It's been four days since my last shift, and I'm still trying to find the words to describe one of loveliest births I've had the privilege of attending as a labor nurse. This kind of birth is so rare in the hospital environment; but the experience has reaffirmed my belief that if a woman truly educates herself, has trust in her body and the Natural Design of birth, and surrounds herself with the appropriate support, a minimally interventive birth can be achieved in the hospital. With the permission of the lovely couple and their doula, I am honored to be able to tell their story here.
The mother is a 32 year old woman G., who was laboring with her first baby. She was accompanied by her husband C., and her doula, S., a lovely woman who stayed by the side of her client nearly every moment of a long, long labor. I came on shift at 7:oo P.M., and the couple had been there since the late hours of the previous night shift. The report I received was that G.'s water had broken at 2:30 in in the morning (so we are now well over 12 hours) and that she, C., and S. had walked for hours trying to get labor started, until finally she consented to have her labor augmented with Pitocin.
When I entered the room, G. was in the throes of full, hard labor. The room was dark and soft music played from their ipod dock on the side table. The labor bed was bent into a "chair" position, with the top of the bed straight up, and the bottom of the bed lowered to support her feet. This was a woman who had determined that her labor would be accomplished on her own terms. She wore her own clothing, a tank top and a short "skirt"...it looked like it might have been a "Binsi" skirt (www.birthbinsi.com). She sat upright on the "chair"bed, bare feet planted firmly on the foot rest. S, a slender (thirtysomething?) woman with short blonde hair perched just behind her, one arm about her waist, the other on her shoulder. In front of her, C. knealt on the foot of the bed, while she rested her forehead on his chest, his hands placed around her shoulders in a soft embrace. Back and forth they all rocked, a single, loving, hard working entity, to the tempo set by G. as she groaned a low, throaty labor song with each contraction. As each contraction slowed, she would exhale and lean back into the S.'s arms, to accept a sip of water or a cool cloth on her face and neck. As another contraction would well up, she would again lean in towards C., S. would take her place behind her, and they would resume the rythm of their labor "dance". Occasionally G. would move from the bed to a birth ball beside the bed, and C. or S. would massage her lower back or perform a "hip squeeze" to help aleviate back labor. As time moved on, G. began standing beside the bed, bending over with each contraction, placing her hands on the bed and rotating her hips through each one. As each contraction would peak, her labor song would progress from a long low moan to nearly a growl...a "she bear", working to bring her baby into the world.
During each contraction (which S. would refer to as "surges"...appropriate, I think), G. seemed to move completely into her own world. As each surge came to an end, she would look up and brightly smile at one of her companions, crack a wry joke about her "situation", or, if I was in the room, ask a question or ask to be checked. What I loved about these times was that she would be completely calm and happily "present", as if the considerable pain she was experiencing during the surges had never happened at all.
One of the things I hear over and over again, from nurses, physicians, anesthesiologists, and from many women is why, with the epidural, women would want to experience the pain of labor. As a nurse, I struggle with complying with the wish of some mothers not to offer them pain relief until they ask for it. We're trained to treat pain. It's difficult to stand by and let it happen. My doula friend C. has helped me by reminding me that the pain of labor does not always mean "suffering". That has helped me when working with mother's who fully understand and want to work with their labor; but so many women equate labor pain with just that...suffering. I've listened to women who've arrived at the hospital with no time before delivery to get an epidural and heard their panicky pleas for "something, anything" to save them from their pain. They truly felt they were suffering. Sometimes I've been able talk them through their contractions, either with my voice alone, or with a visualization, and they realize that yes, they can do this...and they seem to cope better. Other times, no matter how hard I try, the woman is so tightly gripped by her fear of the pain, and of the process, that nothing I do seems to help. This is when I feel the most helpless.
