Posts from the ‘Birth Stories’ Category

Oct 20

We Deliver? How about we make it a better delivery?

permission from CartoonStock

Our Maternity Services

Need Help!

The Maternal Child care delivery system in this country as a whole needs vast improvement. All of these 10 steps as well as the 10 steps to ensure optimal successful breastfeeding are very important.

These items are sadly grossly misconstrued or ignored by many facilities offering maternity services in this country. I have been having the same discussions and occasional arguments with co-workers lately on this battle of the newborn baby staying in the moms room overnight!!! I know~ it is a no brainer to those of you who read, research and understand. Many of my co-workers still defend their philosophy that the baby needs to come into the nursery at night so the mom can sleep!! Many argue with me about labor positions and inductions!! AARRGGHH! I won’t get into our details right now…….

What I have here for you today is NOT new info but I recently reviewed it again as I was searching for evidence to back my discussions with staff. If you haven’t placed this information in your workplace to nudge some resistant peers, I urge you to do so!

This document : THE COALITION FOR IMPROVING MATERNITY SERVICES:
EVIDENCE BASIS FOR THE TEN STEPS OF MOTHER-FRIENDLY CARE can show you research studies or data which support the ten steps below.

The 10 steps for Mother-Friendly Care from CIMS {Coalition for Improving Maternity Services} taken from their website…..are:

Ten Steps of the Mother-Friendly Childbirth Initiative
For Mother-Friendly Hospitals, Birth Centers,* and Home Birth Services

To receive CIMS designation as “mother-friendly,” a hospital, birth center, or home birth service must carry out the above philosophical principles by fulfilling the Ten Steps of Mother-Friendly Care.

A mother-friendly hospital, birth center, or home birth service:

Offers all birthing mothers:

Unrestricted access to the birth companions of her choice, including fathers, partners, children, family members, and friends;

Unrestricted access to continuous emotional and physical support from a skilled woman—for example, a doula,* or labor-support professional;

Access to professional midwifery care.

Provides accurate descriptive and statistical information to the public about its practices and procedures for birth care, including measures of interventions and outcomes.

Provides culturally competent care—that is, care that is sensitive and responsive to the specific beliefs, values, and customs of the mother’s ethnicity and religion.

Provides the birthing woman with the freedom to walk, move about, and assume the positions of her choice during labor and birth (unless restriction is specifically required to correct a complication), and discourages the use of the lithotomy (flat on back with legs elevated) position.

Has clearly defined policies and procedures for:

collaborating and consulting throughout the perinatal period with other maternity services, including communicating with the original caregiver when transfer from one birth site to another is necessary;

linking the mother and baby to appropriate community resources, including prenatal and post-discharge follow-up and breastfeeding support.

Does not routinely employ practices and procedures that are unsupported by scientific evidence, including but not limited to the following:

shaving;

enemas;

IVs (intravenous drip);

withholding nourishment or water;

early rupture of membranes*;

electronic fetal monitoring;

Has an induction* rate of 10% or less;†

Has an episiotomy* rate of 20% or less, with a goal of 5% or less;

Has a total cesarean rate of 10% or less in community hospitals, and 15% or less in tertiary care (high-risk) hospitals;

Has a VBAC (vaginal birth after cesarean) rate of 60% or more with a goal of 75% or more.

other interventions are limited as follows:

Educates staff in non-drug methods of pain relief, and does not promote the use of analgesic or anesthetic drugs not specifically required to correct a complication.

Encourages all mothers and families, including those with sick or premature newborns or infants with congenital problems, to touch, hold, breastfeed, and care for their babies to the extent compatible with their conditions.

Discourages non-religious circumcision of the newborn.

Strives to achieve the WHO-UNICEF “Ten Steps of the Baby-Friendly Hospital Initiative” to promote successful breastfeeding:

Have a written breastfeeding policy that is routinely communicated to all health care staff;

Train all health care staff in skills necessary to implement this policy;

Inform all pregnant women about the benefits and management of breastfeeding;

Help mothers initiate breastfeeding within a half-hour of birth;

Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants;

Give newborn infants no food or drink other than breast milk unless medically indicated;

Practice rooming in: allow mothers and infants to remain together 24 hours a day;

Encourage breastfeeding on demand;

Give no artificial teat or pacifiers (also called dummies or soothers) to breastfeeding infants;

Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from hospitals or clinics

† This criterion is presently under review.

