones that encourage milk production. A study in the journal Pediatrics from 2020 collected all the most recent research about breastfeeding and said that colostrum that thick early milk, usually comes in in the first days, but that milk changes after a few days and consistency and volume. The authors here say that most women, and I put most in quotes, get the second stage of milk supply within 72 hours after birth, but that about 35% of first time mothers didn’t really get this milk in until four days or more after delivery. This delay could be linked to a first birth C section or a higher BMI, or things like gestational diabetes, or the Apgar score for the baby. But for a fraction of women between five and 8% this milk doesn’t really come in at any volume and for these women, the theory is that there might be something wrong with the breast architecture, or it could be consequence of breast surgery, or a hormonal disruption like an issue with the thyroid or PCOS. For more information check out the show notes.
D: And I was just at this point, you know, anyone has that a newborn. Breastfeeding bottle feeding and then pumping, there’s literally no time in between that,
P: yeah, yeah
D” So I basically haven’t slept in three weeks. Can’t let go of this and finally, like it was like my mom and my husband had like an intervention with me and my aunt came up from North Carolina and it was just like, you can just feed this baby formula like Don’t miss this whole newborn phase because of this like it’s okay to let go of this struggle, and I was just I was a mess. Mess, you know,
P: well also not sleeping at all doesn’t in any way contribute to like a happy, balanced, you know view of the world. So,
D: yeah,
P: I’m sympathetic to that. And I’m impressed that your family, many of whom are in the labor and delivery world are supportive because I hear so many stories about people who say, Oh, the nurse said, you have to breastfeed or I don’t know, people just feel the pressure and I, I guess I’m assuming is coming apart from medical establishment. Maybe I’m wrong. Tell me.
D: well, I think I think there’s a I mean, at least in my world there’s that general consensus like even if you don’t want even if you just don’t want to breastfeed, like that’s your right as a woman and a mother and I understand the push for it right to because there’s sort of like, there’s been a sea change around the thinking. But what about the mothers who can, what about the mothers who don’t want to it. Where’s the space for them, especially in the prenatal care, everything is about breastfeeding. There’s no at least in my experience, there was no and if it’s not your choice to breastfeed, here’s how you find the right formula. Here are the different bottle options there isn’t any of that. So you really feel like you’re failing on a profound level as a woman I found maybe that was just my mentality I’m sure not everyone has the same experience but the old I have a generation of women in my family who– do curse on the show. And if you don’t want me to. They just, they could care less about anybody else’s opinions, and they just thought I should just give it up like let go of it like you just need to take care of yourself to like you don’t need to be attached to this. So, yeah,
P: so that sounds awesome that you were supported. And did you, you know, it’s hard to let go of something that you have, you know, packed away in the back of your head and had for a while but it sounds like you were separated from the idea at some point. And what was Do you remember that what that was like did you feel freed were you, you know, was it easy.
D: It was an epic relief.
P: Okay, good
D: My husband could do middle the night feedings and I could sleep friends could come over and help you I could leave the baby for more than a few hours. So once that relief flooded in I was over it, you know, pretty quickly at least consciously I was over it pretty quickly like it felt like a relief for sure.
P: That’s awesome and it is, it is a lot of pressure. and I hear a lot of women say, No, I was told every woman could breastfeed.
D: yeah
P: it’s what Your body does. So yeah,
D: and it’s so much better for the baby, that’s all you hear.
P: Yeah, yeah,
D: and then my grandmother. Yeah, go ahead.
P: Sorry. Go ahead you can tell your grandmother story
D: I was just gonna say she told me, like, in her age, she had too much of a supply but everyone was telling her that the formula was better so she was like, You’re never get they’re never gonna let you get it right, so just do what you need to do for your family and your sanity, basically,
P; that’s a totally interesting perspective. It just so happens that I recently talked to a professor of medicine about the changing cultural appreciation of breastfeeding, I want to include a small clip from our discussion right here, a special welcome to Dr Janet golden, a professor at Rutgers who specializes in the history of medicine, history of childhood, women’s history, and the American social history. She’s the author of several books, including most recently, babies made us modern how infants brought America into the 20th century, which is a very intriguing title, thank you so much for coming on Dr golden.
Dr. Golden: Oh, thank you for inviting me.
P: One thing I want to talk about today is breastfeeding and sort of how we got where we are now culturally.
Dr. Golden All right, that’s it, that’s a great question and I think we can say that there’s a very long history of horses, promoting breastfeeding and forces opposing breastfeeding. In the United States by the 19 post war period 1950s Breastfeeding is just out of fashion it seems primitive It seems something that poor women do the modern scientific way is to bottle feed, and then it’s very precise you can measure how many ounces did my baby, drink some baby books had you weigh the baby before you fed the baby and then feed the baby and see how many ounces, they took in, and then people began to push back against that and saying no. Why should this commercialized enterprise these be in charge, why should medical authority dictate over what’s natural for women. Let’s go back to breastfeeding and of course there is good scientific literature that says it’s, it’s a better alternative, you know, cows make milk for calves women make milk for babies, you know it’s it’s a natural correctly designed product, but of course not everybody can do it and not everybody wants to do it so we live in a world now where two things are true. One is that I think we can stipulate that scientifically medically speaking babies are better off drinking milk, designed for babies, which is from human females, but we can also say that. Secondly, we live in a world where we get clean water, we can properly prepare our formulas the formulas are well designed, and not everybody can or wants to breastfeed their babies so both things are true.
P: So why did you, you want to walk us through like how you got to the other side.
D: How I got to the other side of the of the breastfeeding situation.,
P: yeah
D: Yeah, I thought it was, I thought it was quickly, I thought I was cool, but then I had some like late onset postpartum depression. When you’re in it you don’t recognize that that’s what’s happening. I also think my circumstances played a role in in I, you know, nobody was really around during the week, we had moved close to my mom, but she hadn’t retired yet and she had a sick boyfriend and a dying mother so she just wasn’t she couldn’t physically be there as much. And my husband was commuting and out of New York 5:30am to 730 at night. And so I was just home all winter isolated with this baby, and, you know, it looked like a lot of watching Outlander in my bathroom all day, not realizing that that was not normal.
P: Yeah,
D: cuz I just didn’t. I just I sort of felt like this really culminated in the early spring when I just told my mom I felt like I didn’t have anything to look forward to, like I was just so overwhelmed, taking care of this kid, losing myself, having no time to even shower, let alone like have pursuits or a career of my own things like that. I remember I used to like knowing what time my husband would come home, that’s when I would like put normal clothes on so that he wouldn’t like worry about me.
P: Yeah,
D: and I think when my best friend who’s single and has this very adventurous sexy life in New York as an actor and comedian, she came out to see me and was just like none of this is okay, like what is going on here and I was just like, Well you never had a baby, you don’t understand she’s like, I have seen plenty of people with babies and like you are not okay. And I just, I just didn’t realize it and in hindsight, my husband, seemed to think that he was on top of it because he knew but he never discussed it with me and my mom is of an old school generation that’s not super open to therapy and mental health care and was just kind of like it’s the baby blues so you’ll get through it, you know, so I was pretty annoyed by all that. But I think moving to a new home having community around me it becoming spring getting involved in baby class activities and meeting other new mothers like just being out in the world again. Certainly was sort of how I got through it like I just think moving to a new place, and honestly spring I always have a little bit of seasonal depression, just before kids too, so I think it was just sort of like I certainly didn’t do anything proactive to get out of it. Unfortunately, I didn’t even really recognize it until it was in hindsight.
P: Well, kudos to your friend and you articulated really well that it’s hard to see when you’re in it.
D: Yeah,
P: which is a great explanation for why most people may not usually help comes from the outside because you’re not in a position to be proactive.
D: Yeah.
P: So, this regrettably sounds like an all too common story where many people are sent home from the hospital told they have to breastfeed, there’s no other way. And it doesn’t work out for one reason or another, and they just feel terribly. and there are bunch of other things that contribute to women feeling overwhelmed in the postpartum period, taking care of themselves and a new baby, maybe taking a break from work, and that world they knew well, and dealing with your post pregnancy body, whether it’s fatigure or brain fog or pregnancy weightSo can you talk to us a little bit about like what your work is focused on and how maybe you help women in this circumstance.
D: Yeah, I mean, so we generally work with women around their relationship with food and body. And from my perspective, a contributing factor to the postpartum issues women face is the pressure we’re putting on ourselves to return, quote unquote, to this pre baby body this expectation of losing the weight quickly getting back into exercise very quickly. And I think that that contributes to this feeling of failure because especially with your first child. It is such an overwhelming experience that you literally don’t even have time to shower so how you going to prep keto meal plans or whatever the hell you’re trying to, you know what I mean. Yeah, so there’s this added layer and I think what’s really sad about it is that it’s not. It’s a moment that we dread for our bodies. Typically, and it should be a moment of celebration its a rite of passage like this becoming like this journey from made into mother should be celebrated, and instead we have hardly any support in any area and there’s all these different ways that we’re already, it’s sort of baked in that we’re not going to meet these expectations in some way, whether it’s breastfeeding or being able to stick to a diet or whatever it is. So we really help women around, letting go of the diet mentality in the first place so that they can actually nourish themselves instead of restricting themselves, and also starting to see our bodies as more than a body, right, like we are full human beings and our bodies deserve respect and appreciation and care and nourishment, even if we don’t currently find them beautiful right so it’s a really it’s a, it’s mostly a shift in perspective, this is all an inside job as opposed to, like I said meal planning or something like that.
P: That seems super valuable and super useful and now that you’re talking about this, I do remember being worried getting pregnant that I’d gain all this weight, which. And what would happen after and you know who knows why, then, so I definitely somehow I’ve gotten that message too. Do you have a sense of like where it comes from or like how we change it, you know, more broadly.