I wonder if some physicians and nurses roll their eyes at a woman who has arrived at the hospital with a birthplan, or a doula, or both, because they are not accustomed to the woman being the one who is "in charge". We're used to setting the pace for labor, of determining in what manner the "outcome" will be achieved. When a woman and her support team call the shots, and call them appropriately, there is very little for us to do. Waiting and watching, listening and supporting, while it is the major role of a midwife, is not something that labor nurses get a chance to do much of; and it's not something that physicians are trained to do. I tend to make myself scarce during this type of labor; I figure the woman knows her support team and each knows what to expect of the other. Particularly when a good doula accompanies the woman, there is very little I can offer in the way of education and support. With G.,s labor, as much as I truly supported and admired the way she was accomplishing it, I felt like an intruder when I needed to replace the blood pressure cuff, or readjust the fetal monitoring system. She was very gracious though, and before long I began to feel welcome as a part of her "team".
Several moments stand out for me in my memory of this labor. The first is a "picture" I will forever hold in my heart. While G., C., and S. rocked back and fourth in their labor dance, there was a moment when C. laid his head against his wife's breast. G., her eyes closed, leaned back against S., face turned upwards, and S., as she rocked with G. in her arms, placed her cheek softly against G.'s hair, her eyes also closed, with a look of pure love on her face. My words do little to describe the sweetness of that moment. I so wished I had a camera to capture it for them. Later on in labor I was able to borrow C.'s camera and take a few photos as G. pushed, lying on her side, while S. and C. supported her, and the Nurse Midwife squatted at the end of the bed, smiling at the progress G. was making with her powerful, grunty pushes (no "hold your breath and count to 10" nonsense here...and she pushed for only 45 minutes. I wanted to pull every nurse and resident on the floor into that room and say "See, you can push a baby out without holding your breath !!!!! Of course I didn't, but I made sure to get the word around afterwards). At one point just a short while before G. began to push, she called me into the room and asked me to check her progress, because "I feel like I'm losing control". She wasn't though...in between those contractions she was as clear and "in control" as any one else in the room. I hope that pointing this out to her...that from my perspective she was maintaining perfect control...was something she was able to "hear" as she continued on in her labor. There were a few times when she would come out of a contraction and breathlessly exclaim "I can't do this any more"...but she was nearly complete at that point...a classic "signpost" of transition labor.
At 1:53 A.M...nearly 24 hours from the time G.'s water had broken...a beautiful little boy tumbled into the world and a family was born. He spent the next hour and a half cuddled next to his mother, nursing, snoozing, occasionally protesting. C. was ecstatic, and G., as exhausted as she might have been, instead seemed to experience a second wind. As she chatted and nursed her son, you might never have guessed that only a few moments before she was near exhaustion. S. continued her constant support of G., helping her position the baby for nursing, providing food and drink, and tidying up the room for the coming move to the postpartum room.
If only every labor could be like this; if only every woman had such a wonderful support team; if only every woman believed in herself the way G. did.
Welcome Little One. You are as fortunate to be born to your Mother and Father as they are delighted with you. I will forever be blessed for having been witness to your arrival.
Monday, October 6, 2008
Thursday, October 2, 2008
And I am Thrilled...
...for "AT YOUR CERVIX", as she begins a new journey in her life, the road to becoming a Certified Nurse Midwife...and a blessing to many women in the future. Check out her blog (again, click on the link in my "favorite blogs" section), and enjoy following it as she no doubt provides many wonderful, moving, hilarious, and educational stories of her journey...and be sure to leave a great big
CONGRATULATIONS!!!!!
in her comments section
I Am Humbled...
To know that women can communicate so eloquently and respectfully about a topic as important as a woman's decision to continue or terminate a pregnancy and all the issues surrounding it.
Please go to Navelgazing Midwife's blog (see my "favorite blogs" section and click on the link), and read her September 29 post, and particularly the comments. You will be richer for it.
Please go to Navelgazing Midwife's blog (see my "favorite blogs" section and click on the link), and read her September 29 post, and particularly the comments. You will be richer for it.
Tuesday, August 19, 2008
For K
(Note...for those who, for whatever reason may be reading this blog, and think that I'm in a mass "catch up" mode because it's been waaaay too long since I've made any entries...you would be correct ;-) ).
A couple of weeks ago I was going through my email and opened a notice from a national list that I belong to. In one entry, the poster left a url to her Utube documentary of moments during her pregnancy and birthing. Lo and behold, when one picture captioned "My midwife" came across the screen, I actually clapped and cheered (a little...I mean, I was sitting alone at a keyboard in front of a computer monitor...didn't want to look like I was...emotionally challenged).
