Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

Don’t Let This Happen To You #24 PART 2 of 2: Jessica & Jason’s Back Door Induction April 21, 2009

Continuation of the “Injustice in Maternity Care” Series

 

Please see, Don’t Let This Happen To You #24 PART 1

 

My first hour with Jessica & Jason was spent getting to know them, tidying up the room, setting it up the way I like it (I know, sometimes I can be a bit anal about clutter!  I don’t know how some nurses can work in so much clutter!!), and turning up the pitocin a couple of times.  Around 4:00pm I had left the room to scrounge around for a few more pillows for Jessica.  This took me about 10 minutes since pillows are pretty much like gold in the hospital: rare to find and very precious to have!!  Haha!  Anyways, as I walked into the room Dr. T was leaning over the trash can throwing something away and Jessica was lying flat on her back in bed, spread eagle, completely uncovered, and sitting in a big puddle.  It took me a few seconds to piece together what had happened.  Turns out Dr. T was throwing away the amniohook he used to BREAK Jessica’s water WITHOUT me being in the room!  I quickly stepped towards the bed to raise her head and cover her up.  The entire bed was soaked.  It was getting harder and harder for me to contain myself and I could feel the blood boiling up into my head. 

 

Me:  “What’s going on?”  (said in the nicest voice I could muster up)

 

Dr. T:  “Oh, are you taking care of Jessica today?”

 

Me:  “Yes.”

 

Dr. T:  “Well, I just got out of the OR and I wanted to check her progress and apparently the residents hadn’t ruptured her yet!  So I just did.”

 

Me: “Oh, well, what nurse came in here with you?  I’d like to thank her.”  (also said in the nicest voice I could muster up but clearly my sarcasm was piercing through all my attempts to stay calm)

 

Dr. T:  “No, it was just me.”

 

Me:  “Oh really, well you should have come and got me.  I would have been more than happy to assist you.  It would have liked to lay some more chux pads down under her so that when you broke her water it wouldn’t cause so much of a flood.  I’m going to have to change all the sheets now, all of them.  And what if the baby had a decel…”

 

Dr. T:  (interrupting me)  “Well I couldn’t find you.”  (turns towards Jessica)  “I’ll come back in a couple of hours to check you.”  (turns to walk out of the room and then spins around and turns towards me)  “Why is her pit only at 8mu?”

 

Me:  “Jessica didn’t even get to the hospital until 1:30 and policy states we can’t start pitocin until the patient is fully admitted.”

 

Dr. T: “Well she’s still only 4cm so you are going to have to keep going up on the pit if she is going to get anywhere.”  (This statement really takes the patient right out of the equation doesn’t it!  Outrageous!)

 

Me:  “What’s the baby’s station?  Is the baby still high?”

 

Dr. T: “Um yes, but the head is now well applied.  She’s 4cm/50%/ -3…..maybe -2.”

 

At this point all I can think of is “Liar, liar, liar!”  Dr. T turned to leave the room and after he left I assisted Jessica out of bed to the bathroom so that I could change all of her sheets and help her into a new dry gown. 

 

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I need to digress for a moment to explain exactly how outrageous it was for Dr. T to check the patient and rupture her membranes without me or any other nurse in the room.

 

#1 Although this might seem like a silly thing to be upset about, the fact that he ruptured her membranes without even putting down a few extra chux pads (which were sitting right on the counter) is very rude in my opinion.  It’s like saying “You clean up my mess because I am above that.”  Honestly it wasn’t that difficult to change the bed over and help the patient into a new gown but it’s the principle of it that bugs me.

 

#2  It is an unwritten rule at my hospital that a nurse is to accompany any doctor or midwife during a vaginal exam.  Even the residents are taught this during orientation.  Is a doctor or midwife fully capable of performing a vaginal exam solo…of course they are!  But it isn’t about that.  It’s mostly about touching base with the nurse first to see how things have been going all shift with the patient.  It’s about good communication and team work.  And sometimes another vaginal exam isn’t necessary and the nurse can advocate against it!!!  I haven’t met one doctor or midwife that attends births at my hospital that has a problem with this arrangement….unless they are trying to do something that they know the nurse will question them on….like performing an early amniotomy on a patient whose baby is still high!!  The fact is that that is the ONLY reason Dr. T didn’t come and get me…because he knew that I, and many other nurses, would question the necessity and safety of such an intervention.  So he had to SNEAK it.  What he did was so SNEAKY and it infuriated me! 

 

#3  The other most important reason to obtain the assistance of the patient’s nurse (or ANY nurse at the desk really) is just in case something bad was to happen.  Although something acutely bad is unlikely to happen from just a vaginal exam, the nurse’s role in assisting with the vaginal exam is to maintain the patient’s comfort and protect the patient’s modesty.  (As you can see, Dr. T did none of those things, and things like that happen a lot with some of the docs I work with.  All of the pregnant readers I know understand how uncomfortable it is to lay flat on your back for any length of time when you are pregnant!)  But there ARE acute risks with performing an amniotomy, especially an early or prelabor amniotomy. 