D: Yeah I mean it’s a narrative of diet culture. The diet culture that we live in and this expectation that women’s bodies are never supposed to change. Right we’re battling our bodies from puberty on most of us in our culture, battling weight gain which is very normal in puberty and then, you know, pregnancy, it’s just this idea it’s this narrative we all subscribe to because of our culture and the way that we were raised, and it tells us that we should have the same body after children that we had before, which, if you really think about it like all women’s bodies do is change throughout our lives. And this idea that we’re all supposed to get back like where did your body go What do you mean you have to get it back like you’re still in your body it’s just this new version of your body. Right so again it’s the expectation thing right like there’s this myth we’re all living by that we’re supposed to look the same, our entire adult lives like why do I have, you know 38 After two children, why would I expect to look like I did when I was 17 before I had children or even if children are involved, you know. So it’s really just starting to wake up I think media literacy is really important and also just waking up to this narrative that we’re all living by right like I think I’m supposed to get my body back. Like what does that mean why, you know starting to ask those questions.
P: Yeah, when you see it that way it does not take account of all the massive changes that pregnancy brings and watch a dramatic change in everything is wrought by pregnancy as if it’s this easy thing that you just
D: bounce back from,
P: yeah. Oh my god. Yeah, that is kind of a crazy story that I can’t imagine who wrote that script because somebody who never had, who was never pregnant is my guess
D: I always pictured Don Draper
P: poor Jon Hamm….
D: So handsome. He’s doing fine…
P: I’ll worry less about him… It does, it does sound like a, like a 1950s ad executive kind of thing to sell diet pills or some something crazy right that does not,
D: well yeah I mean, you know this, I think it was Naomi Wolf who says like this, these a culture obsessed with female beauty and this is not her direct quote but it’s not about beauty, it’s about obedience right if women spend all of their time and energy and resources and mind space, trying to control their body that doesn’t want to be controlled, then they don’t have that time energy resources mind space to look up and recognize that there’s so much wrong in our world that if we use those resources, maybe, like what would the world look like if women didn’t diet.
P: yeah, That’s amazing. That is a really good question because there is a lot of a lot of energy. I can imagine that is super prominent in the postpartum period and I hear a lot of people say that they did have body image issues when they were pregnant, and I, I’m not sure I had body image issues but I definitely said to my husband as I started develop a belly, I’m doing this wrong, this can’t possibly be what’s supposed to happen because I’ve never heard anybody talk about how weird this feels and how strange I look right this is such a weird feeling
D: I couldn’t wait to fit in to pregnant to maternity clothes because I felt like that in between, I was, you know, with my first pregnancy, it’s like you just don’t look like yourself.
P: Yeah,
D: but you don’t look that cute pregnant look at, you know, and just the fact that we all think about this so much as is the problem, right.
P: Agreed
D: But yeah it is and I would say that we, you know, the postpartum space is really is really vulnerable and I think a lot of times what happens is women come to us after that and are thinking that they, their whole battle against food in their body is a lot of times wrapped up in wanting to get their body back right like wanting under this illusion of control that we have that we can eat our way back into our pre baby bodies right and that comes up a lot in pregnancy is a massive body image disruption, right, just like trauma can be a body image disruption or illness or, you know, a comment from your mother or something about your body right there’s so pregnancy and childbirth alone are massive body image disruptions because your body is so foreign to you after you give birth, right, nothing is in the same place nothing feels the same, you know, and I think, especially if you are breastfeeding, you feel like your body’s not even yours anymore, so it’s sort of this out of body experience. So, you know, working to heal that body image and to start to respect your body for everything it does and is outside of the way that it looks right and I’m starting to think in terms of body respect, especially when it comes to what’s going on in your brain. How am I speaking about my body, how am I speaking to myself about my body. That’s really sort of where the work is for sure.
P: That’s amazing. That sounds so valuable. I have never heard anybody else talk about it in the terms that you’re using,
D: really.
P: Yeah and it’s, I mean not maybe because I live under a rock like. But, but it is like now that you’re saying this I realize all the stories I’ve been telling myself are basically the wrong thing right. I’m not sure I I’m like not organized enough to do, to stick to a diet, or, you know, eat 1000 calories a day or something crazy like that but, but I definitely, I definitely have that voice, I definitely have that voice telling me to Oh, don’t eat
D: it would be uncommon not to have that voice right because we have it from the beauty ideal side but now we also have it from the medical and wellness industry side where we have these food police and we’ve moralized food choices right we think we’re good or bad around eating clean and dirty all these things so there’s, there’s a lot going on in our brains about food and our culture for sure there’s a lot of anxiety and guilt and shame around food choices.
P: Is there any international example where you think they’re doing it right.
D: Wow. Not that I know of no so there’s an interesting study done in Fiji, a while back where you know the culture there had historically preferred in terms of beauty ideals, a more robust figure food and eating and being in a larger body were seen as a positive thing. And then Western, they got Western television, and basically eating disorders were virtually non existent in the culture there, and then they got Western television and eating disorders skyrocketed they’re seeing the girls on 90210 Right, so the beauty ideals shifted. And it’s become a problem there as well so I think any corner of the world where Western culture and media has reached, because these are European beauty standards right that are really impacting everybody in terms of their body image. So, yeah, there’s a lot tied up in it but not that I know of, maybe, you know that I’m sure there are so many cultures that haven’t been touched by Western culture at this point but not that I know of.
P: Is there any other measure of the degree to which we’ve strayed from, you know, just have a healthy body other than like eating disorders, any other way to recognize like oh this is like eating disorders is a clear measure that we’ve done something wrong.
D: Yeah, so we look at it as like and I think it’s interesting because I think that the issues around alcohol have some parallels here in terms of we no longer see it as an alcoholic or not an alcoholic, there’s this gray area spectrum right of substance abuse, right. And I really believe that a clinical eating disorder. The difference between that and actually you know just the average woman who diets is really just the behaviors and the mind and the thinking is very similar, right, but it’s the frequency and severity and percentage of time and energy right, so I like to look at it as a spectrum, right and most women in our culture have dieted or will diet at some point in their lives, and it’s really, it’s not a question of like do I have an eating disorder or not, but the average woman diets, I think the latest data I’ve seen is 25 to 60% of her time each day thinking about food in her body.
P: Oh, that’s a crime
D: that’s just the average woman that diets right because someone’s suffering from anorexia could be dreaming about it 110% of the time, right, yeah. That is the mind space and the energy we’re talking about here and that is just the average woman who’s googling Paleo Meal Plans. Right, so it is something that impacts everyone really and essentially it’s anti fatness, it’s a fat phobia that we have, and it’s just drilled into us, you know, from, from the womb, basically.
P: So what would be a healthier mind space for like to think about food just obviously this is a long term project and you can, you know, if it could be crystallized in a sentence, we don’t know what it was but, like, just give me a sense,
D: yeah sure so intuitive eating and Health at Every Size, are the framework that we work with and intuitive eating is essentially eating based on your body and your body’s cues, instead of what’s going on in your brain. Right,
P: so that seems like retraining,
D: it is if you look at a toddler dieting yet or hasn’t had their food controlled, they eat when they’re hungry they stop when they’re full. Many of them eat a variety of balanced foods right and they just listen to their bodies.
P: Yeah,
D: we’re the ones who have all these rules in our heads and really the dysfunction begins when we try to make our bodies something they’re not right, our natural genetic makeup has a weight setpoint determined by our genetics our bodies want to be in this certain range healthy and whole. We try to manipulate that and that’s where the dysfunction begins right it’s the binge eating the emotional eating the diet rock bottom of like, I can’t stick to it was 30 days now it’s 10 days and that was one day and now I’m just thinking about starting a diet all the time I’ve never actually dieting, and you feel addicted to food you feel out of control certain foods are off limits you’re cutting your food groups down to nothing, right, and all of this is sort of in the name of health, but at the end of the day, it’s really about weight, and everything tangled up in that for women, which is a lot
P: I’m grateful to you for doing this work because that sounds like literally your audience’s everyone, and
D: yes, yes, well a lot of mothers for sure. Oh it is it is
P: as I mentioned before the phrase bounce back is like she’d come with like a trigger warning or something because it, I definitely that’s planted somewhere in me. So I know that that is out there a lot. And,
D: yeah, I mean all we see is celebrities how they lost the baby weight all over every magazine like women’s weight somehow makes national headlines, Adele Gwenyth gaining weight and in quarantine, I mean, the world makes our weight news. There’s a global pandemic we’re talking about Adele’s weight. So like, of course, we think that, of course, we think about our body, our own bodies and, and whether or not we’re going to be able to lose the baby weight or the pandemic weight and all that stuff.
P: Yeah, that does seem like a colossal waste of time and energy for the person who wrote the article the personal research theoretical everyone who’s reading it right,
D: a lot of money to be made, though, as you know, the stuff about what is Wait comes out at the same time she promoted the book about I’m not even gonna say the title because I don’t want to trigger people into.
P: Yeah, yeah, yeah…
D: that’s what you follow the money and it’s a $72 billion industry that selling things to women to change their bodies and all the mind space and energy follows.
P: yeah, At the same time you’re supposed to have a beautiful pregnancy to the you know,
D: goddess of fertility, no hemorrhoids no sciatic pain, none of that.
P: Yeah, no kidding. That, that is such a de legitimization of, you know everything you’ve actually gone through.
D: Yeah, absolutely.
P: If you could go back and talk to your younger self and give her advice. What do you think he would tell her.
D: Just stop messing with your body and just eat. I mean I came to this word through my own struggle with disordered eating and body image and the term that comes to mind the most for me is waiting on the wait, like not feeling qualified for the life that you want to live or the person you want to be until you reach this expectation in your brain about how your body should look or be, and it’s usually not something that’s attainable for anybody because we know from our own lived experience and from the research that we can’t actually manipulate our weight, so just let your body be, stop messing with yourself is what I would say you know and to really stop seeing yourself as an object and be in a dynamic relationship with your body so that when things like illness or pregnancy or weight gain happen, you still have the same level of self respect and self worth that you had in a smaller body.
