Why does it cost $32,093 just to give birth in America?

The US is the most expensive nation in the world in which to have a baby and it may factor into thousands of bankruptcies each year

Why does it cost $32,093 just to give birth in America?

The US is the most expensive nation in the world in which to have a baby and it may factor into thousands of bankruptcies each year

Read more: https://www.theguardian.com/us-news/2018/jan/16/why-does-it-cost-32093-just-to-give-birth-in-america

Reality shrivels. This is your life now: 88 days trapped in bed to save a pregnancy

The long read: Months before she was due to give birth, disaster struck for Katherine Heiny. Doctors ordered her to lie on her side in bed and not move and gave her a 1% chance of carrying her baby to term

When I was five years old, my parents decided they could no longer watch the nightly news. Or rather, they could no longer watch it if I was in earshot. The coverage of the attack at the Munich Olympics had caused me to have such an intense fear of being killed by gorillas that I couldnt sleep. No matter how many times my parents explained the difference between terrorist guerrillas and primate gorillas and that there were no gorillas in Michigan anyway I remained sleepless with worry late into the night for weeks. My parents eventually gave up and subscribed to the afternoon paper as well as the morning one.

The problem is not just that I am a champion worrier. Its that I court worry I seek it out, I invite it into my home, never remembering how hard it is too dislodge it from its comfortable chair by the fire. I watch true-crime documentaries when Im alone. I Google photos of black widow spider bites. I know the statistics about paracetamol overdoses. I have memorised the beaches with dangerous riptides. I have installed a carbon monoxide detector in every house I have ever lived in. And when I got pregnant with my first child, I bought What to Expect When Youre Expecting and the chapter titled What Can Go Wrong was the one I read first.

Retained placenta; umbilical cord prolapse; foetal arrhythmia; toxoplasmosis; preeclampsia; placental abruption; gestational diabetes; cytomegalovirus: I read about all of them, and learned the warning signs. Perhaps to other women, these complications remain obscure, shadowy threats during pregnancy, but to me they were hard, clear, immediate dangers. When my obstetrician told me that mine was a perfectly normal pregnancy, the very first thing I said was: Are you sure?

And yet I was surprised when disaster struck. The things you worry about arent supposed to happen thats what worry does. Its a preventative. And my disaster happened quickly, without fanfare or drama. One second, I was a nice, normal, happy pregnant married woman of 32, walking across my bedroom to my desk while my husband made lunch downstairs. And then the warm fluid gushed out of me, soaking my clothing and leaving a little wet spot on the pale green carpet.

I yanked down my jeans and pants, expecting blood, but there was only wetness. I knew it was very likely that my waters had broken, but I was barely 26 weeks pregnant. It didnt seem possible. I stepped out of my clothes and went to the top of the stairs to call my husband. He stood on the landing with his hands all sticky from making hamburgers, and I told him what had happened. We discussed it for a surprisingly long time. Was it really so bad? How much fluid? Maybe a cup? Was there blood? Was the baby still kicking? Should I call my doctor? Yes, we decided.

I wrapped a towel around my waist and called my obstetrician. He was a man in his late 50s with a perpetual hangdog expression, and for this reason, my husband and I called him Doggie B. I loved Doggie B. Nothing ever surprised him, nothing ever alarmed him. I could not picture him giving me bad news, and because I could not imagine it, I felt it wouldnt happen.

I want you to meet me at the hospital, Doggie B said. Go to the maternity ward. And I want you at Georgetown Hospital where they have the neonatal unit.

I put on fresh pants and jeans and my husband and I drove to the hospital. It was 29 January 2000, and an ice storm was just beginning. Something happened to me on the way to the hospital: my mind split in two. One half was convinced that that this trip was unnecessary, that, of course, my water hadnt broken, that I was just fine. The other half was just as sure my waters had broken and that I would almost certainly go into labour and give birth to a baby too young to live. The two halves of my mind rotated inside my head like the lights of a lighthouse, the worried part flashing and then disappearing, replaced by the calm one.


At the hospital, a doctor who looked just like Andie MacDowell performed a pelvic exam and took vaginal swabs. A nitrate test was done on one of the swabs for the presence of amniotic fluid. (Its presence would have meant membranes containing the baby had ruptured three months prematurely and would most likely cause me to go, disastrously, into labour.) The other swab was for sent off to the lab to check for the presence of arborisation, otherwise known as ferning, because amniotic fluid produces a delicate, leafy pattern under the microscope. Both tests were negative, although they were running a repeat just in case. I began to feel a little ridiculous.

The Andie MacDowell doctor told us that there was no evidence that I was leaking amniotic fluid, but that they were going to admit me, she said, on the strength of my story.

The strength of my story! I was appalled. Im a writer of course I told a strong story. Maybe I didnt need to be here, I told my husband, as nurses wheeled my gurney into a private room. Maybe I should just tell an equally strong story about how nothing was wrong and go home.

The doctor came back. I just saw the ferns, she said. You have definitely ruptured. Well try to delay labour as long as possible.

Three months? I asked.

Yes, thats the hope, she said.

I wouldnt have been so scared if it werent for the look on her face.

