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Wednesday
Dec012004

Forced Cesarean

We drove 90 miles at 80 mph to get to the hospital that was supposed to treat us nicely... kindly. We passed at least 8 other hospitals along the way and left two, much closer, behind us. We had been led to believe that the university hospital, a hospital that also had a birth center on a separate floor run by over a dozen CNMs, would be a safe space for us midwives who had to transfer a client in the midst of labor and birth. Absolute emergencies, of course, went to the closest hospitals, but this wasn’t an emergency. Yet.

We drove in a caravan, me behind the laboring client whose husband was driving, the other midwife right behind me and then family members behind them. Thankfully, most of the evening traffic had abated, so the gang stayed pretty much together until we got a lot closer to the hospital downtown.

I kept begging God to let the baby come in the van. Please, please, please just let the baby come now.

When we left the house, mom was 7-8 cm and the baby was a –2 station. A huge difference from complete and 0 station before the hugely bulging membranes ruptured. Sometimes membranes not rupturing make me angry! They aren’t always misleading, but this time, those membranes told a whole different story than when they were gone and the head got to tell the story. At least the fluid was clear. I was so worried the fluids wouldn’t be clear once the membranes broke, but that was a pleasant surprise. It is one reason we don’t like breaking them; what we don’t know won’t scare us.The other midwife and I paved the way for the client who was waiting for a wheelchair to bring her up. Does she want to try for a vaginal birth? Well, we doubt that will happen at this point, but, of course, if possible! The charge nurse tsk tsking in the background as she was assigned a bed.

Into the room the entourage goes and mom is hooked, hollering, up to the monitor and asked a dozen questions. Everything is going too fast! It isn’t an absolute emergency. A female resident comes in and says she wants to check my client and she submits to only the 4th exam of the labor. She has a cervical lip and the baby is +2. What?!? She is fractions of inches from having this baby vaginally! The doctor wants to see if she can lift the lip and has my client push with all her might as another nurse is prepping her for an IV and others are bustling about the room. She pushes as best as she can after not pushing for the entire 2 hour journey down to the hospital and into that bed and the doctor takes her hand out and says, “sorry, don’t think it’s going to happen.”

And that’s it.

And that’s it?!

My mind races as I think of alternatives to a cesarean for a cervical lip with a baby at a +2 station (+4 is the baby’s head visible at the entroitus). I mention to the doc that some midwives will use ice in a sterile glove on a swollen lip... might we try that? She said she wasn't comfortable with that, but interesting concept.

I discuss with the client... quietly... but quickly... that an epidural might do the trick. An hour or two without pushing/pressure might relieve the lip’s pressure and the baby could come sliding out. Positive, loving words of encouragement, her perfection, how great she worked all the way down from another county. I nurse starts the IV angrily in the back of her hand causing my client to holler and wince. The anesthesiologist is going to come in now, another nurse says, to discuss her spinal for the cesarean.

Somewhere in all of this is the absence of the CNM who was supposed to meet us in the room. She had an emergency transport from upstairs to L&D, so couldn't meet us. Had that happened, we might never had experienced the story below.

Later, another CNM told me that the new slew of residents and attendings hadn't been sufficiently brainwashed by the CNMs yet to leave things alone. They were eager to cut and learn. Why on my client?

I note a waif of a woman at the bottom of the bed staring, but say nothing to her as I discuss strategy with my client; there are so many people in the room already. The nurse walks out the door and I let her know that my client would really like to discuss an epidural so she might have her vaginal birth after cesarean and the curtain drops in a huff.

Waif woman, it turns out, has been eavesdropping and also happens to be the Attending Physician; the Queen of All Decision Making. The attending says she just doesn’t see how a vaginal birth is going to happen... mom has been through SO much already, isn’t it time to just have the baby in her arms now?

The anesthesiologist comes in and does his Spinal Spiel... checking for dentures, size of the mouth and throat, going over allergies, discussing previous surgeries... and the other midwife, gently, touches his shoulder to explain that mom had to be poked three times for her epidural last time. He shrugs her hand off as if she were a poisonous spider without any other acknowledgement of our presence.

