This week, as part of our campaign to recognise and address obstetric violence as an especially heinous form of gender-based violence, we’ll be sharing the stories of women who have been affected by obstetric violence. This is Meg’s story.
If I must sum up my birth experience, it rests on a profound lack of patient-centred care. I write this acutely aware of the levels of burnout and compassion fatigue in health professionals since the start of the pandemic. My story may not be the worst and is likely nothing in comparison to others, but it matters. It matters because all women deserve humanity in the rawness of birth and postnatal care. We deserve to be seen and to be heard. As a Health Professions Council of South Africa (HPCSA) registered psychologist and as a mom myself, I strongly believe that it is not just about a healthy baby, it is also about a physically, mentally, and emotionally healthy mom too. I share my story in the hopes that it would raise awareness of not only the striking wrongdoings and injustices of obstetric violence and birth trauma, but also of the more subtle (intentional or unintentional) treatment and indignities of women in labour and postpartum recovery that communicates belittling, dismissive, disparaging, and/ or negative attitudes toward women in their most vulnerable and raw state by the professionals who are meant to provide care for them.
I arrived at the hospital at 23:00 on Sunday 9 August 2020 (a few days before my due date) in labour with my first child. My husband had called ahead to let the hospital know we were on our way as I was having regular contractions 3-5 minutes apart. After some confusion at the Covid screening station about admissions protocols for women in labour, we were allowed into the hospital. The reception area was empty, and we were left to navigate the hospital corridors by ourselves. We slowly and laboriously (pun intended) worked our way through the hospital maze, giggling nervously at the absurdity of being watched by security guards when I needed to stop every few minutes to lean on walls during contractions. We found the labour ward with relief, only to be welcome by two disinterested nurses who barely acknowledged our arrival until I tentatively said “um… I’m in labour”. After being questioned on when my C-section was scheduled for, the nurse grudgingly accepted that our inconvenient midnight arrival could not have been avoided as I went into labour naturally. My husband and I glanced at one another apprehensively as we were shown to a room, feeling sheepish at our unwelcome arrival at the hospital.
Once in the labour room, I dutifully informed the nurses that my baby had the umbilical cord around her neck, as my gynaecologist and I had been discussing this for two weeks (with the agreement that we would make a call when I went into labour on whether it would be safe to continue with a natural delivery). The nurse shrugged and told me to lie on the bed. I started to take off my pants (expecting an internal exam) and the nurse pertly told me to keep them on. After being left on the contraction monitor for 30 minutes unattended and then an internal exam conducted, the nurse told me I was 4cm dilated and turned to leave the room wearily. I asked about my baby’s health as this was not mentioned after my exam, to which she replied “[baby is] fine”. My husband then asked what the 4cm dilation meant and explained that this was our first baby. The nurse sighed and almost sarcastically replied “she is in labour” and left the room, turning off the lights on her way out. My husband and I whispered our uncertainty to one another and agreed to take the hint to try and get some sleep. A little while later the pathology lab technician arrived for our Covid tests (which were both negative) and we were left in the dark room again until morning.
I tossed and turned, generally psyched myself up for delivery whilst furiously Googling what to expect at each stage of labour. At 4:30am I buzzed for the nurse as I was bleeding. When I told the nurse, she sighed in exasperation and replied, “I’ll bring you a pad”. No explanation or reassurance was given as to whether this is normal, even though I was visibly anxious about this. When she returned with a pad, the nurse informed us that she would examine me when a machine became available and returned about an hour later. I was now 6cm dilated and left alone again.
By 6:30am I was pacing with contractions and buzzed the nurse to ask if I could use the birthing pool/bath in the room for pain relief. The nurse seemed annoyed at this request and informed us that it had not been used in a while, so it was dirty. She found a plug that partially fit, ran the rusty brown water, poured in disinfectant, and motioned for me to get in. I awkwardly sat in the bath, unsure what to do with myself as the gritty water freaked me out but I felt I would be scolded if I did not use the bath which I had asked for. Again, no enquiry was made on how I was coping, no information was offered around pain management options, and no advice was given around effective labour (e.g., positions for labour/ breathing techniques etc.).
As luck would have it, my gynae was on leave over the long weekend. The on-call doctor arrived just after 7:00am to examine me and informed us that I was now 10cm dilated and it was time. I informed him again that I was worried about the cord around my baby’s neck and he was not aware of this, so asked the night nurse to fetch my file.