I endorse these steps. You can visit their website to also endorse.

Kathy from Woman to Woman Childbirth Education wrote about the CIMS press release on the Need for Transparency regarding the rising C/S rates. Excellent information is discussed here by the CIMS and I enjoyed the discussion between Kathy and RealityRounds.

I also would urge you all to visit and give information to The Birth Survey.

How is your birth place measuring up to these initiatives?

Let’s all continue to make this a better world

in which to give birth!!

Oct 6

5 Comments

**A Full Moon doesn’t always bring lots of babies**

A Full Moon Flight?

We had a Full Moon this past weekend. October 4th– according to my calender. Over the past 35+ years in this business, it has been my experience that the full moon does NOT bring all the babies! We had just one baby born this whole weekend…. and hardly any labor checks. It was eery Quiet. (The “Q” word. Something we only say after our shift!)

The weekend before, however, is another story! We had 13 deliveries during the 2 day wkend and L&D was packed most days during the whole week leading up to this full moon! We had to use a lot of overflow rooms for evals and non-stress tests. Everywhere I turned, it was crazy busy.. and not just in L&D. It seems we get more babies with high bilirubins, more early babies with transitional breathing problems and other little issues whenever we have high census!

In my experience, I have seen the most babies born either on a new moon or the week of waxing or waning of the full moon and not on the actual full moon. Is it like that where you work?? I would really like to know the experiences of other L&D nurses.

So tell me— what happens in your world?

Sep 20

2 Comments

No VBAC’s Banned: So Far so Good

iStock_000004564778Small My little hospital is not one of those hospitals which has banned VBAC’s.

We’ve been doing VBAC’s since 1984. Here is our first VBAC story. You may have read and heard that some places had specific policies against a mother attempting a VBAC. There is really only a small percentage of women who truly are not a good candidate for a vaginal delivery after a cesarean. (Having a previous vertical incision in the uterus for example). There are several places a mother can go to for facts, scientific research, honest information and support if her provider or hospital has denied her an opportunity to VBAC. If this has happened to you, it will be important to do your homework, get the facts and have a really good conversation with your provider. It is important to make an informed choice weighing your benefits and any potential risks.

We do just under a thousand deliveries a year.

From January through July 2009~

We had a 100% successful VBAC rate!!!!

We had 2 mom’s last month that ended up having to go for a cesarean after labor began. I don’t know all the numbers but I had looked over the perinatal data sheets yesterday and I was so very happy to see how we were doing.

Let’s hope we keep it up!

😉

Sep 14

2 Comments

Are YOU an Activist? Healthy People 2020 Public Meeting Announcements

ARE you an activist?

Do you want to have input or learn more??

What do you know about the Healthy People 2010 National Objectives ……. and how the breastfeeding goals haven’t been met?

The PLAN ~ The GOAL:

(From the Healthy People website:)

Healthy People 2010 challenges individuals, communities, and professionals, indeed all of us to take specific steps to ensure that good health, as well as long life, are enjoyed by all.

Healthy People 2010 objectives for breastfeeding in early postpartum period, at 6 months, and 12 months are 75%, 50%, and 25%, respectively. Healthy People 2010 objectives for exclusive breastfeeding through 3 and 6 months of age are 40% and 17%, respectively

So how are we doing???

From the CDC website regarding Breastfeeding Data:

Breastfeeding rates have improved since 1999, but fall short of Healthy People 2010 objectives regarding duration and exclusivity. Among children born in 2006, 74% initiated breastfeeding, whereas 43% were breastfeeding at 6 months and 23% at 12 months of age. Approximately 33% of infants born in 2006 were exclusively breastfed through 3 months of age, and 14% were exclusively breastfed for 6 months.