Mom, in so much pain, enduring the indignities of these people’s questions, being poked, prodded, having the monitors adjusted over and over during contractions (they always forget that not everyone has epidurals and adjust them during contractions)... all she wants is a moment of relief.

She says to the anesthesiologist, a male doc, that she wants an epidural because she wants to try and have a vaginal birth. The attending butts her head in there and says she doesn’t think that is going to happen... and look! the baby is starting to show signs of stress now. Look at those late decels. What?! I go to the machine and see no late decels, but plenty of head compression decels and find hope in them... wanting to scream at the attending for her hate and venom of disbelief in my client and her ability to birth vaginally.

I write this in a linear fashion. This was not linear. This was layer over layer of fear and anger and waves of loud and huge contractions and disbelief and shock and noise and undermining and lying and people talking all at once and hurry! hurry! hurry!

My client asked for a few minutes with her family, leaving the other midwife and I with her husband as she said she really wanted to stop the pain and to try for a vaginal birth. I asked her if she wanted to see the strip because I didn’t believe they were late decels at all and she said she couldn’t look as yet another contraction pulled at her body.

The docs came back in... three now... the original resident, the attending and the anesthesiologist... and the CNM, too... and as my client asked for an epidural, the attending lowered the client’s bed some... pointing to the monitor showing what a hard time the baby was having now. There wasn’t time to see anymore. It was time to go back now!

The anesthesiologist began discussing the epidural and that it wouldn’t last long... maybe two hours... and it wouldn’t be able to be used for the actual surgery. She didn’t care! The attending had to have given him a glaring, evil look or kicked him under the bed or something because then he started this whole other voice.

A grapeseed of evil surrounded by a honeycomb.

Now, if you have an epidural in here, if we have to go back, I just might not be able to re-dose it. Sometimes it’s hard to do that.

Remember, there is a lot of commotion still going on... still so much noise and activity. But he created this tiny pocket of silence where only the client, the husband, the midwife, and I could hear.

So, if you can’t be re-dosed, then, gee, I guess you’ll just have to have general anesthesia for your surgery.

My head swirled. I thought I was going to vomit as his threat washed over me. I wanted to take the IV pole next to me and smash his arrogant head with it, letting him feel the agony he was causing other women at his hands.

There were no options. They evaporated with his remark. This man, no matter what, was going to have needles next to my client’s spinal cord and he had the power to make that experience hell or tolerable. My only regret is not begging my client, just one more time, to try without medication. It was ludicrous since she’d been in good active labor for about 50 hours at that point; it wouldn’t have been fair to do so, but since it is human nature to replay things a thousand times, that is my only major regret.

I wasn’t sure if my client “heard” what he said, but I leaned over and whispered to her, through tears, “you have to go back now” and she said, “okay.”

Promises were made about keeping mother and baby together, Duramorph being used so mom could be pain-free long, but still mobile, and mom was wheeled out of the room with the chaos, leaving dad, the other midwife, and me.

Dad was in the OR for the birth and remarked that someone had to go to the end of the table to dislodge the baby’s head from the pelvis before she could be born abdominally. Another wave of nausea swept over me.

Mom was taken across the hospital to the “overflow” recovery room... the PACU... where no babies are allowed, where moms are not allowed any visitors at all... where the recovery period is 4 hours as opposed to the 2 hour max in standard OB Recovery Rooms. The baby was taken to NICU and found, quickly, to have low glucose. (All this happened within the first hour postpartum.) The nurses wanted to give her a bottle of formula and when dad refused, they readied an IV solution of dextrose! An IV!! Through careful and kind negotiation, dad convinced an NICU nurse to take the baby to the PACU to nurse on mom and, blessedly, they did (after much arguing about policies). The baby’s glucose never went down again.