Dom
Illustration: Dom Mckenzie

Nurses came into my room and began to bustle around me while the doctor explained that my condition was called preterm premature rupture of membranes, or pPROM. The two most dangerous (and most common) complications of pPROM are extreme pre-term birth and chorioamnionitis, a bacterial infection of the foetal membranes. Both are devastating for the foetus. I reached for my husbands hand.

The nurses put me in Trendelenburg, meaning my hospital bed was tilted so that my head was 20 degrees lower than my feet. (I thought it was some long German word that meant head below feet on the side of a mountain.) A nurse wrapped a foetal monitor to my belly with a thick strap, explaining that it could be read from the nurses station, and they would know immediately if I began having contractions. Another nurse slid a pair of puffy compression leggings on to my legs. They inflated and deflated every other minute with a whooshing sound. It was like having Darth Vader breathing at my bedside. I was told to lie on my side in order not to put pressure on my vena cava, which would lower the babys oxygen supply. Yet another nurse poked a needle into my arm to start a line for intravenous antibiotics.

The doctor gave me a shot of steroids to help develop the babys lungs, in case the baby would shortly be needing those lungs to breathe. Arent steroids counter-indicated in pregnancy? I asked.

Yes, but its more dangerous to go without, she said.

Doggie B called the hospital to stay that he couldnt make it in because of the ice storm. In his absence, the doctor ordered the nurses to give me a shot of terbutaline, a medication that can delay preterm labour for up to 48 hours.

Please, I begged. I dont want any more shots. Im not in labour. This could be so bad for the baby.

From the moment I learned I was pregnant, I had divided the world into things that were OK for the baby, and things that were bad for the baby. The first group included rice, poached chicken and yoga, The second group included alcohol, secondhand smoke, deli meat, smoked seafood, raw eggs, soft cheese, pt, caffeine, unwashed vegetables, diet soda, eggnog, x-rays, aspirin, ibuprofen, antihistamines, nasal decongestants, cough syrup, librium, valium, sleeping pills, castor oil, vitamin A supplements, paint fumes, insect repellent, acupuncture, cats, hair dye, altitude, saunas, reptiles, tick bites, microwaves, electric blankets, rollercoasters, bikini waxes, stiletto heels, hot dogs and tap water. I trusted no one but myself and Doggie B to categorise items, and certainly not a doctor I had met 10 minutes before.

They gave me the terbutaline anyway. It made me dizzy and cold, though it makes most people hot. They piled more blankets on top of me. My hands shook uncontrollably.

The neonatologist came to talk to us. He had thick glasses and he talked in percentages. It was clear that he was not interested in offering comfort; he was there to convey information. He told us that for babies born at 26 weeks, the survival rate is 50%. Of the surviving half, one-third had major disabilities, and are likely to be dependent on caregivers for ever. It was common for them to have breathing problems, cardiac disorders, brain bleeds, cerebral palsy. Brain damage, deafness, blindness. Another third had more moderate disabilities: spastic muscles, significant hearing loss, impaired vision without blindness. The final third (the best we could hope for, apparently) had milder learning disabilities, anemia and digestive complications.

I watched him dispassionately, not really listening. He was so stereotypically nerdy that I couldnt get over it. Why was he telling us all this scary shit anyway? I wasnt going to go into labour. The baby wasnt going to be born yet. Why couldnt anyone understand that?


The first night was longer than I would have believed possible. Visiting hours ended and the nurses chased my husband out. He drove home on streets that crackled and shifted with ice. I was not allowed to stand, or even sit. I was served a dinner that I was too nervous to eat. And I learned about bedpans. Peeing into something the size and shape of a casserole dish while lying in bed with your head angled toward the floor is messy and awkward.

But that is not the worst thing about bedpans. The worst thing is the other people involved. Having to ask someone to bring you a bedpan, having to make conversation with that person while you use it, having to apologise because your aim is a little off and now theres a wet spot on the sheets, having to ask that person to wipe you, having to ask her to wipe you again because you still feel damp and sticky, having to thank the person, and you do really thank her, you are so grateful, its just that two hours ago you were an upright person with a little dignity, and now youre not.

The hospital lowered the lights in the hall, just like on a transatlantic flight. Nurses went by on squeaky shoes. I lay on my side and gripped the metal railing of my bed. The lighthouse in my mind revolved, and for one instant the room was flooded with cold, bright, white fear for the baby. Then it was gone. Certainty that the baby would not be born early stole over me, and I gathered that certainty close. I lay awake and watched the sleet falling outside my window. It occurred to me that I could not see the ground.

Doggie B came to see me the next day.

Can you believe this? I said to him. Me, your most paranoid patient!

He didnt bother to deny that I was his most paranoid patient. When he spoke, his voice was mild and unconcerned. He said that I would remain on bed rest, and unless infection forced us to act sooner, he would deliver the baby at 33 weeks, when the greatest risk was over.

I didnt want to have the baby at 33 weeks. I wanted to have the baby at 40 weeks, like everyone else. I knew the risks. But I had also been told the risks of preterm infection: a baby born with brain damage, cardiac defects, limb abnormalities, microcephaly, hydrocephalus, paralysis, bone lesions, eye lesions or possibly no live baby at all. I refused to weigh the risks; I would simply not go into labour, nor would I develop an infection. That was all there was to it.