The picture was of a very special woman...a midwife who I met nearly 10 years ago when I was a brand new L&D nurse, and she was a "vet" nurse, having been on L&D for over 20 years.
That job was one of the most miserable jobs I have ever had. I had just put in my obligatory year of med/surge nursing where I had been very very successful, fresh out of college, when I transferred to where I had planned to be all along, labor and delivery.
First day out of the gate, I went into a total state of shock.
This was the late Nineties...I had "come of age" in the Seventies, in the era of "Our Bodies Ourselves", Ina May Gaskin, fighting for our rights in the hospital to have our partners at our side, to birth our babies naturally, without the fog of Scopalamine or Demerol, of immedate bonding and breastfeeding, of Bradley, Lamaze, and VBAC. Although I didn't give birth myself until nearly fifteen years later, I totally absorbed that mind set. I had pretty much gotten what I wanted when I gave birth for the first time in the late Eighties. I had no idea how much things had changed (read that regressed) in the "Self Empowerment in Birthing" school of thought. I was stunned at all the planned inductions, the "epidural as norm" attitude, and the relative ease with which the decision to perform a Cesarean Section was made. Honest to God, I even remember a physician sitting on the edge of the bed of a newly admitted, beautifully laboring multip, with a history of two vaginal births , then a c/section, and finally a successful VBAC, trying with all her might to convince the mother that it was too dangerous to "attempt" another VBAC, and that she should immediately prepare for surgery! She didn't, thank God, despite what was essentially a temper tantrum by her physician...the same physician who had attended her VBAC!!!!!
Needless to say, things didn't go well for me. I was simply aghast that mother's seemed to just accept drivel like this, few if any took childbirth preparation classes, or if they did, they managed to squeeze them in during an 8-hour marathon Saturday class, and that most of them wanted to "stop being pregnant" by 39 weeks, so they gladly scheduled their inductions, and the first question out of their mouths upon arrival was not "How soon can I breastfeed my baby", but "How soon can I get my epidural"? My sense of shock must have come across loud and clear, because I was not a favorite of the Assistant Nurse Manager or the Nurse Trainers on that floor. We butted heads over and over again. The Nurse Manager and I got along well...she knew where I was coming from. She was a woman who truly cared about both the patients on her unit, as well as her staff, but even she was struggling. Turns out that Ms. Assistant Nurse Manager had applied for the job, but had not gotten it because she didn't have the required Master's degree. The Trainers were her "homies" from years and years of working together. Together, they had as their mission in life to make the Nurse Manager's life miserable. Did I say I hated that Job? I hated, hated, hated it!
Three months into the job (I don't know how I even lasted that long) I was diagnosed with a serious surgical problem, and took a long (about another three months) sick leave post op. Somehow I managed to drag myself back to the unit after my leave, only to learn that, in my absence, the Nurse Manager had left for a position in the hospital I now work in, and Psycho Assistant Nurse Manager had inherited the job because no one else was willing to even apply for it!.
Crap. No, make that Shit! Shit, Shit, Shit! Sometimes, there's only one word that fits, and this is the one!
It took about three days before I was a complete basket case. PNM (Psycho Nurse Manager) decided that I needed to be "reoriented", since I had barely finished my orientation to the unit before I became sick. In other words, she wasn't going to let one of her predecessor's allies stay on her unit if she could help it. At the same time, she was making life miserable for her other "targets", many of whom decided to resign, and with each new space that opened, she brought in one of her "homies" from her former employer, a decrepit unit downtown that still practiced like they were in the dark ages. It was becoming a unit of battleaxes.
I don't know why I kept fighting. I'm very stubborn. I keep thinking that if I just try one more thing I'll be ableto "fix" whatever is going on that is not working. I have an uncanny way of making myself (and anyone close to me) nuts that way. Stupid, I know.
Enter K...othewise known as, "She Who Introduced Me to the Sanity of Hope and Knowing Myself".
