Nursing Birth

One Labor & Delivery Nurse’s View From the Inside

The “All That Matters” Phenomenon: Grieving the Loss of a Vaginal Birth April 24, 2009

The other day I had the privilege of taking care of a couple who was in labor with their first baby.  Denise, a G1P0 at 41 weeks and 3 days, broke her water at 1:00am with contraction starting about 8-10 minutes apart at 4:30am.  She and her boyfriend, Ralph, labored at home until about 8:00am when the contractions were coming about every 3-5 minutes apart.  When she arrived to the hospital at 8:30am, a resident’s vaginal exam revealed that she was 3cm/50%effaced/-3 station!!  Since she was a young healthy woman (her health history only comprised of PCOS, or polycystic ovarian syndrome) and had had an uncomplicated, normal, healthy pregnancy, she was “allowed” to ambulate in the halls all morning but required to stay on continuous telemetry monitoring and not allowed to labor in the tub per her physician’s direct order. 

 

(Side Note:  This particular physician, Dr. O, is an older physician who is part of a group that is well known for aggressive labor management.  They induce almost all of their patients for one reason or another, often once they hit 39 weeks, and if a patient is not already ruptured once they get to the hospital, they will artificially break their patients’ water regardless of dilatation.  That’s right, I have personally refused to give them an amniohook when a patient is only 1 or 2 centimeters and they sneak in the room without me and break her water anyway!  One time, Dr. U (another doctor in that group) ruptured a patient who was still in triage!  They are notorious for setting up “post dates” inductions at 40 weeks and 1 day and although they advertise that they attend VBACs, their statistics show something quite different: Almost NO “successful” VBAC vaginal deliveries and a cesarean rate that is at least 40%.  Myself and many other nurses have bombarded them with research and position statements from a variety of sources, including their OWN association (American College of Obstetricians and Gynecologists, or ACOG)) that states intermittent auscultation is the standard of care for low risk, uncomplicated pregnancies, but they refuse to listen.  So Denise’s situation is unfortunately not uncommon.  To be honest, I am surprised they “let” her get past 41 weeks!  I think they view it as a slap in the face to attend any delivery after 40 weeks!)  

 

When I came on at 3:00pm, Denise was in the middle of getting an epidural.  Turns out that at 12:30pm, Dr. O’s vaginal exam revealed that the patient was “only” (his words) 4cm/80%/-3 so he ordered pitocin augmentation and the pit was started at 1:00pm.  Although the patient had originally told the nurse it was her plan to labor without an epidural, pitocin lead to stronger, longer, and closer contractions which lead to the patient requesting one.  And an epidural was granted.  For the next 3 hours I was instructed to continue to turn up the pitocin to obtain 5 contractions in 10 minutes.  I titrated appropriately until I obtained moderate to strong contractions (per my palpation) every 2-3 minutes, where the baby was still looking good on the monitor.  I changed the patient’s position every 30 minutes: right side, sitting up high, left side, sitting up high, etc. in hopes that I would help the baby makes his way down the birth canal and not get “stuck” in any acynclitic position. (According to the patient, she was complaining of severe back pain the last few hours so I was concerned about an occiput posterior baby.  So since Denise could no longer move herself to help move the baby, I was doing the moving for her!) 

 

At 7:00pm Denise was feeling a lot of rectal pressure, so much that she was breathing through it (even though the epidural was still effective at taking away her back and abdominal pain).  We all were very excited!!  Since Denise was only feeling rectal pressure during contractions I told her it would be best to wait until she was feeling rectal pressure at all times, with our without a contraction, before we called the doctor.  Well Dr. O must have had ESP because he came into the room to perform a vaginal exam.  His exam revealed that Denise was 4cm/100%/ -1 station!  The patient was a bit disappointed that she was still only “4cm” but I assured her that he was completely thinned out and that she had brought the baby down a whole bunch!  However, Dr. O had a different take on it, “You are still only 4cm, he said, “And if you don’t make any significant progress within the next hour we will have to talk about a change in the plan.”  (Could he have BEEN any more vague?!)  And then he turned around and walked out.  “What does he mean by change of plan?” Denise asked me.  “Well I’m not sure,” I said back, “let me go find out.” 

 

The fact of the matter is that I knew exactly what Dr. O meant….he meant that he was going to do a c-section.  But I didn’t want to tell her that for two reasons, 1) it is NOT my responsibility to tell a patient that someone else is going to perform a cesarean section on them, it’s the SURGEON’S responsibility, and 2) I hate even talking about the possibility of a cesarean section when someone is in the middle of labor because it is like you are telling the patient you are already “giving up” on them.  Of course I understand that some cesareans are necessary, but I know that if I was in her position and someone gave me a “cesarean ultimatum” during labor, I would feel like people were giving up on me!  I mean here she is, basically being given a one hour ultimatum, and because of the limitations of the epidural it is not even like she can “do” something to play an active role:  she can’t walk around or get in the tub, we’ve already got her hooked up to pitocin and an epidural, we’ve already tried the position changes, her water is already broken, and I am pretty sure she doesn’t know magic.  So here I am feeling like my hands are tied, but trying to stay positive and encouraging so that the patient does not feel upset, passive, defeated, or worried.  Because those emotions do NOT facilitate labor, and in fact, those emotions can actually release hormones in your body that directly work AGAINST labor. 

