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Why #Metoo Matters In The Delivery Room

modified from flickr/Daniel

For a body that had returned to episodes of violence over and over and over again, it was the first time in my adult life that I was producing something — anything — that might be restorative, and I could feel the change.

There’s this Old Testament story about a locust plague that I used to think of often, in my early twenties. Israel’s gone polytheistic on her theistic deity, and, by the time His punishment has taken full effect, the food’s gone. Wine’s dry. Lights are out. And, everything is full of dead, insect bodies.

“Yet even now!” a little known prophet by the name of Joel would recount Jah’s word to his wayward countrymen, “return to me with all your heart…and I will restore to you the years that the swarming locust has eaten” (Joel 2:25).

The years that PTSD ate up my life like a swarm of angry, green vermin, I used to imagine myself—small, in a blue dress—in Bible school, before the rape and rage and confusion, before the depression and years of drunken, tear-filled debauchery, and wish that I could hang my whole life on that, “even now.”

“The spirit and soul are the body and brain, which are destructible,” Ta-Nehisi writes to his son in his book, Between the World and Me. “That is precisely why they are so precious.”

I had been living with PTSD for the better part of 9 years when I started craving bacon and cottage cheese hard enough for my husband to start buying it in bulk. By the time I took a pregnancy test, the doctor said I was 8 weeks along — and showed me my baby like a tiny, kidney bean tucked away in the corner of my yolk sac.

At week 12, I found out that he did, in fact, have working kidneys, and I cried at the three inch, tiny human inside me, with the beating, butterfly heart. For a body that had returned to episodes of violence over and over and over again, it was the first time in my adult life that I was producing something — anything — that might be restorative, and I could feel the change. My breasts softened. My anger subsided. And, I started obsessively googling studies that showed pregnancy could improve PTSD.

Then, at week 26, when my baby was as big as a head of kale, a technician at Mt Sinai hit me — and him — with her blue gel wand, so she could see his stomach chambers. He jumped. And I froze — silent. Like so many times before.

When she left the room, my husband said, “We can tell them it’s not OK to do that without asking.”

“I will,” I said. But I wouldn’t. And I couldn’t.

Maladaptive: that’s what my therapist calls it. In studies with rats — which boast a close neurological match to humans — scientists have found that a pregnant rat will experience an almost complete rewiring of her brain circuitry before giving birth. By the time her babies are born, she’s bolder, sharper and more efficient, capturing her cricket prey at four times the speed of non-mom rats.

Even a rat addicted to cocaine can get straight in order to take care of her young. But put her in a cage with an aggressive, sexually charged older male rat, leave him to have his way with her, and she’ll come out at a loss. Her associative learning will suffer. Her stress hormones will spike. She’ll struggle to express maternal behaviors.

While our society fights for the recognition of a woman’s right to efficacy over her body, Sharon Dekel, principal investigator at Massachusetts General Hospital, is developing a deeper understanding of what happens if we don’t give women that recognition. Her focus is on the potential negative consequences for a women in childbirth, and, afterward, on another demographic entirely: her children.

In a 2018 study of 685 postpartum women, her research team found that women who suffer from PTSD can have difficulty bonding with their babiesa symptom with the potential to undermine aspects of child development.  

A pregnant rat will experience an almost complete rewiring of her brain circuitry before giving birth—bolder, sharper and more efficient, she can capture her cricket prey at four times the speed of non-mom rats. Click To Tweet

PTSD was a mystery to us before 1975, when, 479,000 cases showed up, all at once. We’d diagnose it just five years later, in 1980, and, eventually uncover one million lifetime PTSD cases from Vietnam. Later, we’d call it a “growing epidemic.”Almost 40 years later, there are as many estimated rape and assault victims as there are veterans alive in the United States, and 94% of them show signs of PTSD.

These women are at a higher risk of developing further mental disorders as a result of birth, according to Dekel. With nearly 4 million women giving birth each year, and up to 12% of them developing postpartum (PP) PTSD, PP-PTSD may be the most substantial, silent societal cost to the American woman’s loss of efficacy that we’ve ever seen.