P: So, that’s amazing advice. Thank you so much for coming on and sharing your story, Where can people find you if they want to dive more deeply into this work that you’re doing.
D: Sure, so we’re at wellness lately.com We have a free masterclass at wellness lately.com slash masterclass that will take you through the five shifts to start to relate to food and your body differently to start to heal from this diet rock bottom that you might be in. So that’s why obviously the.com slash masterclass and everything can be found on our website.
P: That sounds amazing. I’m going directly.
D: Fantastic. Yeah,
P: thank you so much for talking, I totally appreciate our discussion.
D: Yeah, thanks for having me. This is great.
P: Thanks so much to Dana for sharing her story and for her work to help women appreciate their bodies in whatever size and shape they find themselves in. You can find more about Dana’s work at wellnesslately.com And thanks also to professor Golden for her insight about the historical context of today’s breastfeeding culture.
Thanks so much for listening. If you are listening in the car or on a walk, when you get home, feel free to like, subscribe, or write a review…we totally appreciate views because it helps other people find the show…
If you are interested in the idea of “how did we get to our current culture around pregnancy and breastfeeding, tune in for the next episode where I interview two professors of the history of medicine and we talk about how ideas about pregnancy and miscarriage, epidurals and breastfeeding have changed over time…to land us in the spot we find ourselves in today…
Episode 25: This Birth led to a Skydive, a Triathlon and an English Channel Crossing: Gill
Thank you to artist Nancy Farmer for the beautiful cover art. For more glorious pictures of swimming and light in the water, see : www.etsy.com/uk/shop/WaterDrawnArt
or: www.waterdrawnart.com
Episode 25 SN: This Birth led to a Skydive, a Triathlon, and an English Channel Crossing: Gill
This episode could be titled “Overcoming: A Guide”. My guest overcame the challenges of premature birth, and a fourth degree tear, and a misdiagnosis, and a fistula and a stoma. Having had so many elements of her life overturned by her experience of birth, she was reborn in a way, as a complete badass tackling every physical thing that previously induced fear in her. She’s challenging all the ideas that have created limits on her life and in the process, raising awareness and money for others who have experienced birth trauma and changing our perception of what life with a stoma can look like. I’m also lucky to include the medical insights of a fantastic OB, who happens to be the co founder of an organization called Beyond Fistula, helping women in Kenya who are working to overcome their own challenges with obstetric fistula.
You can find out more about Gill at: https://www.stomachameleon.com/
You can find out more about Beyond Fistula: https://beyondfistula.org/
Thank you to artist Nancy Farmer for the beautiful cover art. For more glorious pictures of swimming and light in the water, see : www.etsy.com/uk/shop/WaterDrawnArt
or: www.waterdrawnart.com
What’s a Show
False labor
https://my.clevelandclinic.org/health/articles/9686-true-vs-false-labor
How common is tearing?
https://www.rcog.org.uk/en/patients/tears/tears-childbirth/
Stoma
https://www.webmd.com/colorectal-cancer/colostomy-stoma
Sepsis
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/tog.12623
Audio Transcript
Paulette: Hi, welcome to war stories from the womb. I’m your host Paulette Kamenecka This is Episode 25, which feels like a milestone of sorts, and as such, I have a particularly powerful story today. I’m inspired by the women who share their stories with me, because these stories showcase strength and resilience that often the women themselves didn’t know they have. Today’s guest is an amazing example of this, and this episode could be titled overcoming my guest overcame the challenges of premature birth, and a fourth degree tear, and a misdiagnosis, and a fistula and a stoma. Having had so many elements of her life overturned by her experience of birth, she was reborn in a way, as a complete badass tackling every physical thing that previously induced fear in her. She’s challenging all the ideas that have created limits on her life and in the process, raising awareness and money for others who have experienced birth trauma and changing our perception of what life with a stoma can look like. I’m also lucky to include the medical insights of a fantastic OB, who happens to be the co founder of an organization called Beyond fistula, helping women in Kenya who are working to overcome their own challenges with obstetric fistula.
Let’s get to this inspiring story.
Hi, Thanks so much for coming on the show, can you tell us your name and where you’re from.
Gill: Hi. Yes, sure. So my name is Gill Castle , and I’m from Northern England on the border with Scotland
P: nice, lovely How many kids do you have?
G: I have one I have some who, a little boy who’s nine and a half.
P: Oh wow, that’s a fun age,
G: yeah yes I’m just striking out getting out, or wanting more independence. So, yeah.
P: So Gill before you had kids I’m imagining that you had some ideas about what you thought pregnancy, like, what did you imagine it would be like,
G: oh, a piece of cake. You know, I was fit and healthy, I’m not an ill person, so I don’t do illness, I don’t get ill, you know, don’t really get colds, never had chest infection, you know, there was just, yeah, Well, I was going to get pregnant, and I was going home, baby. And that would be it really. Pretty much.
P: Okay, well it’s a good way to go into it, I guess, as good as any. And did you get pregnant easily.
G: Yeah, I did actually didn’t take long at all. Basically, that we tried for a couple of months, My husband worked away. He then went away and came back and we got pregnant, and literally the day came up.
P: Oh wow, well done.
G: Yeah, yeah, I mean, and the reason I know this is, it was some sort of freak chance because my period was due. Three days later, and it never came. And I mean I don’t really know how that even works but the child has definitely his.
P: Did you find out with like a home kit?
G: Yeah, we just did a, just from the supermarket.
P: Yeah,
G: and get the whole pee on the stick thing and there we are, the two lines I can’t even remember now….if it’s two lines or cross or whatever. But anyway, I was pregnant. And, yeah, and I remember actually my husband not being sort of I mean he didn’t like jump up and down. He’s not a jumping up and down kind of person anyway. Yeah, but he, he was just like, alright, well yeah.
P: Taking it in stride. Okay.
G: But it’s still quite exciting. Yeah, yeah.
P: I’m assuming because you’re in England, you plan to go with a midwife.
G: Yeah, well, in in England. Yeah, well, Yeah, we have midwives, but you don’t, well you’re meant to have a dedicated midwife throughout your pregnancy, but not necessarily they’re not the ones that are at the birth but yeah, it was just going to be midwife. I was going to be an uncomplicated pregnancy so I wasn’t high risk or anything like that, but there was nothing really, you know, to cause alarm, to be honest for pregnancy, so yeah that was just the plan just to be with a midwife and just give birth in the, in the hospital in the city,
P: was the pregnancy easy? did you have, you know morning sickness? or
G: no not the only thing I did have which I would actually rather have morning sickness, none whatsoever…because I had a couple of bleeds, which obviously is really, really stressful, so I had a couple of early scans, but they were always absolutely fine. But yeah I mean I didn’t get heartburn. I didn’t get stretch marks, mind you, that’s probably because I, I gave birth six weeks early so I missed out on that final expansion of the stomach. But yeah, no I was really, really fortunate I was, I was absolutely fine I’ll continue walking. I continued working as well, it was no problem,
P: and then, you said you delivered early so, so what happened there?
G: So what happened was I was a police officer at the time, and I, we were working seven days on, and then four days off. I just finished my seven day set, and I was woken up the following morning. And it was exactly seven o’clock in the morning because I remember looking at the clock woken up at seven o’clock in the morning with a really sharp pain, which I now know was a contraction. And this was six weeks before my due date, so I just had this really sharp pain, then it stopped, and I went to the toilet and there was like just a little bit of pink on my underwear. And I thought, it’s a bit weird but you know it wasn’t in any, any discomfort like the pain it just disappeared.
P: Yeah,
G: so I left it for another hour and a half and then I had another contraction. But again, you know it wasn’t, you know it’s just like a quick kick in the stomach isn’t it, so I just thought, oh, oh. Whoa, that was strange, so I rang the early pregnancy unit at the local hospital and explained what had happened, and they said oh right, you’ve had a show, which is what the pink discharge was in my underwear
P: Show is part of the mucus plug blocking the cervix that starts to come away when labor is starting. It’s liberation from your vagina means that the cervix is starting to open. It might contain a little blood, which is why it’s pink
G: And yeah, you better just put on get checked out but you know we’re not worried. Just just come along and I told my husband, who said, Oh, but I’m about to go and get my haircut. No you’re not. We’re going to the hospital. There was a pause as we both looked at each other and then he was like, right okay we’re gonna go. Yeah, we took all the hospital bags off we went. And I was put under observation, and they said oh you know, you might be having contractions but they were really, really far apart, you know, an hour and a half apart. They said, You know, we’re just going to monitor you. We’ll see what happens if you progress, but what it might be, is false labor.
P: Yeah,
G: so there’s my order was written just completely stop, and then you’ll go home. Yeah, so I sort of had this in my head that this was all just fake it was all false wasn’t gonna go anywhere . That was our that was, I was fine, really, was doing my knitting, and I wasn’t really, I don’t know why I wasn’t bothered it just wasn’t, I wasn’t concerned.
P: I have to say I’m impressed that you brought your husband along I would definitely have dismissed my husband thinking like to try to make it so.
G: Yeah, yeah. Well, I think, number one, I don’t like driving into the city anyway, and the parking at that particular hospital was an absolute nightmare. So, and it was sheer, good luck and good fortune that he was there. Yeah, cause he works away, and he was actually due to be back until two weeks. But I think the week before the baby was due. So he just happened to have come home, and he was due to leave again a couple of days later. So, I mean if this had happened a week later he would have been on a boat in the middle of the North Sea, unable to come back. So yeah, that was one of the lucky things, not many lucky things but that was one of the,
P: so you’re at the hospital, and how long are you there and they’re monitoring and like what what’s going on.
