I've had the misfortune of experiencing the evolution of a simple upper respiratory infection into a major exacerbation of long asyptomatic asthma. As such, I've had little time or energy for much more than multiple physician's visits interspersed with frustrated, boring days at home with the occasional tentative (and frequently abortive, due to shortness of breath and a general inability to tolerate much in the way of activity) foray to the grocery store or the bookstore.
And so, the blog has suffered my absence.
My husband though, I think has suffered the most, bless his heart. He, in addition to running his own small consulting firm, has been keeping up with (well, as much as any non-homemaker can) the housework, laundry and cooking, dealing with the misadventures of raising two impetuous, impertinent, impulsive, sometimes rebellious, usually know-it-all, but always endearing and beloved teenage boys, and a wife who is one minute crabby and whiny, and the next remorseful and grateful. God bless that man!
I miss work. I haven't been there for nearly two months! After multiple trips to my family physician and pulmonologist, one trip to the ER (I tried to go back to work...wasn't gonna happen, my body immediately let me know), and even one trip to an urgent care center two days before Memorial day (sure...let's just add double otitis media to the mix...I can handle it...not), I found myself in the care of an amazing Nurse Practitioner who works in my pulmonologist's office. What a stroke of luck! My appointment with this wonderful woman came only after multiple phone calls trying to get another appointment with the pulmonologist ("No, July 25th will not work, I'm consistently satting 90 percent at rest, I've got to be able to get well enough to get back to work, and I can't wait two months to find a way to get this fixed!".) Finally I called my case manager in a weight loss-program I am now involved in and told her my plight...I was afraid to exercise unsupervised until I got this respiratory thing under control, but I couldn't get an appointment to get the advice of my physician. She, bless her, brought up the idea of pulmonary rehab. Really? Did I really need something that drastic?
Turns out I did. I made one call to the coordinator of the pulmonary rehab department, who promptly got me an appointment with the NP. That wonderful woman (the NP, although the director of the rehab department is wonderful as well) did more for me in one 30 minute appointment than the ER, and three physicians had done in six weeks! In the past week I've undergone a slew of pulmonary tests, I've been x-rayed and CT scanned, scheduled for allergy testing and a sleep study, been exercise tested (managed to gasp my way through), and admitted to the pulmonary rehab program.
All indications are that I should be able to return to work with in a month's time, probably part-time first, gradually increasing back to full time.
I knew being an L&D nurse was a big part of my identity, but this experience has really pushed home just how true that is. Maybe that's not a good thing. Maybe I need to get moving on some of those "transitions" I talked about when I began this blog. I've certainly had time to think about them enough.
It's also hard to "watch" via Facebook, my friends working their backsides off, knowing that my absence is contributing to a lack of staff during the busiest time of year on our unit. When coming off of a shift, they will comment to each other how busy things, are, how tired they are, and here I sit...in front of the computer, inhaler at my side, just wanting to be there to lighten their load a little. I love my family. They are my first priority; but I get a lot out of my job (in addition to the frustrations), and I respect the work that my coworkers do.
C'est La Vie. What is, is. For now, I'm slowly improving, looking forward to getting stronger and learning more about how to control this disease through rehab, and I've even managed to start losing some of this extra weight ( "...the journey of a thousand miles begins with a single step..."). With my husband's help, and my "expert" directions, I'm starting to get caught up on all the long-neglected organizational tasks that I've put off in favor of sleep when I wasn't working, and I'm hoping that will clear a path to beginning some of those "transitions" (I'm the kind of person that needs to be organized in order to have a mind clear enough to concentrate effectively...at least at home...at work, I've learned to with the flow...the crazy, ridiculous flow...it's called survival!). Truth be known, I think this has been coming for some time. I wasn't taking care of myself well enough. The last few weeks at work I could barely make it to the car, so exhausted would I be at the end of a shift. My body finally revolted and forced me to take a good long look at how I've been not caring for it, and here I am; but I think (hope, pray) that I've dodged a few serious bullets in the past few weeks, and am now on the road to a full recovery, with a wiser appreciation of just how important it is to not let myself get run down.