There’s a whole lot we can’t control. We can’t go back in time and turn the tide of America’s rape epidemic. We can’t control whether a woman is young, whether there’s real risk to her baby, or whether or not it is her first pregnancy (all factors that also drive increased risk).

But in control itself we may find a solution.

Dekel’s studies show that one deciding factor with the potential to positively or negatively override almost everything else in a woman’s situation is her perception of whether or not she feels that she maintained efficacy over the birth process.

Providers would need to consider all the factors influencing her choices to create an environment where a woman is truly in charge, according to Ruth A. Wittmann-Price, an Assistant Professor in the Department of Nursing and Health at DeSales University.

In a 2004 theory entitled, “Emancipation in decision-making in women’s health care,” she purports that a woman is almost always influenced by her own empowerment and personal knowledge in a situation, the social norms that exist around her, whether or not she has opportunity for reflection and if she is operating within a flexible environment.

To develop decision science without discussion of oppression and an emancipation process in the humanistic care of women, Wittmann-Price points out, would be to deny obvious barriers to shared decision-making. And my own emancipation began with the realization that I wasn’t ready to assert myself.

In the weeks that followed, while my nursery sat full of unpacked boxes, my husband and I focused our preparation on my mental well being. In the process, I learned that my experience of assault had taught me everything I needed to know. My requests would not be honored. My consent would be assumed. The power dynamics over me would be strong. I’d feel lesser, possibly even guilty for saying what I needed. It was up to me to change that narrative, even when my brain insisted otherwise.

There are all kinds of pre-existing factors that may influence how you react to a high-stress situation, according to Jim Hopper, PhD, a nationally recognized expert on psychological trauma. It starts with what he calls the hardwired, evolutionary stuff, that can predispose reflexive responses. Then, there’s your prior learning history, your childhood, how you dealt with aggressive and dominant people growing up, socialization and habit based prior learning.

In an environment like birth, they have the power to influence everything. The day I went into labor, they were all there — the reflex, the learning history, the socialization and the knee jerk responses. But in the small, sacred space between my disorder and identity, I found enough dissonance to use my voice. Through it, I developed my three most poignant memories of that day.

The most powerful is when I met my son — perfect, and purple, with a head full of thick, black hair. I had been pushing for three hours when his head and left shoulder finally ripped through my episiotomy, and I pulled the rest of him out of me and into my arms.

I love you. I love you. I love you. And I had never felt a love like that.

The second was labor hour eight, when I called out our epidural safe word: pineapple. My husband I had developed it based on a mutual understanding that in order to try for a non-medicated birth, I’d need to yell for an epidural without actually meaning it. Under no circumstances was he to agree to giving me one, unless I said the word.

We’d tossed around other words: pumpernickel (too long), coffee (too common), and watermelon (too much red puke in my recent past). Ultimately, pineapple it was.

Pineapple: put a needle of ropivacaine hydrochloride in my god damn spine, and do it now.

I’d said my safe word three times, and requested she turn the pitocin off twice, by the time my midwife, buried in the corner in a rousing game of Tetris, slowly said, “I think we’re here to have a baby, and we don’t want to slow things down.” But I knew my brain, and my body. The pain of pitocin-induced contractions was driving me toward a place I couldn’t go again. A place where the world would go dark, and I’d be on my back, in pain, submitting to someone else again.

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By the time she reluctantly, slowly, moved across the room, and did what I asked, I’d involved advocates. My husband and doula, who had spent hours of deep conversation understanding my trauma cues, concerns and triggers, knew when to ensure I got results.

“Get her an epidural, now,” I heard him say.

“Turn the pitocin off — she’s asked you multiple times,” my Doula added.

“She can contract on her own. Let her do it.”

When I heard the beep of the machine turning off behind me, the pain I was feeling, six hours into hard contractions, didn’t improve in the least. Mentally, however, I was back in charge. And somewhere, deep inside me, I felt like the most powerful woman alive.

“But to let the baby out,” writes Maggie Nelson in The Argonauts, “you have to be willing to go to pieces.” And pushing my son out put me past the brink of what I thought was physically possible.

