April 06, 1998

Deanne's story

MY EXPERIENCE OF LABOUR

I recently gave birth . I had prepared myself, or so I thought. I am a medical doctor who has spent the last decade working in various positions , including obstetrics and as a psychiatry registrar for the last five years. With fairly obsessional detail I had read many books about pregnancy and labour , both medical texts and non medical (usually more helpful) books aimed at the general public. I had also listened to the odd friend speak about their experiences of labour , but found many friends saying " you forget ..." .

For those who like facts and figures, I had a twenty nine hour labour and a normal vaginal delivery. I began experiencing mildly painful contractions at 5.30 am and spent most of the rest of the day in and out of my spa at home. These initial pains were more like period cramps in intensity , but gradually increased in severity throughout the latter part of the day. I left home at one am Wednesday to go to the birthing centre when the contractions were becoming much more intense and gave birth at 1040 that morning. For analgesia I apparently used nitrous oxide for about 4 hours in the latter part of second stage, although I had been requesting just about everything in sight for analgesia, including epidurals and a (medically inappropriate) forceps delivery ! -anything just to get rid of the agonising pains!.

Apparently second stage was delayed because of a swollen anterior lip of cervix. Once this was pushed back I delivered the baby about 20 minutes later by normal vaginal delivery. A moderate post partum haemorrhage left me feeling lightheaded and exhausted for a week or so but I was otherwise unscathed.

Why then did I feel so UNPREPARED for what I was experiencing ?

After much thought , I realize it is because I was completely unprepared for the EMOTIONAL and COGNITIVE experiences of labour. The books had never mentioned it.....

During late first and second stage of labour some of my experiences included the following;

• Extreme disorientation to time
  
• Impaired memory, with only patchy recollections of very emotionally significant statements or events.
  ( eg; Memories not of the quality of the pain, but of myself thinking "I will NEVER go through this again")
  
• Perceptual changes; eg, changes in the volume of conversation around me, as if a knob on a radio were being turned down and then up again; and impaired awareness of vision, with only vague recollections of rooms and people in them.
  
  I have memories of feeling like I wasn't coping and frequently wanting to cry, but instinctively not allowing myself to do so or it might make the agony of the next contraction even more unbearable - ie every single ounce of energy had to go into trying to cope with the intense pain of the next contraction.
  
  
  The above cognitive changes were always present, but varied in intensity as the contractions came and went. Apart from the abnormalities in my auditory perception , they also occurred both with and without the use of nitrous oxide.
  
  The diagnostic criteria for a Delirium(DSM IV) are as follows;
  A.Disturbance of Consciousness( ie reduced clarity of awareness of the environment), with reduced ability to focus, sustain, or shift attention.
  B. A change in cognition ( such as memory deficit, disorientation, language disturbance) or the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia.
  C. The disturbance develops over a short period of time( usually hours to days) and tends to fluctuate during the course of the day.
  D. There is evidence from the history, physical examination, or laboratory findings that the disturbance is caused by the direct physiological consequences of a medical condition.
  
  As a result, I believe I have experienced a delerium. In fact most women in labour probably experience a delerium. I don't believe I have ever seen it articulated as such before and thought it was worth sharing, particularly as it raises interesting issues about our ability to consent in such a clouded cognitive state of mind.
  
  Deanne Williamson
  
  Reference; American Psychiatric Association. Diagnostic And Statistical Manual Of Mental Disorders - Fourth Edition. American Psychiatric Association, Washington. 1994 .
  
  
  
  This page has been built with HomePage Publisher.