Fortunately, the nurses changed shifts at this point. Much to my relief, the day nurse was kind and supportive, which was in stark contrast to my experience with the night staff and all other hospital staff during my stay. During the shift change I started shaking and vomiting (I had not eaten since dinner the previous night and had no pain medication). The day-nurse asked the night-nurse to bring me some ice, to which the night nurse snapped, “they said they didn’t want ice” and stomped off. To clarify, we had said we did not want ice in the water jug provided when we arrived at the labour ward the night before. Between contractions the on-call doctor made small talk by showing us his collection of forceps and snapping them open saying light-heartedly that I needed to push, or he would need to use them. I was clueless, out of control, and vulnerable. I had no idea how or when to push properly but felt pressured to get on with it, which resulted in very severe haemorrhoids (which I did not have during pregnancy). Bizarrely, it was also right at this point in my strained pushing that the catering staff casually walked in to serve breakfast on my bedside tray.
The birth itself was a blur. I was already feeling unsure and unable to ask for help, but now I felt completely out of control of my body and what was happening around me. It all felt surreal. After a few more forceful attempts to push (between waves of vomiting), I was given an episiotomy and forceps were used to get baby out. During the episiotomy, I caught sight of the amount of blood on the bed in the TV reflection above my bed and I could see my husband’s distress and panic. I shut down, went into freeze response, closed my eyes tight and I yielded to the cutting, stretching, and pulling to get both my baby and the placenta out. I only opened my eyes again when the nurse firmly told me “look at your baby!” and placed her on my chest. Thankfully, the doctor could unloop the cord from her neck and my beautiful daughter was born at 8:24am on the 10th of August 2020, healthy and strong.
I am not sure whether or why an episiotomy was needed as nothing was explained to me before, during or after delivery. While the on-call doctor was professional and clearly well-experienced, I could not shake the feeling that this older male doctor was becoming impatient with me floundering in labour and that I was wasting his valuable time. Later, when my own gynae came to check on me, she could not hide her surprise that I had an episiotomy and asked if there were complications during labour, which I could not answer as I did not know what was medically going on during labour.
As I lay shaking violently on the hospital bed while I was being stitched up after delivery, my husband held our daughter for the first time. I could feel every stitch and every pull to put me back together as I still had had no pain medication at all, besides one quick jab of local anaesthetic which did not seem to make much difference. I told the doctor that I could feel everything through chattering teeth. The kind day-nurse came over to stroke my hair, look me in my eyes and tell me we were nearly done, and she would bring me something for the pain. She held me up as I stood, walked, showered, and got back into bed to nurse my baby. I am forever grateful for this kind hospital employee who met me in my rawness with humanity amidst the sea of aloof, tired and disconnected hospital staff. She showed me a glimpse of the kind of care all women deserve in labour all the time.
I was moved to the maternity ward later that morning and was again met with a wall of compassion fatigue from hospital staff. I was in excruciating pain and had extensive stitching. I was not offered an ice pack after delivery to reduce pain and swelling. I was not offered any assistance in showering/ bathing in the maternity ward beyond the first shower straight after delivery. I was not offered support, advice or help with breastfeeding. I had to buzz for my pain medication several times as it was not brought on time. My husband and I were largely left alone in the ward and only saw the nurses when they delivered my medication and came to check baby’s vitals. My husband fulfilled the role of ‘nurse’ for the rest of my hospital stay as we cluelessly navigated the fog of shock, pain, sleeplessness, and the joy of marveling at our new baby. He was the one to help me shower, dress, walk, go to the toilet, pick up baby, breastfeed etc. We were paying for private healthcare (with a whopping extra R7000 out of pocket for my husband to have a couch in my room as Covid protocols did not allow him to leave the hospital and return to visit) but could just as easily have been doing it ourselves in the comfort of our own home.
On the day of discharge a familiar nurse came to tell me that she needed to remove my stitches, to which I anxiously replied that my gynae had told me that my stitches would dissolve. She became irritable and insisted that she had to remove my stitches, which I refused, and she then sighed in exasperation and said she would have to call my doctor, much like I was a misbehaving child. Soon, this nurse then came back to petulantly tell me she had thought I had a C-section (as though it were my fault) so my stitches could stay in. I was stunned that she was completely uninformed about my medical records despite having been on duty a few times during my stay. My gynae came back to check on me and I tearfully mentioned that I had still not gone to the toilet since the birth and was terrified. She was surprised that no nurses had made a note of this, prescribed stool softeners and a glycerine suppository, and indicated that she wanted me to go to the toilet before I could be discharged. No nurses followed up on whether I was able to go to the toilet thereafter before discharge.