G: So we got there about nine o’clock in the morning, I lost track of time really. All I know is that by, say, two o’clock in the afternoon, I was in established labor, and obviously the contractions have been getting closer and closer together. And because I was in early labor they needed to monitor the baby, so they had lots and lots of wires and things were strapped to my stomach and I couldn’t get off the bed I couldn’t walk around, couldn’t get myself comfortable at all. And when I was really in full swing of labor, I remember saying to the midwife. Oh is this. Oh, is this actually labor. Am I having a baby today, and she said oh yeah you’re very much having a baby, you’re going to have a baby really quite soon. And I was like, Oh, I just couldn’t. I couldn’t quite get my head around what she was saying, so so so yeah that’s when I sort of realized mid afternoon that I was on my way to have a baby,
P: That is kind of shocking especially the way they treated you when you came.
G: well yeah you know just, I mean they did sort of laugh in the delivery, delivery suite and my husband did as well because to them it was obviously really really big but I was, I just kept saying, oh this console and I did sort of say, oh thank God for that because I’m not coming back in six weeks time and do this all over again. Better be a baby or the other. All right, so by about four o’clock in the afternoon. That’s when I was in, I was in the grip of it all, but, as in the UK it’s probably similar in America but in the UK we have the opportunity to write a birth plan.
P: Yeah.
G: Which is nonsense most of the time isn’t actually level, level gets followed but now for one reason or another, and I’ve forgotten. I’ve written in my birth plan that I didn’t want to have any pain relief until I asked for it.
P: Yeah,
G: because I thought well I’m going to be the best judge of what I need, and I don’t want people given it to me too early. I want to be honest for as long as possible because then I’ll get the maximum benefit from the pain relief…I’d forgotten that said that. So then I was thinking well I don’t want to ask for pain relief, because they’re not giving me any, so they mustn’t think that I’m fat enough yet to be given pain. So I was laboring away but I’ve seen no gas and air with absolutely nothing until eventually I said you know, pain relief yet, and we’ve been waiting for you to ask it’s on your birth, no it’s not that you are like, Oh my gosh. Anyways, well you can try gas and air but we don’t think, you know, I think you’re a bit far gone for that and they were right.
P: Yeah,
G: I took a bit of gas and air and I was like well, for quite a lot, basically said This is rubbish. But then that’s when it all started to get a bit complicated because, obviously, you will know this but when a baby’s born, it actually has to help itself out with a birthing canal, at the end.
P: Yeah,
G: but because was only four pounds seven and he was tiny, he, he got tired, was exhausted, and he was back to back as well. So, his heart rate dropped, and then all hell broke loose. So I just remember all of us in numbers there’s loads and loads of people there, and they said right we’re gonna have to get you into theater give you an epidural and and get this baby out. You know, they said, no time to do a C section or anything like that we’re just gonna have to get the baby out. But they didn’t really say that quite as explicitly as that. I just remember lots and lots of people, and just the conversation of right we’re going to theater. And, you know, we’re going to get the baby out
P: that’s super interesting to me that they said like, this is an emergency. There’s no time for a C section, because I would imagine that vaginal delivery would take longer.
So I brought this question to a doctor. Today I’m lucky enough to talk to Dr Matityahu who’s an amazing OB and the co founder and executive director of beyond fistula, an organization in Kenya, that helps women who have encountered fistulas in childbirth. Her organization helps women heal and rebuild their lives working out social and economic issues that these injuries can create, and she actually introduced me to Gill–an introduction I’m entirely grateful for. Hi Dr Matityahu thanks so much for coming on the show.
Dr. Matityahu: Thanks for inviting me again I love speaking with you and I love everything that you’re doing to inspire other women so thank you.
P: So one question I have is Gill talks about how they say, we’re gonna have to get this baby out and there’s no time for a C section isn’t C section the fastest way to get the baby out.
Dr. M: I mean it’s either C section or vacuum or some people will still do forceps. If the head is crowning and you can, and it’s right there and you can just sort of put a vacuum on the head and gently pull or put forceps on and gently pull and get the head out within a minute or two, then you would do that if the baby’s head is a little bit higher up and there’s no way to immediately encourage delivery and C section.
G: Well, you would have thought, you know, but they, I mean, considering that I went into theater, and it took three attempts for me to be given the epidural.
P: Yeah,
G: because they couldn’t get it in my spine. And I do remember being absolutely petrified at that point because of course they say you know this is really sharp needle, you have to keep as still as possible, because it’s going in your spine. And, I mean, there I am sitting on the bed holding a pillow to try and keep them but having contractions and trying to keep reliving, I mean, so, I mean it took them three attempts and then they finally got it in as soon as I got the epidural in. I Do you remember how she lined back and sort of going, Oh, right. Hi everyone. Hi, nice to meet you, sorry I’m not normally that awful, I’m horrible. I’m really sorry and, and I looked at my husband and I said oh have you been here all the time. And he said he was absolutely gutted, because he was starving, he said, You mean I could actually let you go and got something to eat,
P: so they get it in and then do you have a long period of pushing or are you already ready to push or how’s that all work.
G: To be honest, I don’t remember any pushing at all. I don’t remember anyone saying anything about pushing to me. I remember literally just lying back and saying hi everyone, and then they fiddled about, and then they brought out this baby.
P: Oh wow,
G: literally, literally, you know, and I remember they sort of reduced this white mucousy covered while baby, literally in front of us, and I was a bit like oh and then he was whisked away straight away to where they put them on the side and the works on him. We heard him crying, so I wasn’t, I wasn’t that concerned, and they had said you know, we’ve, we’ve given you the steroid injection, because the lungs are the last thing to develop in a baby so we’ve given you that to his lungs when he was grunting which is fairly common with newborn premature babies. Anyway, he was taken off to special care and that’s when I was stitched up and really that’s when the catastrophe happened
P: they take the baby and he’s off. You said he’s like four pounds seven ounces, something like that, yeah, yeah, that’s a pretty decent size for thirty four weeks
G: Yeah, that’s right
P: the person’s dishing up is an OB. Yes, she was a consultant, and she’s the one who told you that situation.
G: Yeah, so, so they said, you you’ve sustained a tear. And so while you obviously the epidural is still working. We will, she’s going to repay it. So you just lie there and she’s going to repay you. And, you know, don’t worry about it. You’ll then go back on the ward and be reunited with your baby. But because I couldn’t feel anything, because I’d had the epidural, I really had nothing to worry about. I mean, I was kind of aware that women could tear giving birth but I didn’t really know anything about I didn’t really understanding, to be honest, the significance of having a tear on the extremity of the tear, of course.
P: How common is tearing?
Dr. M: tearing is pretty common, we grade the tears by numbers so a first degree tear would be a really superficial tiny tear in like the vaginal mucosa or some of the tissue around the entrance of the vagina. A second degree tear is probably the most common, and it’s sort of through the vaginal mucosa and and through some of the muscle, and a third degree tear and they call it a partial or a full third degree tear is a tear that goes through the vaginal tissue and into the sphincter around that the rectal sphincter, so it’s a tear that’s either a partial sphincter tear or a complete sphincter tear is a third degree sort of partial third degree or full third degree, and then a fourth degree tear is a tear that goes, again, through the vaginal mucosa of vaginal muscle through the rectal sphincter, and in addition, through the rectal mucosa so it’s a tear that goes right through and into the rectum, that’s a fourth degree tear those are much less common,
P: to put some numbers to this discussion, according to the Royal College of Obstetricians and Gynecologists in England, up to nine in every 10 First time mothers who have a vaginal birth will experience some sort of tear graze or a episiotomy for third and fourth three tears the numbers are a little different. They say six out of 100 or 6% of first time mothers experienced this
G: yeah, I just wasn’t worried cuz I didn’t feel anything so far as I’m concerned, I was just like well this is normal. I want a baby, I’ve torn she’s gonna stitch me up and I’m gonna go back on the ward and meet my baby, and it’ll all be fine.
P: It sounds like she didn’t present it as something to be worried about.
G: Well no, that’s because she didn’t think it was at the time which we found out in the nature investigation that she, she completely misdiagnosed me
P: so as far as you know she stitches you up and you go back to the ward
G: yeah, yep so she says, and, and they said Ryan, you’re going to go back on the wards and all you need to do is you just need to keep the wound clean. So even though it’ll be painful, you must, You know, have a shower, keep it clean and dry. Don’t avoid having a bath or shower or anything like that. And I thought well that’s absolutely fine that’s, you know, that makes sense to me. If I can do that no problem at all. So once the epidural wore off. And we finally met our baby at two o’clock in the morning, he was born at 20 past eight at night finally met him on the ward at two o’clock in the morning. And that was very surreal because the ward was really dark, and we were terribly British about the whole thing, so we didn’t want to make any noise. We didn’t want to disturb anybody, so we didn’t even want to turn on the light, so we I mean this is ridiculous. So we turned on our mobile phone cameras are the lights that we can actually look at our child for the this time so I mean a lot of all of that you know obviously affected the bond that I had, because the very first time I saw him he was twisting my face for literally two seconds, and he was away. Then when we met him, we weren’t allowed to, we should have done really, really well I think about it with some of the other people on the ward. It should just put the light on, but we didn’t and I think, you know that that impacted as well, the emotion you felt able to feel.
P: Yeah, why did they have him for so long. What were they doing for all those hours?
G: they didn’t have the staff to discharge special care.
P: Okay,
G: so there wasn’t actually any need for him to be in there, because after he’d been in there for about two hours or something, they said right yeah he’s absolutely fine, he’s ready to come on to the world, but he needed to presume he must have needed to be signed off by a consultant or, or the registrar or somebody must have needed to sign him off the ward and they didn’t have that person, so that’s why we had to wait so long, not because they were doing anything significant.
P: Okay good, so he’s totally fine.
G: He was absolutely fine.
P: But this process messes with your ability to bond and,
G: yeah, yeah,
P: I am totally sympathetic to the impulse to be quiet for other people it’s, it’s hard to have such a, an emotional experience in a packed house.