 

So I walked out to the desk to find Dr. O but he had already left.  (I don’t think he went very far, maybe into another patient’s room, but nonetheless, he was no where to be found.)  I felt an obligation to tell Denise something so I went back into to the room and said this:

 

Me: “Denise, I think Dr. O is with another patient right now but once I find him, if you would like, I can ask him to come back in to answer any questions you might have.”

 

Denise:  “Yeah, I would like him to come back in because I don’t want a c-section.”  (starting to get a bit teary eyed)  “I mean, is that what he meant by change of plan?  Can they give me any other medicine to help with my contractions?”

 

Me:  “Well I don’t know what he meant exactly but he could have meant he would like to try an IUPC which stands for intrauterine pressure catheter.  It is a thin tube that lies beside the baby’s face and actually measures in millimeters of mercury how strong your contractions are.  If I have an IUPC, I might be able to go up on the pitocin if the contractions aren’t “strong enough.”  Right now the external monitor only tells me when they are coming and when I feel your belly it is all subjective.  Unfortunately there isn’t any other medicine we can give you to help “speed up” labor besides pitocin.  He could also have meant a cesarean.  But we won’t know until we talk to him.”

 

Denise: (almost in a scared tone)  “But I don’t want a c-section!  I want to push my baby out!  Oh I don’t want a c-section!” 

 

Me:  (feeling like I wish I could help but don’t know how)  “Well let’s talk about what you can do.  If Dr. O comes in to check you, you have the right to refuse his vaginal exam and request more time.  You also have the right to ask him about all of your options, if there are any, besides a cesarean.  You have the right to ask him his reasons for why he thinks a cesarean is necessary.  You have the right to hear all that information and then take as much time as you need to decide what you would like to do.  If you need some alone time with Ralph or if you need to call your mom or any other family members you have that right.  I just want you to know that if you and Dr. O decide together that a cesarean is the best option, it will NOT be an emergency and therefore you can take as much time as you need to prepare.  The baby is not in distress and in fact, has looked beautiful on the monitor all day.   If you both decide that a cesarean is the right course of action, I promise I will go over everything to expect with you, I will make sure anesthesia sees you before you get to the OR so you can ask them any questions, and barring any other emergency, I will be with you the entire time, from the moment I wheel you in to the OR, to the moment I wheel you out of the recovery room.  I’ll help you breastfeed as soon as possible.  I will stay with you the whole time…”

 

At this point I was starting to get a bit emotional and realized I was rambling so I excused myself and went out to the desk.  I just knew in my heart what was going to happen and I was deeply saddened by it.  And don’t get me wrong, I am not trying to be overly dramatic but I just knew that when she broke her water at 1:00am and came to the hospital at 3cm, she was not expecting to end up with a cesarean. 

 

Well exactly one hour later Dr. O came back into the room to do a vaginal exam.  I turned towards Denise and I said, “Is that okay with you, Denise?” and she said “Yes.  According to Dr. O, Denise was still the same and had made no “progress.”  Dr. O, while standing at the foot of the bed, looked up at Denise and said “Well Denise, we’ve run out of options here.  If we continue to keep you on pitocin eventually the baby is going to run out of gas and crash.  Uteruses can only take so much and your uterus is going to get thinner and thinner and will be at risk of rupturing if we continue like this.  You have essentially been 4cm for 7 hours and for a primip, you need to progress at least one centimeter an hour.  We need to do a cesarean and as soon as I tell the charge nurse we’ll get going on it.”

 

At this point Denise burst into tears, “OH GOD, BUT I DON’T WANT TO HAVE A C-SECTION!  I WANTED TO PUSH HIM OUT!  I WANTED TO PUSH HIM OUT!   I REALLY THOUGHT I COULD DO IT!  I WANTED TO DO IT!  I WANTED TO PUSH MY BABY OUT!”  Ralph gave her a big hug and I kept squeezing her hand trying to bit my lip so that I didn’t start to cry myself.  She was sobbing.  And then Dr. O said “Listen, Denise, there is no reason to get like this.  I mean, when you came to the hospital this morning I also had 4 other patients that came in around the same time.  Everyone else has already delivered…you’re the only one left.  And some women even came in with cervixes more closed than yours.  You see, the baby just isn’t coming down enough in the birth canal to dilate your cervix, and it’s just a failure to progress.  It’s just failure to progress that’s all.”  Then he turned to me and said “As soon as I tell the charge nurse we’re going to go.  So then I said, “Well I am not at all ready to go yet.  And I think she deserves a minute to come to terms with all of this, Dr. O.  She deserves some time to make her decision and call her family.  And then Dr. O looked straight at me, baffled, said “Whatever” and then stormed out slamming he door behind him. 