Mom was left alone in recovery despite my trying to get in. When we sent the baby, the mother-in-law (MIL), an NICU nurse herself, tried to stay, but the client said she wanted to sleep. The PACU nurse made snotty comments about mom sleeping so well until the family interrupted. I asked dad if he told the nurse to shove it and that mom would MUCH rather lose some sleep to nursing than sleep through the first 4 hours postpartum without nursing. He said he said something to that effect.

Mom's belly incision was made above the old incision... and in a drunken fashion. The resident's first incision on a belly? We are waiting for the records to see what the uterine incision will be... hopefully, the same incision, but, considering the surgical and emotional punishment foisted on her throughout her short L&D experience, I wouldn't doubt if they gave her a vertical incision on her uterus.

After the baby nursed, I gathered myself together, said my good-byes to the troups and went home. I’d gone to the mom’s home 23.5 hours earlier, fully anticipating a wondrous and amazing birth. And here I was going home, defeated. Feeling so useless as a midwife. Feeling powerless as a doula. Feeling useless even as a friend.

I sobbed the entire way home.

Reader Comments (7)

teaching hospitals. ugh. i've seen them intubate healthy, vibrant babies with clear fluid just to learn!

ugh. ugh. ugh.

{{hugs}}

December 2, 2004 | Unregistered CommenterSage Femme

How do you go and process from here? What is your next step? I'm a letter writer, talker, communicator of all mediums. I'm not sure what I would do but it would be very difficult for me not to find some way to respond.

I'm a boat rocker. Maybe I shouldn't be a midwife. ;) lol

How is your client coping now?

December 2, 2004 | Unregistered CommenterDynamic Doula

I just did a birth like this--though first time mom--this past weekend. It is heart breaking.

So did your client end up with a vertical incision?

July 23, 2010 | Unregistered CommenterKnitted in the Womb

No, it was parallel (if you can call the jagged cut parallel) to the old one.

I'm sorry you had a birth like that this week. I'm still traumatized by it years later. Email if you ever need to process. I'll listen.

July 23, 2010 | Registered CommenterNavelgazing Midwife

I had a similar birth with my son two years ago... "forced" to have an induction (it was my first baby) due to "oligohydramnios" (I had TONS of fluid when my membranes ruptured), had an epidural because of tremendous pitocin contractions, dilated fully an hour later, pushed for three hours (my husband said that he could see the baby' head during contractions), and then, because of some fresh meconium stained fluid and some "decels" (I didn't see the strip, but I think they were just multiple variable decels, nothing too crazy), they called a C/S. I remember very clearly during the surgery that the attending told the resident to "push the baby back up" so that he could be born through the incision. makes me sick to think that I was so close to a vaginal delivery.

Awful PPD afterward... and then an amazing natural VBAC 22 months later. :)

August 9, 2010 | Unregistered CommenterSigrid

I have re-lived one of my last births of a client thru this very emotional story, it was much like this, i also felt useless, good for nothing midwife, honestly i felt like i took her to the worse place, the one we had concidered since she had delivered there before after her c-section she had a vbac in the hospital and we decided to go there because they had given her that before, why not now, baby was visible she ha pushed for a lil while, arom clear, but with my client they didn't even do a vaginal on her that i remember, the OB on call walked in said its illegal for me to do a VBAC at home, i mentioned ACOG and the new laws, he ignored me, my client with contractions had to bear all the insults possible to man kind in less than 30 minutes, they didn't even put the iv in they litsened to baby she was doing great no decels, it wasnt a tranport for emergency i was because mom was getting tired, they forced a c-section on my client, i stayed with her mother in law and sister in law outside begging everyone to let the mother in law in so she wouldn't be alone, it was terrible. terrible

December 28, 2010 | Unregistered CommenterEunice Midwife

It was a teaching hospital that did my c-section. They couldn't properly place the spinal OR epidural and I ended up under GA. They also cut my baby's bottom as she was born (she was breech). Never again will I let people "learn" on me during a birth.

March 19, 2011 | Unregistered CommenterSusan

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