I have a client due now-ish, someone whom I've felt a sweet connection to from the beginning. The stakes are high for her, as she wants to have a VBAC, and she deeply questions the necessity of her c-section a few years ago.
This client, like many VBAC women, has a "supportive" OB -- who has scheduled her repeat c-section for one week past her due date. And like many VBAC women, is under a tremendous amount of pressure to go into labor spontaneously and has spent many hours fretting, losing valuable sleep as she worries about how to get labor started.
She has armed herself with tons of information, so she knows that VBAC theoretically has less inherent risks than repeat cesarean. She understands that a healthy, spontaneous labor can begin at 42 weeks, which is 2 weeks past a due date. She understands the details of her own c-section and why she is particularly low risk for possible VBAC complications. In fact, a lot of this information came from her supportive OB -- the one who scheduled her repeat c-section.
She understands that hospitals have administrative protocols, so perhaps that is the sole reason why her surgery was scheduled. When the hospital sent forms for her to sign, her OB said, "Oh, don't worry about those things!" But her due date is approaching, and the supportive OB is now saying "Hopefully we won't get to that date, so let's not worry about it now."
But she is starting to worry, because that repeat section certainly becomes more possible with each passing day.
And then yesterday she had high blood pressure. She's a pregnant woman at 39 weeks, moving triple her usual blood volume and supporting another life inside her own body. She's working hard. She's also caring for a toddler. And she's anxious about her baby's upcoming birth. Of course she's got high blood pressure.
Her OB's solution to high blood pressure is to make her not be pregnant anymore (and notice that what my client has is high blood pressure, not pre-eclampsia, and it is important to know the difference). She has swept her membranes, and wants her to return in 24 hours for another blood pressure check and for another sweeping "if this doesn't work." And then the next step would be for an induction, if her cervix is favorable. And if not, c-section.
Between now and then, I gave her a few suggestions. She has been avoiding salt, but I explained to her why the body actually needs salt and so suggested that she use a little sea salt on one small thing on her plate. I also suggested soaking in epsom salt baths, maybe 2-3 times before she returned for the blood pressure check. I also suggested that she reach out to her ever-loving network of family and friends who have offered to help her when the new baby comes and tell them she needs their help NOW, to care for her daughter, to cook up a few meals, to run some errands -- because nothing is more important right now than putting her feet up, resting, drinking lots of water, and putting to use those very same meditation and visualization exercises for labor that she's been practicing for weeks.
She returned to the OB, and guess what. Her blood pressure was down. Not only that, physically she felt better. She thanked me for the suggestions, but I told her it was her body, and that she had done it. Just wait till she's in labor.
A Mom Is Born is written by doula, a wife, and a mother. This blog is a lot like birth: a little political, a little personal, with a whole lot of work and passion. You can also follow A Mom is Born on Facebook.
Showing posts with label c-section. Show all posts
Showing posts with label c-section. Show all posts
Tuesday, September 28, 2010
Thursday, May 13, 2010
What's a Good Doula to Do?
Recently, one of my clients went in for a c-section after a trial of labor. The nurses could see how much support I was providing my client, who was definitely more than panicked by labor. I'd say she was bordering on hysteria at times, but with guided visualization and breathing exercises led by me, she would calm down.
When the nurses brought scrubs for the husband to wear into the OR, they gave me a set, too. "She needs you in there," they said.
I went into the bathroom to change, and I could hear the anesthesiologist saying no. Rather than put the scrubs on, I came back out. I asked the nurse "No go?"
The anesthesiologist looked at me directly -- and not unkindly -- said no, I could not go in. She even said she was sorry, then explained to my client "There's just so little space in the OR, and with both your husband there and your doula, it will be too crowded."
I have to admit that I was disappointed, having never been in the OR yet, but I readily accepted her decision. Doulas almost never go into the OR. More importantly, I felt like my client had no expectation for me to be there, and she was fine with it. I told her I'd wait in her room, that I'd be there as soon as they brought her back in, and that I couldn't wait for her to introduce me to her baby.
Soon it was just me in the room, and I was tidying up my client's belongings. Another nurse came in. "Do you still have the scrubs?" she asked. "Put them on, because I think you should go in there."
I told her that the anesthesiologist had already refused me (what I learned in training was that it was the anesthesiologist's call, since doulas and partners would need to share the same space with that doc).
She shook her head. "I'm the OR charge nurse" (or whatever her title was...), "and it's no one's decision but mine, and your patient needs you."
