Monday, May 23, 2011

What do you say?

What do you say when a woman comes to you, tells you the story of her traumatic birth experience that ends with her feeling that her body caused the traumatic chain of events, when you know that it was in fact her care provider's lack of evidence based practice that caused the trauma?

Scenario: First time mom feels the pangs of labor and heads into the hospital. She is nervous and excited when she finds out that she is 4cm dilated and will be admitted. She is anxious to meet her very first child, but nervous as she has no idea what to expect. She walks the halls endlessly, hoping that it will not be long. She goes to bed in hopes of some sleep before she begins her life involving sleepless nights. She wakes to the nurses explaining that a Pitocin drip will be started because her body simply hasn't progressed as much as they would like it to. She is not given any of the risks or side effects - nothing to worry about. Pit units increase hourly, her body still isn't responding as quickly as the doctor would like. Never encouraged to get up and walk around, move, sway, dance. Only stay in bed with monitors watching and listening. Within hours of starting the pit, the doctor comes in and explains that breaking the bag of waters will speed things along. She is excited at the idea, and allows it. She is not explained any of the risks. Immediately contractions are unbearable. She begs for anything to help. She is turned down for an epidural due to a back injury. She is offered a narcotic to help ease the pain, never explaining what it might do to her, or what side effects it may have. She gladly accepts, hoping for a reprieve from the horrible pain.

Finally - she begins to feel the urge to push. However with this urge comes instruction from the nurses, NOT to push. The doctor wasn't there yet. She needed to push. She couldn't help but push. She vaguely hears the heartrate monitor slow down. Rushing sounds around the room. Rushing, hushed tones. She looks up and there are so many people, looking at her. She is told that her baby is not responding well to labor, and that she needs to get onto her hands and knees to see if it helps. It doesn't. Baby's heartrate continues to slow, and takes a longer time coming back up. She is told to quickly flip onto her left side and begin pushing. Baby's heartrate slows. She is told that she has 5 minutes to get her baby out, or else it will be an emergency cesarean. She is terrified, and pushes with all of her might. They cut her, while pulling out a vacuum. No risks or side effects are explained. They simply say that they need to get the baby out. Now. Push now!

She pushes with all of her might, bursting blood vessels in her eyes. They use the vacuum on her baby's head, pulling. Pulling. Finally, woosh. Baby emerges. She only gets a short glimpse of her baby on her chest as they are rubbing her down violently. No gentle meeting, no emotional first look. They take her baby away to clean, weigh, and measure her. "No wonder she was stuck! She is over 9 pounds!", they say. They take 30 minutes to sew her up from the cut and then extended tear from the vacuum. No explanations are given still. When she finally receives the baby into her arms, she is wrapped up tight like a burrito.

Her recovery is full of pain and tears, as the pain from the wound on her perineum is excruciating and makes it difficult to sleep, to nurse or enjoy her baby. People told her how "lucky" she had been to avoid a cesarean, and how the birth she had was necessary because of how big her baby was. That thank goodness the baby didn't die from getting stuck, being over nine pounds. People nodded their heads in agreement when she told them that she would have a cesarean with the next baby, to avoid the trauma she endured the first time.

It isn't for another 3 1/2 years that she learns that her experience didn't have to be that way. It wasn't until after she had decided to have an elective cesarean with her son which resulted in a 9 day NICU stay due to severe respiratory distress. After the neonatologist pulled her into the "family waiting room" while her son was being fully intubated and explained that this was "a common side effect" of elective cesareans in particular, but also cesareans in general. She was never told any of the risks of a cesarean by the OB who was telling her the risks of a vaginal delivery with another large baby.

She wasn't told until nearly 3 1/2 years and a permanent scar later that Pitocin is a drug WELL known for causing fetal distress, and even death. She wasn't ever encouraged to get up and move around, to work *with* her body, instead of accepting drugs that put her baby in unnecessary risk. It wasn't until she birthed her 10lb 10oz baby girl onto her bed at home, that she knew her body was more than capable of birthing a large baby....without drugs, without intervention.

But her story is pretty easy to identify what went wrong, if you know enough about the physiology of childbirth and how the common drugs used can affect things. Some other stories are more involved, and women genuinely believe that their body was to blame. The sad part is - 98% of the stories that I hear of that involve major fetal distress and a cesarean involve an induction or augmentation with pitocin. And what is heartbreaking is that almost ALL of them shouldn't ever have been induced or augmented to begin with. They were given scary scenarios in which baby would be greatly harmed or even die if they didn't induce or move labor along faster.

They were lied to.

And no, I don't think that all doctors are evil. I genuinely believe that some of them have just lost touch with evidence-based medicine, and don't know what they're doing. But it doesn't remove responsibility from them. Some are too wrapped up in having too many clients, wanting to get them in and get them out. They are the ones responsible for causing a baby to go into distress - not the mother's body. Not the baby. The doctor, quite scarily, prescribes a drug well known for its damaging effects and then swoops in to save mom and baby from the very thing s/he put into motion in the first place.

Women and babies are paying for this. And what's worse is - there are so many women who will willingly sign up for a surgical delivery (and the many, many risks that come with it) for their next baby because they are terrified of repeating the situation from their first birth. What do you say? Do you cry out that they could have had a much different story to tell? Do you tell them that their doctor was completely misinformed, or outright lied to them?

Will they listen? Will they listen to save the next baby, or cling to their story to save themselves from any responsibility or feelings of guilt for the first?

We have to try. Gently, but we have to try. I am willing to risk sounding like a lunatic (even though the information I give is 100% backed by the medical literature that their care provider is supposed to know as well) and possibly bruise some feelings if I think there's even a TINY chance something will spark. My heart nearly literally bleeds for these women. Without having someone to get in *my* face, I never would have gone on to birth my 10lb 10oz baby at home. I would have believed that my body was broken and incapable of birthing the very babies that God allowed me to grow. I would have believed that the intervention that nearly damaged my first child, was necessary.

Sometimes it works. Sometimes they (we) listen. Please don't stay silent. You never know who is listening.


Johanna S said...

This was sad, beautiful and very well said, all at the same time. I have a 3-year-old and we are trying for #2. Labor and delivery with her was very similar to your first experience. Pitosin, epidural, rushed delivery, no vacuum, but painful physical and emotional healing process. I dare say almost traumatic. It felt so chaotic. I have learned so much since then and I am so grateful to women like you who take the time to blog about this so that women like me are more educated and can have a different experience/outcome next time around. I am praying for a healthy pregnancy, healthy baby, and hoping for a home birth! I think I already found the midwives we want to work with and I can't wait to have an excuse to interact with those lovely women more often!

Bonnie said...

I think you gently have to get in their face. Do it through the backdoor if you have too. "how does it make you feel when you get information after the fact, that might have changed your decision making, had you known before the fact".
Assume that they know something they don't know. "Isn't it a drag to find out that most episiotomies are unnecessary, and yet some doctor's cut ALL of their first time mothers without telling them that they do it.".