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Entries in natural birth in the hospital (2)

Tuesday
Nov222011

Guest Post: Max's Birth Story

A dear NetFriend sent me her amazing hospital natural birth story and since she doesn't have a blog and I do, I get to share it with everyone here. Lucky us!

Slightly edited for clarity (with permission) and names and initials have been changed for anonymity.

"Oh, He Doesn't Do That"

As is the case with so many birth stories, the events that defined Max’s story were set in motion months before his actual birth day. Max was my 9th baby. My eighth pregnancy had been awful. Hyperemesis Gravidarum requiring a PICC line, Zofran pump and home health care. A week-long stay in Telemetry, Gestational Hypertension and a week-long NICU stay. When all was said and done, I ended up with a healthy child but it was a long, miserable, emotionally and physically difficult pregnancy and recovery. One of my greatest supports had been my OB. Through it all, he was there. He was actively engaged the whole pregnancy, always listening, always advocating, always caring. So obviously, the first thing I did when I got the second line in Oct 2009 was call his office for an ASAP appointment.

“Hello, I need a new OB appt with Dr. M.”

“I’m sorry, he’s deployed. Can I make you an appointment with another one of our physicians?”

“DEPLOYED! WHAT? He can’t be!! I need him!”

I immediately felt awful. Here was my doc, deployed to Iraq and I was being all selfish and worried about myself. I felt even worse when I found out later that his son was also deployed. His poor wife!

I asked for an appointment with one of his partners, a woman who is lauded as the grand dame of natural childbirth in our area. She used to do home births, will go to extremes to avoid C-sections. Doulas and patients love her. I didn’t. It was apparent by 10 weeks that we weren’t going to be able to work together. I saw her long enough to get prescriptions to manage the nausea and vomiting, which thankfully wasn’t Hyperemesis this time around, and then went looking for another provider.

I went to interview the one group of hospital-based CNM’s in our area. I was hoping I would like them, and I did. Unfortunately, they didn’t like my history. After the three of them discussed it, they decided that I was too high risk and out of their scope of practice. I was devastated. I was so looking forward to midwifery care again. They referred me to an OB in their practice.

“He’s a great guy. You’ll love him.” I was told. At this point I was 16 weeks and just wanted to get a care provider and move on. I felt totally defeated. Whatever, fine, I’ll make an appt. I diddled around on the Internet and found a few reviews of him, they were glowing but there didn’t seem to be a lot of ‘noise’ about him. Not like the woman OB I had left behind. Her name is everywhere.

I started seeing Dr. K for what ended up being a very vanilla pregnancy. He was a great guy and we did get along very well. We talked a lot about my kids, his grandkids, politics, etc. After all, this wasn’t my first rodeo; I didn’t have a lot of questions and didn’t need a whole lot of patient education. Sometimes we talked ‘shop’. Me, being a woman who has immersed herself, literally, as a mother of 9 and figuratively, as a doula, childbirth educator and parenting educator in birth for almost 18 years and him as an OB. The NIH VBAC Conference occurred during that pregnancy and we talked about that and quite frequently about other birth issues.

I never sat down with him and listed what I wanted/didn’t want/believed in/liked etc. We never did a birth plan. We just chatted. He would leave me with little gems like, “A lot of my colleagues practice fear-based medicine, not evidence-based medicine.” And, “I just try and respect the mother.” And, “You know what you are doing. You listen to your body. I listen to you.” This let me know that for the most part we were on the same page.

Not surprisingly, my blood pressure started creeping up in the late second trimester. Nothing scary, just worth watching and it quietly crept up and up week after week. I reached 38 weeks and started getting nervous. I had endured one pre-eclampsia labor with magnesium sulfate and really, really didn’t want to do it again. With that baby I had gone from fine to extremely sick over a weekend. I knew how fast I could go downhill. Dr K wasn’t concerned but respected the fact that I was. At my request, he checked my cervix and I was 2-3/80%/0 station. He agreed to induce me that Friday which would be 38w5d. It took some finagling but I was ready.

Friday morning I showed up at the hospital. He hadn’t booked me in; I was supposed to come in and tell them my blood pressure (BP) was up and get a preeclampsia work up and then he’d just decide to keep me and have the baby.