 

I threw myself onto Denise and have her the biggest hug I could.  I whispered over and over in her ear, “You are NOT a failure Denise, I know you wanted to push him out.  I know you did.  You have done so much work today and you never gave up.  You are a strong woman, Denise, you did not fail and your body did not fail.  NOBODY is a failure here.  It’s okay to cry.  It’s okay to cry, Denise.  Please know you did so much for your baby and you never gave up.  You are a strong woman…”

 

I stayed there for about 10 minutes with her and Ralph, letting her cry.  When she calmed down a bit I encouraged her to take her time to talk with Ralph and call her mother or family if she needed too.  I told her that I needed to get some things ready and that I was going to give them some privacy.

 

So by this point I was pretty upset.  For one, I think the way Dr. O went about the whole thing was so cold and insensitive.  Um hello, do you think telling a patient that “everyone else” has already delivered is going to make them feel better!?  Because in my opinion, it just stresses the insane notion that her body is in someway a “failure.”    I could mull over and over and over again in my head everything that surrounded this whole situation and I have almost made myself sick over wondering if this was really a necessary cesarean for “true” arrest of descent/dilatation.  But regardless, I feel like he completely took Denise and Ralph out of the whole process and it should have been handled better.  Second, Dr. O did NOT go over the risks and benefits of the cesarean with them, claiming later that the residents “review that” on admission (which, by the way, they don’t…they just have everyone sign a consent for “vaginal delivery possible cesarean section”).  Third, Dr. O did not at all go over other options besides cesarean, and even if he thought the safest course of action was a cesarean at that point in time (which I am not disputing), he didn’t even say anything like “and our other options, X, Y, & Z, are not the best course to take because of A, B, C, so it is in my professional opinion that the safest course of action is to perform a cesarean section.  But please take your time to talk it over.”).  I have seen other doctors do this before.  Even in situation where everyone agrees that a cesarean is absolutely necessary, it is still the patients right to make the final decision.  And finally, he didn’t even give them a chance to talk it through and when I asked for “some time” he got pissed. 

 

So I walked out to the desk to get my paperwork ready and Dr. O was writing a note in her chart:

 

Dr. O:  (sarcastically and not even looking up from what he was writing)  “So when do you think you’ll be ready to go?”

 

Me:  (frustrated)  “It’s not about me being ready, it’s about Denise and Ralph being ready!  I think it is more than just a courtesy to allow them some time to come to terms with this new development.  They have a RIGHT to some time, Dr. O.  This isn’t an emergency.  The baby has looked great on the monitor all day and I shut the pitocin off.”

 

Dr. O:  (frustrated)  “I don’t know why you are fighting me on this!” 

 

Me:  (increasingly frustrated) “I’m not fighting you on ANYTHING Dr. O, but you have to understand, she is devastated that she is going to have a cesarean.  We owe it to her to let her calm down and not wheel her down the hall as a sobbing mess!  Her whole family lives in a different state, including her mother, and I think that it isn’t too much for her to ask for some time to call her family before she goes in for MAJOR ABDOMINAL SURGERY!” 

 

And then he said it….he said that phrase that breaks my heart every time I hear it…

 

Dr. O: “She’ll forget all about it when she is holding a baby in her arms.”

 

This phrase comes in many forms but every one says the same thing, “All that matters is that you get a baby out of this deal… and your experience, your experience doesn’t matter.”

 

Kristen, a doula, graduate student, mom, and author of the blog Birthing Beautiful Ideas wrote an amazingly insightful and moving must read post entitled, “Scars That Run Deep: ‘All That Matters’ After A Cesarean” that explores this very topic. 

 

Kristen writes:

 

“You have a healthy baby.  That’s what matters.”

 

Mothers who express sadness, anger, or disappointment after undergoing a cesarean section often hear these words uttered by (presumably) well-meaning family, friends, and health care workers.  In fact, these words seem to be one of the most common responses that people give upon hearing that a mother has had a cesarean.  I presume this is because it can be jarring to witness the juxtaposition of the joy and wonder of a newborn life and the mother’s grief over her baby’s entrance into the world.  And so, particularly in a culture that does not have a well-developed ritual for expressing and experiencing grief, people try to fill up the mother’s “empty grief jar” with an elixir of “healthy baby joy.”  But, as we all know, grief and joy don’t work like that.