One long, late, dark night on the unit I was working in the newborn nursery all alone (for of course, all mothers were encouraged to "rest" by leaving their newborns to cry it out in the nursery all night). I had just managed, as a new L&D nurse, to get the entire nursery (that night about a dozen babies) bathed, vaccinated, fed, tucked in and charted for the night (I came to find out later that this was both unheard of and discouraged for nurses of my level of inexperience, but PNM was working very hard to get me to dig myself into a hole, and she didn't care if she put any or all of the infants on the unit at risk to do it). As I stood looking out over the parking lot from the (now quiet) nursery's window, K. walked up beside me, put her hand on my shoulder and said "nice job...you're going to be good at this...if you can stand it much longer".
I almost (almost...I'm too stubborn to otherwise) cried.
As we continued to talk, I learned that K. was as unhappy with what she was doing as I was...I remember breathing a huge sigh of relief hearing her say she hated seeing women being "treated like cattle" - finally someone acknowledged how I felt!. When I asked her why she was still there, she told me she was apprenticing as a Direct Entry Midwife, and wouldn't be there much longer. She had thought about going back to school for a CNM, but she knew that she would be forced, in that capacity, to work within this system, and the system stunk. She was willing to give up her nursing license to do it.
That morning when I got home, I did my usual "tears on the pillow" dance with my husband, who had finally had enough. He demanded that I quit the job. When I said we couldn't afford it, he pretty much threw a temper tantrum. "God Damn it, I just got the rest of your life handed back to me back on a surgeon's knife, and I'm not going spend it with you miserable. You should have learned by now that life is too short, and not to put up with crap like this. Quit! We'll manage!"
I quit the next day. Took a letter into human resources regarding the situation, and got them to agree to let me use my vacation in lieu of notice (heard later that PNM got nailed for some of the behaviors I described in my letter...I was also congratulated on a "very professional" resignation letter - I had included rebuttals to demands that had been made of me regarding standard of care, and backed them up with references to research articles, quotes from the State Board of Nursing, etc...typical for me, couldn't just write a simple, one-page resignation letter...had to write a tome...but it worked for me). When I went back to my unit to collect my things from my locker, not one head lifted from whatever they were doing...the experienced nurses because so many of them were the complicit cronies of PNM; the new nurses because they knew not to piss off PNM by seeming to sympathize with me; certainly I got no acknowledgment from my new (or old) Preceptors, or the unit Trainers, and absolutely not from PNM; but I did get a warm, tearaful hug from K. "I'm happy for you, honey. You've made the right decision. You'll be a great labor nurse when you find the right fit. Keep the faith. Go be happy."
That soft, warm hug kept me buoyed for weeks until I landed my next job...which was wonderful, and which led me to my current job. I did keep the faith, because K. had faith. No, things have not been easy...I "live and learn" every day. PNM isn't the first "Nurse Ratched With an Agenda" that I've had to deal with...and she won't be the last...but each time I come up against one, I recognize them earlier, and quickly beat them at their own game. I now practice on my own terms, those that are supported by good research and established Standard of Care.
K. is now a practicing Certified Professional Midwife. The state board of nursing has made a few underhanded threats about taking her nursing license from her for "practicing medicine without a license", until finally she gave up that license...something she had worked very hard for...something she was rightly proud of...and that was valuable to her...so that she could not be challenged by them any longer.
Unfortunately, K. and so many other midwives like her have more to fear than the state board of nursing...but they keep the faith. They support my faith. K. supports my faith. I have the opportunity now, to run in to her from time to time when she transfers a client, or when we attend the same event. It is always wonderful to go get my next "hug" from her.
Thank you, K. You are a blessing among blessings,
A couple of weeks ago I was going through my email and opened a notice from a national list that I belong to. In one entry, the poster left a url to her Utube documentary of moments during her pregnancy and birthing. Lo and behold, when one picture captioned "My midwife" came across the screen, I actually clapped and cheered (a little...I mean, I was sitting alone at a keyboard in front of a computer monitor...didn't want to look like I was...emotionally challenged).
The picture was of a very special woman...a midwife who I met nearly 10 years ago when I was a brand new L&D nurse, and she was a "vet" nurse, having been on L&D for over 20 years.