I frowned at Doggie B. Why 33 weeks? Why not go to May 10? That was my due date.

He shrugged. OK, May 10.

He was a much better liar than the Andie MacDowell doctor.

After Doggie B left, the nerdy neonatology doctor came to my room again. He wanted me to go down to the neonatal intensive care unit (NICU). You need to see what a preemie looks like, he said, pushing his glasses up his nose. You need to prepare yourself.

The Andie MacDowell doctor was there, too. A three-pound baby takes some getting used to, she said. You dont want to see one for the first time in the delivery room.

To both of them, I turned a deaf ear and a sullen face. I was not going into labour. I was not going to go to the NICU and no one could make me. Conversation was cut short when another nurse came in and told me that my monitor had showed slight disturbances, and gave me another shot of terbutaline.

I cant believe terbutaline makes you cold, this nurse said as she took blankets from the blanket-warmer and I shivered beneath them. Out in the hall I heard her say to someone: That one is so contrary.

I could see remotely that all these doctors and nurses knew something I didnt. I found out much later that what they knew were the odds. Fifty per cent of women with pPROM go into labour within 48 hours, and 95% deliver within one week of rupture. Four of the remaining 5% deliver within two weeks. One percent of women with pPROM experience spontaneous resealment of the membranes and go on to carry the baby to term.

One per cent.


Do you knit or crochet? one of the nurses asked me early on. Lots of bed rest patients find that helps them pass the time. No, I read and I write, I answered, pretentiously. And untruthfully, because I have always watched a great deal of TV.

I couldnt write because I couldnt sit up. I also couldnt write because if I focused too much on my situation, the lighthouse in my mind would revolve and the worried, scared part of me would rush out, gibbering with alarm, baying, screaming, howling that the baby was going to be born too soon, the baby was coming now, the baby was going to die. How could I write with that going on?

I had a headache from being in Trendelenburg. I couldnt remember what it was like to look someone in the eye, so long had I now spent gazing up at everyone from thigh-level. When I ate, it was one wobbly, precarious forkful at time. After a while, I just gave up and if I couldnt eat it with my fingers, I didnt eat at all. I drank through a straw, until everything tasted the same: like the plastic of the straws.

I couldnt write, so instead I read. Constantly. Ceaselessly. I had to hold the book open in front of me sideways, like someone gripping a large steering wheel. My husband brought me books and I stacked them on my overbed table, and as I read each book, I held the next book in my free hand, with my finger marking the start of the first chapter so that as soon I finished one book, I could immediately start another. I must have read dozens of books while I was in hospital, and I can only remember one of them.

Only one book held my interest. I told my husband exactly where to find it on the bookshelf near my desk and he brought it to me: Steven Callahans Adrift, a memoir of the 76 days in 1982 during which Callahan had survived in an inflatable life raft after his sailboat sank. I had fallen in love with the book when it was first published, in 1986. It seems like a strange choice of reading for a teenage girl, especially one as studious and non-athletic and seasickness-prone as I was. But I have always been drawn to survival stories: they dovetail nicely with my chronic fear of disasters.

Callahan spent more than two months in a rubber raft in the middle of the Atlantic, spearing fish to eat raw, using solar stills to distil water, and making endless, desperate makeshift repairs to his patched and leaking vessel. I had read Adrift many times over the years, but now I read it again, and was inspired by his suffering and ingenuity in a new way. I was in a hospital bed where nurses brought me meals three times a day, and I slept in a bed on clean sheets and was in no danger of drowning. I could do this. I could.


You dont sleep in hospital. You cant sleep. Too many people coming and going. A nurse comes every four hours to check your vitals: temperature, pulse rate, blood pressure, babys heartbeat. Another nurse comes in every two hours to make sure you are doing your kick-counts. Meals come three times a day, plus a night-time snack for pregnant women, which means four times someone comes into your room to deliver a meal, and four more times someone comes back to collect the tray. A nurse comes every time you need to use the bedpan. An orderly comes every morning to take you for an ultrasound. Your obstetrician comes by every day to check on you, and you dont want to miss his visit, because he is the only one who tells you what you want to hear no, theres no sign of infection; yes, Im sure youll carry to term. The hospital chaplain stops by once a day. She was a mousy woman with a perpetually scared expression. Its not a good look on a hospital chaplain.

So thats more than 30 people coming to your room and interrupting your sleep. And then theres the physical part of it. If you are confined to bed, after you lie on your side for a few days, it begins to feel as if your hip sockets are lined with metal shavings, as if the sheets are covered with shattered glass. Before long, red, rough, scaly patches the size of saucers appear on your hips and your shoulders the beginnings of bedsores. The compression leggings chafe your thighs.

You forget how to sleep. The line between waking and sleeping used to be as clear and sharp as the line down the middle of a road, but after two weeks, that line has blurred and is almost invisible. You stagger back and forth across it like a shambling drunk, until there is no more sleeping and waking; there is just this dim, dull, soupy consciousness. Your reality shrivels down into one long, hazy, beige-tiled tunnel. You used to worry, but it has gone beyond that now. Worry used to be inside you, but now you are inside it. Worry is a dome that has descended over you and trapped you. This is your life now. This is your world.