Check the CDC website above for a complete evaluation of how we measure up. I am so happy for thoses states who actually accomplished these objectives! There are some that exceed these goals and others who are really behind. I think because of this, the national picture as a whole is misleading, reflecting an average of a lot of highs and lows. It doesn’t show a true picture for those areas struggling. I want to learn more to help my area move up towards the goals.

What can we do to improve and work towards accomplishing these goals ????

I got this important email letter today and promptly registered to go the meeting in Philadelphia on November 7th. I want to learn all that I can about what goes into the planning and possibly what more I can do at my local level to help meet the breastfeeding objectives. From the US Lactation Consultant Association:

During October and November the Department of Health and Human Services (DHHS) will conduct public meetings in Kansas City (Kansas), Philadelphia (Pennsylvania), and Seattle (Washington) on draft objectives for Healthy People 2020. The public will have an opportunity to comment on the draft objectives at the public meetings, and on the public comment Web site. The comments received will then be used to revise the objectives appropriately. We hope that you will consider attending if you live near one of these sites. We will coordinate work on this with the US Breastfeeding Committee. This presents a wonderful opportunity to have our voices heard on national policy-making relative to breastfeeding.

I’m not public speaker, I am interested in policy making for the HP2020.

I want to go and learn from my well respected colleagues.

Check it out! Click on the HP 2020 icon at the top of the post!

Sep 2

3 Comments

Babies EVERYWHERE! Wordless Wednesday

Babies Everywhere!!

I got this greeting card a while back and I adore it.

1950’s to 1960’s style maternity outing…

cloth diapers and outfits

Partial of the inscription inside reads:

“Whatever you’ve got, bet your glad it’s not this!”

(Credit—> Shoebox division Hallmark)

Aug 31

2 Comments

A Wonderful Day in the BirthingHood

What a great fun day in the world of birthing.
The first words I heard at work today were words that I just love to hear when used in this sequence….

“Section’s Canceled”

Hooray!

Her Cesarean had been scheduled because her baby had been in a transverse lie position…. for weeks. However–> this smart little genius baby had positioned his little self into a beautiful head down position before arriving at the hospital this morning! Mom was also contracting regularly and was 3 cm dilated. This was her second baby, first exam of the day, so she hung out for a while until it was clear she was continuing to make cervical changes and labor was underway.

A few others decided it was their time to make an appearance today. One baby boy was a couple weeks early and another a few days over 41 weeks.

Ever hear that things sometimes happen in 3’s ??

As luck would have it, 3 young men decided to be born within 15 minutes of each other! All 3 were spontaneous vaginal deliveries. All 3 boys were breastfeeding within that first hour and 1/2 … not bad!

All the moms were so happy with their birth experiences. All the babies were healthy. The staff worked really well together. Our midwife was awesome! The doctors were fun, funny, thoughtful and kind and made really good patient centered decisions.

It was just an all around wonderful day in the birthinghood!

005

Aug 24

15 Comments

Frustrations in Obstetrical Care …Culturally Sensitive? Oppressive Male Partners?

027 The drama that went on here this weekend would be fodder for 10 or more Jerry Springer shows!

~Unreal~

I kept thinking…

“Please help me”

I am not and never have been prejudiced or bigoted in thought process, personality or behavior towards others. I am actually on a campaign to help educate our staff on being culturally sensitive and delivering culturally competent care in relation to obstetrical, breastfeeding and newborn care…. I’m currently organizing a quick reference handbook so certain beliefs & cultural values are better understood by our staff.

This type of sensitivity is very important to me.

It may not matter how I say this. Despite me trying to convince you that I am not intending to offend any type of people…..someone will most likely get annoyed or upset. I don’t usually enter into this type of discussion. I am quite adept at diffusing anger. I am not singling out a problem with any specific culture, ethnicity, or country of origin. I am not attributing any certain behavior to any certain culture.