That job was one of the most miserable jobs I have ever had. I had just put in my obligatory year of med/surge nursing where I had been very very successful, fresh out of college, when I transferred to where I had planned to be all along, labor and delivery.
First day out of the gate, I went into a total state of shock.
This was the late Nineties...I had "come of age" in the Seventies, in the era of "Our Bodies Ourselves", Ina May Gaskin, fighting for our rights in the hospital to have our partners at our side, to birth our babies naturally, without the fog of Scopalamine or Demerol, of immedate bonding and breastfeeding, of Bradley, Lamaze, and VBAC. Although I didn't give birth myself until nearly fifteen years later, I totally absorbed that mind set. I had pretty much gotten what I wanted when I gave birth for the first time in the late Eighties. I had no idea how much things had changed (read that regressed) in the "Self Empowerment in Birthing" school of thought. I was stunned at all the planned inductions, the "epidural as norm" attitude, and the relative ease with which the decision to perform a Cesarean Section was made. Honest to God, I even remember a physician sitting on the edge of the bed of a newly admitted, beautifully laboring multip, with a history of two vaginal births , then a c/section, and finally a successful VBAC, trying with all her might to convince the mother that it was too dangerous to "attempt" another VBAC, and that she should immediately prepare for surgery! She didn't, thank God, despite what was essentially a temper tantrum by her physician...the same physician who had attended her VBAC!!!!!
Needless to say, things didn't go well for me. I was simply aghast that mother's seemed to just accept drivel like this, few if any took childbirth preparation classes, or if they did, they managed to squeeze them in during an 8-hour marathon Saturday class, and that most of them wanted to "stop being pregnant" by 39 weeks, so they gladly scheduled their inductions, and the first question out of their mouths upon arrival was not "How soon can I breastfeed my baby", but "How soon can I get my epidural"? My sense of shock must have come across loud and clear, because I was not a favorite of the Assistant Nurse Manager or the Nurse Trainers on that floor. We butted heads over and over again. The Nurse Manager and I got along well...she knew where I was coming from. She was a woman who truly cared about both the patients on her unit, as well as her staff, but even she was struggling. Turns out that Ms. Assistant Nurse Manager had applied for the job, but had not gotten it because she didn't have the required Master's degree. The Trainers were her "homies" from years and years of working together. Together, they had as their mission in life to make the Nurse Manager's life miserable. Did I say I hated that Job? I hated, hated, hated it!
Three months into the job (I don't know how I even lasted that long) I was diagnosed with a serious surgical problem, and took a long (about another three months) sick leave post op. Somehow I managed to drag myself back to the unit after my leave, only to learn that, in my absence, the Nurse Manager had left for a position in the hospital I now work in, and Psycho Assistant Nurse Manager had inherited the job because no one else was willing to even apply for it!.
Crap. No, make that Shit! Shit, Shit, Shit! Sometimes, there's only one word that fits, and this is the one!
It took about three days before I was a complete basket case. PNM (Psycho Nurse Manager) decided that I needed to be "reoriented", since I had barely finished my orientation to the unit before I became sick. In other words, she wasn't going to let one of her predecessor's allies stay on her unit if she could help it. At the same time, she was making life miserable for her other "targets", many of whom decided to resign, and with each new space that opened, she brought in one of her "homies" from her former employer, a decrepit unit downtown that still practiced like they were in the dark ages. It was becoming a unit of battleaxes.
I don't know why I kept fighting. I'm very stubborn. I keep thinking that if I just try one more thing I'll be ableto "fix" whatever is going on that is not working. I have an uncanny way of making myself (and anyone close to me) nuts that way. Stupid, I know.
Enter K...othewise known as, "She Who Introduced Me to the Sanity of Hope and Knowing Myself".
One long, late, dark night on the unit I was working in the newborn nursery all alone (for of course, all mothers were encouraged to "rest" by leaving their newborns to cry it out in the nursery all night). I had just managed, as a new L&D nurse, to get the entire nursery (that night about a dozen babies) bathed, vaccinated, fed, tucked in and charted for the night (I came to find out later that this was both unheard of and discouraged for nurses of my level of inexperience, but PNM was working very hard to get me to dig myself into a hole, and she didn't care if she put any or all of the infants on the unit at risk to do it). As I stood looking out over the parking lot from the (now quiet) nursery's window, K. walked up beside me, put her hand on my shoulder and said "nice job...you're going to be good at this...if you can stand it much longer".