 

Risks related to amniotomy that have emergent consequences include:

1)     Umbilical cord prolapse

2)     Fetal heart rate decelerations related to umbilical cord compression

3)     Change in presenting part

 

Let me give you an example.  One time I had a doctor that ruptured a patient with polyhydramnios and a high presenting part.  (That means, the baby’s head was not well engaged into the pelvis and was still “floating”.)  After the gush of water flooded the bed, the baby started to have pretty serious heart rate decelerations with every contraction related to compression of the umbilical cord.  When the doctor did a vaginal exam to check her dilation, he found that he was no longer feeling a head, but a HAND.  Since the baby was high and floating in a large amount of fluid and the head was not well engaged when he ruptured her membranes, the first thing to rush out was the baby’s hand.  The doctor was unsuccessful at moving the hand back.  And that woman, a grandmultip (G6P5) who had had FIVE previous spontaneous normal vaginal deliveries ended up with an emergency cesarean section.  And it was VERY IMPORTANT that I was in the room when all of this happened since I was the one who ended up almost single handedly assisting her into knee chest, throwing on some oxygen, and wheeling her down to the OR as the doctor rushed to scrub in.  Yes, emergencies can happen that fast.  (This one however was almost completely avoidable!!)  Please know that I am not telling this story to scare anyone.  But the LESS interventions you have, the significantly LESS chance you have of that kind of emergency happening.  And if a physician or midwife is going to take the chance with any intervention like amniotomy, it is very important that he or she has assistance from a nurse in the room. 

 

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Okay, thanks for letting me rant there for a minute.  Back to the story…

 

So after I helped Jessica clean up I offered to help her out of bed into any position she liked.  After all, it’s important to use gravity to help you and not work against you!  Jessica decided that she wanted to get up into a rocking chair.  I continued to titrate the pitocin to obtain an “adequate” contraction pattern.  Jessica’s body was actually pretty resistant to the pitocin so I ended up eventually getting all the way up to “max pit,” or 20mu/min, around 6:00pm.  Jessica was contracting about every 2 ½ -3 minutes each lasting for about 40-60 seconds.  Jessica complained most about her back pain and so we tried a variety of positions to ease this for her including using the rocking chair, standing at bedside, birthing ball, back rubs, slow dancing etc.  Jason was an excellent birth coach and the two of them really worked well together.  Jessica did not feel comfortable walking in the halls (some women prefer a bit more privacy and I can’t really blame them!) so she did a lot of pacing in the room.  Around 6:45pm, Jessica was getting really tired and asked if she could get back in bed.  We tried a few positions in bed (side lying, kneeling, etc.) but the back pain was too intense. 

 

I wished at that moment we could have gotten her into the Jacuzzi but despite what some other people might tell you, trying to continuously monitor a patient in the Jacuzzi is almost impossible, especially since there are no monitors in the tub room at my hospital so I cannot see or hear what the baby’s heart rate is doing when I am in there manually holding the monitor to her belly so the bubbles don’t knock it off.  This is yet another reason why back door inductions frustrate me.  If she was in true labor and not on pitocin, I could have done intermittent auscultation which is very compatible with using the Jacuzzi.  Some women think they can have it all (for example their induction and the Jacuzzi).  But fact of the matter is that agreeing to an unnecessary induction automatically makes a natural birth plan harder, NOT impossible, but harder. 

 

Turns out the only position that Jessica liked at that time was sitting straight up in bed, leaning forward on the squatting bar, with the foot of the bed lowered so the bed looked like a “chair.”  She was moving and breathing very well in this position with Jason and me as her coaches, and she seemed to start to drift off into “Laborland.”  At 7:00pm Dr. T came into the room and stated he was going to do a vaginal exam to check for progress.  Jessica had started to complain of some intermittent rectal pressure so I had assumed that the baby had moved down some.  Turns out she was 5cm/100% effaced/-1 station!!  “This is great!,” I said to Jessica, “You are doing such a great job!  Not only are you 5cm now but you have thinned all the way out AND you have moved the baby down a lot!!  You are doing so well!!” 

 

Both Jessica and Jason seemed excited about the progress which is great because I was afraid that Dr. T would say something annoying like “Oh bummer, you are only 5 cm.”  But the truth is that in order for your cervix to dilate you have to thin out first and therefore progress in effacement and station are also signs of great progress, not just dilation. “Do you want anything for pain?,” asked Dr. T.  “No, not yet, I want to try to go longer,” she replied.  Jessica spent the next two hours sitting straight up in bed, leaning over the squat bar, with the bed in the “chair” position.  Jason was standing beside her rubbing her lower back while I was helping her to stay focused on her breathing.  She had a couple mini “freak outs” like “I can’t do this anymore!,”  “This is it, I can’t take one more contraction!”  “How much longer is this going to be?!”  What is important to remember is that these “freak outs” are NORMAL and it doesn’t mean you are weak or a wimp.  Far from it!  Labor is one of the most intensely physical experiences of your entire life.  It is comprised of sensations that are unlike any others you have felt before.  And that is why positive encouragement is so important.  I know it is hard to see someone you love in pain but Jessica had said she did not want any pain medication or an epidural at this point so providing her with unconditional support was what was needed.