 

Kristen goes on to write about why having a healthy baby isn’t “all that matters” after a cesarean, the concept of mourning the loss of a vaginal birth, and why a mother’s birth experience IS part of “what matters” regarding the entire childbirth experience.  Kristen also outlines step by step details about what a mother experiences when she undergoes a cesarean, from the minute the wheel her into the operating room to the first time she gets to hold her baby to caring for a newborn after major surgery.  Kristen writes,

 

In addition, the de-valuing of the mother’s birth experience–a de-valuing implied by the “healthy baby line”–undermines the significance of one of the most transformative days of a mother’s life.  For on the same day that her baby is born, she is “born” as a mother.  And if this dual-birth is marked by passivity and separation, then it is no wonder that the mother grieves her birth experience.  That having her healthy, miraculous, wonderful baby is not all that matters to her.

 

In fact, her sadness is partially a result of being separated from her healthy, miraculous, wonderful baby during the first few moments and even hours of that baby’s life.  And it can be the result of a feeling that her body is “broken,” “unable” to bring her child into the world on its own.  And it can be the result of a feeling that her body might not even “know” how to work properly to bring a child into the world.  And it can be the result of feeling as if she has disappointed not only herself but also her partner and/or other friends and family.  And it can be the result of the sheer difficulty of recovering from major abdominal surgery and simultaneously caring for a newborn baby, two of the most physically and emotionally demanding experiences that any person will ever undergo.

 

In other words, her sadness and her grief are understandable.  They are normal.

 

Please check out Kristen’s post in it’s entirety on her blog.  The excerpts I have provided here are only a small piece of this very eye opening composition.

 

In the end Denise gave birth to her 9lb 8oz baby boy, Rayne Nicolais, by cesarean section at 9:01pm.  Baby Rayne was found to be in an occiput posterior position and still very high in the pelvis when he was born.  I had the opportunity to stay with Denise, Ralph, and Baby Rayne for the entire experience and with the help of a ton of pillows, Denise breastfeed Rayne skin to skin in a football hold for an entire hour and 15 minutes in the recovery room.  And boy was he a vigorous breast feeder!! 

 

Although all in all, there was a positive outcome to Denise’s birth experience, I do wish that for Denise and Ralph, things could have turned out differently.  I wish that Denise could have PUSHED her baby out like she so desired and worked so hard for.  And of course I am grateful that at the end of the day Baby Rayne was a happy, healthy, chubby, bouncing baby boy.  In the recovery room where Denise really held her baby boy for the first time, she welled up, looked at her boyfriend and said, “I think I am falling in love all over again!”  It was so beautiful!  As a nurse, experiences like this solidify what I feel in my whole being is true about pregnancy and childbirth; That the journey is as important as the destination. 

 

In closing I would like to leave you with one of my favorite quotes…

 

“It’s not just the making of babies, but the making of mothers that midwives see as the miracle of birth.” ~ Barbara Katz Rothman.

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49 Responses to “The “All That Matters” Phenomenon: Grieving the Loss of a Vaginal Birth”

  1. courtney Says:

    After pushing for an hour my doctor wanted to perform a c-section, but thanks to a great doula, great nurses and a doctor that understood my desire to have a vaginal birth, I was able to push out a 7.5 lbs baby boy.
    I can understand the grief that a woman would feel in these situations and I am thankful every day for my birth experience.

  2. Renee Says:

    Thanks for posting this, and linking the “Scars that run deep” post. It has helped me face some of my fears about my impending C-section for breech presentation of my first baby. Unless I can get him to turn in the next two weeks, I probably won’t even be “allowed” to go into labor.

    I trust my OB’s opinion (she doesn’t want to try a version because ultrasound can’t reveal whether the cord is wrapped around his neck) and besides that, a vaginal breech delivery is against hospital policy. It’s hard to keep envisioning the vaginal drug-free delivery I’ve been preparing for, when faced with the cold reality that I may never get to experience labor…

    • nursingbirth Says:

      Renee I am happy that you have found support in this post and in the “BirthingBeautifulIdeas” post. I encourage you to continue to think positively, perhaps to read the book “Birthing From Within”, and if you do end up needing a cesarean for breech baby (my hospital does not do vaginal breech deliveries either 😦 ) I encourage you to read up as much as you can about it, to write a birth plan (yes, you can write a birth plan for a scheduled cesarean), and to advocate for yourself so that you still have an empowering birth experience! Because you still can!! I wish you the best of luck with your next few weeks! Also, please check out ICAN’s website: http://www.ican-online.org/

  3. BirthingBeautifulIdeas Says:

    NursingBirth, as a c-section mama, I can tell you that despite Dr. O’s rudeness and ignorance about normal birth (and the emotions and psychology of birth, for that matter), YOU made a difference to Denise and Ralph. I’m sure that your encouragement and your advocacy (even if they will never know all that you did for them) has helped with the healing process. Now let’s just hope that she switches practices so that she can VBAC next time! 🙂

    Thanks for the link to my post, by the way!!!