This weekend, we had mother’s giving birth who have recently arrived in the United States from the following areas: Argentina, Poland, Liberia, Egypt, Iraq, India, Dominican Republic and Nigeria. Sometimes their husband, boyfriend or significant other was from yet another different country. These are not unusual immigrants for our patient population. It is however, unusual to have such diversity in a single 2-3 day period!

My concern is this— As a health care provider– how do you even begin to try to understand another’s strong belief’s or values when you are treated with tremendous disrespect and confronted with attitudes which are unusually demanding of the caregivers to “provide” for any and all needs. Now this is of course what we do…. provide for the needs of those in our care. That includes our responsibility for understanding different certain religious beliefs, cultures and their various norms and values. But this should be done within an environment or culture of MUTUAL RESPECT.

As much as it is our responsibility to provide for those individuals in our care….. to be culturally sensitive. I feel there should at least be some responsibility on the part of the patient — and or their family- to learn what may be expected of them …. to communicate their history, needs and or wishes to the doctors and nurses~~ or at least to try to understand when it is explained to them at the time of birth and not lash out with anger or disrespect to their caregivers. Is it too much to ask for a little bit of responsibility to understand at least a little something about what is involved in childbirth, postpartum, newborn care and the legal recording of birth in the facility, state and country in which they have come to and chosen to give birth! {Many times I have been told they came here so their baby would be an American citizen.} Am I allowed to ask that those from other countries try to be somewhat sensitive to and try to understand our culture? I am not trying to victim blame here. Really. Many of the patients exhibited rude entitled behaviors and were very disrespectful to staff. We are all “others” to each other –> but one big blending of society. Lets ALL understand and respect each other.

Some of the behaviors we dealt with include:

A mother is married, the father of her baby is NOT her husband. The FOB becomes physically violent that his name can not be on the birth certificate–yet– until there is an affidavit submitted that the husband is not the father…. This turned into an all out fist fight between the the 2 men. “SECURITY!!”
A husband refused to allow his wife to be examined in labor during his absence, yet left for hours at a time demanding the hospital provide for his transportation to and from his business 15 – 20 miles away.
This same father would not allow his wife to speak for herself…. then called our unit many times after the birth when he was not there to say he was sure his wife was suffering from post-partum depression and we needed to treat her!
An unmarried young girl had a PFO against the father of her baby — She did NOT want to see his family yet that FOB’s family demanded to be allowed to visit, displaying hostility, speaking loudly and threatening staff in a non-English language outside the entrance to our unit!
Another mother delivered and the father of her baby was currently in jail on drug charges. She met the criteria (for other reasons) where she and her baby were screened for drugs…. Both were positive for cocaine and heroin… sadly.. 😦 This infant needed to be placed in protective custody of Children’s Services and treated for withdrawal. This is always difficult and heart wrenching. This mother spoke very little english, was ANGRY the tests were done and we were not able to help her understand a situation of this magnitude easily with the language line….
Frenzied inpatient banging on the window and yelling for the only nurses’s attention to simply ask a question or get more supplies for their infant even though she was involved in an exam with a doctor on a new very sick infant and had signaled she’d be there “in a moment’…
The family and multiple extended family members demanding minute by minute updates on a sick newborn, interrupting our care by knocking on the doors and windows to the nursery… after we have explained all minute by minute updates to the parents of that baby who were at the bedside. I have a feeling that culture may have placed a value on the elders decisions over the actual parents, but this mother did not want the father’s family to be in the nursery with her. They don’t understand HIPAA or even know what it is! My job is to support the mother and keep her informed and with her baby.
A family not wanting to answer most of the questions for the birth certificate because… it was simply an invasion of their privacy. Alright then.. it will remain blank and the Bureau of Vital Statistics can deal with it, right?
A father of a baby requesting then ultimately demanding to speak to the doctor ONLY for each and every one of his questions.. (I am just a nurse).. did I mention it was the weekend?? We don’t have doctors present 24/7 !