 

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A quick story…

 

When I used to run cross country in high school we would often have “distance days” were our workout consisted of running a 13-18 mile long run.  We would start right after school and often not get back until it was dusk.  Those runs were grueling especially since we lived in a very hilly town.  I remember thinking or saying things like “I can’t do this anymore!” or “No, just go on without me!”  I remember feeling so many times during those runs like I wanted to “quit” and walk.  But I knew that if I did, it was just going to take me that much longer to get home.  And one of the things that kept me going the most was the support from my teammates.  “Just run until that phone pole” then “just run to that fire hydrant” then “just run to that stop sign.”  I got through it because I took it one small stretch at a time.  When I thought about how much farther I had to go, when I thought about the whole run as a whole, the task at hand seemed overwhelming and insurmountable.  But when I took it “one phone pole at a time” I felt like I could handle it.  There was no other way to get home but to run.  And it hurt.  And the cramps in my sides made it hard to breathe.  And sometimes I would have to lean over into the woods and throw up.  Every bone and muscle ached, from my ears to my toes.  I remember my knees stinging with each footstep.  But there was no other way to get home but to run….  And when I finally crossed onto the track at the high school to run the last stretch I felt like I could do anything.  I did it! 

 

I am not trying to claim that running a long run is exactly like labor.  For one I was only running for a few hours, not hours and hours and hours.  And I knew exactly how much I had left, unlike moms in labor.  And genital pain was not involved at all!  Haha!  But the point is that a great mix of positive encouragement from my teammates, self determination, and the technique of taking it one step at a time was the reason I succeeded.  If my teammates just left me in the dust every time I said “Just go on without me!  I have to walk” then I wouldn’t have been as successful and I wouldn’t have gotten as much out of the run.  So ladies, it’s NORMAL to “freak out” a bit, which is why surrounding yourself with positive, helpful, and supportive coaches (not just “specators”) is so important, ESPECIALLY in a hospital birth.

 

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Jessica labored like this for about two more hours.  She was definitely in Laborland, kinda spacey, like she was in a trance.  At around 9:00pm Jessica said that she was feeling a lot more rectal pressure and wanted an epidural so I went out to the desk to page a resident.  Lucky me Dr. T happened to be sitting at the main desk chatting with another doctor.  I told him that Jessica would like to be checked to see how far along she was because she was considering an epidural.  He came into the room and low and behold, she was 6cm/100% effaced/ 0 station.  Woohoo!  Jessica stated she wanted the epidural so I proceeded to get things set up so that we would be ready when anesthesia came in.  I had already reviewed with her the risks and benefits of an epidural earlier on (when she was more comfortable), so now I just had to explain to her what to expect from the procedure. 

 

After setting up the room I walked out to the desk to see how long it would take anesthesia to see her.  Turns out that anesthesia was tied up in a cesarean section so Jessica would have to wait.  (Unfortunately, even in a hospital that has 24/7 anesthesia like mine, they are not always available for epidurals.  So if this is your only reason for deciding to have your baby at a high-risk hospital, I would make sure you review all of your options.  And if your only labor preparation is deciding you want an epidural, it is imperative that you prepare for the possibility of not getting one!)  When I was at the desk, I checked the orders to make sure Dr. T had written for the epidural.  And that’s when I found his progress note:

 

X/X/XXXX

2115

S: Complains of more pain, wants relief

O: Cervix 6 cm dilated, completely effaced, 0 station

     EFM shows Ctx every 3 min x 60, baseline 140, +accels, Æ decels, moderate variability

A: Active phase labor with unsatisfactory progress

P:  Anesthesia notified for epidural

     Recheck in one hour, if no significant progress, anticipate primary cesarean section for arrest of dilatation

                                                                                              Dr. T

 

 

 

I was floored.  I couldn’t believe he was basically already throwing in the towel for Jessica.  It was her first baby for goodness sakes!  Babies come in their own time!  I mean, she hadn’t even gotten the epidural yet and the pitocin has to be shut off for the epidural so by the time the “hour” was up, it would have been completely unfair to expect her to have made any “progress.”  And what does that mean anyways?  So I called him out on it:

 

Me:  “Dr. T.  You are already throwing in the towel for her!?  Why does the plan even mention a cesarean at this point?!”

 

Dr. T:  “You’re kidding right, she has only changed 2cm in the last 7 hours.”

 

Me:  “Well that’s not really true because I didn’t even get her contractions into an adequate pattern until about 6pm.  And it’s her first baby.”

 

Dr. T:  “Jeeze, you call that progress?!  I can’t be here all night you know…”

 

(YES he really did say that.  This is also the doctor that told me once to tell a multip who was 8cm and feeling pushy to “Not push” because he wanted to finish the ice cream he had just ordered with his wife and kids.  I mean, I’m all for him spending time with his kids but he was ON CALL and this was a third time mom who was feeling RECTAL PRESSURE and was 8 CM!  There is NO telling her “Don’t push!”  It’s called the fetal ejection reflex for goodness sake!  And guess what, not only did he missed the delivery, but he then chewed me and the resident out for it.  I’m not making this up…In fact I can’t make this stuff up!)

