(This is in response to Medscape's article, "Homebirth Gone Awry: Is This Typical?" [the post before this one]. Writing was the only way I could answer the absurd accusations in that ridiculous article.)
Barbara E. Herrera, LM, CPM
Being a homebirth midwife who sees women throughout their pregnancies, births and on into postpartum, I am familiar with the way these experiences and how they affect women and their families.
So, when I was asked to assist a woman choosing obstetric care with a doctor and, once labor began, to deliver in the hospital, I never knew what lay ahead.
Starting at the beginning of her care, Myrtle’s (not her real name and the details are slightly altered to protect her privacy) vitals were taken by a nurse and she only saw her doctor for five to seven minutes at each visit, although for her initial appointment, she saw him for ten. And, at that first appointment, she met the doctor naked! Myrtle was covered by a paper drape, but, not having met this man before, she felt vulnerable and very uncomfortable. After that visit, she was sent to the lab for blood work and was called two weeks later telling her she was extremely anemic and needed to take prescription iron supplements. She learned through reading on the Internet that her constipation was from the supplements and waited for five days for the nurse to call her back to tell her what she could do to help with the problem.
At visit number one, Myrtle was told she had to have chorionic villi sampling and was scheduled for the next day. She was not told the risks of miscarriage after CVS, but was excited to know if the baby had any birth defects. When she presented the next day, she first had an extensive ultrasound (unexpectedly!) and then had the procedure which caused her discomfort and, again, she had to disrobe for a stranger. When the results came back normal, she breathed a sigh of relief.
But when she was sixteen weeks, Myrtle had her blood drawn again (by another stranger; this time, a lab technician) for the Quad Screen, a screen to determine a woman’s risk of delivering a baby with either Down Syndrome or neural tube defects. When she told the nurse at her prenatal appointment she’d had CVS, the nurse couldn’t find that information in her chart and told her to go to the lab appointment anyway. The Quad Screen came back showing her risk of having a baby with neural tube defects was 1:25 and she was scheduled for the diagnostic testing, both a Level 3 ultrasound and an amniocentesis. At the prenatal appointment when she learned she would need further testing, she told both the nurse and the doctor she just met that she’d had CVS and it came back normal, they both said it was important to have the test, so she followed the orders and had both the ultrasound and amniocentesis.
The ultrasound showed problems with the kidney and heart, but did show there was no problem with the baby’s spine – so far, they said. Myrtle worried every day that her baby was severely deformed and she and her husband debated keeping the baby or terminating the pregnancy. Waiting for the amniocentesis results was excruciating, both physically and emotionally. The procedure caused internal bleeding and she was put on bed rest for the two weeks she had to wait for the results. She lost time at work and, therefore, income for her already strapped family. The results were normal for Down Syndrome and neural tube defects, but she still had the heart and kidney problems to contend with.
At 28 weeks, Myrtle was sent to the lab after her appointment (where she met another doctor in the practice) to do the Glucose Screen, checking for Gestational Diabetes. When she drank the 50 grams of glucose, she became extremely dizzy, fainting in the bathroom where she was found 45 minutes after she drank the glucola. Taken to the emergency room in an ambulance, she was given a lengthy ultrasound and an MRI to check the baby and her brain, had an IV put in and remained overnight to make sure she did not have a concussion. While she was in the hospital, she had to drink the glucola yet again, felt extremely dizzy and nauseated, but was told if she threw up she would have to drink it again, so she forced the liquid to stay down. She felt horrible for two days afterwards. No one had asked her how her diet was before sending her to the screen, did not talk about any alternatives to the glucose drink, but did tell her if the screen was positive, she would have to drink twice that amount and have her blood drawn four times. Terrified while she waited, she did not hear that her results were normal until her next prenatal appointment two weeks later.
At Myrtle’s 34-week appointment, she saw yet another doctor and he measured her fundal height two centimeters larger than her dates, so was sent for an ultrasound. The amniotic fluid volume was slightly elevated, so was scheduled to have an ultrasound each week to watch the problem. At this sono appointment, the baby still had the heart and kidney problems; she was told the baby might need surgery after the birth and to be prepared to have a scheduled cesarean if the baby was still showing dangerous signs near birth. The OB explained that sometimes when the baby has defects, there is more amniotic fluid; she was sick to her stomach with worry every waking moment, having to leave work on early disability because she could not focus and do her job.
Myrtle saw the doctor she’d chosen originally at her 36-week prenatal visit and even though he measured her fundal height as size equal to dates, he said it wouldn’t be a bad idea to keep going to the sono appointments, becoming Biophysical Profiles after 38 weeks. The technician who strapped her in never shared information about the testing she was doing, causing her to wait in agony for someone to call. Often, she called the office herself to see how the baby was doing.
When Myrtle was 39 weeks, the OB she saw told her she had to be induced in one week if she didn’t go into labor before then. The female OB said, “We’ll just put a little pill inside and you’ll have your baby that day!” Myrtle was excited and scared all at once. She was going to have her baby! But what if he needed surgery.