In the meantime, the writing bug is hitting me again (a person can only knit so many preemie outfits and blankets, watch so much TV, read so many books, or vegitate on the internet...did I mention I'm spending money I don't have on things I don't need on EBAY?...for so long), and just in the nick of time I got a (coincidence...I think not) response to my last post that gave me the idea for my next one.
Stay tuned!
Saturday, May 30, 2009
Thursday, April 2, 2009
On Childbirth Education
More than once in my work I've met a couple who brought with them the expectation that what they learned in childbirth class is what they would experience in the hospital. Simple, right?
Unfortunately, no.
I know a few childbirth educators. Most of them are excellent (My beloved friend C., well, she's just the absolute best of the best). Others, not so much. At least one of them is not particularly supportive of her clients who are planning to birth in a hospital (read that...she can barely contain her disgust), and therefore, not helpful at all...a total waste of her clients' time and money. Others are just plain not giving their students accurate information - for example their couples come in asking for oral vitamin k instead of injected vitamin k for their baby (we don't have it); they ask to be monitored via doppler or fetoscope (we don't have a fetoscope, and we don't have the staffing to use doppler monitoring...aside from which, no hospital is going to risk not having a paper tracing of a labor; they ask that the newborn nursery not bathe their baby, but simply massage the vernix into his or her skin (fat chance!); or, they ask to be allowed to eat during labor (good luck), or my personal favorite, not to be administered an enema or shave prep (we haven't done this in over twenty years, so I'm wondering why these particular educators are not checking to see if their information is realistic, accurate, or current). I'm not saying any of this is right, it's just what is, albeit at best unfortunate. Finally, several educators, whose classes I've not had a chance to observe, or who I don't have an opportunity to converse with often, are, well, I'm just not certain what kind of information they are giving (or not giving) to their students.
Case in point: I once cared for a sweet couple having their first baby, who were genuinely shocked that their very aggressive obstetrician was just that...extremely agressive. This couple came in, and Mom was 4 centimeters dilated, with bulging membranes. She was laboring beautifully, and I told her physician as much. As if he didn't hear a word I said, he ordered "(have a resident) Rupture her membranes, put in internals, and start 4 by 4 Pit (twice the amount of Pitocin that is normally used)". Truth be known, it was the day of "The Big Game" in our town, and Mr. MD wanted this delivery over before "all the traffic started up". Baloney...he didn't want to risk being called away from his toasty box seats, but what do I know...I've only watched this ass leave several dozen labor rooms looking like the aftermath of a suicide bombing, always in such a hurry to be done that he can't bother to leave a perineum intact, put instruments back on the table instead of dropping them on the floor, or even put his bloody gown in the biohazard can instead of tossing it aside for the nurse to pick up. This is one of those guys that make me wonder why in the hell I keep doing this.
Why indeed...because I want those who choose to give birth in a hospital to know that they have options...options that far too many physicians and nurses don't let them know they have. No, I can't monitor you with a doppler...and I can't find oral Vitamin K for your baby, but, damnit, if I don't think you need Pitocin (yet), I'll tell you...and If you want to wait until your membranes rupture on their own, and you and your baby are doing well, I'll remind you that you don't have to consent to that. If I can't "effectively facilitate communication" between physician and patient (some physicians are not interested in two-way communication), I'll advocate for my patient.
This couple stood their ground though. they gently, but firmly asked the resident who was itching to carry out their physicians orders why this was necessary. They asked for more time to make a decision. Finally, after being cajoled and hassled for hours, they gave in. They consented to having the water broken.
But we have a happy ending...for this couple at least...miracle of miracles, before the resident could finish a delivery in another room, I saw a look..."that look" come over the mother's face, and my heart nearly leapt for joy as "that look" turned into an unmistakable grimace, followed by a surprisingly loud grunt from such a petite woman, and a splash of fluid from beneath her gown spilled onto the floor, over the shoes of her startled husband, and flowed into the towel I quickly flung onto the floor to catch it. At my urging she climbed into bed just in time for her little boy to squirm his own way into the world, without Pitocin, without internal monitors, without artificial rupture of membranes, heck, without even a doctor in the room! Baby in the Bed! I loved it. Take THAT Dr. Ass (as if he cared...as if he even realized it was possible).