 

Me:  (getting pretty upset but trying not to scream at him)  “Are you kidding me!  She wasn’t even in labor when she got here!  If she was, you wouldn’t have started her on pitocin.  She wasn’t even in labor!  You didn’t have to be here at ALL but YOU were the one who sent her in for induction.”

 

Dr. T:  (smirking)  “Induction!  She was 4cm!”

 

Me:  “But she couldn’t feel any of her contractions!  And now you are just going to cut her without at least seeing if the epidural helps?!  This is her first baby!  This delivery has consequences for the rest of her life!”

 

I was afraid I was going to strangle him at this point so I just left the desk to go back into the room.  Anesthesia didn’t show up until 10:30pm and at 11:00 pm Penny, the night nurse, came in to take over.  I stayed until the epidural was finished and tucked her in.  The next day I got the full scoop on what happened from Penny and the patient’s chart.

 

Apparently Jessica got great relief from the epidural and slept like a rock for 2 hours.  Luckily the baby tolerated the epidural well and remained happy on the monitors. Dr. T must have fallen asleep in his call room or gotten distracted because he never came back to check her.  At 1:30am Jessica woke up feeling a lot more rectal pressure.  Penny called the resident to check her and her exam revealed she was fully dilated (HOORAY!!) but that the baby was still at a 0 station.  Since the resident was busy with other patients she agreed, per Penny’s request, to NOT call Dr. T and wake him up but rather to shut off the epidural, allowing it to wear off a bit, and use passive descent to help get the baby down more before they started pushing.  (Although Jessica was feeling more rectal pressure, a practice push revealed that she could not feel her bottom enough to push.  If she had started to push at that time, she would have just tired herself out).  Also, Penny knew that Dr. T was notorious for only “letting” patients push for about an hour (even if they can’t feel their bottom) and then if the baby isn’t out he performs a cesarean for “failure to descent.”  Phooey! 

 

One hour later at 2:30am Jessica was feeling an uncontrollable urge to push and a vaginal exam by the resident revealed that she was 10cm/100%/ +2 station!!  Yay!!  Penny said that she felt it was best not to make Jessica wait for Dr. T to rise and shine so she instructed Penny to push whenever she felt she needed too.  She said that Dr. T didn’t even make it into the room until about 10 min before Jessica pushed out her 8lb, 6oz baby boy at 3:05am after only approximately 30 minutes of pushing!!!!  The baby was also found to be in an occiput posterior position, which explains all that back pain Jessica was experiencing and perhaps the length of her labor as well.  Dr. T did cut an episiotomy but the baby delivered before he could get his hands on a vacuum J.  According to Penny, baby Christopher James nursed like a champ and stayed skin to skin with mom for almost a whole two hours! 

 

Fortunately for all those involved, Jessica and Jason’s story had a wonderful ending!  However, despite the fact that Jessica’s birth did not end in a cesarean section doesn’t mean that there were not many injustices in the way her care was managed by her birth attendant.  Stories like this always get me thinking…what if?  What if Jessica had been sent home from the office instead of sent in for a back door induction?  Would the baby have eventually turned around so that he was no longer occiput posterior?  Would her natural contractions been easier to handle and therefore would she still have opted for the epidural?  If she was not induced with pitocin and therefore not required to be on continuous monitoring, would the freedom to move around more in labor and the ability to use the Jacuzzi tub helped to alleviate her back pain if the baby stayed occiput posterior?  What if she had had a different nurse that encouraged her to get the epidural earlier on?  What if Dr. T had gotten his way and started to make the patient push before she had regained use of her legs and feeling in her bottom?  What if Dr. T had kept her membranes intact until much later in the labor?  What if Dr. T had checked her one hour after she was found to be 6cm and she hadn’t made “satisfactory progress”….would she have been given a cesarean for “failure to progress?” 

 

In summary, I would just like to say that unlike what many OBGYNs, nurses, friends, family members, moms, journalists, etc will tell you, the journey matters just as much as the outcome.  The fact is that women truly amaze me no matter how they give birth.  Whether it is a natural home birth or a scheduled cesarean section, the bottom line is that women have superpowers!  They can grow people inside of them after all!!  And my greatest wish is that all women will feel in control of the decisions regarding their birth and in the end feel empowered no matter the mode of delivery.  But as a society we have to be more conscious of how our overly medicalized maternity care system affects the thoughts, feelings, and emotions of our patients and families as well as their outcomes.

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53 Responses to “Don’t Let This Happen To You #24 PART 2 of 2: Jessica & Jason’s Back Door Induction”

  1. nursingbirth Says:

    I am SO sorry this took me so long to post!! My best friend got married this weekend and I have been very busy with her wedding festivities!! I hope you all enjoy!

  2. bel Says:

    I love this series and I had a hard time waiting for Part 2, but it was very worth it. You have a wonderful blog.

  3. Kateisfun Says:

    No worries- I’ve been checking back daily for the second half… is it inappropriate to say it was worth the wait? These tales are truly horrifying, I cannot believe there are medical professionals that act in this way. I think I said this in my last comment, but thank goodness for you and other like-minded nurses. Education is SO important. My husband and I were talking about an article he read that talks about how Americans are ‘outsourcing’ their health care, expecting doctors to take care of everything with little to no help from the patients. This seems to be a dangerous cultural shift and we need to realize it’s in our best interest to take some of this “care” back into our own hands. Thanks again for your writing.