There are times when these situations unfortunately occur. Many times the individuals involved are Americans who are 2nd or 3rd generation of mixed ethnic background or are of no discernable ethnic or cultural background, have lived in this country all of their lives and still exhibit the same type difficult personality traits. Since they are more “Americanized” shall I say-or however is politically correct to discuss it— it isn’t so difficult to diffuse hostility’s, discuss options, assist with birth, newborn care, breastfeeding, do birth certificates…etc. It is my opinion that sometimes they understand things better simply from living here. We will ALWAYS encounter individuals with difficult personalities regardless of background who may be demanding in nature. They may not initially understand what’s happening but usually respond well to a gentle receptive approach.

That was NOT the case this weekend!

I only wish for strength and future guidance to help and support those who don’t quite understand.

Don’t yell at me or treat me with disrespect.

I ask those individuals new to our country to help themselves a little and learn some of our language and the framework for which we deliver our obstetrical care.

Please.

Aug 11

12 Comments

Not your Usual Birth Plan

002

A birth plan is usually a written plan from the mother to her caregivers describing her wishes, what type of options she’d like to take advantage of, things she would like to happen thru out her labor and birth, what things are important to her as she experiences birth. There are various resources out there to help a new mom explore options and formulate a plan.. especially for a hospital birth. It is important that the mom review this with ALL her care providers AND especially the L&D nurses…. the advocates who help you actually realize the goals with in your plan. I have a fellow L&D nurse blogger who has done extensive research on the topic and wrote a 2 part series on Writing Your Birth Plan- Tips from an L&D Nurse over at nursingbirth. I would highly recommend you check it out especially if you plan on a hospital birth.

Many times these birth plans accompany a mom’s prenatal chart weeks in advance of her birth. Over the years there has been a gradual acceptance of the plans in my facility where historically, there had been much resistance for the mother’s input what so ever. Much like the attitudes towards homebirth…. The doctors or nurses would casually peruse the plan then toss it aside and have a good laugh…. saying…. ” oh- she’ll end up a section for sure!” Unfortunately, they were often right about that– many of those early birthplans never seemed to go as mom wanted, giving the staff fodder for snide comments and remarks. Sad but true. 😦

Recently, we recieved a birth plan that was not at all like any other. Maybe some of you have seen plans like this… maybe some of you actually wished for births like this…. Hey~ who am I to judge? …. I am only here to help, it isn’t my birth.

Her Birth Plan requested:

Pain medication as soon as possible….. I prefer to have an epidural as soon as possible
Please do not try to make me have breathing patterns through contractions… I’m afraid I’ll be too nervous
If a Cesearean is needed, please put me to sleep
I want only my mother with me in the labor and delivery of my baby
When the baby is born, I do NOT want to touch him until you clean him off
You can do his eye ointment and Vitamin shot, bath and all procedures before I hold him
I want to hold him wrapped in a blanket, not skin to skin
I want the baby to be in the nursery as much as possible at night so I can rest
I want to feed my baby formula from a bottle. I don’t want to breast-feed
I want to stay in the hospital for the whole allotted time so I can rest

My first thoughts were… Sweetheart, you could have ALL THIS without even asking!” ……..

Sadly, despite all efforts to improve, … things still happen exactly like this for many births. We just don’t usually see it written out as a formal request or plan! At least this is how this mother wanted things to happen.

This little mommy came in and delivered vaginally. Her plan was very easily carried out. 😉 I am very happy to report that she and her son were healthy and she displayed very postive interaction with him. Very loving and caring. She was very very happy with her birth and with being a mother!

That is all that really matters in the end. Options– and what you as an individual would like to have for your birth. How much education she had before chosing these options… I’ll never know.

Now I am asking the rest of cyberspace world.. have you ever seen birth plans like this???

Aug 7

10 Comments

A Formula Rep turned my Maternity Leave Injury into a new career as an IBCLC? Really?

My contribution to this fabulous Carnival of Maternity Leave , is a story of how during my maternity leave, an injury occurred leading to a career change specializing in Lactation… ! It starts with the birth of my third and last baby…… A girl….. (after 2 boys) was also born by C-Section.. a first for me.