Well, my admitting BP was 160 (something) over 90 (something) and didn’t come down much with rest. Oh, and I do not have white coat hypertension. The whole pregnancy my BP had been lower at office visits than at home. Think the 8 kids at home could have had anything to do with that? The bogus preeclampsia workup became a necessary one. I think Dr. K was a little surprised to be honest. My blood work and urine was fine, so no Magnesium Sulfate but I was definitely having this baby.

I was admitted, installed in a labor and delivery room and my GBS antibiotics started. During the initial admission questions I told them I was allergic to iodine so make sure he doesn’t use a betadine perineal wash. I was told, “Oh, you have Dr. K, he doesn’t do perineal washes.”

Dh (Dear Husband) and I just hung out and watched a little TV, talked and walked the halls for a few hours. They wanted two full doses of the antibiotics in before (they did) Artificial Rupture of Membranes; we had at least a solid 4 hours of waiting. We got to the hospital at 9am; they didn’t start the antibiotics until noon. So far it was a long boring day. Finally, at 4:30 the two doses were in and here comes Dr. K to break my water. He breaks it, watches the baby on the monitor for a minute and then says he’ll see me later and leaves. The nurse takes me off the monitor (??) and tells me to go do whatever I want and let her know if I start contracting. I was a little confused.

“Oh, continuous monitoring? He doesn’t do that.”

I was confused, but thrilled. I popped in my ear buds, grabbed my Dh and we start walking. It’s a small hospital and L&D is just a little “L” but I walked and walked. Back and forth. Grooving to my music. I don’t do Enya and waterfalls when I am in labor. I prefer to sing and dance. I was pacing to “Dancing Queen.” Unfortunately it wasn’t really working.

I’d pass the nurses’ station and my nurse would raise her eyebrows questioningly and I’d shake my head. Finally after an hour passed I decided it was time to really get down to business. I was determined to not be up all night and equally determined not to need Pitocin.

I sent Dh to dinner and asked for a birth ball. It was about 5:30pm. I turned on my ‘baby’ music, sentimental country and Michael Bublé-type songs, something to get the emotions going. I sat on the birth ball and did some nipple stimulation. Within 15 minutes I had two good contractions and that was all she wrote. I was in active labor.

I was pacing around the labor room when Dh got back. A, my nurse, put me on the monitor for 15 minutes, which showed a happy baby and active pattern and then I was off again.  For a little while I walked the halls, this time much slower, stopping to put my head on the wall and sway my hips during contractions. The nurses would give me thumbs up as I went by. It wasn’t long though before I knew I was done being out where people could watch me and I retreated to my room. I was starting to get vocal during contractions. During one good one as I stood next to the bed in a shallow squat, I growled through the contraction, A turns to me and says “Really cooking now, huh?” …smiles and keeps charting. That was the extent of her interference in my labor dance. Sometime during this Dr. K was called to tell I was in active labor. He came, watched me for a minute, asked if he could check me, I was a 6 and he said, “Great! Call me when it is time to have a baby!” 

The biggest disruption in my labor was shift change. I had had one nurse since I walked in the door at 9am and now, when things were getting pretty intense they changed. BOO! Luckily, I was blessed with another great nurse, D. I was back on the monitors for a few minutes. After a couple contractions I told D, “I need to get up and off the monitors!” She asked, “Just a few more minutes?” and I said “NO.” She said, “OK” and I’m off the monitors, never to be on them again. I mention to her that I don’t use leg rests and prefer to support my own legs etc. She said “Oh, Dr. K? He doesn’t like the bed broken down.” I also mention that I’d like the lights on low. “Oh, he doesn’t use the spotlight.” I am now very active and starting my litany of “I want to be done. I’m done. I don’t want to do this anymore. Can I just be done?” which I know means baby is coming soon but I always seem to forget that when I am in the thick of it.