    • nursingbirth Says:

      Kateisfun, I don’t think it’s inappropriate at all! In fact, I am honored you’ve been “staying tuned”!!! You are right, sometimes I feel like I am in 1950 because it still seems like everyone is just blindly following doctors orders. AHH!!

  4. Christina Says:

    Wow. Thank you so much for starting this series and sharing the stories. I wish more people realized that some care providers really act this way – and that they would choose more carefully and be more on top of advocating for themselves and their babies. I don’t know if you have any plans to make this series its own category, but if you do, I would love to link to it. Until then, I’m going to write a short post with a link to this story – I wish all my birth class clients would read it!

    • nursingbirth Says:

      Christina, that is a great idea!! I will make it its own category 🙂 I wish all birth clients would read this stuff too!!! 🙂

  5. Kathy Says:

    (said in my best sarcastic voice) — oh, but doctors only practice evidence-based medicine, and are only thinking of what is best for their patients, and would never do a back-door induction, and it’s a miracle this mom did not actually have FTP after the doctor predicted it, because we all know that they are perfect prognosticators!

    (now, I’m being serious) — I want to freakin’ SCREAM!!! [ok, deep cleansing breaths, deep cleansing breaths… let it go.. let it go…] 🙂

  6. Joanna Says:

    Ughh! This make me SO angry. Something pretty similar happened to me, only my Dr left the hospital and refused to come back despite repeated calls by the nurses. My baby ended up in NICU, but thankfully ended up fine. (And as you can imagine, that is the short story!)

    Thank you so much for your wonderful blog. Stuff like this happens every day, and the only way that anything is ever going to change is for people like you to not be afraid to speak up about it.

    My nurses in both my births (my second was a waterbirth) were so supportive, and made all the difference in my birth experiences. In my first, they were my biggest advocates (all three shifts), and in my second she was my biggest cheerleader. I have the utmost respect for them.

  7. Katherine Says:

    Wow. So glad that they had a happy ending, but what a crazy way to get there!
    Grrr . . . makes me want to just slap that doctor! THESE are the kinds of things you need to know about your doctor before you choose them! (hmmm . . . have you encouraged any of these moms to complete the birth survey?)

    • nursingbirth Says:

      Katherine, I rarely get the opporunity to talk to moms postpartum because I work on L&D and we only recover our patients for 2 hours and then they head downstairs. Its that lack of continuity of care that has always bothered me about the way we do things at our hospital. And the first two hours postpartum isnt a time when mothers typically remember anything you tell them…haha….but in a good way because they are too busy falling in love with their babies!! I think I’ll have to start branching out an talking to more postpartum nurses about the birth survey because you are right….it would be amazing if everyone filled it out!!

  8. Aisha Says:

    I am absolutely horrified to hear this. I am expecting my first baby I am 26 weeks. I’ve always been fascinated by labor and delivery and now more so than ever (obviously). I always wanted to be pregnant and feel what its like to go through this process but I have been increasingly dissapointed from the prenatal care that I’ve received so far. I don’t believe in unnecessary interventions and I’ve never trusted doctors.

    I had a miscarriage in June and the doctor pretty much ignored me from my first appointment all the way up to when I had the miscarriage. Sent me home with pain meds and didn’t explain anything, just treated me like some ignorant-uneducated-uterus carrier. I had to do research on my own on why miscarriages happen and research on my own everything else. I thought they were the experts!
    So when I found out I was pregnant again, I waited until I was 6 weeks to make my first appointment and scheduled it with a midwife (at a large OB/GYN practice) thinking that I’d get more personal care and the midwife would educate me on this journey.
    So far she’s been good, minimal interventions on anything which I am absolutely grateful for, but she doesn’t really explain much and I still feel like I have to take my pregnancy and my health into my own hands.
    From reading this amazing, eye opening blog- I think I am going to wait until the very last minute at home before going to the hospital.

    Thank you for doing this, and please keep the stories coming! Its empowering!

    • nursingbirth Says:

      Aisha, I am so sorry to hear about your misscarriage and even more sorry to hear that you didn’t get the support you deserve. But on the other hand, I am very excited for your pregnancy and I am so happy to hear you are already 26 weeks!!! It makes me so happy to hear how this blog may help you in your decision to forgo any unnecessary interventions and put off going to the hospital. YAYAYAYAYAYAY!! I write this blog for women like you! Keep reading!

  9. Jan Andrea Says:

    Gah, the more of these stories I read, the higher my blood pressure goes 😛 I had three wonderful homebirths, and I’m forever glad that I did. Makes me want to be a midwife.

    • nursingbirth Says:

      Jan Andrea, makes me want to be a midwife too!!! I have tried counting back from 100 by 7….it doesnt seem to help my blood pressure at work! Hahaha!