Every day about 10am, an orderly arrived with a gurney and I carefully scooted on to it and then the orderly pushed the gurney through the hospital halls to the prenatal department.

Two weeks had gone by, and I hadnt gone into labour. This seemed to surprise everyone but me and Doggie B, who began, cautiously, to speak of resealment. The nerdy doctor came by and gave me a whole bunch of new statistics about what the babys chances were at 28 weeks, at 30 weeks. He didnt go beyond 30 weeks, though. They removed my IV. Everyone talked about something called BP as though they were speaking of the Rapture. (Bathroom Privileges.) The atmosphere in my room became positively springlike, despite the snow outside.

Doggie B said the first step would be for me to get up and take a shower. A shower! Nothing could have been more tempting. He gave me a date. Now it was something to look forward to. I had my husband bring in a bottle of my favourite shampoo and a bar of coconut soap. The day finally came. A nurse removed my circulation leggings. I sat up slowly and swung my feet to the floor. The nurse took my arm and helped me to stand. I stood there, swaying. Amniotic fluid poured out of me and splashed to the floor. The nurse let go of my arm in surprise. I lay back down and turned my face to the wall.

It took me a while to regain my strange equilibrium, especially considering that the doctors now suspected I had been leaking continuously since the first rupture. Rupture of the membranes is considered prolonged (and therefore dangerous) when more than 24 hours passes between the rupture and the onset of labour. My waters had broken more than 300 hours ago. The risk of sepsis was very high.

Katherine
Katherine Heiny. Photograph: Leila Barbaro

But still, two days maybe three and the stubbornly optimistic side of my personality fought its way to the forefront and re-planted its battle flag. The Andie McDowell doctor wrote in my chart: Patient needs to understand that resealment is highly unlikely at this time and that preterm birth is almost a certainty. Yeah, well, thats what she thought. This baby was not coming early. I simply wouldnt allow it.

Another week in bed went by. Every once in a while, they had me stand up, and every time I leaked amniotic fluid. But still I didnt go into labour. Nor did I have a fever or abdominal pain, the two greatest indicators of infection. Life as I now knew it went on.

After I had been on bed rest in the hospital for 25 days, there came a time when I stood up and no fluid gushed out of me to splatter on the floor. The nurse and I looked at each other in amazement. Go take a shower, quick! she said. Ill change the sheets on your bed.

It was not the slow, luxurious shower I had dreamed of, but I can tell you this: it was pretty fucking nice. They didnt allow me out of bed again that day, but I was finally taken out of Trendelenburg. I stood up the next day and again there was no leak. I took another shower.

When Doggie B came to see me next, I was sitting in a chair to greet him, radiant, both my pride and my belly enormous.

I had done it. I had resealed. I was in the 1%.


Doggie B wanted to send me home. I fought him. I had been in the hospital for almost a month at this point, and I was pretty much institutionalised. Go home? Without the foetal monitor? With no nurses to listen for the babys heartbeat every four hours? No daily ultrasound? Uh-uh. He was crazy if he thought I could handle that much responsibility. I told him that I needed to be in the hospital near the NICU. I pointed to my chart where it said Severe Risk Pregnancy in big scary letters. Doggie B stood firm. He discharged me and my husband drove me home.

Steven Callahan writes of seeing the first food after his rescue a cake of chipped coconut topped with a dot of red sugar and how he looked at it in wonder and thought: Red! That was exactly how I felt when I saw my house again. Green! Blue! Lilac! My hospital room had been unrelentingly beige.

I was still on almost total bed rest, allowed up for 15 minutes twice a day. A shower in the morning and dinner at night. Out of the hospital, the lighthouse in my mind revolved faster and faster, unchecked by the nurses reassurance. I counted constantly how often the baby kicked, and took my temperature five times a day. The amniotic sac had resealed, but the rupture had been extremely prolonged, greatly increasing the chances of an infection reaching the baby. Even feeling the babys movements could not quell my worry. Doggie Bs receptionist learned to put me straight through to him when I called.

Time ground slowly by. My husband brought me breakfast in the morning before he left for work. Our housekeeper brought me lunch. My husband brought me dinner and we ate at the card table he had set up in the corner of our bedroom. Then I crawled back into bed and worried until I fell asleep, woke up, and started another day. That was my routine, and I never varied from it. I dont mean I never varied from it significantly; I mean I never varied from it at all.

Thirty-one weeks. Thirty-two weeks. Thirty-three. Still I didnt go into labour. I lay in bed and stroked my abdomen with my fingertips. Thirty-four weeks. Thirty-five. March ended and April began. A blizzard of cherry blossoms replaced the snow outside my bedroom window. Thirty-six weeks. Thirty-seven weeks. I no longer watched TV or pretended to read books. I knew nothing but my belly and the endless waiting. Time had softened and stretched like taffy, pulling itself into long, gooey ribbons. Thirty-eight weeks. Thirty-nine. I was certain that the baby would be born on 21 April, the same day Steven Callahan was rescued. But 21 April came and went. And then one day I got up to take my morning shower and felt the slightest trickle of fluid run down my leg. My waters had broken for the last time.