I don’t stay in the same position for more than one contraction. I am most comfortable (as comfortable as one can be minutes before birth) standing next to the bed. I started to push during the peak of contractions and it was obvious baby was coming soon. D looked at me and asked, “Time to get Dr. K?” and I told her yes, it’s time, baby is coming soon. We had 15-30 minutes based on prior births. She calmly left to go get the doc. It’s just me and my husband and we’re both very quiet and concentrating. I have another contraction standing next to the bed and let loose with the classic, “uuuuuuuUUUUUNNNNGGGGGGHHHhhhhhhh!” The door burst open and in bustled a different nurse with her eyes wide and scared looking and snapping on gloves. “I HAVE TO CHECK YOU!!!” By this time the contraction is over, I’m out of labor land and look at her and say, “No you don’t. I’m fine. D went to get Dr. K.” “But I do!! I have to check you!” “No you don’t,” and this went on for a couple minutes until D walks into the room. “B, what are you doing in here?” “She sounded like she was pushing!!” “I know, I told you I was getting Dr. K, everything is fine!” and she bustled the hysterical nurse out the door. Dr K comes in a few minutes later with a smile, watches a contraction, says something quietly about it being almost time and then he just kind of stands off to the side. I’m still flipping all over the place, hands and knees, over the back of the bed, squatting. I request the squat bar and Dr. K tells some random nurse, “Get her the squat bar!” At this I look up through my ponytail hanging in my face. He is standing there, not gowned and masked, not wearing the HazMat suit all the other doctors do. He is wearing his scrubs, as always, and a pair of gloves, standing with his hands clasped, his hip kicked out and his glasses on his nose. Just watching.

Finally, I end up kind of perched on my left hip, with my arms wrapped around my husband’s waist and my face buried in his stomach and, “Here he comes!!” Dr. K continues to just stand there. My husband leans over and says, “When she says that, she means it.” Because my litany of labor whining has never stopped and the “Here he comes!” came out in the middle of “I can’t do this.” And “Am I done yet?” Dr. K springs into action!! Which for him means he twitches his finger at the nurse to push the delivery table closer and he walks over to the side of the bed the baby was going to land on. He bends over, tells me, “The baby is right. here.” With the next contraction I give my first real push and the head is out. Being the busy body I am, I direct Dr. K to “Get the shoulder, get the shoulder!” and I feel a hand gently push my knee back just a bit more, then I feel one shoulder go, then the other and then my little boy sliding quickly out. There he is!! Dr. K looks at him for a couple seconds and immediately gives him to me. The nurses throw a couple of warmed blankets over us and everything is quite calm. Max is extremely alert, breathing beautifully and absolutely covered in vernix. We had to wipe some off his eyes just so he could open them.

Dh and I wonder over our little guy. Dr. K monitors the cord, the unclamped cord and B (the hysterical nurse) listens to Max’s heart/lungs while he hangs out on me. After a few minutes, Max starts squeaking a bit and B starts rubbing him and saying “Good baby, give us a cry.” Dr K. pipes up, “Leave him be. He’s pink, breathing, his cord is still pulsing. He doesn’t need to cry.”

You have to understand that Dr. K has a very quiet calm voice but you would have thought he yelled at her. She backed off completely, like back to the baby warmer. Max started nursing, the cord stopped pulsing, the placenta came. It was all good. My perineum was intact, but I was bleeding. Too much. B was back listening to Max and when she looked down at Dr. K and D working on my lower half her eyes got all big again. That woman needs to learn to control her facial expressions. I knew I was hemorrhaging, it’s par for the course for me. I had told D that she should have Pit hung and ready and she had listened so there was already a bag of Pit ready to go. They hooked it up and opened it up wide and were doing all the usual things. I may have received other meds too, I don’t recall, I was pretty wrapped up in my baby. The bleeding slowed to acceptable levels although I would end up anemic and it would take me weeks to catch up. Max was over an hour old when they asked if they could take him to the warmer, examine and weigh him. A little while later we went to the Postpartum floor and had a nice uneventful postpartum stay.

It was a lovely birth. I never felt that I was being “managed” or controlled. Despite my laundry list of risk factors I was never treated like a ticking time bomb which has often been the vibe in previous births. The memory of it really helped carry me through the following week when Max was admitted to the Children’s Hospital for what turned out to be viral meningitis that he caught from a couple of his siblings. In big kids it was a fever and headache that was easily controlled with a dose of Motrin and going to bed early one night. In a 4-day old it ended in a three day hospital stay on a monitored unit.