But for those situations that are not the recipients of such Grace, what are the Childbirth Educators in question telling their students? I wish I knew. This poor couple, when I told them what their OB wanted me to do, were absolutely stunned...who wouldn't be? They had learned in their childbirth class to stay home as long as possible, that they could avoid pitocin if the labor was progressing well, that internal monitors were an uncessary intervention if the baby was doing well and easy to trace (as was the case here), and that they should avoid having the membranes artificially ruptured if possible.
All good information; but were they encouraged the to speak with their care provider about this information? This wasn't the first couple that had come under my care with these same or similar expectations, only to be blindsided by the basic hospital "business as usuall" delivery system. All of these couples seemed genuinely confused that their physicians would order care that was so different from that they were taught to avoid.
Perhaps the educators did encourage these couples to speak with their care providers, and the couples did just that, only to be brushed off or outright lied to. Perhaps the couples, as expectant couples are sometimes apt to do, just assumed that their care provider would practice as their childbirth educator taught, so they sort of "zoned out" when the educator was advising them to speak with their provider...like so many couples do when the topic of cesarean section is brought up...they assume it won't happen to them, so they don't really listen. Or maybe, just maybe the ecucators themselves are simply teaching a philosophy...without reminding their students that theirs is not the only philosophy out there...and that, if they can, they need to learn the philosphy of both the hospital, and of the provider they are trusting to care for them during the most important moments of their lives...or at least be prepared for the possibility that they may have some significant "negotiating" ahead of them, and be given suggestions (doula anyone?) to help navigate those negotiations.
Moms, Dads, what do you think? What has been your experience? Educators, do you ever hear from your students after they give birth? What do they tell you?
Enlighten this frustrated Labor Nurse, please.
Unfortunately, no.
I know a few childbirth educators. Most of them are excellent (My beloved friend C., well, she's just the absolute best of the best). Others, not so much. At least one of them is not particularly supportive of her clients who are planning to birth in a hospital (read that...she can barely contain her disgust), and therefore, not helpful at all...a total waste of her clients' time and money. Others are just plain not giving their students accurate information - for example their couples come in asking for oral vitamin k instead of injected vitamin k for their baby (we don't have it); they ask to be monitored via doppler or fetoscope (we don't have a fetoscope, and we don't have the staffing to use doppler monitoring...aside from which, no hospital is going to risk not having a paper tracing of a labor; they ask that the newborn nursery not bathe their baby, but simply massage the vernix into his or her skin (fat chance!); or, they ask to be allowed to eat during labor (good luck), or my personal favorite, not to be administered an enema or shave prep (we haven't done this in over twenty years, so I'm wondering why these particular educators are not checking to see if their information is realistic, accurate, or current). I'm not saying any of this is right, it's just what is, albeit at best unfortunate. Finally, several educators, whose classes I've not had a chance to observe, or who I don't have an opportunity to converse with often, are, well, I'm just not certain what kind of information they are giving (or not giving) to their students.
Case in point: I once cared for a sweet couple having their first baby, who were genuinely shocked that their very aggressive obstetrician was just that...extremely agressive. This couple came in, and Mom was 4 centimeters dilated, with bulging membranes. She was laboring beautifully, and I told her physician as much. As if he didn't hear a word I said, he ordered "(have a resident) Rupture her membranes, put in internals, and start 4 by 4 Pit (twice the amount of Pitocin that is normally used)". Truth be known, it was the day of "The Big Game" in our town, and Mr. MD wanted this delivery over before "all the traffic started up". Baloney...he didn't want to risk being called away from his toasty box seats, but what do I know...I've only watched this ass leave several dozen labor rooms looking like the aftermath of a suicide bombing, always in such a hurry to be done that he can't bother to leave a perineum intact, put instruments back on the table instead of dropping them on the floor, or even put his bloody gown in the biohazard can instead of tossing it aside for the nurse to pick up. This is one of those guys that make me wonder why in the hell I keep doing this.