I almost (almost...I'm too stubborn to otherwise) cried.
As we continued to talk, I learned that K. was as unhappy with what she was doing as I was...I remember breathing a huge sigh of relief hearing her say she hated seeing women being "treated like cattle" - finally someone acknowledged how I felt!. When I asked her why she was still there, she told me she was apprenticing as a Direct Entry Midwife, and wouldn't be there much longer. She had thought about going back to school for a CNM, but she knew that she would be forced, in that capacity, to work within this system, and the system stunk. She was willing to give up her nursing license to do it.
That morning when I got home, I did my usual "tears on the pillow" dance with my husband, who had finally had enough. He demanded that I quit the job. When I said we couldn't afford it, he pretty much threw a temper tantrum. "God Damn it, I just got the rest of your life handed back to me back on a surgeon's knife, and I'm not going spend it with you miserable. You should have learned by now that life is too short, and not to put up with crap like this. Quit! We'll manage!"
I quit the next day. Took a letter into human resources regarding the situation, and got them to agree to let me use my vacation in lieu of notice (heard later that PNM got nailed for some of the behaviors I described in my letter...I was also congratulated on a "very professional" resignation letter - I had included rebuttals to demands that had been made of me regarding standard of care, and backed them up with references to research articles, quotes from the State Board of Nursing, etc...typical for me, couldn't just write a simple, one-page resignation letter...had to write a tome...but it worked for me). When I went back to my unit to collect my things from my locker, not one head lifted from whatever they were doing...the experienced nurses because so many of them were the complicit cronies of PNM; the new nurses because they knew not to piss off PNM by seeming to sympathize with me; certainly I got no acknowledgment from my new (or old) Preceptors, or the unit Trainers, and absolutely not from PNM; but I did get a warm, tearaful hug from K. "I'm happy for you, honey. You've made the right decision. You'll be a great labor nurse when you find the right fit. Keep the faith. Go be happy."
That soft, warm hug kept me buoyed for weeks until I landed my next job...which was wonderful, and which led me to my current job. I did keep the faith, because K. had faith. No, things have not been easy...I "live and learn" every day. PNM isn't the first "Nurse Ratched With an Agenda" that I've had to deal with...and she won't be the last...but each time I come up against one, I recognize them earlier, and quickly beat them at their own game. I now practice on my own terms, those that are supported by good research and established Standard of Care.
K. is now a practicing Certified Professional Midwife. The state board of nursing has made a few underhanded threats about taking her nursing license from her for "practicing medicine without a license", until finally she gave up that license...something she had worked very hard for...something she was rightly proud of...and that was valuable to her...so that she could not be challenged by them any longer.
Unfortunately, K. and so many other midwives like her have more to fear than the state board of nursing...but they keep the faith. They support my faith. K. supports my faith. I have the opportunity now, to run in to her from time to time when she transfers a client, or when we attend the same event. It is always wonderful to go get my next "hug" from her.
Thank you, K. You are a blessing among blessings,
Speaking of Communication...
Some people are just more skilled at (or creative about) it than others.
I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.
We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.
It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.
Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!
But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).
C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)
Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.
Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.
If only we could all be.
I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.
We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.
It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.
Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!
But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).
C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)
Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.
Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.
If only we could all be.
Communicate, Communicate, Communicate...
But do it well...do it honestly...and allow for the inevitable misunderstandings.
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
Saturday, July 26, 2008
A Letter To My Beloved Midwife Friends
My Dears K, N, A, and T....
I love you guys...you know I do. I can't thank you enough for being there when I get saturated with medically managed, high risk births, and you spend entire afternoons with me reminding me "how it's done" when things are blissfully normal, helping me regain my perspective; but sadly, things are not always normal, even during some of the births you attend, and you have to transfer.