Our son was born 12 hours later at Sibley Hospital in Washington DC. We named him Angus. And so my life changed again in another minute, another second. The two halves of my mind fused back together. I went from severe-risk pregnancy to healthy new mother. I was totally unprepared. For so long the goal had been to stay pregnant I had almost forgotten that a baby was the end result. I knew nothing about newborns, nothing about breastfeeding or burping or vaccinations. The nurses had to show me everything. One them said, in a careful voice: Ive heard about you, I think. I could tell that whatever she had heard was, at best, a mixed review. Didnt you rupture very early and do a lot of bed rest over at Georgetown?

I felt a stubborn thump of pride. Thirty days at Georgetown. Eighty-eight days altogether.

Wow, she said. I bet you never want to see a hospital again.

I didnt know how to tell her that almost the opposite was true. It wasnt just that I knew about hospitals now, and knew I could survive a long stay in one. I was a different person from the one who had been admitted all those weeks and months ago: a tried person, a changed person. Very few experiences transform your view of the world and yourself, but bed rest did that for me. I had beaten nearly unthinkable odds. All the things I have always meant to fix about myself but had never got around to my stubbornness, my hypochondria, my inflexible nature had turned out not to need fixing. Had, in fact, turned out to be survival skills.

Twenty-four hours went by, and I cried because I never wanted Angus to get any older. The impossible had happened: time had speeded up.

Six months later, I arranged to speak to Steven Callahan by phone. I told him how much his book had meant to me, how much he had inspired me. We discovered that we had both been obsessed with numbers, with calculating and re-calculating the days of our progress. I told him that my ordeal had altered me in some fundamental way, that sometimes I even missed the mind-bending, terrifying force of it. He agreed.

Sometimes I feel a loss, he said, in terms of the fact that few if any experiences I will ever have again can equal the intensity and importance of that one. You try to mine the precious elements of the experience, but they slip away from you, and thats another loss. You try to appreciate this enormous gift youve been given, but eventually you just get on with it.

The precious elements of my experience were fading, too. I took my bathroom privileges for granted now. I slept on my back again. I went for walks. I worried about traffic jams and deadlines and love handles, just like a normal person. I got on with it.

Angus is 17 now, taller than me, taller than my husband. He has the beginnings of a moustache and a voice as deep as James Earl Joness. He knows how to do laundry, and make spaghetti. He can take the Metro by himself, and he learned to drive this summer. Its possible he watches porn on the internet. (Its extremely possible.) I have new fears and worries, about teenagers. The bright, icy terror of the hospital is behind me, but it has taken a long time.

One day, when Angus was about three years old, I cleaned out a closet and unexpectedly found the plastic water pitcher that had been by my hospital bed. In an instant, the lighthouse in my head revolved, and everything went white and cold. I was certain that the baby was in danger so certain that I had to run to the bathroom and vomit. I dont know why this surprised me, or why I thought I would be different, immune to the after-effects of my ordeal. All survivors have scars.

Main illustration by Dom McKenzie

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Read more: https://www.theguardian.com/lifeandstyle/2017/oct/24/88-days-trapped-in-bed-to-save-a-pregnancy-bed-rest

Postnatal depression I felt disembodied for so long but suddenly I was back in my own body

Jessica Friedmann talks to Viv Groskop about the terrifying years she experienced after the birth of her son

Jessica Friedmann thought she was managing well after the birth of her son. Then suddenly her thoughts took a dark turn. I had to come back into hospital two weeks later for a checkup and I realised that all I wanted to do was get out of the moving car. I was feeling as though I couldnt handle being alive any more and that it would be better for Owen if I wasnt.

Friedmann, 30, has written an extraordinary account of extreme postnatal depression as seen from the eye of the storm. She lives in Canberra, Australia, with her husband, Mike, 34, who is in the Australian air force. Their son, Owen, is four. The period of feeling foggy, as she calls it, dates it back to Owens early weeks. Friedmanns experience is at the sharp end of things. While the NHS suggests that the baby blues usually dont last more than two weeks after giving birth, Friedmann was ill for, she estimates, two and a half to three years.

She says cautiously that now she is fine. She had anticipated that she might feel fragile during her pregnancy. But when I was pregnant, I felt strong and vibrant, she says. I had experienced depression in the past and I was worried that I would feel resentful about sharing my body with another human being. You know, the idea of feeling colonised, of having another person growing inside me But it felt intuitively right and I felt safe.

Similarly she imagined she felt confident during and after the birth, despite some complications. I had to have a caesarean because he was breech I had a haemorrhage. But afterwards I thought I was OK. It turned out my uterus was inflamed and so I was on a course of antibiotics.

As her physical symptoms improved, her mental health deteriorated. A couple of weeks after he was born, I went from feeling euphoric to feeling good to feeling not good to feeling desperate quite quickly. Antidepressants helped, but did not fix everything. That got me up to half-speed. I thought that was as good as it was going to get. I felt so slow and tired.

Jessica was part of pilot programme in Australia where mothers can be monitored by a psychiatrist after birth. This helped to sort out her medication. Because she had had depression before, she was also seeing a therapist. But despite all this, she still felt at a loss as a new mother: You can read as much as you want, but you dont know what having a child is going to feel like. I didnt know it was ordinary to be in that much pain or to be so tired that I just couldnt function.