G: Yeah, and in a dark house when you know, people see things, and you just think, you know don’t want to, and I’m sure you know when I look back I think noone would have cared.
P: Yeah.
G: Expressing joy over seeing their baby you know but you just saw yeah we never had a baby so we were just still in the motions of not having a baby, you know. So, we were on the ward and it was really shocking, actually, because my husband was a Royal Marine. When we were on the ward we were looking at all these women, who was literally staggering about holding onto walls, grimacing with pain, barely able to walk some of them, and Chris my husband looked at me and he said you know Gill, this reminds me of a field hospital.
P: Wow.
G: Yeah, and it really does a study, and never envisaged some ward looking like this normally when you see women with babies they sit at home on a property, or they go along the street with a prom or buggy or pushchair. You don’t see them when they’ve literally just had a baby, but in a way, made me feel a bit better, because all right well they’re just as much pain as me so that kind of normalized it a bit.
P: Yeah,
G: but at the same time, couldn’t sit properly. I could barely walk. It was really painful but that’s the kind of person I am I just thought right well I’m not going to get beaten by this you know all I’ve done is have a baby. Loads of people. Loads of people have tears, so I’m not going to make any sort of complaint or fuss, I’m just going to get on with it. So that’s what I tried to do, but as the day’s progressed, the pain just got worse and worse and worse, and the very next day after having the baby. I noticed like a brownie discharge on my underwear. And I said to the midwife. I’ve got like brownie sort of discharge on my underwear not much but there’s obviously something interesting oh no that’s fine. No, that’s fine, that’s just sort of the tissues all fixing together that’s just a bit of mucus and you know it’s nothing to worry about.
P: Yeah,
G: so I was like all right okay and then I thought well I know when I’ve like fallen over in the playground and scraped my knee. You do get a jelly mucousy type stuff on your knee when it’s healing. So I just thought well maybe, maybe that’s what it’s from
G: Gill talks about brownie discharge on her underwear, should that have been a red flag.
Dr. M: I think that if someone just said I have some brown stain, you know, when blood is exposed to air and is oxidized and dries, like, it turns brown and so if there’s just a little bit of brown staining. You know, I’m guessing that a midwife might think, oh it’s just some old, blood that sort of oxidized and dried on your underwear,
G: the pain just started to get worse and worse and worse, and after about two days, I started getting poo in my pants. And I thought, Well, no, but I wasn’t really because I wasn’t very much, I couldn’t really work out where it was coming from because it didn’t really seem to be coming from the normal area.
P: Yeah,
G: and then it was getting to the point that every time I went to the toilet. I was pulling the emergency buzzer, because I was in so much pain I was frightened to go to the toilet.
P: Yeah,
G: I have to add something that the toilet is going to go rific and, and then I clearly remember, after three days, I was in so much pain and so much distress, I had a shower. And I remember I mean this is, you know so mortified when you think about it, this is what you do when you’re in it. And then so I was in the shower. I could not work out where this poo was coming from and basically I couldn’t work out what was part of my body and what wasn’t. And a midwife came past, and I was completely naked in the shower and I bent over and showed her my backside and said, right, is my bottom in the right place. I said I can’t, I can’t I can’t work out what’s happening I said there’s poop coming out all over the place and I’m just, I can’t work out why my bottom is, and she’s looked at me like I was completely insane, and said, that’s absolutely fine, it’s fine. Just finish your shower, go back to your bed, sort yourself out, you know so yourself.
P: Okay, I want to stop you right there. Now looking back, do we think she should have known that something was off.
G: Oh 100% I mean, I remember being hysterical in the shower, you know and I clearly remember saying, I don’t know why I’m about this I don’t understand what’s happening to my body like where is it all coming from, can you just show me where it is.
P: you don’t feel like the normal bowel movement.
G: No, no. Yeah, I always remember that she just sort of like she didn’t examine me obviously she didn’t come close to me she obviously just glance and said, Oh, you’re absolutely fine basically make it out that was completely mad. And I actually thought I was mad because I knew that there was something seriously wrong. But I couldn’t, I couldn’t get anybody to understand what I was saying.
P: So, I have to tell you as an objective third party that I find this so frustrating to hear I’m so desperately frustrated on your behalf that you’re not being taken seriously.
And then Gill tells the story about the poo coming out in the shower, and she doesn’t know what’s going on with her body, is this a red flag.
Dr. M: If anyone were to say, me or I’m sure one of my colleagues, like I feel like there’s poop coming down my leg in the shower, I think we would say we need to examine you like why would that be coming out, best case scenario I think maybe you have diarrhea and you’re just, you know, things are in pain down there and your rectum sphincter is relaxed, but even with the benefit of the doubt, I would wonder like why would you have stool running down your leg that is not a complaint that is typically heard at all. So, so I think that would make me immediately worry and say wow I really need to investigate like why is there stool, coming down your legs and that is not normal.
G: so then I went back to my bed, staggered back to the bed, and by this point, I could smell poo. I remember I was visited by a friend who’d come to see me and the baby, and she’d said, it smells like poo in here….And I was like oh, it’s the baby, and then I think well that’s not like that’s not long. She can smell something. Yeah, so I said to the midwife. On the evening shift I said, I think I’ve got poop in my pants. She was like really, and I said yes. And I said, I definitely have, and I said I don’t know what’s going on because I didn’t have this couple of days ago. So the way she looked and she was like oh I can’t see anything. And I said, But I’m in so much pain, I said it doesn’t seem to be getting any better. And she said what everyone had said to me repeatedly whenever I’d said how much pain I was in, they just said, Oh, the heat that you can feel around your body around the area that is just the tissues knitting together, and they are producing heat when they’re getting back together. I was sort of thinking, well, well okay, that makes sense, but I’ve had cuts in the past, and they haven’t got this hot, I mean I knew it was a big would but all the same, you know, it just doesn’t make any sense but that’s what everyone just kept saying to me, so I told this to the midwife been through my pants and she looked at me and she said no I can’t do anything. So the next morning, there was a change of midwives. And then the next midwife came on and she said oh you know how you said oh well I’m absolutely fantastic apart from the fact that I’m poo in my pants, you know, apart from that I’m great. And you know what you’re talking about. I said, there’s not be mentioned on her, Handover. Is this not on my notes, shut down and are we talking about what I was like, right. Last night I told the midwife that I poo in my pants. That my friend is about to come in the room. That’s the situation. And she said oh so she had a look and again so it looks like it’s healing fine. Yeah, no, You’re okay. So again, it was like, well this is just, like, completely mad like two people examine me now I would say that there’s not a problem, and everything’s healing. Yet, I know I’m pooing my
P: two midwives check her on successive days and say she’s healing, even though we know ex post there is a problem. Why does it look like there isn’t a problem.
Dr. M: So, you have to do a really good exam to see what’s happening underneath your repair.
P: Okay,
Dr. M: so if you’re just looking into the vagina, and you see your suture line that the vaginal mucosa is sort of closed up on top, you’re not able to look at what’s underneath that and so it’s the layer underneath. That’s not closed until unless you do a rectal exam or put your finger into the rectum and see, do I feel an opening do I feel a defect or is it completely closed off and smooth. You don’t do a rectal exam you don’t know what’s happening underneath. You have No idea. So I mean, it looks nice on top, it’s like if you had a bullet wound in your abdomen, and I just put a shirt over it and you’re like yeah that’s sure it looks great.
P: Yeah,
Dr. M: so like the top layer looks great, everything’s closed off and smooth and looking fine but underneath I’m hemorrhaging. so it’s sort of like it’s the deep layers that have to be evaluated and if you’re just looking and you’re like, everything looks good on top. That’s not telling you the whole story.
G: later that day I was trying to work on a project but by this point, I couldn’t really walk. Essentially I collapsed in the corridor. And I was found by a male midwife. And he said, you know, you’re right and I said no, I can’t do this anymore. I said I literally can’t do this. And I remember like my voice was really weak. And I was just saying, I can’t, I can’t, I just can’t, I can’t do this. It’s so painful, I just can’t cope anymore. And you know what he said to me, said oh, maybe it’s your perception of the pain.
P: Oh my god.
G: Yeah, and I thought, are you having a laugh, like, oh so I’m a wimp. Yeah, part of it died at that point because I just thought right. Oh my god, I, you know, literally just collapse in the corridor. I’ve said to this man that I cannot cope and he said to me, maybe it’s your perception of the pain. And then he said oh, what would you like me to tell you, and I was like no I’m fine thank you. I don’t want you coming anywhere near me.
P: No kidding. Oh my god,
G: you know, and then I just thought that when I am just going to go back to my bed, and I’m going to die because no one’s taking notice of me and be seriously wrong. And while you can probably guess, you know, I’m quite articulate, I’m more than capable of sticking up for myself, I was a police officer for heaven’s sake, but I was in so much pain and I was so weak I wasn’t able to speak up for myself but I could I didn’t have the energy to fight with people to be seen.
P: Yeah, I mean, this is, this is the tricky thing you learn in medical contexts that you have to be your own advocate, but it’s wildly unfair to make a woman who’s just given birth, be her own advocate. Yeah, you’re filled with hormones, you’ve just basically run a marathon by giving birth, these two things don’t go together.
G: Exactly, exactly and my body was fighting too much to give me the energy to then fight for support and help. So that’s my bed but obviously this midwife must of thought Better go and see what’s going on. So another female midwife came and said oh you know I hear you, collapsed, and I examined you. Yes, if you can, but I’m sure like everybody else you’ll say there’s nothing wrong with me. This is after now five days. And she tries to examine me, and I remember she basically put her hand toward where the tear was. And then she immediately brought her hand back And she said, Wow, I couldn’t even get near to it I could feel the heat coming off you, I was basically hovering over that and she said and you, you jumped back on the bed. Yeah, and I was like well yeah I mean an awful lot of pain. That’s right. We need to get you examined by the consultants, the consultants gynecologist.