    • nursingbirth Says:

      BBI, thanks for visiting 🙂 I hope you got a lot of hits today!!! And as far as VBAC, can I get an AMEN!!

  4. Christina Says:

    I wish I had a L&D like you! Mine said that she was glad I didn’t take a childbirth class because she wouldn’t have any bad habits to break.

    Reading this story brought back so many emotions from my c-sectio. I felt exactly how Denise did. We went through almost the same experience. After planning on a drug-free natural birth, I went through the “cascade of interventions.” I pushed for three hours with no progress and was told I needed a c-section.

    That’s so great that she was able to breastfeed in recovery. I was forced to be alone in the recovery room, and it was almost 4 hours before I was able to see my baby.

    And to Dr. O- We don’t forget all about it once we hold our baby. We never forget.

    • nursingbirth Says:

      Christina, your story stikes a cord with me. Thank you for sharing. What that nurse said to you is upsetting, unhelpful, and downright unsupportive. And I am so sorry that you were separated from your baby! I hope you have made some peace with your birth experience and I am so happy that you are seeking out support and more information!! Thanks for reading!

  5. sara Says:

    first of all, I want to say I LOVE your blog-it’s perfect! I hope you keep on writing regularly. 2nd of all, this story really broke my heart-Doctors should take sensitivity training! If they could only remember that what is so commonplace to them, only happens to a women a handful of times in her life. Thank God there are nurses like you! Don’t ever give up fighting.

    • nursingbirth Says:

      sara, thank you for the encouragement!! sometimes I wish I could rewind, pull the doctor aside, and have him/her start again!! Oh that would be wonderful wouldn’t it!! And you are absolutely right, this experience only happens to a woman a few times, if any, in her life. And each time is different and special in its own way!

  6. Hi, just wanted to say I agree completely that _of course_ while we all want a healthy baby (the “product” of birth), this total lack of attention to the _process_ misses the point about how important an experience birth is. I wrote about that issue just this week over here at the Massachusetts Friends of Midwives blog: http://mfomnews.wordpress.com/2009/04/18/what-i-never-knew-about-labor-and-childbirth/

    Thanks for an excellent site–btw, I love Barbara Katz Rothman too!

  7. Kortney Says:

    I look forward to a new post from you everyday, and often brought to tears on a regular basis. Thanks for this blog.

    I am so thankful, after hearing these stories you’re sharing, for the birth experience I had with my little girl 4.5 months ago. I went to the hospital and was just 1cm and 75 percent – they sent me home to labor. I came back eight hours later and I was “only” 3cm, but my water broke just before they checked me.

    It was a slow, long labour (26 hours total), but I refused all intervention (except a shot of morphine) until they made me go on pit after 22 hours of contractions. Long story short (there’s the full story on my blog in December 2008 if you’re interested), I pushed for four hours and with the help of the vacuum, got her out.

    I had fabulous nurses and doctors and am so thankful for that!!

    • nursingbirth Says:

      Kortney, I am so happy you are enjoying this blog! Thanks for sharing your story! I will definitely check out your birth story (you’d think that since I work L&D I would be sick of birth stories but because I am a birth junkie, I can’t get enough!! 🙂 ) I hope you keep reading! I hope your last 4.5 months have been full of great times with your little one 🙂

  8. Rebecca Says:

    This post makes me sad because I have been at too many births like this and never know if the outcome would have been different if the mom could have avoided interventions. Thank you for making space for this mom’s emotions around her c-section! And how fabulous that you could help get breastfeeding started – it is frustrating when baby is taken away for hours post-surgery.

  9. Katelin Says:

    Seriously, just spent an hour reading your blog.
    WOW!! WHO ARE YOU? I mean, these stories, happen everywhere and it’s scary. I think your blog is revolutionary and provocative! WAY TO GO!

  10. Memory of Labor Pain Influenced by a Woman’s Childbirth Experience

    By Megan Rauscher

    NEW YORK (Reuters Health) Mar 11 – Research shows that for about half of women who give birth, memories of the intensity of labor pain decline over time. However, for some women, their recollection of pain does not seem to diminish and for a minority, their memory of pain increases with time.

    The study also shows that the memory of childbirth pain is influenced by a woman’s overall satisfaction with her labor experience.

    Dr. Ulla Waldenstrm, from the Department of Woman and Child Health at the Karolinska Institute, Stockholm, and colleagues queried 1383 mothers about their memories of labor pain at 2 months, 1 year and 5 years after giving birth. Women who underwent elective cesarean section were excluded.

    Five years after the women had given birth, 49% remembered childbirth as less painful than when they rated it 2 months after birth, 35% rated it the same, and 16% rated it as more painful.

    “A commonly held view,” Dr. Waldenstrm noted in an email to Reuters Health, “is that women forget the intensity of labour pain. The present study…provides evidence that in modern obstetric care, this is true for about 50 percent of women.”