Shortly before being discharged my husband went down to reception to finalize all the paperwork. He was told that everything was in order and nothing was needed from us. We were all set to go, only to be stopped by the security guard at the maternity ward entrance and told that I could not take my baby out of the ward in the hospital basinet. My baby was unceremoniously placed in my arms, the basinet swiftly wheeled away, and my husband carried our luggage. I was in visible pain, tearful, and walked very tentatively (cowboy style) with my newborn in my arms, but it was clear that no help was available, and a wheelchair was not going to be offered. We once again navigated the maze of the hospital corridors alone to collect my script from the pharmacy. There were no seats available and I spent 45 minutes standing painfully with my newborn in my arms in the busy hospital lobby while my husband waited in a queue at the hospital pharmacy. I was in unbearable pain, pale, shaky, lightheaded and focusing all my energy trying not to faint with my baby in my arms.
My husband then went to the admissions desk and was informed that we had documentation missing. My husband expressed frustration that he had been down to check what was needed earlier that morning. At this point the strain of standing, the stress of the experience, and the effects of the laxatives hit me like a tidal wave. I quickly plopped my baby in my husband’s arms and did my best to run to the closest toilet as I had soiled myself in the hospital lobby. This was the pinnacle of shame, humiliation, and loss of control for me and I was thoroughly defeated. I did my best to clean myself up in the lobby bathroom and made the final trek to the car, trying to muster up a brave face for the eager family who couldn’t wait to meet the beautiful new arrival when we got home.
Overall, our birth and hospital experience was tainted by a lack of patient-centred care. We paid an enormous bill to have our baby in what we believed was one of the top hospitals in our city and were extremely disappointed by the level of care we received. I was not treated with dignity and care. I was out of control, fearful and felt that I was a complete burden on very strained system.
Ten days later, I wept ugly shaking tears in my gynae’s office as the humiliation of my birth overwhelmed me. She was appalled and made furious notes as I spoke. She encouraged me to write up a point-by-point letter of my experiences. I did write this letter a few weeks later. I sent this letter to the hospital management (and my medical aid) and initially received no response. After two follow ups with the hospital, the head of the maternity/ labour ward gave me a call. She informed me that the hospital had had a recent change in management in the labour and maternity wards. She apologized for my experience, promised that she would speak to her staff, and I heard nothing further. My medical aid never acknowledged my letter. I have had the time and insight to process my birth, but I have deeply affected by this experience.
I could not sit or stand for 5 weeks after my birth due to my injuries and was in a blur of painkillers, trauma and navigating a newborn. My husband and I were grateful for the bubble of privacy that Covid gave us. I could not cope with even my own mother (who is wonderfully supportive) coming to visit after birth as I could not face her deep emotions related to my birth. I could not cope with her talking about it or expressing her anger over it. My husband and I were both terrified of having a “difficult” (AKA normal) baby who would cry constantly and need my full attention 24 hours a day as I could barely get out of bed to go to the toilet or eat. I cringed when well-intentioned, veteran parents said “oh just wait until the 2-week/ 6 weeks/ 3 month mark where they are out of this sleepy newborn phase” as I feared that I could not cope with that as I was hanging on by a thread. And so, I lay with my newborn in my bed for weeks on end until I felt more in control of my body and more human again. I went on medication for post-partum anxiety and I slowly regained my sense of self again. I started speaking to friends and to my husband about my birth. I prayed and I processed.
I have doubted myself many times and heard the whisper “It was not THAT bad. Maybe that is just what birth is like? Other people’s stories are far worse. You are being over-sensitive/ privileged/ entitled to have expected to be treated differently”. I have had people say, “at least you have a healthy baby” or “but you are so lucky that you have an easy baby” after hearing my birth story. About 3 weeks after having my baby I started being contacted by my work again and in one voice note from a colleague she said, “I am sure you have had time to recover and settle by now, so I just wanted to ask you…”. I burst into tears as I felt like a complete failure for not bouncing back after birth and not being able to deal with the work enquiries in my usual efficient, focused manner. I felt so far removed from myself and who I had been.
Almost a whole year has now passed. I still recoil when people ask when we plan to have a second baby and need to fight the bubbling rage when family excitedly ask, “are you pregnant again?!” when I have good news to share or even just video call them unexpectedly. I do want more children, but I need time and I need control over my body for a while longer. I have decided to share my story and join the movement of advocacy for obstetric violence and birth trauma because I need to know that there is action and advocacy for a better experience the next time around. For my next baby and for other women from all walks of life.