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Friday
Jun022006

Martha

On Martha Stewart today, is a re-run of a Baby Show where the entire audience is pregnant. Standing by, in case of emergency (?), is an obstetrician (also pregnant) and two male EMTs. What the heck does she think the EMTs can do?!?

While I adore EMS personnel, I have also seen horrible things happen through their hands.

One birth was when the unborn baby's heart tones plummeted and wouldn't rise no matter what position we did - until a hand was put in her vagina and the head lifted up. Prolapsed cord? An occult cord? The midwife couldn't feel anything, but the difference couldn't be ignored.

A family member called 911 and when EMS got there, we explained we thought there was a prolapsed cord somewhere and the midwife needed to go with the mom in the ambulance. The began yelling at the midwife to get out of the way so they could do their jobs. Eventually, the threat of the police and the delay in arguing moved the midwife as the mom was put on a gurney and wheeled to the ambulance. The ambulance just sat there, apparently deciding where to take the mom. (I learned wayyyyyyy later that the ambulance doesn't make that decision, but dispatch does.) I can still see the midwife pacing the front yard, waving her arms wildly and telling the guys to GET her OUT of HERE!

The baby came vaginally and needed a little help getting started - not much - and there was, indeed, a long nuchal cord.

Another birth, the baby was very large and needed a great deal of help getting started. EMS came out once, but we sent them away because things seemed to have resolved. When the baby began showing signs of hypoglycemia (seriously lethargic, shaking, sweating), we called EMS again and this time, the baby - who was beginning to have respiratory distress - needed to go immediately.

The paramedics insisted on putting the baby in a car seat. IN A FUCKING CAR SEAT! A baby in respiratory distress! We should have just taken the baby to the hospital ourselves - it was less than a 3 minute ambulance ride (6 minutes in a car) away.

The car seat was strapped onto the gurney and the paramedics stood yacking with the firefighters as the midwife, again gesticulating wildly, explained the baby needed to go NOW.

I went ahead to meet them at the hospital and got there before them! When they rolled in (no lights or sirens), the baby was taken out of the car seat in full respiratory distress and needed to be bagged for too many minutes as the ER personnel (this was a Children's Hospital) asked over and over what the heck the kid was doing in a car seat! No seemed to have an answer. I was screaming, "because they are idiots!" in my head.

This baby, besides the hypoglycemia also had GBS infection. She was closer to 12 pounds than to 11 pounds. She was hospitalized for a couple of weeks - a giant amongst the Lilliputians of the NICU.

I have also seen wonderful, respectful EMS folks. Once we did the in-services and they figured out we were legal and had the client's/patient's best interest at heart - and once we learned how not to struggle with the power (they are superior in the heirarchy of care) - things improved immensely. Speaking calmly, respectfully, and giving explicit information, even when it is asked for 20 times, makes for a much easier transition for the birthing family.

We had a mom faint after losing (quite) a bit of blood and when EMS got there, they were very good about tending to her, making sure the baby was good before scooping mom up and taking her to the hospital. One of the paramedics whispered to the other midwife and I that his daughter had homebirths and he vanished before being able to ask where she lived. It was nice to have someone "in the know" there to temper the ignorant (and I don't mean that all negatively) ideas people have about homebirth and midwives.

The birth centers had the best EMS transports. Was that because they were on the normal route and we got to know the individual guys (rarely were there gals) who came through there? Was it because we brought that station brownies and cookies all the time? Was it because they got to watch deliveries in the center (because things resolved or the birth began before they got there)?

Two opinions demonstrate the polar opposites of an EMS' attitude.

1. "Please deliver the baby! The last thing I want to do is deliver the baby. You are welcome in my wagon anytime."

(in the very same meeting, said directly after the last statement)

2. "I wouldn't want you anywhere near my wagon. You would never be allowed inside unless you were the patient."

And there you have it.

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