    However, a woman’s labor experience was an influential factor. Women who reported labor as a positive experience 2 months after childbirth had the lowest pain scores, and their memory of the intensity of pain had declined by 1 year and 5 years after giving birth.

    “Memory of labor pain declined during the observation period but not in women with a negative overall experience of childbirth,” the team notes in the March issue of BJOG: An International Journal of Obstetrics and Gynaecology.

    Roughly 60% of women reported positive experiences and less than 10% had negative experiences. For women who said that their childbirth experience was negative or very negative, on average, their assessment of labor pain did not change after 5 years.

    “A woman’s long-term memory of pain is associated with her satisfaction with childbirth overall,” Dr. Waldenstrm said, summing up. “The more positive the experience, the more women forget how painful labour was. For a small group of women with a negative birth experience, long-term memory of labour pain was as vivid as 5 years earlier.”

    The researchers also found that women who had epidural analgesia remembered pain as more intense than women who did not have an epidural, suggesting, they say, that these women remember “peak pain.” However, their perception of how painful labour had been also declined with time.

    Dr. Waldenstrm and colleagues suggest that healthcare professionals take into account a woman’s overall experience with childbirth when assessing whether a woman needs further support postnatally.

    BJOG 2009;116:577-583.

  11. erin Says:

    Thanks again for writing this great blog. I am also a c-sectiion mama and planning for a second in Sept. As a question to you about the post (regarding your professional opinion), other than give the patient more time to progress (and be a bit more nice about breaking the news to the patient), what else could Dr. O had done to help her? Was there another solution that could have helped her deliver naturally?

    • nursingbirth Says:

      erin, I have racked my brain about this very point since that day. In hindsight (OP and very large baby, pitocin leading to early epidural etc) I dont know if there truly was anything else at that point that would have helped Denise deliver vaginally except maybe a bit more time. But even if she did truly need that cesarean (which I am not necessarily disputing) the way Dr. O went about it was completely inappropriate and did not allow Denise to feel like a part of the decision making process at all which I feel could have a negative affect on her memory of this experience for the rest of her life.

  12. erin Says:

    Oh, one more question… I’m interested in writing a birth plan for my second c/s and didn’t know that I could do that. Do you have any resources for writing one or suggestions of things that might be important?

  13. Julia Says:

    From a nursing student, birth junkie, and hopeful future midwife, thank you for sharing your insightful thoughts & experiences on this wonderful blog! Please keep it coming – I just started reading but your blog is quickly becoming my favorite.

  14. Joy Says:

    That DR. O pisses me off. I have an “older” doctor but he’s really involved with his board (the same one Dr. O belongs to). I thought women had up to 24 hours (after their water breaks) to give birth before a c-sec is scheduled. Can you refuse a c-sec in a non-emergent situation?

  15. Hannah Says:

    As a serious birth junkie, I am greatly enjoying your blog, but I have to ask… Are there OBs that deliver at your hospital that you think do good by their patients? My OB and the 3 other doctors in his practice seem to be polar opposites to all of the doctors you talk about in your posts.

    My doctor let me walk around 4cm dilated, 80% effaced for a week with my first baby. And I walked around the same for almost 3 weeks with my second. No induction for this girl! And even when my second baby measured huge on ultrasound, he didn’t throw in the towel. I had a spontaneous vaginal delivery with both of them, minor second degree tears on both, 40 minutes of pushing with the first, 12 minutes with the second. My second labor was longer than the second. It took me nearly 9 hours to move from 4cm to 7cm, but less than an hour to go from 7cm to holding my boy in my arms. It seems like this doctor would have cut me long before I was allowed to push.

    I guess what I’m asking is do you have any positive stories about births that go well with doctors you respect?

    • nursingbirth Says:

      Hannah, I feel that it is directly related to the backwards, overly medicalized, “high risk” culture of my hospital that we have so many OBGYNs who act outrageously. I feel this way because we have recently acquired two other OBGYN groups within the past two years that came from a local community hospital that was closing its L&D ward. I have complained to nurses who worked with them at the communtiy hospital about the bullshit they pull at my hospital and they ALL seem FLOORED that these groups are acting this way because they have told me, in so many words, “Drs “So-and-So” never pulled that shit at the community hospital.” The fact is that LUCKILY I do work with a handful of OBGYNs that do not act like complete assholes all the time (excuse my language) and truly do right by their patients. If you haven’t already please check out: https://nursingbirth.wordpress.com/2009/03/26/%e2%80%9ci-needed-to-know-my-body-could-do-it%e2%80%9d-a-vbac-story/

      It is a story about a very empowering VBAC birth that I was very honored to be a part of. Although the birth attendant in the story was a midwife, the attending physician that works with her (it’s his office that she works for) is AMAZING and is definitely an obstetrician that follows a midwifery model of care. However he rarely if ever attends any of his clients vaginal births because he truly believes (as he has told me) that the midwives that work for him are more qualified than him to attend normal, uncomplicated, labor and birth! He always talks about how obsetricians are SURGEONS by DESIGN that are trained to LOOK FOR and TREAT PATHOLOGY. He even jokes that the “normal” patients bore him. This doctor was at the desk the entire time the midwife and I were in the room with the patient during her VBAC labor and birth but he was only on stand by incase the midwife said either a vaacuum or cesarean was necessary (neither of which were). I can think of two other OBGYNs that are also very awesome, both work with midwives and both rarely attend vaginal births…..their midwives do!!