"Is she having another panic attack?" I asked.
"No," said the nurse, "but if she does, you're the one she responds to."
Truly, I felt that my client and her husband were fine, even relieved to choose a c-section (and they did choose it). I said to the nurse, "The anesthesiologist looked right at me and told me no."
"But it's my call," she insisted. "They won't give you a hard time, they'll give me a hard time."
Had my client been unravelling, perhaps I would have reconsidered -- perhaps. But doulas walk such a tough line in the hospital; I'm only as good as the doula the staff has dealt with just prior to me, and whatever I do sets the mood for the doula they encounter after me. And doulas have to work hard to earn the respect of OB's, more often than not. Ultimately, I decided not to go.
What would you have done?
.
When the nurses brought scrubs for the husband to wear into the OR, they gave me a set, too. "She needs you in there," they said.
I went into the bathroom to change, and I could hear the anesthesiologist saying no. Rather than put the scrubs on, I came back out. I asked the nurse "No go?"
The anesthesiologist looked at me directly -- and not unkindly -- said no, I could not go in. She even said she was sorry, then explained to my client "There's just so little space in the OR, and with both your husband there and your doula, it will be too crowded."
I have to admit that I was disappointed, having never been in the OR yet, but I readily accepted her decision. Doulas almost never go into the OR. More importantly, I felt like my client had no expectation for me to be there, and she was fine with it. I told her I'd wait in her room, that I'd be there as soon as they brought her back in, and that I couldn't wait for her to introduce me to her baby.
Soon it was just me in the room, and I was tidying up my client's belongings. Another nurse came in. "Do you still have the scrubs?" she asked. "Put them on, because I think you should go in there."
I told her that the anesthesiologist had already refused me (what I learned in training was that it was the anesthesiologist's call, since doulas and partners would need to share the same space with that doc).
She shook her head. "I'm the OR charge nurse" (or whatever her title was...), "and it's no one's decision but mine, and your patient needs you."
"Is she having another panic attack?" I asked.
"No," said the nurse, "but if she does, you're the one she responds to."
Truly, I felt that my client and her husband were fine, even relieved to choose a c-section (and they did choose it). I said to the nurse, "The anesthesiologist looked right at me and told me no."
"But it's my call," she insisted. "They won't give you a hard time, they'll give me a hard time."
Had my client been unravelling, perhaps I would have reconsidered -- perhaps. But doulas walk such a tough line in the hospital; I'm only as good as the doula the staff has dealt with just prior to me, and whatever I do sets the mood for the doula they encounter after me. And doulas have to work hard to earn the respect of OB's, more often than not. Ultimately, I decided not to go.
What would you have done?
.
Tuesday, April 27, 2010
Sunday, Three Years Later
I wake up to my phone ringing at 6AM. My client is in labor, experiencing strong contractions every 7 minutes.
She had called me three years earlier, also on a Sunday morning. Her contractions were mild, but steady, about 10 minutes apart. She went to church, ate lunch, went for a walk. I joined them mid-afternoon, and she was admitted to L&D at 8cm. She began pushing once fully dilated. And pushing. And pushing. And pushing. She pushed for 2 hours, and the baby budged not at all, and in the moments before dawn, she delivered her baby via C-section.
That was the very first birth I had ever attended. I have never forgotten her, always wondering if my inexperience contributed to her c-section.
And some thirty births later, she sits on a birthing stool, leaning on her husband for support, one hand on a squeeze bar, the other hand powerfully gripping mine. In the expanse of the room, we huddle in the corner, hospital bed pushed out of the way. Her OB catches her baby while half-crouching, half-lying on the floor. Via a well-placed mirror, the mother and father watch their beautiful daughter come into the world -- an unmedicated, spontaneous, vaginal birth after cesaerean -- and all the wondering is gone.
.
She had called me three years earlier, also on a Sunday morning. Her contractions were mild, but steady, about 10 minutes apart. She went to church, ate lunch, went for a walk. I joined them mid-afternoon, and she was admitted to L&D at 8cm. She began pushing once fully dilated. And pushing. And pushing. And pushing. She pushed for 2 hours, and the baby budged not at all, and in the moments before dawn, she delivered her baby via C-section.
That was the very first birth I had ever attended. I have never forgotten her, always wondering if my inexperience contributed to her c-section.