I was so pleased that you had found an M.D. to back you up....not an easy (heck, pretty much impossible) thing to do in this overly conservative area; but now that backup is being taken away.
And why?
Now, I'm getting this information second hand (it might even be third hand), but I trust the source I got it from implicitly, although I'm allowing for a margin of error in the sending vs. receiving of the communication that it took to trickle down to me; but it seems that Dr. H.'s partners are frustrated that their decisions were being second guessed when you would arrive the hospital with your client, and they were on call instead of him. An example that was given to me went something like this; when the Docs expected continuous monitoring, they got comments like "But Dr. H. says we don't have to have that"...and similar stories.
Oh my treasured friends! You know better than this! As incredibly knowledgeable and skilled as you are, once you and your client decide to transfer, you are no longer on your own turf. By definition, the pregnancy of the woman you are caring for has now become high (well, at least higher) risk, which takes you out of the care provider position, and places you into the support position. I know I'm not telling you anything new; but perhaps because Dr.H. has been so easy going and laid back when you came in, you assumed that his partners would be as well.
Not so. In my albeit distant and limited experience with all three of these physicians, they each have their own style of managing their patients. As with any practice, if a woman in labor comes in and her own physician is not the one on call, some compromises are going to have to be made if the other physician has not been consulted on the birth plans. At the very least there is going to have to be, if there is the time for it, some gentle discussion of whether or not she is comfortable providing care the way you assumed Dr. H. would. Keep in mind that you can't really be certain what decision's Dr. H. might have made...depending on the reason for your transfer, he might have insisted on continuous monitoring as well.
I can't speak for any of these physicians, any more than I can speak for any of you; and although I am well aware that our area is full of intervention-happy Docs who would just as soon have you prosecuted as look at you, I don't believe that every doctor out there is out to deny a pregnant or laboring woman her right to make well-informed decisions about her own body, her own baby, and her own birthing; but I do believe that every doctor has a right to practice in a way in which he or she is most comfortable...in a way that does not compromise their values, and that protects them from a lawsuit that could jeopardize their license, their practice, their family, and their employees and their families.
This is only fair.
If we want the medical community to respect us as collaborators, then we have to collaborate. We would not want them coming into a client's home and insisting on lithotomy position for the birth, or forbidding any food or drink in labor; in kind, we should not be insisting that they practice in a way that compromises their comfort level when a client is transferred into their care. Some compromises are going to have to be made, and the client needs to be made aware of this.
I know that, once a client is transferred, you feel very protective of her...that you want to advocate for her; but in truth, the legalities in this situation are that only a client (or her family) can advocate for herself. The fact that a transfer has taken place, in and of itself, is a clear indication that the client's hopes and expectations for her birth are not going to be completely met. It's a sad reality that we can't always have what we want, no matter how hard we try. Remember that old adage...how do you make God (the Universe, etc.) laugh? Plan something.
Life is unpredictable; the beginning life, as you all have experienced over and over, is equally unpredictable. Given the love and support of her treasured midwives, a client encountering a disappointment in her birth experience can be helped to feel the joy and beauty of her baby's birth, no matter how that birth is accomplished. True, the personnel of the hospital you transfer to may not be as supportive as we would like them to be; but that comes as no surprise to any of us; we know what kind of environment you are likely to encounter once the decision to transfer is made. Of course things could be done better than they are currently being done...but we aren't going to be able to achieve change with the one birth that is currently in question. It will take dozens and dozens of delicately handled transfers for the medical community at large to even begin to trust, respect, and cooperate with you. It's just the unfortunate reality that we have to accept right now.
Maybe it's not too late. This was a wonderful opportunity for collaboration; given Dr. H.'s respect in the community at large, once it became known that he was willing to back you up, maybe others would be willing to open their minds to the possibility (although I remember the situation with Dr.S. from years ago, and my hope is diminished somewhat). Maybe a well-written letter of apology and compromise, along with a request to meet and discuss the situation might change things for the better.
I can hope, can't I?
Blessings and Love,
K.
I love you guys...you know I do. I can't thank you enough for being there when I get saturated with medically managed, high risk births, and you spend entire afternoons with me reminding me "how it's done" when things are blissfully normal, helping me regain my perspective; but sadly, things are not always normal, even during some of the births you attend, and you have to transfer.