P: Yeah,
G: came down to examine me, and they actually had to give me gas in it, because they couldn’t get anywhere near me. And the consultants, really look for that long to be honest and she said, right, you’ve got a fourth degree tear, which has been missed. And she says you’ve got an enormous abscess around the tear, she said that’s now burst, and you’ve also got a rectal vaginal fistula, which is where you have a hole between the lining of the rectum and the vagina. You’ve got poo coming out of the vagina. And, and I remember actually being really relieved. I was like, you know, thank God for that. Like there actually is something seriously wrong with me.
P: Yeah,
G: so she said right, well, I’ll have to get the colorectal surgeon to come down and see what he thinks. But she said I think the only way out of this is to give you a stoma, so that we can divert the feces away from this area, give a chance for everything to heal, we can repair you reverse the stoma. And you know, get on with your life.
P: what’s a stoma is an opening on the abdomen, that can be connected to either your digestive or urinary system to allow waste to be diverted out of your body. If it can’t move through your rectum bowel movements leave your body through the stoma and are collected in a pouch that you empty out, it can be temporary or permanent. There are a number of different reasons to get a stoma, like Crohn’s disease or bowel cancer or for obstetric reasons.
G: I was just relieved to be honest if it said to me, we’re going to chop off both legs I would have said I don’t care. That takes away the pain to do a heavier light so they went off and I burst into tears obviously and ushered off into it, I finally got my own private room. Do you remember joking and saying, Gosh, what you have to do to get up. So yeah, so then that was the next the next stage really but, I mean we’re only talking about less than a week after having a baby, the fistula tract was actually septic. And that was septic for a year and how on earth I didn’t get sepsis. During those five, you know. Well, I think I must have been pretty close, because I, you know, I just remember just being so weak and unable to function.
P: When they examined you and finally sort of validated everything that you had been describing for days. Did you understand exactly what they were saying like what the process was and what they’re going to do
G: well by sheer good fortune. One of my friends who I met in the city that I was living in had had a stoma, in the last year, but she had a different one she had had an ileostomy, which is the small intestine, and I was going to get a colostomy. So as I was like right, I do actually have a vague idea of what this kind of entails because I’m remember talking to her about a bags and all this sort of thing. I did have like a little bit of an idea but at the same time it was just too much information really
P: Yeah,
G: I mean I knew that a fourth degree tear was bad. I knew a fourth degree tear was like the worst that you could possibly get. Y
P: Yeah, yeah,
G: I mean obviously I wasn’t particularly overjoyed about getting the stoma but you know I just thought, you know it’s only for 12 weeks. Yeah, only for 12 weeks. So this is fine 12 weeks 12 weeks, and then look at all the life.
P: Yeah, and it sounds like a fix. Right, so,
G: yeah, it was just, oh, you know, that’s fine and I thought well you know my friends you had a stoma and, yeah, she’s another great time with it but I thought well, it doesn’t matter, because it’s only 12 weeks. And I was just relieved. I was just so relieved because right we have a solution to my problem, and I’m going to get fixed and I’m going to get better and I’m not going to have this infection, and people are actually going to start taking me seriously. And they did.
P: Yeah and it is so and so, this whole time. Is the baby with you or how’s it going are you breastfeeding.
G: Well I tried to breastfeed, but obviously, because he was premature and like obviously my body just was too busy.
P: Yeah,
G: I didn’t have any milk supply.
P: Yeah,
G: and really, I don’t know what it’s like in America but in the UK, they’re pretty obsessed with breastfeeding.
P: Yeah, same here
G: which I can understand why I know that it is best for the baby. Understand this, but because I wasn’t very well, I didn’t have any sort of energy to to argue with him and say that I wanted to do it in any different way so they I mean, they were trying their best to give me the best chance to be able to breastfeed, but you know I mean I was expressing, and I was breastfeeding. I was like struggling to survive.
P: Yeah,
G: and I didn’t have any milk whatsoever, so so yeah. At that point I was exclusively breastfeeding. After a week, but it was eight days, eight days after the baby we were transferred to a different hospital, so that I could have the surgery. And of course, after I had the surgery, you know, my body was just like, No, yeah, there is no milk. There is no milk, like we have nothing to give this baby. And it was after that that I said right this is it. Like, I am not breastfeeding anymore. My baby is hungry, I’m exhausted. Just put him on a bottle. And I remember the poor little so the first time I had a bottle, he just, he was just so you know, gluging it down. Finally, really full for the first time the poor little thing. And someone else cand do it
P: totally…in the in the US, there is a press now to say fed is best, yeah. Breastfeeding is best because there are all kinds of things that can make breastfeeding just too challenging. And when you go to the other hospital your baby can come with you.
G: You know, my poor husband, so I had to go in the ambulance. Yeah, but my son couldn’t go in the ambulance. and my baby was tube fed. So my husband had to take this tiny tiny little baby who’s being tube fed in the car, the very first time across the city to this hospital neither of us have ever been to. Yeah, and you know what it’s like the first time you, you have your baby in the car.
P: Yeah.
G: One of you is always looking at his breathing. We crushed the chest but yes, he didn’t know anyone that and he didn’t really know what he was doing and he was following the ambulance and so it was just so stressful to get across, city with this time and of course some was tiny as well I mean, 4.7 pound is not small, but it was a small for the car seat
P: ours too when we put her in the car seat we were like, oh she doesn’t fit at all….my baby was born early too and if it makes you feel any better. As soon as my husband dropped us off on like the lawn in front of our apartment. He crashed the car, driving it back to the garage he crashed it like it’s stressful.
G: Yeah, totally, totally. So I had my surgery, but I had to then go on the adult Ward, because the head you know the midwives can’t cope with someone who’s just had a stoma, and they said the adult colorectal Ward can’t cope with a premature baby, that’s been too fast. So he had to actually go into special care. Just so that that was somebody with them all the time, which was you know, that was an eye opener and put things into perspective for us because at the end of the day, we have a lovely healthy little boy. And yeah, I you know was in my wheelchair being wheeled across the sea and we felt guilty actually that he was in special care because he was around, babies who needed to be in special care. Yes, that was, you know, it helps to have a dose of of perspective sometimes I think,
P: yeah, but I’m glad he had that opportunity because this is probably the only circumstance in which you and your husband feel confident that he’s totally cared for by people who know what they are doing
G:Yeah, that took that pressure off…I was on a separate board for two or three days I think and filled with old people’s the youngest person there, and I remember the women on the ward, sort of saying oh you know. Well, it’s worth just got round, but I literally just had a baby, and you have to leave your baby at like eight days old and you know this is a horrific but it decided to probably last because I didn’t really care. Yeah, but you know I can’t be upset about that because I’m just now trying to deal with this stupid bug, that’s on me and leaking all over the place and, and, yeah, couldn’t bend over, I couldn’t do anything. I still obviously had all my tear, my abscess injuries. You know, it’s just the complete mess basically everywhere.
P: That sounds super challenging and I bet you were on high dose antibiotics for the abscess and
G: yeah so, essentially because of the fistula tract was septic but it wasn’t fixed for a year. I had But, basically, a year on metronidazole, which is a really strong. It’s a really strong antibiotic. I was I was basically on that about, well, I was on up pretty much every month for you. It just kept flaring up and getting worse and then it needed drained. As an emergency and hospital and.
P: Wow
G: Yeah
P: So tell me what happens when you pass the 12 week mark when you’re supposed to be going in for the reversal of the bag
G: Well, we didn’t know it was way before that we realized that it wasn’t going to happen, really, because the hospital wrote to me after I’d been home for a month, and up until that point, I kind of just thought, you know, I’ve just been unlucky. This is just what happens sometimes when you give birth.
P: Yeah,
G: but the hospital wrote to me and said, It is not normal. What happened to you, will launch an investigation, and I was like, oh, oh right, so hang on. What do you mean, like the you obviously know something’s up here.
P: Yeah,
G: and I was invited to meet the consultant who delivered the baby, and she was profusely apologetic and, I mean, they found out she wasn’t entirely truthful at that meeting, and I stand by what I said to her I said you know I’m not bitter about the whole thing, you’re a human being at the end of the day and you’ve made a mistake, and yes it has had a catastrophic consequences me but if you hadn’t got my baby out when you did, he would have died. Maybe I should have had a C section but I just I don’t know it just didn’t feel right to me to be to.
P: Yeah,
G: I don’t know angry about it. And I’ve never genuinely, genuinely, never been bitter, just think it’s a pointless emotion.
P: Yeah,
G: it wasn’t gonna get me anywhere at all. So I just, I just kind of accepted that she had made a mistake and it has happened but I didn’t realize at that point. Exactly what mistake she had made until I got the results of the investigation,
P: that seems like a generous response then is also life lengthening for you, because it’s a lot of work to carry around anger for something that happens, that was a mistake.
G: Oh, exactly and, you know, there’s certain members of my family that are extremely bitter about things that have happened in their past life and I’ve seen how that can destroy you.
P: Yeah,
G: and how pointless it is and I just think, you know, just so I’m not, I’m not going to go there, it’s it Yeah, it doesn’t, it wasn’t going to make me any better., I mean some people say, Oh, she was sacked. And I said why would you want it to be so like I would feel awful. I said that wouldn’t make me feel any better,
P: yeah, yeah.