And some thirty births later, she sits on a birthing stool, leaning on her husband for support, one hand on a squeeze bar, the other hand powerfully gripping mine. In the expanse of the room, we huddle in the corner, hospital bed pushed out of the way. Her OB catches her baby while half-crouching, half-lying on the floor. Via a well-placed mirror, the mother and father watch their beautiful daughter come into the world -- an unmedicated, spontaneous, vaginal birth after cesaerean -- and all the wondering is gone.
.
Sunday, August 2, 2009
More Labor Support is Necessary in Canada -- and in the US, too!
From The Daily News out of Canada, an article on how labor support can reduce surgical births by as much as 20%.
I'm curious as to what guidelines the Canadian Society of Obstetricians and Gynaecologists feel aren't being followed, guidelines that are aimed towards lowering unnecessary surgeries. From what I admit can be a jaded point of view, I'd never think that the American College of OB/GYNs would describe any surgeries as unnecessary, especially because hospital guidelines which dictate how a woman should labor seem to be in place for lowering unnecessary liability more than anything else. Hospital c-section is considered the gold standard of life-saving hospital care, which I think it can be when c-sections are truly necessary - but not when they are the self-fulfilling prophesies of labor practices that are not mother- and birth-friendly.
.
I'm curious as to what guidelines the Canadian Society of Obstetricians and Gynaecologists feel aren't being followed, guidelines that are aimed towards lowering unnecessary surgeries. From what I admit can be a jaded point of view, I'd never think that the American College of OB/GYNs would describe any surgeries as unnecessary, especially because hospital guidelines which dictate how a woman should labor seem to be in place for lowering unnecessary liability more than anything else. Hospital c-section is considered the gold standard of life-saving hospital care, which I think it can be when c-sections are truly necessary - but not when they are the self-fulfilling prophesies of labor practices that are not mother- and birth-friendly.
.
Wednesday, June 10, 2009
Women Must Be Informed, Political Collaborators in Their Own Care
Dr. Tiller's clinic in Witchita, KS, one of the few in the country that provides late-term abortions, is closing. With his murder, in addition to wiping out the life of a husband and father, the anti-choice movement has taken away women's access to critical, necessary services. And while the current political make-up shows that the anti-choice movement cannot overturn Roe v. Wade, Dr. Tiller's death is a reminder that all it takes is a sniper to reduce our choices even further. And since OB-GYN's aren't racing to provide abortion services at the risk of their own lives, Dr. Tiller's practice may not ever be replaced.
When I'm not a doula, I work as an abortion counselor. Although most of the women I meet with are between 4 and 7 weeks pregnant, the clinic where I work provides abortion services up until the 23rd week of pregnancy, which is the legal limit of abortion care in the state of Massachusetts.
Your reaction may be visceral, no doubt. At 23 weeks, abortion can be extremely difficult to understand or justify, and it is not uncommon to shake your head and say "I have a real problem with that," even if you are pro-choice. It is tempting, if not comforting, to separate yourself from a woman who would make this choice by assuming that she must be a monster. And I'll be honest and say that once I sat down with a woman who seemingly had no feelings about having an abortion in her 23rd week of pregnancy. It chilled me, her apparent lack of feeling. But many more times than just once, I have sat down with couples who are heartbroken: a routine ultrasound in the 20th week discovers massive deformities; an amniocentesis details profound genetic abnormalities that at are incompatible with all but the briefest of life, and suffering is certain; a doppler at 22 weeks returns no heartbeat, reducing a wanted and cherished baby into a diagnosis of fetal demise. And sometimes, due to the time it takes to run tests, or to the human inconsistencies of those who administer those tests, or the varying reliability of technology, a pregnant woman in those situations can be beyond 23 weeks. And so what do we do in the state of Massachusetts? We tell her she can deliver her dead, deformed, or doomed baby in a labor and delivery unit of a hospital -- which is as monstrous as it sounds -- or we recommend she travel immediately to one of the few clinics in the United States that can terminate her pregnancy. And with the death of Dr. Tiller and the closing of his clinic, there is now one less place where a woman in this delicate and devastating situation can go for care that is humane and treats her with dignity.
And on the other end of pregnancy, women are also losing choices in childbirth. In my line of work, I hear many birth stories from women, and the majority of them have the same eerie arc: first, induction; second, confinement to a bed; third, bone-crushing pain; finally, forced pushing while lying on their backs. Statistically, more than 30% of those stories end in c-section, and these are in pregnancies that had been normal, low-risk, and healthy. It's also the basic formula for reality birth shows on cable TV, where birth is boiled down to a medical event that skirts death practically every time.