  10. […]  Get an amniotomy too soon.  Because hey, after having 2 or more vaginal births, it’s fun to have an emergency cesarean for cord prolapse (yes, despite what […]

  11. Rebecca Says:

    The end of the story was well worth the wait! I have you on my Google Reader now so I won’t miss a post 😉 Your stories are great, and should be required reading for women before they choose a care provider for their pregnancy! Probably 99% of the women I’ve worked with have no idea what’s going on behind the scenes – as patients, we are trained to believe that everything the doctor does is necessary (and that even if we object to something the best we can do is “I wish he/she wouldn’t have done that” instead of refusing consent.) Even as a doula, I probably only get a 50% view of “behind the scenes” and most of that is what I guess is going on.

    Once again, thank GOODNESS for great nurses like you who advocate for patients! In some ways I want to tell you – don’t become a nurse midwife, not that I don’t love midwives and it sounds like you’d be a great one – but wow, we need nurses like you so badly.

    • nursingbirth Says:

      Rebecca, thanks so much for the encouragement!! I reall appreciate it! I hope you keep “doulaing” too!! I am glad you are enjoying the blog. And about the fact that many women say “I wish he/she wouldn’t have done that” ….I hear that ALL THE TIME from women. It frustrating and upsetting to hear because it’s hard to tell a women you have just met (like in my situation) to stick up for herself!!

  12. Joy Says:

    Oh my! The thing that made me most angry was breaking her water without someone else in the room (for modesty reasons). It’s bad enough that when you’re in labor you feel so completely vulnerable and at the mercy of whichever doctor/nurse is there for you. You really do! That doctor should have his license revoked. Where is his JOY in delivering babies?

    • nursingbirth Says:

      Joy, that was the part that bothered me the most too. Walking into that room and finding the patient completely exposed. He didnt even say like “Hold On!” when I knocked. He didnt say anything. When I am assisting with a vag exam and someone knocks I always yell “One minute please!!” And I also dont let the doctor just take down all the sheets either. I just hold them up like when you are changing behind a towel at the beach. haha I mean honestly, where he is “going” he doesnt need to SEE anything! LOL

  13. enjoybirth Says:

    Well worth the wait. I am SO glad she ended up with a vaginal birth and so SAD that the OB was so impatient. I am glad that she had another nurse after you who helped protect her.

    I posted the back-door induction I attended as a doula a few weeks ago. http://enjoybirth.wordpress.com/2009/04/19/sneaky-induction-birth-story/

    Now I know what to call it and will be teaching the moms in my Hypnobabies Classes about back-door inductions!

  14. Yehudit Says:

    Would it help if a team of doctors staffed the ward (on shifts) rather than individual doctors coming in for particular patients (on call)? That way, Dr T has to be there only for his shift, and gets to go home regardless of what happens to the women labouring – he hands over to Dr X, rather than having to ‘hang around’ until a woman delivers.

    • nursingbirth Says:

      Yehudit…that is how it works at my hospital currently. Dr. T happened to be on call for his group that night. And at 6am he was going to be “off shift” but you see, Jessica was the only patient from his group on the floor and if you dont have any patients on the floor you dont have to stay “in house”. But if you have a patient you have to stay within a certain distance from the hospital…like no more than 30 minutes. Dr. T just doesnt ever like to be on call. And what I have to say about it is then maybe he is in the wrong field! Because guess what Dr. T (and many others)….babies come whenever they want! Hahah!

  15. Tina Says:

    “Well she’s still only 4cm so you are going to have to keep going up on the pit if she is going to get anywhere.” (This statement really takes the patient right out of the equation doesn’t it! Outrageous!)”

    Yeah, it kinda does.

    One of my personal favorites is when I hear doctors on tv say “We’re” only so-and-so cm dilated or “we’re” getting ready to push”, or whatever. I didn’t know “we” get to share the work load because, quite frankly, I don’t think having him sit at the bottom of the bed with a mask and catchers mit is really an equal division of labor.

    (Currently 39 weeks and 5 days, 1cm dilated and 90% effaced)

    • nursingbirth Says:

      Tina….first off “Yay for your cervix!!! :)” And about the “we’re” hahaha that made me laugh so hard when I read it…it’s SO TRUE!! It has always annoyed me too! (P.S. Congratulations ahead of time on your birth and new addition to the family!!)

  16. erin Says:

    Thank you so much for this wonderful blog!! I wish I’d known about it when I gave birth to my first child 2 years ago, as I feel that I could have avoided a c-section… And now required c-sections from here on out. I would have loved to have been more detailed in my birth plan as you describe and have educated my husband more about the different scenarios. Thanks so much for educating women about child birth!!

  17. Marissa Says:

    doctors with this attitude make me so upset. last time I checked it was my body, and I’m supposed to be consulted before the doctor does something to me. some doctors seem to think birth is a process they can completely control, but that just doesn’t work as well.

  18. pinky Says:

    I am feeling grateful for the Docs I work with. The manager sucks but most of my Docs are too busy doing other stuff to interfere with sh1t like this. They also don’t routinely do episiotomies. In some cases it is warranted but not routinely. So when they do go for the scissors, I know they have a good reason in their heads. And if you ask them, they will tell you why they chose X, Y or Z thing to do. I find when I don’t understand why they did something and it bugs me, asking them what their reasoning was is very helpful. Many times they tell me something I never thought of.

    I think a lot of Docs are afraid to send a woman home at 4cm. What if something happens? (sarcasm here). But OBs are being sued for sh1t that is not their fault. So I can see where they have gotten pretty defensive in the last 10 years.