G: But but yeah so then got the results of the investigation and the investigation found the consultant. Initially, diagnose a second degree tear. She stitched me up with this in mind, and then she thought no, hang on a minute. I actually think I’ve got a third degree tear here, so she took all the stitches down and stitched it back up again. She thought I was fixed. So, she’d actually missed the fact that I had a fourth degree tear, and the fact that I had a rectovaginal fistula
P: Gill says that the consultants confused what kind of tear she had with the obvious what kind of tear has that work. Well, I mean, it’s hard to say, Would it be obvious
Dr. M: It’s hard to say would it be obvious….tissue is usually just shredded and bloody and raw and it’s really hard to see clearly what’s happening down there, and it takes, it takes a lot of experience to always be right. And so you can see that the sphincter is torn and you know, I mean you just you just have to be really thorough and do a rectal exam and really check to make sure that things are intact because it’s not so obvious, it’s not just in your face like you have to be a detective to like look and evaluate and really see what’s going on underneath, to be sure that you’re getting the whole story fourth degree tears are not that common… three tears are not that common you know third degree tears are definitely more common, but even that is not as common, and you know you get a third degree tear and you’re like, Oh, is it really a full third degree or is it just partial oh no it can’t be full, no I can’t have done that much damage you know just like symptoms I think we talk ourselves out of how how severe something is, you know, and then once you realize like, okay, it’s a 3rd degree tear, let me fix it,
P: it’s totally interesting to hear because I think as a patient you think everything is over once the baby is out. You think the birth is over, like there’s nothing else to happen, it’s by no means over.
Dr. M: No, by no means over and and you know all repairs are not the same and and all of us do not do the same quality of repair. So I just it just makes me sad. It just makes me sad that it wasn’t fully evaluated it was missed and it Wasn’t repaired.
G: There was a little bit of debate about whether the fistula was caused by the abscess bursting really sure, well when that was caused to be honest, or it could have been through forceps or just not sure. And it was brought up that you know when she wasn’t entirely sure what she was dealing with, she should have called for the colorectal team to come down for advice, but she didn’t she just carried on. And so as a result, because she used all of this tissue twice to create two lots of stitches, it was really friable yeah and it left no viable tissue to do a repair. So she essentially left me a irrepairable, but also on top of that, my sphincter was so badly damaged externally and internally, which obviously is what a fourth degree tear is but the damage was so profound, I couldn’t be repaired anyway. The way that she she’d she’d made it in part like literally impossible, and it was all because she didn’t want she missed it. So, I mean to cut a long story short, I sued the NHS and I won in two years, which is unheard of. Normally it takes six or seven years.
P: Oh wow,
G: but it was pretty it was pretty clear cut, You know she missed it. She botched it. So she didn’t obviously reveal that to me, that would mean. Yeah, but it is what it is.
P: Yeah, certainly not what you expected when you entered this process.
G: No, and I remember things my mother I you know, could I not just had a premature baby did I have to have this on top, you know, a fourth degree tear and then the rectal vaginal fistula, and then abscess and then the stoma….now, still, and because I had a stoma I ended up losing my job, police officer so it was all just like one, it was just snowballing like a wrecking ball..going through my life just throwing things, and yeah, like you say, you know when you get pregnant, especially when I’ve got pregnant so easily and my pregnancy had been so easy. I wasn’t used to being incapacitated in any way, and vulnerable and reliant on anybody. So that was quite difficult. It’s just not who I am, who I have to be.
P: Yeah, I saw on your blog, you mentioned that in the US we call them near misses, I think, which is seems like a silly way to categorize it but there are 30,000 women in the UK who suffered a severe pregnancy complications after birth.
G: Yeah well it’s 30,000 women every year new UK experiences. Well, as a traumatic birth, there’s can be anything really, but they do say I think something like 20% of women suffer some sort of extensive tearing, and that’s a lot.
P: That’s a huge number
G: it is a lot. I mean, my particular injuries. Very very slim chance it’s like naught point 5% or something ridiculous I was extremely unlucky but. But yeah, I think it’s cool as a result of childbirth and injuries as a childbirth is so much higher than people realize. Yeah, one of my things is, obviously I’ve got my blog, I’m really open on talk about my injuries, I don’t really care. Who knows what, but also the flip side of my blog is about the fact that you can overcome all of these things and have a positive and happy life, etc, etc, but a few people have said to me oh you know I don’t want to share your blog with my pregnant friends or with people I know that want to get pregnant, because I think it’ll frighten them. I said this is the problem that we have…that people patronize women, and they think that we’re not strong enough to take information. And I said, you know, I wish I had known all the signs and symptoms, were of a fourth degree tear this down right, the day after having a baby if I’d see brown discharge on my underwear out straightaway would have said, Excuse me, I am demanding to be seen I think this might be possibly to this species. This is not right. Yeah, the end of the day, it’s up to women, whether they access this information that they’re don’t not give it to them in the first place.
P: No, I agree, I agree, more information is probably better to know, especially since you’re supposed to be your own advocate. Yeah, except to some degrees, it is on your shoulders, you know, no one cares about your health more than yourself. So
G: yeah, exactly,
P: you sort of need to do need to know these things and he would never tell like a cancer patient not to look at everything that happens when he had cancer. But yeah, absolutely. Yeah, absolutely. Yeah so I totally agree with your message. And going back to your blog, I don’t know what word to use, other than to say you’re an incredible athlete. I mean all the things you do I’m pretty risk averse and so I’m looking at the list of this skydiving in the triathlon,
G: but I’m, I’m quite risk averse,
P: your about to swim the English Channel that doesn’t sound risk averse.
G: Oh no, I mean I’m nature frightened about the thing that skydivers off awful. Oh my gosh it was.
P: So wait, so tell us about all this, so you’re, you’re not pursuing police work anymore and then and then how do you kind of turn it around.
G: I remember seeing on forums people describing their stomas, and saying, Every time I look at my stoma. It reminds me of a horrific reason why I have it, you know, most people have them as a result of bowel cancer or Crohn’s and colitis or whatever. And I remember reading that and thinking well I am not going to look at my stoma like that, because I haven’t saved. That’s going to every day of my life I’m going to be miserable. Yeah, because I’m going to have. So I thought right I’m not actively not going to think like that. So I accepted my stoma pretty early on in that way. It wasn’t until about two or three years down the line that I read an article by an athlete who has a stoma. And she said she had hers as a result of Crohn’s and Colitis, which is a really nasty disease in the, in the bowel, which people suffer, lots of pain for many years. Yeah, then they get a stoma, and it makes them a lot better. And she said you know I’m so thankful for everything that the stoma has given me..it was like a light bulb, and I suddenly thought, well, hang on, it’s all been about what the server’s taken away, took away my job, it took away my bond with my baby. it took away my lovely maternity leave. You know, it’s, it’s taken away so much. And then I thought, well no, hang on, I actually think about this, what does the stoma do why have you got the stoma. Was that right, well I’ve got it because otherwise I would be incontinent, I’d be pulling my pants. And if that was the case, I’ll be wearing adult nappies or diapers, or I wouldn’t I wouldn’t be leaving the house, so I thought, oh, actually. Look what it’s actually enabled me to do. I can leave the house and go for walks and go swimming and it was it was a revelation. So then I looked into it a bit more, and looked into what stoma products used to be like in the like the 1950s, and what we’ve got now these are amazing, but they’re so discreet and waterproof and you could just do whatever you want with a stoma so then as you start to think right. I am going to go out there and I’m going to do absolutely Every single thing that I’ve wanted to do, because I’ve had. Yeah, definitely. While I was completely incapacitated by the fistula and everything else yeah I just thought, you know, I’m not incapacitated anymore. I just need to get out there and make the most of the life that I’ve got. And that’s not right. Well, the first thing I’m going to do is I’m going to lose weight, cause obviously I was heavily overweight, so I joined as an indoor cycling class. I thought right well I could do that because there’ll be a toilet nearby. It’s not scary. So if, if I get absolutely exhausted after 45 seconds. I can just stop I’m not gonna be in the middle of the countryside. So join the cycling class, and I loved it. I was really unfit though I could only stand up like once on the pedals. But it was actually run by a local Triathlon Club. and I’d always wanted to do a triathlon, when I was younger, because I’ve always been pretty sporty, but I’ve always said you know I couldn’t do that. I couldn’t do that…far too tiring and but then I just started to think, Well, why shouldn’t you like all these other people do traveling, why shouldn’t you have a go and you actually now have the ability to do this, you know, just remember that year when you couldn’t even walk anywhere, or you can’t. And I thought right that’s it, I’m going to sign up to do a triathlon. So I signed up to do a triathlon sorted out my swimming and got back into running and cycling, I mean I wasn’t by any stretch of the imagination, spectacular, but I was able to do all these three things, and I went to this first triathlon and the organizers were fantastic, because they’ve never had anyone with a stoma do it before and I had like 10 million zillion questions about what happens if I got badly, and well I get disqualified about to go and change it and all these sorts of things and, you know, there were really kind and there was sort of saying you know this isn’t the Olympics, you’re not getting this, you know, it will be fine. So I went off and did it and I was just so I just thought right well there you go that’s one thing you thought you could never do. Do not cry describe life is like. It’s all about getting the little bricks, and that was like my first little brick. Yeah, so then I went to get my next little brick, and that was like the next stage talks on I did. And so that was after. After that, the tribe club on mass decided to enter a half Ironman, which is a 1.2 mile swim, a 56 mile bike ride, and a 13.1 mile run. I just thought I might want to get right I’m going to do it so I signed up to do it, but part of doing this. Half Ironman was I had to do open water swimming. Now I’m terrified of open water swimming about absolutely terrified. You will no doubt remember the ridiculous film jaws.