VBACs are becoming harder to access, despite evidence that indicates that VBAC is lower risk than repeat C-section. Providers, among both OB's and L&D nurses, have attended fewer and fewer low-risk, healthy childbirths that are purposefully unmedicated and without interventions. What results over time is that if a laboring woman wants a natural birth, she could go to a hospital and have no medical professionals with the experience or willingness to support her desires. Birth centers are losing funding, and homebirth is either criminalized or unregulated in half of the US. In the other half of the country, the standards of care that do govern it are so limiting that its practice is nearly impossible but for a few renegade midwives who are essentially providing care without the benefit of professional support in case of a true obstetric emergency. Healthy women who could experience the normal physiological process of birth are beholden to the artificial constructs of time, liability, and television drama. The art of childbirth, and the choices that encourage birth as a safe, non-medical event, are being lost.
Unless we have a vision that is greater than the arguments of pro-life vs. pro-choice, homebirth vs. hospital, natural birth vs. epidural, we will lose what is truly at stake at the heart of these issues: choices. The quality of women's health care is dependent upon choices and access to qualified care providers, and women must expect no less than to be informed, political collaborators in their own care.
.
When I'm not a doula, I work as an abortion counselor. Although most of the women I meet with are between 4 and 7 weeks pregnant, the clinic where I work provides abortion services up until the 23rd week of pregnancy, which is the legal limit of abortion care in the state of Massachusetts.
Your reaction may be visceral, no doubt. At 23 weeks, abortion can be extremely difficult to understand or justify, and it is not uncommon to shake your head and say "I have a real problem with that," even if you are pro-choice. It is tempting, if not comforting, to separate yourself from a woman who would make this choice by assuming that she must be a monster. And I'll be honest and say that once I sat down with a woman who seemingly had no feelings about having an abortion in her 23rd week of pregnancy. It chilled me, her apparent lack of feeling. But many more times than just once, I have sat down with couples who are heartbroken: a routine ultrasound in the 20th week discovers massive deformities; an amniocentesis details profound genetic abnormalities that at are incompatible with all but the briefest of life, and suffering is certain; a doppler at 22 weeks returns no heartbeat, reducing a wanted and cherished baby into a diagnosis of fetal demise. And sometimes, due to the time it takes to run tests, or to the human inconsistencies of those who administer those tests, or the varying reliability of technology, a pregnant woman in those situations can be beyond 23 weeks. And so what do we do in the state of Massachusetts? We tell her she can deliver her dead, deformed, or doomed baby in a labor and delivery unit of a hospital -- which is as monstrous as it sounds -- or we recommend she travel immediately to one of the few clinics in the United States that can terminate her pregnancy. And with the death of Dr. Tiller and the closing of his clinic, there is now one less place where a woman in this delicate and devastating situation can go for care that is humane and treats her with dignity.
And on the other end of pregnancy, women are also losing choices in childbirth. In my line of work, I hear many birth stories from women, and the majority of them have the same eerie arc: first, induction; second, confinement to a bed; third, bone-crushing pain; finally, forced pushing while lying on their backs. Statistically, more than 30% of those stories end in c-section, and these are in pregnancies that had been normal, low-risk, and healthy. It's also the basic formula for reality birth shows on cable TV, where birth is boiled down to a medical event that skirts death practically every time.
VBACs are becoming harder to access, despite evidence that indicates that VBAC is lower risk than repeat C-section. Providers, among both OB's and L&D nurses, have attended fewer and fewer low-risk, healthy childbirths that are purposefully unmedicated and without interventions. What results over time is that if a laboring woman wants a natural birth, she could go to a hospital and have no medical professionals with the experience or willingness to support her desires. Birth centers are losing funding, and homebirth is either criminalized or unregulated in half of the US. In the other half of the country, the standards of care that do govern it are so limiting that its practice is nearly impossible but for a few renegade midwives who are essentially providing care without the benefit of professional support in case of a true obstetric emergency. Healthy women who could experience the normal physiological process of birth are beholden to the artificial constructs of time, liability, and television drama. The art of childbirth, and the choices that encourage birth as a safe, non-medical event, are being lost.
Unless we have a vision that is greater than the arguments of pro-life vs. pro-choice, homebirth vs. hospital, natural birth vs. epidural, we will lose what is truly at stake at the heart of these issues: choices. The quality of women's health care is dependent upon choices and access to qualified care providers, and women must expect no less than to be informed, political collaborators in their own care.
.
Subscribe to:
Posts (Atom)