#10 is on his/her way. I pray we get a similar experience and outcome in April 2012. I know that with Dr. K in my corner I at least have a fighting chance.

Monday
Feb142011

Thoughts on "One Born Every Minute"

You can’t Google about natural birth the last couple of weeks without coming up against half a dozen posts or articles critiquing the new show on Lifetime, One Born Every Minute. One of the most vocal was Gina, The Feminist Breeder, who wrote “Lifetime Shows Us There’s One (Unnecessary Intervention) Born Every Minute.” Gina says,

"So I couldn’t help myself.  I took notes the entire way through this train wreck and yelled at the television every 60 seconds.  Here is what I saw, and here (in blue block quotes) is what I yelled at my TV."

Kristen, from Birthing Beautiful Ideas (a blog I’ve never seen before… how have I missed this?) writes in her post Dear Lifetime: It’s not Weird, it’s Normal,

“… I worry about pregnant women and their partners watching “One Born Every Minute.”  And it’s not because I think the show is going to make them want to run out and ask for every birth intervention in the world as if they’re candy.  Rather, I worry that the show will create or even reinforce in women’s minds a pretty bogus distinction between  “What’s Normal and What’s FREAKY-DEAKY-WEIRD-AND-ABNORMAL During Labor.”

I’d considered not watching the series, but since I’ve recently hung up my homebirth midwife hat and picked up my full-time monitrice-doula hat, I thought, “What the heck… how different could it be from what I already know to be true in hospitals?”

Last Tuesday night, I watched both the first segment, “To Medicate or Not,” (the one that had the natural birth couple in it) and the second installment, “Expect the Unexpected”; Sarah left the room. (You can see the full segments in those links.)

It turns out I was right; the shows weren’t all that different from my own personal hospital experiences… as a doula or as a midwife who’s transferred/transported women to them.

I didn’t sit screaming at the TV. I didn’t get high blood pressure from enormous amounts of frustration. Sure, I rolled my eyes a few times (some things said and done were absurd… more below), but, hard as it is to say, I stand behind the “You Buy the Hospital Ticket, You Go for the Hospital Ride” belief I’ve had for years. I don’t know if 28 years in hospitals has numbed me (I don’t believe it has at all) or if my idealistic belief that I Can Change The System has been flushed down the toilet, but I have pretty much given up any hope of seeing massive institutional changes in that area of the birth world.

When I first started, I thought things were so awful –the induction rate, the cesarean rate, etc.- that they couldn’t possibly get any worse. And look! Not only has it gotten worse, it’s gotten horribly worse. I’ve come to the realization that, until we have a 100% scheduled cesarean rate, it can always get worse. Of course I pray for a miraculous change in The System, but I’m just not going to hold my breath anymore.

 So the TV show. I tried to watch it from two viewpoints… one, from a mom who knows nothing about birth and two, from a sociological point of view. Marrying the two, I definitely winced thinking of the messages being conveyed throughout the episodes.

The first was how Blessed (gloriously, exaltedly Blessed) an epidural is. I would swear someone (or many someones) in the epidural industry is paying for product placement in shows like this. I almost sat and counted the number of times “epidural” was said, but decided it was pointless; we all know how many times an epidural is brought up in labor already. And giant pet peeve of mine: “Her epidural,” “My epidural.” Ugh. How did this procedure acquire possessives? Counter that with a cesarean. Rarely do I hear women say, “My cesarean.” It’s usually I had a cesarean.” Are women claiming ownership to the epidural because they can remain more “civilized”… more themselves? Versus a cesarean that very nearly transforms the woman’s perception of herself or, at least, her body? A great topic for someone who studies these things.

Women on the show were so passive. Their bodies doing things they had no knowledge of until someone (or some machine) told them something was happening. “Oh! I’m complete?” I know this is a duh kind of obvious to those of us who know natural/normal birth, but the message is ghastly to those that don’t know any better. It was so funny (not haha), the woman who was on the birth ball, in the shower… she looked so out of place! The same way a woman in a homebirth who did nothing but lie on her back in bed would. Isn’t that just sad?