A week later, she entered the hospital at 5:30am but had to wait until 11:00am to be checked in and get a bed. She changed into a hospital gown, naked underneath, was strapped to the fetal heart monitor, had an IV inserted, and then the nurse (who she had just met 25 minutes earlier) did a vaginal exam. Myrtle was told she was “long, closed and posterior.” What did that mean? she asked. The nurse told her it didn’t matter and left the room.
The nurse came back an hour later with the little pill (Cytotec), did another vaginal exam and pushed the pill onto Myrtle’s cervix. Within the hour, she was writhing in pain and the nurse asked her if she was “ready for her epidural”; she said she was, but the anesthesiologist had two cesareans to do first. He arrived two and a half hours later. Myrtle was in excruciating pain, but the nurse kept telling her, “This isn’t anything yet! Wait until you are really in labor.”
The external monitor showed the contractions were barely peaking above early labor contractions, but because Myrtle was screaming so much (still waiting for the anesthesiologist), the decision was to begin pitocin instead of inserting another pill. She kept saying the contractions were one on top of the other, but because the monitor said they were erratic and mild, the nurse ignored the request to hurry and get the anesthesiologist. Repeatedly, she was told he was busy and she would have to wait.
When the doctor finally arrived, he tried to get the catheter into Myrtle’s spine five times before hitting the right spot. He told her she would feel relief in 15 minutes or so and complete relief in 30. She waited and waited, but the pain never abated, the anesthesiologist having to come back and try again. When he was successful with the placement, the epidural only took on half her body; hardly any relief at all.
The nurse told her she was really complaining a lot about the contractions so she felt her fundus and left to go get the doctor. When he came in (a doctor in the practice she had yet to meet), he inserted an internal monitor so the contractions could be read more closely. The monitor showed Myrtle’s contractions as tetanic – extremely hard and extremely long – exactly what she had been saying for two and a half hours. The pitocin was turned off immediately and the doctor told her she was now three centimeters dilated and she had to have her baby by 10:00pm or she would have a cesarean… that women cannot be on pitocin that long.
It didn’t take that long to have the baby because the fetus could not tolerate the tetanic contractions, his heart rate going down into the 90’s. She had an oxygen mask put on and moved to her left side, where she remained until the birth. We watched as the baby’s heart rate went from 70 to 90 before, during and after contractions. No one seemed alarmed. The OB had just stepped into a cesarean, but said he would check back when he was done in 45 minutes or so. All she could do was wait.
The nurse started bringing more paperwork for Myrtle to sign, telling her it was “just in case” she had a cesarean. Worried, she asked if that was what was happening and the nurse told her, “Not yet.”
The baby’s heart rate never got above 100 and when the doctor came back an hour later, he said it was time to “get the baby out of there.” I was told to leave, but Myrtle told me what happened next. She was wheeled down a hallway and told it was an emergency to get the baby out. Because her epidural only worked halfway, she was going to have general anesthesia and wouldn’t be awake to see her baby. Her husband also wouldn’t be allowed in the operating room. She said she cried and the nurse told her to stop it, she had to get control of herself or the anesthesia could go the wrong way and cause problems.
Once Myrtle was in the operating room, she had another mask put over her face and went to sleep. When she awoke, she was very groggy and didn’t know where she was. A nurse injected something in the IV she had in her hand and she went to sleep again. By the time someone told her she had had her baby, he was already eight hours old. One of the medications she was given during the surgery caused an allergic reaction – a medication she’d repeatedly told the nurses and doctors she was allergic to – so she was sedated and intubated until the reaction wore off.
Her son was 15 hours old before she saw him. He was in the NICU being tested, checking his heart and kidneys because of the prenatal testing’s findings. He was hooked up to several monitors, had an IV in his head and Myrtle wasn’t permitted to hold him until the testing was complete. She was told she might upset him and that would make testing harder for them to do. 30 hours after the birth, all the test results showed there was nothing wrong with his organs and Myrtle was finally permitted to breastfeed her baby. He’d already gotten bottles for more than a day, so her attempts failed and she cried because she’d wanted to nurse so badly. The nurse in the Nursery told her it was easier to bottle feed anyway, that her baby would sleep more and “not bug her at night.”
Myrtle left the hospital six days after her cesarean, taking with her a staph infection that required cleaning and packing for three months and a colicky baby who, she later learned, was allergic to most formulas. She was in pain for a year and didn’t have sex for 14 months because of her fear of getting pregnant again. She seriously considered tying her tubes.
This story haunted me for years. How could the doctor miss a normal pregnancy, labor, birth and postpartum period? How could he pathologize such a normal part of a woman’s life? How could so many things be missed, incorrectly diagnosed, over-diagnosed and, dare I say, negligent? Is there anything we can do to help women see the path where medical care leads? How do those of us who work with natural birth every day tolerate such things? Is there an avenue of discussion where we can process our experiences together?
Do we even want to?