    • nursingbirth Says:

      Pinky, I am so happy to hear that you work in very supportive enviornment with great teamwork between nurses and docs. (Despite the fact that you have a less than stellar manager!) There are a few docs and midwives that I work with that I have the same relationship with, like, if they do do an intervention I know its good reason. And that is because if I ask them about it, they are OPEN to talking about their reasons and their research, and their experience. I tell you those are the best providers to work with and go too! On the flip side there are many docs I work with that if I even ask a question just to learn more about something they automatically get defensive. And I work in a TEACHING HOSPITAL! It’s not surprising that those are the docs with the highest cesarean/induction rates and the worst relationships with the nursing staff!!

  19. jen Says:

    Wow. What a crappy doctor….and this comes from an OB resident. I occasionally see some nutty things on L&D but no one would get away with that bad of a personality at my hospital. At board sign out he’d have to defend that primip C-section call to too many people…

    Please keep in mind that not all OBs are like this. Yes, I occasionally do a vaginal exam without a nurse bc I can’t find her but I write it on the strip and try to give her a heads up after. Yes, I occasionally get annoyed bc I feel like I’m getting the interference put up when I try to do something and it actually is indicated or needed or the nurse is just plain snarky, but overall I trust the good majority of my nurses and have learned in residency they’re a big part of the team. This doc is a big loser, and really is not representative of OBs in general. But unfortunately it’s a lot easier for many people to say ‘OBs are evil! Midwives are saints!” when it really is case-by-case. Not saying you did that at all, but I do often see it on some anti-OB websites. And now I’m rambling, bc I am coming off a brutal night shift. good night!

    • nursingbirth Says:

      Jen, it’s nice to have an OB resident commenting on my blog. Welcome! I completely agree, care providers need to be taken on a case by case basis and you can overgeneralize that “all OBs are bad” etc. And not all nurses are one way or another either. That is why is it so important for women to RESEARCH their care providers before just picking the first name out of the phone book or automatically signing up with the same doctor their bank teller goes to!!

  20. Krista Says:

    Great Blog! I’ve been checking back for the 2nd half of this story and happy to read the rest……thanks so much for sharing your experiences! Your last paragraph: all I can say is, I couldn’t agree more! The more I hear about the American Maternity System, the less faith I have in it. I have 3 kids…..3 completely different experiences (all hospital, but that’s where the similarities end) and I’m done as far as having more babies, but if I were to have another, we’d have to find a way to homebirth because I just couldn’t go back to a hospital knowing everything I know. Thanks again!

    • nursingbirth Says:

      Krista, thanks for sharing your experiences! I hope you continue to enjoy the blog and share your wisdom with those around you!

  21. Basiorana Says:

    Uhm, not that I don’t love your blog and I’m definitely keeping a lot of this in mind for when my fiance and I start having babies in a few years, but how is it a “superpower” if almost half of all humans– nah, half of all mammals– can do it? Doesn’t superpower imply that birth is some kind of abnormal event requiring abnormal fortitude? I’d much rather look at it as a fundamental part of life, nothing “super” about it– because that means that ANY woman, even me, can do it!

    I guess I just always find that disturbing when I see people saying how it’s a superpower, because that means to me that only the best and brightest and strongest women will have the birth they want, the truly unusual types, and the rest of us won’t be super enough– because if we all can do it, it’s human, not superhuman.

    • nursingbirth Says:

      Basiorana, I see what you are saying and I agree with you. But I suppose when I said “superpower” I meant it in a lighthearted positive empowering way. I feel that from the time women are little little girls were are taught to fear birth, to be ashamed of our sexuality, to be self concious about our bodies and our natural human abilities eg, childbirth & breastfeeding. Definitely not all women have grown up like this, but too many of us have. So when I say “superpower” I guess I don’t mean it as literally as you might have taken it. II don’t mean “superhuman” and I have dedicated my life to empowering women to believe in themselves and thier natural human ability. Although I admire your take on it and your take on prengancy and birth, what I wish for isfor every woman to have an active role in her own empowering birth experience, however and whereever that may be. I wish for all women to come through their birth experiences feeling like they can do ANYTHING!! So in that respect I want them to feel SUPER because they ARE SUPER, and I dont mean super as “abnormal” I mean super as “excellent”, “powerful,” “marvelous,” “sensational”!!!!! POSITIVE POSTIVE POSITIVE!!

  22. Yehudit Says:

    Ah, but in my hospital the doctors have to be ‘in-house’ whether he/she has a patient or not (actually, we are a big hospital with >5,000 births per annum, all spontaneous vaginal deliveries by midwives and the docs only reviewing women with complications and doing instrumentals/cs, and there is still plenty enough to keep a few docs pretty busy overnight). Maybe the difference is that the midwife has to stay with the woman throughout active labour (like an L&D nurse), and will attend her for the birth as well (therefore no need for the doctor…)

    • nursingbirth Says:

      Yehudit, that is so interesting!! Hmmmm, you write = “all spontaneous vaginal deliveries by midwives and the docs only reviewing women with complications and doing instrumentals/cs”. (sarcastically) What a novel idea!! Haha! We have had quite a few traveler nurses come through our hospital that are floored by the way we do things. It’s so backwards and frustrating! Unfortunatey, we aren’t alone in how backwards we are.