But while these things are normal and usually fairly transient for new parents, she realised that her symptoms were more serious. For me the key tell for depression is that I stop sleeping. Its a kind of interrupted sleep. In the early days, instead of getting sleep between Owens feeds, I would stay up all night and be awake. At the time I thought it made sense. That kind of sleeplessness is common if youre experiencing depression. Its a sleeplessness that is like agitation.

It got worse as she found herself heading into the world of what therapists call postpartum mood disorder. I started having intrusive thoughts. Although at the time I didnt have the language to express that. Its compulsive thinking about violence towards yourself or towards your child. You are thinking things that you dont want to think. But the majority of new parents dont have those thoughts. Or at least Ihope they dont.

Jessica
Jessica Friedmann. Photograph: Heather Lighton/Scribe

Her mother took over the care of her son for a while. At one time Friedmann had the urge to walk out of the window. Recovery was slow: Depression is very isolating, so I felt so grateful that I had so many people around me who Icould ask for help.

Friedmann realised she was getting better when she felt more in control of her mind. It was almost like a light came on. I had felt disembodied for so long and suddenly it was like I was back in my own body. I felt as though I were present in all my senses in a way that I hadnt felt for years. It was like falling in love or wearing glasses for the first time.

She now has a close, easy relationship with her son, but still worries about the impact on him. I think hes a very resilient child. From the beginning when I was in such a bad way, I just followed him and his needs. Ididnt try to put him in a routine. We had a period of separation at one point. But theres a lot of love and trust between us.

She says cautiously that anyone who is depressed should also get help for whoever is looking after them: Mike didnt talk for years about whathe was going through. Because hewas so worried about me. But if youare the caretaker for someone witha psychiatric illness, looking after yourself is not selfish.

Her advice to her earlier self would be to be more realistic about the caesarean. I wish I had known more about the effect it has on your body. The whole too posh to push thing makes it seem like its supposed to be awalk in the park compared with avaginal birth. I didnt really realise that its a major abdominal surgery thattakes six weeks to recover from. Ithurt a lot. It was scary.

Most of all, though, she says she wishes she had been kinder to herself. Although when you are in the grip of a psychological crisis, the idea of having a self is nebulous. And the idea of kindness to that self even more so. I look back at those months now and its all just a fog. I wish I had known how to simultaneously be experiencing a psychological crisis and be an advocate for myself. But that is almost impossible. I think mental illness is such a bear trap because in any other crisis you can articulate what is going on. But I couldnt. She sighs, realising the impossibility of what she is wishing for. Then she jokes: Maybe a series of flashcards would have helped?

She hopes her book about this experience will help others feel able to say Im sick when things become too difficult to manage. Her story, she says, is partly one about severe postnatal depression but its also about the complicated business of starting out in family life while feeling overwhelmed something which happens to everyone who has a baby.

Theres nothing straightforward about parenting, she says. Its grief, sorrow, exultation.

Things That Helped by Jessica Friedmann (Scribe, 12.99). To order a copy for 11.04,go tobookshop.theguardian.comorcall the Guardian Bookshop on0330 333 6846. Free UK p&p over 10, online orders only. Phone orders min. p&p of 1.99.

Read more: https://www.theguardian.com/lifeandstyle/2017/may/13/postnatal-depression-i-felt-disembodied-for-so-long-but-suddenly-i-was-back-in-my-own-body

I cant forget the horror of my sons birth | Leah McLaren

Despite medical advancements, childbirth is a major cause of post-traumatic stress disorder and yet nobody talks about it. Leah McLaren tells the harrowing story of the arrival of her second child and her fight for treatment and support

The seconds that stretch between the act of giving birth and waiting to hear a baby cry are the most harrowing moments in an otherwise privileged life. My second son, Frank, didnt cry.

Late last summer in a London hospital, he was born semi-conscious. His pulse was faint and he was floppy as a rag doll, a pale bluish grey in colour. There were angry red indents on his nose and skull that would later turn into deep purple bruises. According to his hospital notes his Apgar score at birth (on which 10 is hale and zero is non-responsive) was two. Just before emerging, Frank turned to the left and got stuck in the birth canal no amount of pushing could make him budge. He was wrenched out of me, first ineffectively with a vacuum and then later, definitively, with a pair of giant metal salad tongs called forceps. The midwife briefly placed his limp little body on my chest and then scooped him up again and over to the opposite side of the room where the doctors began their work.

At first, still dazed from the birth, I didnt fully understand what was going on. I remember thinking how strange it was that for hours on end all the focus had been on my body, and the monumental effort to make it do what it was supposed to, and now everything had shifted. It was like Id been split in two and what was left of me the remaining husk seemed almost incidental to the scene.

I heard an alarm wailing in the corridor outside our room and I thought, vaguely, that there must be an emergency on this floor. Residents and interns in scrubs began streaming through the door, craning to see the patient our motionless, minutes-old son. Before long there was a standing- room only crowd around the baby. My husband squeezed my hand as I processed the silent revelation that the emergency was us.