It’s true, the show capitalized on the friction between Nurse Pam and the natural birth mama, but even in the second installment when there was no natural birth juxtaposition, we could see who the nurses smiled with, who they joked with and who they were the kindest toward: the women who didn’t cause any extra work for them. If a woman needed her belts adjusted because she moved or even if she had “annoying” family members, you could almost hear the heavy sighs as they had to go out of their way to do the task or speak to the family member. Never mind these things are part of their job; if they took an extra two seconds, it seemed an extreme bother.

This is one of the main things I feel I can offer my clients (slight segue), that I work well with hospital staff, helping wherever I can, helping the nurses not have to do things like moving the belts or changing chux or whatever. I’ve spent many a-labor holding the monitor on a swaying, moving mom. This delights the nurse who really doesn’t care if mom’s mobile and rocking, as long as the baby can be seen. I think this was where the natural birth mom’s doula could have helped a lot, by holding the belt on the laboring woman’s belly when she was on hands and knees. If the woman is anywhere near the monitor… on the ball, standing, rocking, etc… why not have her on the monitor so you can get her off without any issue when you want to later? Making the nurse happy AS the woman gets her needs (wishes) met creates a much more pleasant atmosphere and the client has better post-birth memories.

I had a transfer not so long ago and one nurse was initially guarded with me, but warmed up quickly. During the labor and birth, I was encouraged to take a more active physical and even clinical role than I know would have happened if I’d have been Guard Midwife. The birth became a wonderful, empowering moment for my client… her wishes honored and honored respectfully and happily… not just because she was compliant (she refused more than one recommendation), but because everyone was clearly listening to and hearing each other. As I was leaving, the nurse thanked me for all my help and told me it was refreshing to see a homebirth midwife not be combative, that most of the other ones she’d seen have been “bitches.” (Her word, not mine.) I left vowing to repeat this positive experience, that I would work hard not to have my midwife-monitrice-doula interactions be contentious and, somehow, find a way to also help others have a more harmonic hospital birth experience without sacrificing autonomy and self-respect.

I would be remiss if I didn’t mention two incredibly huge gaffes and one smaller one that one of the nurses made. First, when a baby’s heart rate was going down and mom was worried, Nurse Linda, a tiny, older nurse (second segment) told her the baby was just getting used to her lower blood pressure… that she’d had high blood pressure and now it’s normal, so the baby has to adjust. I can only assume this was right after an epidural was placed (can’t tell from watching), but what a stupid way to explain what was happening. The baby’s “getting used to a normal blood pressure?” Geez.

The second thing this same nurse said that nearly had me falling out of my chair in disbelief was when a mom was pushing, had been pushing for what seemed to be about two hours at that point, and as the tiny nurse was showing a family member how the head came down and receded with each push –while the baby was still inside - she casually says, “Oh, that’s turtling.” Uh, no it isn’t. Turtling is when the head is born and then is pulled back up, mooshing back against the perineum. Said more clinically:

“Once the shoulders impact at the pelvis inlet, the fetal head which has already left the pelvis, often recoils tightly against the maternal perineum. This is termed the ‘Turtle sign’…”

photo by Kristina Kruzan

The woman did, later, have a shoulder dystocia, but the turtling had not happened yet. I wonder what the other nurses –and the tiny nurse’s supervisor- had to say about her clinically incorrect remarks.

The third was when a mom was on hands and knees and her sister made a snickery comment about her being “doggie style” and Nurse Linda pipes up, “We prefer to call that knee-chest.” Excuse me? No “we” don’t; we call it hands and knees.

I acknowledge I’m not like a lot of Natural Birth Advocates (NBAs) who refuse to watch these types of shows. Besides watching as an informal continuing education, they are what many pregnant women watch and I like to be able to answer questions regarding what they’ve seen on them. Bloggers and commenters have begged for a realistic (not reality!) show about homebirth, but honestly? I don’t think it’s dramatic enough to show. And don’t we like it that way?