I was so pleased that you had found an M.D. to back you up....not an easy (heck, pretty much impossible) thing to do in this overly conservative area; but now that backup is being taken away.
And why?
Now, I'm getting this information second hand (it might even be third hand), but I trust the source I got it from implicitly, although I'm allowing for a margin of error in the sending vs. receiving of the communication that it took to trickle down to me; but it seems that Dr. H.'s partners are frustrated that their decisions were being second guessed when you would arrive the hospital with your client, and they were on call instead of him. An example that was given to me went something like this; when the Docs expected continuous monitoring, they got comments like "But Dr. H. says we don't have to have that"...and similar stories.
Oh my treasured friends! You know better than this! As incredibly knowledgeable and skilled as you are, once you and your client decide to transfer, you are no longer on your own turf. By definition, the pregnancy of the woman you are caring for has now become high (well, at least higher) risk, which takes you out of the care provider position, and places you into the support position. I know I'm not telling you anything new; but perhaps because Dr.H. has been so easy going and laid back when you came in, you assumed that his partners would be as well.
Not so. In my albeit distant and limited experience with all three of these physicians, they each have their own style of managing their patients. As with any practice, if a woman in labor comes in and her own physician is not the one on call, some compromises are going to have to be made if the other physician has not been consulted on the birth plans. At the very least there is going to have to be, if there is the time for it, some gentle discussion of whether or not she is comfortable providing care the way you assumed Dr. H. would. Keep in mind that you can't really be certain what decision's Dr. H. might have made...depending on the reason for your transfer, he might have insisted on continuous monitoring as well.
I can't speak for any of these physicians, any more than I can speak for any of you; and although I am well aware that our area is full of intervention-happy Docs who would just as soon have you prosecuted as look at you, I don't believe that every doctor out there is out to deny a pregnant or laboring woman her right to make well-informed decisions about her own body, her own baby, and her own birthing; but I do believe that every doctor has a right to practice in a way in which he or she is most comfortable...in a way that does not compromise their values, and that protects them from a lawsuit that could jeopardize their license, their practice, their family, and their employees and their families.
This is only fair.
If we want the medical community to respect us as collaborators, then we have to collaborate. We would not want them coming into a client's home and insisting on lithotomy position for the birth, or forbidding any food or drink in labor; in kind, we should not be insisting that they practice in a way that compromises their comfort level when a client is transferred into their care. Some compromises are going to have to be made, and the client needs to be made aware of this.
I know that, once a client is transferred, you feel very protective of her...that you want to advocate for her; but in truth, the legalities in this situation are that only a client (or her family) can advocate for herself. The fact that a transfer has taken place, in and of itself, is a clear indication that the client's hopes and expectations for her birth are not going to be completely met. It's a sad reality that we can't always have what we want, no matter how hard we try. Remember that old adage...how do you make God (the Universe, etc.) laugh? Plan something.
Life is unpredictable; the beginning life, as you all have experienced over and over, is equally unpredictable. Given the love and support of her treasured midwives, a client encountering a disappointment in her birth experience can be helped to feel the joy and beauty of her baby's birth, no matter how that birth is accomplished. True, the personnel of the hospital you transfer to may not be as supportive as we would like them to be; but that comes as no surprise to any of us; we know what kind of environment you are likely to encounter once the decision to transfer is made. Of course things could be done better than they are currently being done...but we aren't going to be able to achieve change with the one birth that is currently in question. It will take dozens and dozens of delicately handled transfers for the medical community at large to even begin to trust, respect, and cooperate with you. It's just the unfortunate reality that we have to accept right now.
Maybe it's not too late. This was a wonderful opportunity for collaboration; given Dr. H.'s respect in the community at large, once it became known that he was willing to back you up, maybe others would be willing to open their minds to the possibility (although I remember the situation with Dr.S. from years ago, and my hope is diminished somewhat). Maybe a well-written letter of apology and compromise, along with a request to meet and discuss the situation might change things for the better.
I can hope, can't I?
Blessings and Love,
K.
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