P: Yes,
G: which we all so, you know, I watched that when I was eight, and it terrified me out of the sea for 30 odd years. I had to face up to that fear really to do that section of it, and I did. I mean I went off and did my half Ironman. It sounds really easy but it wasn’t really hard,
P: nothing about this sounds easy. I assure you…
G: And that was actually when I decided to come really public about my story and what has happened to me, because I decided to raise money for the birth trauma Association, So I went in the local paper and all that sort of thing and on the BBC Radio Newcastle and I was out there for the first time with my whole story, I raised 5000 pounds for the birth trauma association which was, I was really pleased with that was like the next brick. And the next one that I wanted to get was I wanted to get back my love of the sea. My love of open water because when I, when I was eight, I was actually learning how to sail, and I was like a little, I was like a little fish, I was always in the water. And I thought, You know what I want to reclaim that and it was all about getting back control over my life. Because so much that had happened to me had been out of my control, I lose my job and my injuries and all that sort of thing. And then I just thought, no, you know what I’m not having fear like me what I can and can’t do. So anything that I’m frightened of. I’m gonna damn well beat it because I’m in charge of my life. So I joined a local group of sea swimmers, and I mean it’s a bit of a joke between us all, because for a year and a half, literally a year and a half, I couldn’t open my eyes when my face was in the water, because if I couldn’t see what’s underneath me, I’d have a panic, like a panic attack.
P: Yeah,
G: I mean I went to the same beach, with the same people all the time, and they were all really really confident, and eventually a friend said, you know, if you don’t open your eyes in the water, you can swim into a rock, it’s actually a practical benefit.
P: Yeah.
G: Okay, so I then tried like three seconds at a time, five seconds at a time opening my eyes and, and then I did it when it was the water was really clear and then I could see that there…then just all of a sudden I don’t know my brain must have just got anything tonight. Okay, it’s fine. Fine, you can do this and I can’t get that really I mean I do still have a lot of fears of open water sample I would never, but I say never, I’m gonna have to swim on my own for the open water, and swimming in the dark… It’s really liberating and exhilarating and addictive actually overcoming things makes you feel really powerful. And the more that I overcome the more powerful, I feel, and yeah I just I don’t like to be beaten, really. A big part of it is, it’s showing my son that what happened during his birth hasn’t ruined my life by any stretch of imagination, you know, it’s actually ended up empowering me.
P: how did you end up skydiving?
G: We only went skydiving, because my two friends were going skydiving, and I had a little thought in my head was, wonder what it’s like everyone says it’s amazing. And my husband said but Gill You cry on aeroplanes and you’re terrified of heights. Everyone says that. And I was like, Yep, I do want to get to like 80 and be like, Oh, I really wish I do not skydive so I mean I did it and I was completely hysterical before. I mean hysterical. And when, when I landed. it was being videoed, and the guy was attached to the guy that was filming that was some exit that wasn’t it was just awful. I’m sure I gave myself PTSD all over again. It was awful. But I did it and so then again I was just like well yeah, we go I never thought I could do that so well I just spent the whole winter in a bikini, three times a week in the North Sea so raising money again for the birth trauma association so that was something I never thought I could do stand out in the cold like that and get my stoma bag and public for everybody to see. So they were two more things I wondered if I was able to do was set that up. Good, gave me more confidence. Ultimately, I’ve signed up to like you said before from the English Channel solo, And I’d be the first ostimate to do so, but I’m saying that really blase but actually inside I’m quite hysterical
P: that this is an amazing list of accomplishments, how long is the English Channel. How wide is it.
G: It’s 21 miles, but you end up somewhere about 25 Because of the current.
P: Good lord and how long is it supposed that take
G: about 14 hours. about…
P: And you don’t eat while you’re in the water.
G: oh no, you do. So there’s, yeah there’s really strict rules on what you do, so you have to wear a regulation size swimming costume. Basically nothing that covers like your legs or arms. Swimming cap, goggles. That’s it. And then once you’ve started swimming you’re not allowed to touch the boat, and no one is allowed to touch you. So to get fed, they get a pole, and they, they use it either a cup or a bowl or something, to give food to you and then you can get it out of there, but you can’t stop to feed for too long because the current so strong that you could be swept like 500 meters, which doesn’t sound like much, but
P: who’s making rules, there’s a governing board?
G: the English Channel Swimming Association because you actually have to have a channel observer with you on the boat, making sure that all the rules are followed, it’s the pinnacle of open water swimming, and more people have climbed Everest than have swim the channel.
P: I bet, good lord
G: Yeah, so when you swim the channel you, that’s a bold start at Dover stove is where you start off and there’s a board with people’s names on who’s from the channel.
P: Wow.
G: Yeah, so you don’t get to put your name on our board unless you follow exactly the same rules as everybody else so you really could do without all of that but wouldn’t be official.
P: That is totally amazing and it makes complete sense to me that more people have climbed in the Himalayas, which I’m superficially I’m sure it doesn’t seem as hard as it actually is although I think people can well understand how hard it seems to swim 25 miles in open water. I am totally gonna donate to that effort, I’m so excited for you. I’m very excited and a little upset that they will let you wear a wetsuit
G: Oh yeah, I know, no, that’s the challenge isn’t it. And this is what attracts me to swim in the channel as well as opposed to something like the Himalayas, because in the Himalayas, you can get to boots and somebody else, you can get a sherpa who’s going to carry all your stuff, you know like, there are ways to make it easier. Yeah. When you swim the channel, it’s, it’s you that you can’t it there’s nothing that you can do that is going to make it easier for you compared to somebody else, you know, other than your training and things like that it’s all down to you. So that’s why I find it so when you cross it, that is, that is your achievement obviously you’ve got your whole team behind you, so they’re part of that but it is you in that channel.
P: So, that is totally amazing. I hope they filmed part of it.
G: I am in the documentary I am being filmed for a documentary so no pressure at all
P: good. Well, again, hopefully they’ll be good editing if it’s necessary.
G: Yeah,
P: I am super excited for you. That sounds awesome. Your story is a prime example of taking the challenges of birth and being resilient with them and sort of turning it all around so I’m so appreciative that you share this story for us today, it is amazing and I think another thing that’s kind of really relatable in your story is that so many women get dismissed when they bring up pain or other elements in the birth that they found challenging, you know almost everyone has a story where that that plays some small role, where they say, Oh, is this, and someone says no, you’re fine, which has to be changed his crazy approach to healthcare, and as in the UK, the US the near misses, which are considered severe pregnancy complications, is like, on the order of 60,000 women every year. And here for sure it’s categorized hemorrhage or hysterectomy or some kind of clot that doesn’t count all the trolls, I’m sure if you counted everything that was traumatic it would be a much larger number. Yeah, but it is something that I think we need to we need to fix for kids.
G: Yeah, I mean at the end of the day with us. We’re the ones bringing the next generation into the world, so we need to be looked after we’re important. The mother is the cornerstone of the family, family unit and if we don’t look after our mothers that we’re not looking after our family unit, and therefore we’re just not looking after society, so it should be discussed it should be talked about and we should be supportive and we should be relieved. We’re not asking for much. But yes, asking for basic rights.
P: Oh completely and my guess is it’s even trickier in the UK because maternal mortality rate is really good internationally. Yeah, yeah, yeah. And that’s when people focus on,
G: I mean since I’ve become more public the amount of women that I know that have contacted me and have said, you know, gosh I had x y and Zed and, thank you so much for speaking out and you just think that so many women are just suffering, suffering in silence and, and the winter bikini challenge that I did, I had a sign on the beach saying I have a stoma, as a result of traumatic childhoods, I’m trying to raise awareness of these issues. The amount of women that stopped me on the beach and we, we didn’t necessarily have long conversations. For a lot of them, they just said, Thank you so much, and that’s all it says. And that’s all there. Needless to say, Well, they didn’t even need to say that but now, and that was countless women that I met, and I just think you know and I just live in the Northeast of England. But I think there is, I think there’s definitely gonna be more more of us being more vocal about it more prepared to Cooper first and, you know, breaking down the stigma of being so public about it and saying, This is not a failure of our bodies here. We’re not bad mothers because we haven’t given birth properly, that’s not nothing to do with that. I think that’s messages gradually getting through to women so that feel more able to speak up. Yeah, you
P: know, the alternative name of this podcast was gonna be, it’s only fucking reproduction. Yeah, right. Yeah. Yeah. To expect to do it seamlessly it’s just Yes, doesn’t even make sense right it’s,
G: yeah, Yeah, exactly.
P: So I totally appreciate your story, I will look forward to posting all, all the snippets I can from your site on in the show notes so people can follow you. Over this Thank you. I’m assuming we can donate to the effort just from the channel right sponsor you, or something.
G: Yeah, so it’s on my website which is www dot stoma chameleon.com It’s on the very first page of it, there’s a little bit of blurb and a link there to sponsor me. It’s actually on a GoFundMe, but you’re not giving me money to do this when all the money is good the charity and I’ve had to do it that way because I’m fundraising for three separate charities, so I was there any way I could do it. So the first is the birth trauma Association. Second is colostomy, okay. And then the third one is the Jacobs well appeal, which is actually really important to me because they send out products and supplies to countries like the Philippines, where they don’t have anything like that. You know kids are using things like plastic bags and tin cans and things like that, Lord,
P: yeah that sounds amazing. That sounds like amazing work.
G: Yeah, it’s so important so you know I just want them to have the products to enable them to live the life that it just even to go out and go for a walk. Yeah, so that’s what I’m fundraising for and that’s where you can find, find the details.
P: Thank you again so much for coming on to share your story,
G: but thank you very much for inviting me on very, very honest we’ve been outstanding you very much.
P: Thanks so much to Gill for sharing her story. You can find her at stomachameleon.com, and follow her quest to cross the english channel, and raise awareness and money for women who’ve experienced birth trauma, and for other stoma patients. Thanks also to Dr. matityahu for her expertise, and for alerting people to the occurrence of fistula, which she said is uncommon in well resourced countries, because if women push for 3 hours unsuccessfully, they can get a C section, but in under resourced countries women can push for days, which she said often leads to death for the newborn and life changing physical consequences for the mother. You can find her organization, beyond fistula at beyondfistula.org
Thanks so much for listening. If you liked this show, feel free to like or subscribe, or go to Gill’s page or dr. matityahu’s to get more details about the incredible work they are doing.
we’ll be back soon with another story about how women handle the challenges they face in their efforts to grow their family