  23. Yehudit Says:

    Maybe you need to send all the US Ob-gyns to European countries for elective placements! Then they might see that it is actually possible to have an interesting life (from a medical point of view) and stay the hell away from normal labours.

    I love our docs. One wrote in the plan having been called to review (for possible augmentation) the other day: “Not for synto [aka pit]. Normal labour care. Await events.” I love them.

    • nursingbirth Says:

      Yehudit….I am JEALOUS! 🙂 I didnt realize you were working in Europe. Wicked cool 🙂 Well put by the way about how docs should stay “the hell away” from normal labors!! 😉

  24. Sarah Says:

    I just wanted to tell you how fascinated I am by your blog. My mama and another really good friend are both L&D nurses and my mama is also a lactation consultant so I have been surrounded by it my whole life and it intrigues me to read about the things that you deal with and here’s a great thing even though I am not in the medical profession I still understand what you are talking about. As I was reading your blog the other day I realized that if I had not been scared of blood and needles I would have gone into the nursing profession and probably done L&D. I have always loved visiting my mama at the hospital and hearing about what she does. Reading your blog also helped me in making some very preliminary decisions regarding my own baby deliveries. Please keep up the good work and keep advocating for women that need someone to advocate for their rights as they are in pain and can’t make their own decisions known.

    • nursingbirth Says:

      Sarah, you are so lucky to have one rocking mama!! 🙂 And even though I don’t know you I just know you’re going to be a great mama too!! 🙂 I am SO HAPPY that you have found my blog and it has helped start to get the wheels turning for you! I hope you visit often and keep commenting! I love to hear about everyone else’s opinions and experiences!

  25. Yehudit Says:

    Yes, I don’t think there is anywhere in the US where the spontaneous vaginal deliveries are pretty much all midwife cases. Do midwives use L&D nurses in the US? Or do they provide continuity of care in labour? Because I don’t think I would want to be the sort of midwife who just comes in to catch.

    • nursingbirth Says:

      Yehudit, at my hospital, the midwives are pretty much the type that stay there the whole time with the patient and work with the L&D nurse. However there are a few who just come in to “catch” and it always makes my wonder why they got into midwifery in the first place!

  26. Jill Says:

    Oh my hell, I can’t read any more of your blog tonight. It’s already way past my bedtime and now I’m going to be up fuming forever thinking about stories like this. I don’t know how you do it, honestly. Many times I have thought about being a doula, but if it meant I had to attend births like this, I would go on a homicidal rampage. You are a better woman than I not to lose your head in situations like this!

  27. sarah henrikson Says:

    Wow, what an absolutely fantastic blog. These stories, frustrating as they are to read because of the things that go on, need to be told. Thank you for sharing!! IT is so great there are nurses like you who stick up for patients.

  28. Renee Says:

    Just curious… are nurses not allowed to do SVE’s?

    I work in a small hospital (400+,- deliveries a year) and we have a lot of autonomy. I work nights and there is no one but us (actually tonight it’s only me). We triage patients ourself, and when we get a labor patient the doc only comes in when we call and say they are ready to push.

    I couldn’t imagine working somewhere where there is always someone looking over your shoulder. How do you deal with it?

  29. Michele Says:

    HI there. I’m also a Labor & Delivery nurse, and I enjoyed reading your blog. I’ve worked with all sorts of OBs, good and bad, and I can also say the same for nurses.

    Just wondering…… How much does your malpractice insurance cost? Oh wait- you don’t pay that because you’re a nurse, not a medical doctor. How may times have you been sued due to a bad outcome? Not just a deposition, but actually had the finger directly pointed at you? How much sleep did you lose over it? How much did you lose in wages because you took time off to meet with your legal team? How did it affect your family life? How did it feel to know you did everything right, but now there’s a dead or damaged baby, and the family wants someone to pay?

    Nobody wants a bad outcome, and I truly believe that everyone does their best to ensure the best outcome possible. After all, doesn’t every parent expect a “perfect” baby. We live in a highly litigious society, and I understand perfectly well why a small minority of OBs are extremely conservative. Quite frankly, I’m tired of women coming in with this attitude that they somehow have control over their labor and deliveries. Nobody does, not even the OB. I agree that some interventions may do more harm that good, but not all interventions are bad, especially when carried out under the appropriate circumstances.

    I hope your blog does no scare women. I would hate for them to come into hospitals thinking we are all a bunch of bullies.

  30. Alyssa Says:

    I am in awe of your blog. I DESPERATELY want a nurse like you. HOW do I find a nurse like you? How do I make sure I don’t get a doc like this? I am trying to find an OB right now since my husband and I are trying to start a family in a few months and I am terrified of the process being like your posts. (pushed into stuff, over medicalized, drugged) I live in a smaller area and don’t have access to any other place but a standard hospital where the stats show that caesareans are at 40% and inductions are at 60%. I don’t want to be one of these women unless there is a TRUE medical emergency but I don’t know where to begin to get the care that I want.


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