      So to answer your question, yes I do work with some OBGYNs that are awesome but the majority I work with follow an obstetric/medical model of maternity care and seem to always be anticpating something to go horribly wrong with every women they care for. If they didnt, then all of their statistics wouldn’t show sky rocketing cesarean and induction rates.

      P.S. I am so happy that you found some OBGYNs that were so awesome!

  16. MM Says:

    This birth story could be my birth story–but instead the jerk in the room was the nurse, not the OB. The OB didn’t show up until I was already prepped and hysterical in the OR because it was all done against my consent.

    So much for informed consent and informed refusal.

    Way to go for being such a great nurse. We need more like you in the world!

    • nursingbirth Says:

      MM, I am all too familiar with the unsupportive nurse unfortunately because I have seen it before with some of the women I work with. Sometimes I feel that a bully nurse is worse than a bully birth attendant because she is typically the one who spends the most time with you. I am so sorry you had such a traumatic experience and I hope that through support groups, friends, family, and reserach you can one day make peace with it.

  17. This story sounds similar to my first birthing experience (http://realityrounds.com/2009/04/22/shes-a-nurse/). I was actually given much longer to push, but my OP baby was not budging. I was not given any options as far as pushing in different positions etc., and I must admit, I resented this later. As far as baby number 2…..VBAC baby! Thank God for midwives.

  18. Krista Says:

    Another great post, as usual. To all the hoping-to-VBAC ladies out there, let me give you hope! I’ve had 3 kids….first was c-section (and truly was an emergency and I am so thankful for that….not the emergency, but knowing that I’ll never doubt whether or not the c/s was truly necessary….nobody messes with placenta abruption!). Anyway, I’ve had two unmedicated hospital VBACs since and its changed my life! First VBAC was with an OB and even though she was “supportive” of me going natural, I knew I wanted a midwife the second time around. I don’t think we’ll be adding to our family, but if we did, I think we’d have to do a homebirth…..that *is* the next logical step, right? *lol*

    • nursingbirth Says:

      Krista, thanks for sharing your story with all the VBAC hopefuls out there!!! It is so unfortunate that for some many women, all they hear about are birth horror stories when they are pregnant!

  19. Evie Says:

    Did you report the doctor for not attaining valid consent before surgery?

    • nursingbirth Says:

      Evie, my hands were tied on this one because the patient had already signed her OR consent upon admission to the hospital (a practice I continue to voice my opposition too at work) which states in it “all the risks and benefits of above procedure have been explained to me and I have been given the opportunity to ask questions.” But i know that this wasnt truly the case. But there was her signature, in black and white, right on the paper. This is a perfect example of why you should never sign anything without REALLY reading it first!

  20. Kateisfun Says:

    Wow, another heart-breaking, yet awesome post. How do you manage to stay in your line of work with the seemingly daily frustrations of working with OBs like Dr. O? I really admire your staying power (I know those new moms do, too); I think I would have broken down long ago. Bless you!

    • nursingbirth Says:

      Kateisfun, believe me, I tell myself that I am going to quit and that “this time is the last straw” at least once a week! Haha! But seriously, one day I was talking to my husband about my options and I decided that I’ve got to stick it out longer because these women need support!

  21. I love your blog!! I wish I had found such a validating website after the birth of my first child. I was 41w4d with an uncomplicated pregnancy and a reassuring NST. But I was induced via cytotec even after I voiced my concerns with that drug to my doc. I labored for 17 hours and pushed for 3 (during which my doctor and nurse argued over whether I was 10cm or 9 with a ‘lip’) when my doctor said the baby was not going to move any lower down the birth canal. I had a c-section that I was terrified about for a 9lb 4oz baby. I grieved for weeks over my loss of a vaginal birth, and everyone around me seemed to be confused as to why I was upset. To complicate matters, I had great trouble breastfeeding and was unable to continue past 3 weeks. That loss only magnified my feelings of grief. I did a lot of research on VBACs before the birth of my 2nd child. I had a supportive doctor, I had a birth plan, etc but I ended up with a breech baby and a repeat section. Now after 3 babies, I am starting medical school this year and am leaning toward the ob/gyn field. I hope to be a physician who cares about her patients, their needs and their birth experience. I am excited to continue reading your blog as it is informative and engaging. Keep writing!!

