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Re: cesarean artFrom: Anna Meenan, MD (annam@uic.edu)Thu May 4 11:22:08 2006
Replying through the web archives because my cable company has screwed up my e-mail. If the message I am replying to is all chopped up and truncated, I can't help it. (And why hasn't that been fixed, BTW--it's been going on for a long time.) The reason I suggested that this woman is severely depressed and needs help is the following passage from the text on her website: "I am thinking about it everyday. Every single day. I am obsessed. Unfortunately my husband filmed the scenes and I am obsessed with seeing this horror flick. I went from being depressed to trying to recover as I don't get much support with my problem. I feel ridiculed and disappointed. My immediate surrounding expects me to be happy and especially to function. Most days I am happy and I do function but my obsessive thoughts keep on festering and rotting and fermenting in the back of my mind day in day out." I find the last line particularly disturbing, with the mention of obsessive thoughts "festering and rotting and fermenting". It is not healthy for someone like this to be caring for a newborn. Obsessive thoughts like that could even be a symptom of postpartum psychosis. Apparently, even with her brave attempts to cope through her art, she is not coping and may need more help than what her art can provide. I wondered if her OB had seen the pics because a doc who apparently did a routine repeat c-sec is pictured with blood dripping from her hands and the comment that she "always has her scalpel handy". If I was her OB, those pictures would traumatize ME. This woman freely admits that she made CHOICES, and that her c-sections were the result of a lack of "guts" on her part (though I don't entirely agree with her). She is upset over the fact that she needed a c-section for recurrent decelerations in a 43-week gestation. 43 week gestations carry HIGH mortality rates due to placental insufficiency, and there were clear signs that that was the problem here. Why is the doctor always the one blamed when nature betrays a woman? Is it the doctor's fault that this pregnancy went post-dates? Did the woman refuse an ultrasound early in pregnancy to pin down uncertain dates? For the second birth, she implies that she had the option to return to her home country (wherever that is) to give birth. Would she have been able to have her VBAC there? Why didn't she go? Is maternity care in her home country substandard? Should she be glad she had the opportunity to have her baby here in the good old USA? I understand that a c-section can be an upsetting experience and that some women will have difficulty coping and need more support. I get all that, and I try as much as possible to be empathetic and supportive and give women a chance to vent and process things after a c-section. What I DON'T understand is this tendancy to blame the obstetrician for everything, and to find them somehow lacking if they don't provide hours and hours of emotional support after a c-section. Obstetricians are busy people. Most of the ones I know really are doing their best in the empathy department but are not psychiatrists or trained counselors. They are surgeons, and I think this woman is expecting too much of a surgeon. Just as I wouldn't want a psychiatrist operating on me, I am saying again that this woman needs a psychiatrist, because what she's done on her own to cope thus far, while admirable, is NOT WORKING, and I see serious problems when I read what she wrote. I am not dismissing her concerns. I am saying that she needs more help than she's getting.
-- Anna Meenan, MD, FAAFP
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