Leah
The sound of his cry induced black thoughts, a darkening of my already dull mood: Leah with Frank just after his birth. Photograph: Rob Yates

We watched the doctors placing a toy-sized oxygen mask on our sons face and heard them fall silent as their movements became quicker. We scanned their faces for panic or relief and saw nothing, only blankness. We waited for the babys cry, but it never came.

Hours later, to our immense relief, we were told Frank was fine. The resident paediatrician made it clear he wasnt concerned or even particularly interested in Franks case. He could offer no real explanation for why our son was born flatline (his term) apart from the obvious deduction that hed been knocked out by the grip of the forceps on his head. It happens, the doctor said. We dont know why. He had a touch of jaundice, but there had been no evidence of oxygen deprivation.

By contrast, I was worse for wear. In addition to the forceps, Id had internal and external tearing as well as an episiotomy cut open and stitched back together. As one doctor later put it: Its like a truck drove through your pelvic floor. I was given transfusions for blood loss and paracetamol for the pain, which didnt help much.

When I was finally taken up to the neonatal unit in a wheelchair and able to hold him, my son was so bashed up he looked like hed been in a bar fight. You should see the other guy, the nurse joked. You already have, I said. The other guy is me.

This is not the story of a personal tragedy. Im conscious while writing this of the many mothers who have experienced far worse. Pregnancy and childbirth, when it goes wrong, can result in all manner of horrors, including the loss of a child an experience I cannot pretend to understand.

Instead, this is a story about whats been written out of Britains official birth narrative. Franks birth, as described, would be classified in our maternity system as a success. For a system that prides itself on being female-centred, the NHS maternity care system is failing post-natal women. Not only has the physical and mental health of new mothers become secondary, it sometimes seems inconsequential. This is the untold story of the suffering our maternity care system ignores.

Its difficult to admit this now, eight months after Franks birth, but in those first weeks I did not feel the exhilaration that comes with a baby. I cared for my son dutifully, feeding, bathing, burping, swaddling, soothing him through the night, but much of the time I felt weirdly detached, like a zombie shuffling through the motions.

The sound of his cry induced black thoughts, a darkening of my already dull mood. I remember looking at him and registering the fact he was beautiful, but being unable separate his body from the horror of his birth. I obsessed over the idea that something was wrong with him, that hed been deprived of oxygen and the doctors had hidden it from me. I took him to see the community midwife twice because I was convinced his eyes were crossed. When I demanded to know if the midwife thought he looked like he had brain damage she looked at me oddly.

In those first few weeks I had flashbacks every day. Id be standing in the queue at Sainsburys and suddenly Id be back in the madness of the delivery room, blood pooling on the floor beneath my bed wondering if my baby was dead. I ruminated over the details of what happened for weeks, unable to think about little else. Some days I told the story to anyone who would listen; others I could barely speak at all. Finally I went to see a psychiatrist who diagnosed me with trauma. Not post-partum depression she was very clear on this point but post-traumatic stress, as a result of the physical and emotional ordeal of Franks birth.

Physically I was also struggling. As Frank grew bigger and bonnier, lighting up the world with his first gummy grins, I wasnt bouncing back. Every time I found myself alone in the room with a doctor, health visitor or community midwife Id demand they examine me to determine whether or not I was healing properly. Again and again I was told everything looked fine the stitches had healed and I was given the all clear for exercise, for sex, for life. But something was amiss.

Like many new mothers I was suffering from stress incontinence (urinating when I coughed or sneezed) and a weakened pelvic floor, but there was something else. A strange dragging sensation, a heaviness that wouldnt abate. I described these symptoms over and over and was ignored by health professionals until one day, over a cup of tea, a girlfriend suggested I might be suffering from a pelvic organ prolapse. The next day I booked an appointment with my GP who referred me to a gynaecologist who confirmed that, indeed, I had a moderate-to-severe case of a condition called cystocele, otherwise known as a prolapse of the bladder. What this means is that my vaginal wall was so badly damaged giving birth that my bladder was spilling out into my vagina. The best course of treatment, he told me, was corrective surgery. Its something I cant have until Im three months clear of breastfeeding, which is some months away yet. In the meantime Ive been prescribed a course of post-natal physiotherapy, which involves performing pelvic floor exercises under the supervision of a doctor and having vibrating wands shoved up my nether regions in order to reverse tissue damage.

This is not as fun as it sounds.

In spite of all this, Im one of the lucky ones. Most women who experience birth injury and trauma never get properly diagnosed or treated. Its hard even to get any one to recognise there might be a problem. My husband, astonished there was no routine follow up for me after such a traumatic birth, tracked down the obstetrician whod delivered Frank to seek guidance from her. She did not respond. We found out later this sort of contact is not encouraged; no comment or advice could be offered. A hospital collectively delivers.

The Birth Trauma Association, a peer-to-peer support group, estimates that 10,000 women in Britain are treated for post-traumatic stress disorder as a result of birth each year. Thats the largest single cohort of PTSD sufferers in the country. They estimate as many as 200,000 more women may feel traumatised by childbirth and develop untreated symptoms of PTSD.