    • nursingbirth Says:

      MedSchoolMommy, thank you so much for commenting. Sometimes in my posts it might seem like I am “anti obstetrician” but in fact I am not. I understand that not all obgyns follow an obstetric/medical model of maternity care and I hope that if you do decide to become an obgyn you will continue to believe in a more holistic model of care that has roots in your own very powerful experiences. I hope you keep reading too! Also I am so bummed out that after all that VBAC research your baby was breech! That kind of irony just baffels me! I hope your wishes come true!! Stay true to yourself!

  22. enjoybirth Says:

    Thank you for standing up for your patient and allowing her time to come to grips with the change in plan she was facing. I had an emergency cesarean for a good medical reason, but had NO time to come to grips with it. I wasn’t even in labor and was 34 weeks, so wasn’t even expecting to have a baby that day, let alone that week.

    I had no time to adjust, for good reasons, baby needed to come out THEN. But for moms that have time, when it isn’t an emergency, certainly they need time.

    And that OB was SO wrong. Holding your new baby doesn’t make it all better. For some moms it does, but for some moms it doesn’t. We need to respect the mother’s, let them have choices and a feeling of control (when time is not of the essence) that can play a huge outcome of their perception of their birth experience.

    So thank YOU for supporting this mom in such a loving, understanding way.

    • nursingbirth Says:

      enjoybirth, thank you for the encouraging and supportive comment! I agree with you whole-heartedly 🙂

  23. Debbie Says:

    I just found your blog and I really apprecated this post. I had a 30 weeker 4 years ago. I am blessed in that he is healthy and show no signs of his prematurity, but I can, even now, so relate to the loss of the birth experience that I expected. I cried all night and for days after. I thought it was just worry for my NICU boy, but now I realize I was crying for the loss of my ideal pregnancy. I didn’t really have a nurse talk to me at all after the delivery so wasn’t able to express my feelings at all at the time. I am so glad that you were there to support this mother and that she was able to breastfeed her baby right away.

  24. Birth_Lactation Says:

    You are an awesome advocate for the women in your care.. :-p and very skilled at assisting mom’s in voicing their true wishes to their “uninterested, couldn’t be bothered” doctors. I have worked with quite a few of those and still do. Isn’t it sad that as long as I’ve been doing this, there are some things that are nearly the same? That some physicians AND nurses continue to make decisions which make their job easier instead of what may be best practice. 😦 I’ll have some stories about later. Thanks for this story! Look forward to more. Melissa 🙂

  25. Catie Mehl Says:

    Thank you for your blog, I am really enjoying it. I’ve noticed you’ve had several OP babies lately. Have you heard of the technique called “Rotational Positioning” for turning OP babies? As a doula I have used it several dozen times and it has worked every time. And a friend of mine who is an L&D nurse has started to use it with great success as well.

    Keep doing what you do, we need more nurses like you!

  26. Jill Says:

    Oh, the “all that matters” line. It makes me want to stab people in the eyeballs. MOM MATTERS TOO.

    I suspect it was the epidural that doomed your patient in this post. There’s only so much movement you can do when you’re stuck in bed. My first son was OP and I, too, had an epidural…but I had no one to help me move at ALL. I pushed for four hours on my back before somebody figured out that he was turned the wrong way.

    This is why I think preventing malposition during pregnancy is SO important. I was hypervigilant about it with my second pregnancy. BEfore, I’d had no clue that you could even do something like that. Helping your baby be in the ideal position for birth just isn’t that important when it comes to the obstetrical model of care, along with a lot of other things that get overlooked. My mind aches with the “if onlys”…if only I had known he was OP…if only I hadn’t had the epidural, I could have moved around and pushed in a different position…if only, if only.

    • nursingbirth Says:

      Jill, I can see how easy it is to get caught up in the “if onlys”. I am so happy that you used the “if onlys” in a positive way as motivation to research more your second time around and plan the birth experience you always knew you could have!

  27. Sara Says:

    Oh, Melissa! I’ve been reading your blog all day (a slow Friday at the office) and just got to this post…now I’m sobbing in my cubicle. I am currently pregnant with my second child and am planning a VBAC for April ’12. My son was born by emergency c-section, after his planned homebirth resulted in a transfer to the hospital. From the moment that my birth team mentioned the possibility of a transfer, I felt that they had given up on me. And honestly, I might have been able to come to terms with the fact that was not going to have my peaceful homebirth if someone [ANYONE] had taken me in their arms and reassured me that I was not a failure and that it was not my fault the way that you did for Denise. God bless you for your commitment and dedication to the women whom you serve.
    This new pregnancy has brought up a lot of the emotional trauma from my previous experience, but when I asked my midwife for advice, she told me to stop reading so much about VBAC and to just enjoy being pregnant. I’m having a hard time and don’t know where to turn. I know that this post is old, so maybe you won’t read my reply, but if you have any words of encouragement to share, I could surely use them.


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