Well– first, let me back up a few years… I’ve had a potpourri of maternity leaves. I have been a Maternity/L&D/Nursery since the mid 70’s. I always worked full time and had never entertained thoughts of staying home with my children once they were born because the USA didn’t assist in providing any type of viable option for families who rely on two incomes or single moms with one income. Prior to FMLA, maternity leave was pretty much up to the employer as far as I understand it. The USA doesn’t offer any paid leave (unless offered by individual employer). For my first baby in 1979- I took 7 .5 weeks and went to a weekend 12 hr shift job which at least allowed me 5 days each week with him.

When my next baby was born in 1985, I worked at the same facility I am now. We were allowed to save up ALL Vacation, Holiday, and Sick time to be used collectively with your hospital allowed 12 weeks off. I was able to have 5 1/2 months total, partially paid time to be with my new baby. Since he had to have surgery at 3 months, I needed that time and could have used more.. My leave was actually supposed to end on Christmas day (YUK).. however, they graciously allowed me to come back on the 26th… also his first day in Day Care. 😦

So back to my third baby in 1988~I had had a C/S — (that’s another story). I had to be hospitalized for 10 days after the surgery with a whopping infection. A fresh incision and chills with a temp of 103.8 do not go well together! [Nurse Curse] Anyway, I made it thru–> healed and returned to life as a mother of three. The same type of collective accumulated paid hours were allowed withthe hospital’s offered 12 weeks. I didn’t have as many hours saved up as last time but was hoping for the best length of time. One day in church, I held my little 2 month old baby girl on my shoulder with one hand, while using the other to hold the hand of my active 3 yr old boy as we made our way down the aisle. Suddenly, my boy squealed with delight and whipped over in a different direction. I held my daughter and did a sudden twist and reach for my son as he squirmed away. I immediately felt something “give” in my back.

It took a few days for me to feel the true extent of the injury. I thought it was just a little pulled muscle. After a 5 hour drive to my sister’s for a family visit, I ended up writhing on the floor with the unstoppable intractable “fire hot poker” pain of full blown sciatica…. all down my right side. I had to go to the hospital ER away from home, unfamiliar doctors, for help and drugs! Boy, I needed relief. As explained to me by the doctors… this was not the same as sciatica from many other causes. This was a swollen inflamed sciatic nerve… we didn’t know why yet. The only thing helping at that point was medication and ice.. a lot of ice. I still insisted they give me meds I could take while breastfeeding, so they weren’t too strong.

I got home, went thru an MRI and diagnostic process, different doc’s, different opinions. I had a disc “blow-out” with”free extruded disc fragments” at L5-S1. Some felt surgery was needed immediately, others said to wait. After careful consideration, we decided to wait and do some conservative type treatments with oral and epidural steroids. I still had to heal well enough to work, though. I spent many nights crying and wondering HOW I could work ??? How could I go and be on duty…running all over to keep up with the pace, helping people thrulabor and delivery…respond to emergencies…how?? I could barely care for my family! I called many friends while I was on periods of bed-rest and had various treatments during the time I had left of maternity leave. (I eventually did have to extend the leave a couple weeks for more recovery. I ended up witha 5 month leave altogether). I was searching for ideas.. visions of something less physically taxing which could combine my knowledge of labor/delivery/postpartum and neonatal care….. and allow me to continue working. I was, after all, the major bread-winner in our family!

Finally, a friend came up with an idea. He was actually a formula and drug rep for Ross labs.. TRUE!! But he was a friend, had heard I was hurt and stopped by the house to see how I was. He was a rep to many hospitals in the NorthEast and had exposure to what else was going on– what other hospitals were doing. This was 1988, only a few years after the emergence of the Lactation Consultant profession. I had never heard of it. Sometimes word traveled slowly (by pony express) and things changed slowly in my little neck of the woods. He encouraged me to check it out and gave me phone numbers of LC’s at some of his other hospitals. I was really excited! I called a few and found out more about the lactation profession and the relatively new Board exam given every year in July to gain the credential of IBCLC. I was actually naiveenough to think I could take the exam with my current knowledge base! HA! (Unfortunately, this is what many nurses with a little experience think…we think we already know it all! Ha!)