I was told I’d get a second wind — some kind of strength I didn’t expect, especially when I saw the top of his head. But I didn’t feel anything except panic. I was going to pass out. I needed to puke. I couldn’t find the strength to push.

I have had the power siphoned from my body like a balloon blown up and let go. I have spent years picking my way with the gullied parts of me, where it no longer exists.

But I have never been more palpably aware of the power in, and over, my body than on floor 3M at Brooklyn hospital, on my back, minutes before midnight, when my midwife told me to stop breathing.

She said it like I had no other option: breathe, or birth a baby.

You’re not working hard enough (while pulling on the inside of my labia).

It’s been too long (while checking her watch).

You just don’t seem to want this (looking at me).

Poor kid, he’s got such a headache (looking at him).

I argued—on my back—insisting I needed air. Needed more time. Needed help.

Inside, feeling like I’d failed—like I didn’t love him enough to get him out. Like all the other women in the world knew how to give birth, but not me.

Human memory is a sensory experience, writes Bessel van der Kolk, a Boston-based psychiatrist noted for his research in the area of post-traumatic stress. And when a nurse grabbed my foot, I wasn’t in the delivery room anymore.

I was 21. And, someone else had their hand on my foot. Someone else was tucking it under their arm. And, someone else was telling me to be quiet, while they had their way with me, in ways I’d been trying to forget ever since.

Sexual assault is horrific in its own right. But it should be understood in the broader context of what causes long-term trauma in the body, which typically has two things in common: loss of empowerment and loss of human connection—i.e. being treated as an object—according to Hopper.

Inside I felt like I’d failed—like I didn’t love him enough to get him out. Like all the other women in the world knew how to give birth, but not me. Click To Tweet

I felt both, in that moment. But I did what I wished I would have done, the first time. I yelled.

Get away from my foot, get my husband now, kind of yelling.

Don’t fucking touch me. I’ll push when I’m ready.

My bed a bailey, my partner and doula standing citadels, we enforced my requests.

I breathed.

I slept.

When I woke up, I ran my own fingers around my baby’s temporal bone, and noticed there something in my perineum that wouldn’t move — something that had it taunt and hard, like a rock, and not budging.

“Just cut me,” I said.

“You have room.”

“No I don’t. Do it.”

I had no way of seeing that my son’s hand was against his face, blocking his head from coming further than I’d pushed it, but that’s exactly how I would deliver him, an hour later, suckling his knuckles, heartbeat steady, on his path through my birth canal.

“I didn’t realize!” my midwife would call out. But somewhere, in the place that exists only between a woman and her body, I’d know that I did. And that I’d done what I wanted, midwives and naturalists, birth advocates and medical advisors be damned.

While there’s no concrete proof that my assertion of self in my birth kept me—a woman with almost all the risk factors of PP-PTSD—safe, Dekel points out that her studies show that a woman’s positive appraisal of her birth experience may have more to do with her mental health than the experience itself.

She’s encouraged by the fact that woman today are being screened for depression during pregnancy and postpartum, but notes we need to do more.

“Currently I don’t know of any program that focuses on empowering mothers or women prior to giving birth or postpartum,” she says. “There’s nothing routinely implemented to screen women at risk for developing PP-PTSD.”

Her hope is to that alongside others, her team can develop a more holistic approach to obstetrical care that integrates a better kind of team collaboration between psychiatry, psychology and OB department.

I still sometimes wake up in the middle of the night, mid-flashback of myself like a rat locked in a cage, while someone else has their way with me. I struggle with confusion. I wonder about efficiency. Like many women who have been sexually assaulted, I struggled at first with feeling like breastfeeding was a hostile take-over of my body.

A single sound or stirring from my son can cut through all that. Suddenly, my confusion is gone. And, in its place, a connection that feels as natural as breathing.   

I have another flashback that comes to me, increasingly often, in that place. In it, I see my husband’s teary face, looking at me, looking at my son.

“Look what you did!” he says.

“I’m just going to stitch you up,” the midwife adds, from somewhere beneath me.

I don’t have to close my eyes to feel the warmth of my son breathing on me, after that. Or, to feel the warp and weft of the needle, putting back together parts of me I used to believe were broken for good.