On the physical injury side, the British Journal of Obstetrics and Gynaecology in 2015 found that 24% of women still experience pain during sex 18 months after giving birth. The same year researchers from the University of Michigan gave 68 women MRIs seven weeks after having babies. Of the admittedly small sample, they found 29% had fractures in their pubic bones, which all of them were unaware of, and 41% had tearing and severe damage to their pelvic floor muscles that had remained undiagnosed. Another recent US study, published in the journal PLOS One, found 77% of mothers still suffered from back pain and 49% experienced urinary incontinence a year after having their babies.

Its obvious that childbirth is deeply traumatic for many womens minds and bodies. Just over a century ago almost 7% of pregnant women in England and Wales died from it. But birth is much safer now so why are so many women still suffering its after-effects undiagnosed and untreated?

Part of the reason is that the conversation around birth trauma and injury is steeped in shame and institutional sexism. Im not just talking about the general prudishness surrounding womens reproductive health issues. There is a prevailing attitude I encountered among many health professionals which is that new mothers should basically learn to suck it up. As one GP said to me in semi-exasperation: Youve had two children. Your bodys changed. You cant expect to feel the same as you did before.

Rebecca Schiller, chair of BirthRights, an organisation that seeks to promote human rights in childbirth, told me that institutional denial of womens experience is a huge problem, especially when it comes to post-natal care. There is a general attitude of Your experience doesnt matter, all that matters is a healthy baby. When, of course, the two are inextricably related.

Part of the problem, I have come to believe, is that pregnant women are not properly informed of the risks of birth trauma and injury in advance.

With my first pregnancy I was determined to have an all-natural, drug-free, at-home water birth. I rented a birth pool at the urging of my NHS homebirth midwife and when labour began I went around the house lighting scented candles. But seven hours in, when my baby turned out to be an undetected breech, I was rushed to hospital in a wailing ambulance. Once it was determined my son would be born via emergency caesarean, a doctor talked me through all the risks in advance and asked me to sign a surgical waiver. And yet, with my second son, when I waived my right to an elective C-section and opted instead for a normal birth, I was assured by several midwives that opting for a VBAC (vaginal birth after caesarean) was the safer, better option and would result in an easier recovery than a surgical birth.

As I found out later, women in my age group (40), especially those who have had a previous C-section, have much higher rates of assisted births and assisted births often lead to injury and trauma. The NHS and the NCT have very little to say on birth trauma. There are no birth trauma or injury counselling services and after care, as I found out, is difficult to come by. There are private options (like my psychiatrist), but there are private options for everything if you can afford it.

Eight-month-old
Your experience doesnt matter; all that matters is a healthy baby: a bonny Frank. Photograph: Phil Fisk for the Observer

To get state-funded care, you have to fight for it, which many birth-injured and traumatised new mothers are in no state to do. Complicating matters further is the issue of post-partum depression. Just look at the postnatal chat groups online and you will find women frustrated at being told they simply have a hormonally induced case of baby blues when what theyre actually feeling is a normal reaction to a profoundly distressing experience. Diagnosing a birth-injured or traumatised mother with post-partum depression is the healthcare equivalent of asking a justifiably irate woman if maybe, just maybe, shes about to get her period? And yet it happens all the time.

There is a reasonable explanation for this apparent state of institutional denial. Birth trauma and injury conflict with the NHSs dominant maternity care ethos, that natural births are safer and more empowering for women. This despite the fact that the UK has one of the highest infant morality rates in western Europe and, according to the NHS litigation authority, pays out hundreds of millions in maternity negligence claims each year.

As the NHS continues to pay scant attention to the issue, rates of birth injury and trauma continue to rise, due to a confluence of factors including ageing mothers, obesity and larger newborns. But why isnt more attention paid to the routine psychological and physical harm endured by so many post-natal woman?

This is a question Maureen Treadwell, chair of the Birth Trauma Association, has been asking for nearly two decades. She founded her organisation in response to the number of women she knew whod been refused pain relief during labour and ended up traumatised by the experience. If a man underwent dental surgery having begged for anaesthetic and not received any, wed recommend therapy yet if the same thing happens to a woman we tell her shes a good girl, well done. Its madness, she said.

According to Treadwell, birth trauma is exacerbated by a culture that celebrates only one kind of birth. The system, as well as the dominant culture, fills women with false expectations. It deludes women into thinking that birth ought to be this wonderful, empowering experience and when it isnt women feel terribly ashamed.

Last year when Jamie and Jools Oliver had their fifth child, Oliver tweeted about his wifes unbelievably composed natural birth. It sounds ridiculous, but I cried reading that tweet. New mothers are deeply susceptible to guilt and it often begins with not having performed birth in the circumscribed way.

Eight months on, Frank and I are muddling along in an exhausted state of contentment. The trauma of his birth is fading, superseded each passing day with the marvellous reality of him. My body is now the body of a mother battle-worn, cosy and intimidating in its accomplishments. I am grateful for my boys and for the fact that I got help for a condition many mothers experience but for which few ever seek acknowledgement, let alone treatment.

Like I said, Im one of the lucky ones.

Read more: https://www.theguardian.com/lifeandstyle/2017/may/07/i-cant-forget-the-horror-of-my-sons-birth-post-traumatic-stress-disorder-childbirth