I called one of the LC’s at a hospital not too far from me. We talked a while and I had my eyes opened as to the extensive and vast knowledge base needed to become a lactation professional. I launched a quest for the best way to gain this knowledge. I joined LLL and went to meetings. I made home visits with the local LLL leader. I wrote many letters, made many phone calls searching for some type of education program. (remember– no Internet back then!)

Finally I found the perfect program for me. There was a correspondence course offered to be done all through the mail and phone calls designed to be an 18 month course. It was a Lactation Consultant Course offered by BSC Breastfeeding Support Consultants! (the link shown is for their current course) Back then, you could be called a Certified Lactation Consultant after completing the clinical practicum and final exam. Because of continued back problems, I started this course in early 1989, had to take a few months leave from the course and completed it in early 1991. I then went on to continue studying and sat for the IBLCE exam in 1993 earning my IBCLC status!

I have always continued to work as a staff nurse. I found a corset style back brace and found the best balance possible between family, back pain, work and more pain. I was able to get the pain subdued with steroids to carry on with life. In 1992, during a particularly gruesome relapse, I eventually consented to a myleogram… something I had previously NOT wanted. They also did a CT scan while the dye was in place. These tests showed my right Sciatic nerve had been pushed way up out of place by the disc material. I consented to surgery by a fabulous neurosurgeon the very next day. It turns out, the disc was actually adhered to my sciatic nerve!! He had to meticulously excise it off the nerve!! My post-op pain was minimal compared to the pain I had before surgery. I was able to go back to full duty in 8 weeks!

Over 20 years later, I am still working as a staff nurse and am now a CLC… Certified Lactation Counselor. Becoming a breastfeeding professional has enhanced and fortified my life! I am immensely happy I have gone down this road. To think it all came about as a suggestion from a Formula Rep!?!?!

Hope all had a great WBW 2009!!

Jul 19

16 Comments

HomeBirth Transfer~ Doc says NO to C/S~

I wrote a few stories a few weeks ago because I was proud of my hospital that week– sorry I didn’t finish the stories until now……

iStock_000004564778Small

~She lived about 8 -10 miles outside of town. “Ellie” was having her first baby at age 32. First baby, first pregnancy, no risk factors…. an easy uncomplicated pregnancy. She had done some research, not extensively, judging from some of my conversations with her and her husband…but she knew what she wanted. She had made a beautiful plan with a CPM for a water tub home birth. This particular midwife has been doing home-births in my area for a long time.. (She was the one cowering in the L&D hallway in this story…). The story of how things progressed up to transfer to the hospital was told to us by both the mother, father and midwife.

~Her labor started with regular contractions at 39 weeks. They progressed from early labor which lasted around 6 hours to a more active labor with contractions about every 2- 3 minutes. Her cervix had dilated to 6-7 cm. This pattern of contractions continued for hours. Ellie was in and out of the tub, walking, dozing, in and out of the shower, squatting, doing many different position changes throughout the next 6 to 8 hours. When she was re-examined by her midwife, she had made no cervical change in all that time. This can happen sometimes, things can stall out and pick back up again. Ellie reported that the contractions may not have been as strong at that, so she wanted to wait it out, maybe nap. The baby’s heart rate checks were all good.

~Everyone rested about 2 hours … Ellie’s water broke (clear fluid) about 1 am and her contractions got more intense. The CPM checked her cervix about 3 am and felt no change. She still was 6 -7 cm dilated and the head was at about -2 station. The midwife then brought up the idea of possibly transferring to the hospital. Ellie said NO! Is my baby alright? “Yes….” said her midwife.. “Then No..I’m staying here, — I can do this.”

~Back to the tub… In and out of the shower, total body massages.. contraction pattern the same with increased intensity…next cervix check at 730 am… still 6-7 cm. Now Ellie was tired. Really tired. Exhausted! The baby was great on all checks. Her midwife again brought up the transfer to hospital idea, talked to her about the possibilities of pitocin, epidural etc… Ellie was now wanting anything, agreeing with anything–to get this over with.

~She arrived at the hospital around 8- 830 am very upset. Her husband and midwife were with her and her CPM had all her prenatal care info. Some of the first words out of Ellie’s mouth were that she wanted an epidural and a Cesarean! The nurses on duty this morning were awesome! They calmed her down, had her hooked up to the fetal monitor and observed her contraction pattern and the fetal heart rate pattern response. The baby looked excellent! The midwife and hubby coached her through the contractions while the nurses gathered their admission data. The doctor checked her and she was still about 6-7, swelling of the cervix noted, about -1 station. Ellie asked him if he would please do a C/S and he said no… (yeah!). He said that he felt the best option at this time was to do the epidural she was asking for and observe her contraction pattern… possibly add Pitocin. He talked to her so nicely and non-judgmentally. Many of the other docs would have taken her right into the OR with very little discussion of options. She had been 6-7 cm dilated for some approximate 16 hours.

~After the epidural, Ellie and her husband and midwife all slept. The doc did NOT start pitocin right away, he said that she may need to rest and the contraction pattern couldstart to become of better quality once she rested and was better relaxed. WOW! Where did this guy come from? I’m so amazed and happy and quite frankly, shocked. This was a newer OB here.. I wanted to ask him where he’d been all my life! I went in to talk to Ellie and introduced myself. I told her I was so sorry thingsweren’t progressing the way she had hoped and sorry she didn’t get to stay home. She thanked me and said at this point, she was ready for it to be over! I told her she was really quite fortunate to have this particular doctor on duty today. Except for one bad apple from the night shift just leaving when Ellie arrived, everyone was wonderfully supportive and accommodating. Ellie’s contractions indeed did start up in a better intensity pattern on their own….. however their continued to be a lack of progress. Once again, she asked the doctor to get it over with now and please do a C/S.

~The doctor said NO again! He explained that her uterus was probably tired and the quality/intensity of contractions just may not be what was needed for the job to get done. He explained that the fetal heart rate tracing was beautiful and her membranes had been ruptured less than 12 hours. No baby risks… He felt it possible the baby merely needed to get in better position and the contraction quality needed to improve.. and then he would re-evaluate. Ellie agreed with renewed optimism. The pitocin drip was started. She didn’t need much before the contraction pattern got much stronger, longer and better quality. He came to re-evaluate her only after these better contractions had been consistent for 2 hours. The vaginal exam revealed the cervix was the same ..still the same and possibly more swollen. He said he felt the head was not as well applied to the cervix as it had been.. but still at -1 station. He examined her with and without a contraction. Same in his opinion. Ellie lost all her fight. Her support people rallied to help her, but she was now insistent.

~This time the doctor said she certainly had reason to feel this way, had given this a great try. He told her he still felt she could try longer… that we could alter positions with the pitocin, keep her comfortable with the epidural and keep going… the baby was handling all this just fine. He did say that there was a possibility the baby had his head in a tilted position making it difficult to descend the birth canal. He then let it up to her and told her if she wanted the C/S, he would do it at this point.

~YES I want a C/S! Ellie exclaimed. We did the C/S about 3 pm… some 7 hours after transfer and approximatelyclose to 24 hours of being 6-7cm dilated. Her gorgeous 7 lb baby boy was delivered operatively with apgar scores of 9 and 9. Pink and vigorous! Beautiful. I was able to get him skin to skin in the OR.. that was one of the first times all the players didn’t object and I went with it! (It won’t be the last….and next I’m trying for breastfeeding on the OR table!) Upon delivery, the OB noted the baby had been acynclitic . This is when the head is tilted to the side, ear towards the shoulder. It is probably responsible for her long stall in labor. The OB still felt she could have delivered vaginally given time and good management. I am just so happy he was there. I am proud of this mom, her partner and midwife and of our whole team! This mom was able to make good educated choices about her care despite dealing with the stress of a transfer.. and was able to feel so very very proud of how hard she tried.

In the end it was her…… who gave in to the C/S … not her doctor.

Of that we can be proud

🙂