Why indeed...because I want those who choose to give birth in a hospital to know that they have options...options that far too many physicians and nurses don't let them know they have. No, I can't monitor you with a doppler...and I can't find oral Vitamin K for your baby, but, damnit, if I don't think you need Pitocin (yet), I'll tell you...and If you want to wait until your membranes rupture on their own, and you and your baby are doing well, I'll remind you that you don't have to consent to that. If I can't "effectively facilitate communication" between physician and patient (some physicians are not interested in two-way communication), I'll advocate for my patient.
This couple stood their ground though. they gently, but firmly asked the resident who was itching to carry out their physicians orders why this was necessary. They asked for more time to make a decision. Finally, after being cajoled and hassled for hours, they gave in. They consented to having the water broken.
But we have a happy ending...for this couple at least...miracle of miracles, before the resident could finish a delivery in another room, I saw a look..."that look" come over the mother's face, and my heart nearly leapt for joy as "that look" turned into an unmistakable grimace, followed by a surprisingly loud grunt from such a petite woman, and a splash of fluid from beneath her gown spilled onto the floor, over the shoes of her startled husband, and flowed into the towel I quickly flung onto the floor to catch it. At my urging she climbed into bed just in time for her little boy to squirm his own way into the world, without Pitocin, without internal monitors, without artificial rupture of membranes, heck, without even a doctor in the room! Baby in the Bed! I loved it. Take THAT Dr. Ass (as if he cared...as if he even realized it was possible).
But for those situations that are not the recipients of such Grace, what are the Childbirth Educators in question telling their students? I wish I knew. This poor couple, when I told them what their OB wanted me to do, were absolutely stunned...who wouldn't be? They had learned in their childbirth class to stay home as long as possible, that they could avoid pitocin if the labor was progressing well, that internal monitors were an uncessary intervention if the baby was doing well and easy to trace (as was the case here), and that they should avoid having the membranes artificially ruptured if possible.
All good information; but were they encouraged the to speak with their care provider about this information? This wasn't the first couple that had come under my care with these same or similar expectations, only to be blindsided by the basic hospital "business as usuall" delivery system. All of these couples seemed genuinely confused that their physicians would order care that was so different from that they were taught to avoid.
Perhaps the educators did encourage these couples to speak with their care providers, and the couples did just that, only to be brushed off or outright lied to. Perhaps the couples, as expectant couples are sometimes apt to do, just assumed that their care provider would practice as their childbirth educator taught, so they sort of "zoned out" when the educator was advising them to speak with their provider...like so many couples do when the topic of cesarean section is brought up...they assume it won't happen to them, so they don't really listen. Or maybe, just maybe the ecucators themselves are simply teaching a philosophy...without reminding their students that theirs is not the only philosophy out there...and that, if they can, they need to learn the philosphy of both the hospital, and of the provider they are trusting to care for them during the most important moments of their lives...or at least be prepared for the possibility that they may have some significant "negotiating" ahead of them, and be given suggestions (doula anyone?) to help navigate those negotiations.
Moms, Dads, what do you think? What has been your experience? Educators, do you ever hear from your students after they give birth? What do they tell you?
Enlighten this frustrated Labor Nurse, please.
Wednesday, March 4, 2009
The Ultimate Transition
She was only fourteen. Fourteen. A tiny wisp of a girl, a pale, sweet, freckled face encircled by ringlets of short red hair. And she was going to become a mother. She had gone into labor the night before, things had stalled, and her labor was to be augmented with pitocin. When she went to her local hospital, her blood pressure had shot up, so she was transferred to our unit. She labored in the haze of a magnesium-induced fog, an attempt to prevent the seizures for which she was at risk because of her blood pressure.
The father of her baby was nowhere to be found. "He's too young for that" his parents had explained to her. I'm thinking...hmmm...well, he wasn't to young to make the baby...and she doesn't get to say "I'm too young for this". Instead, she prepared to raise, with the help of her family, the little boy that she carried.
She had wonderful support though. Her sisters were there...all four of them, all with the same fair skin and curly copper-colored hair. They ranged in age from mid-thirties to late teens. It seems our little mother had been a surprise baby herself, conceived during a rebound relationship of her mother's shortly after her sister's (half-sisters, but sisters, just the same) father's death. It was not lost on her that she was the offspring of yet another absentee father.
Her mother wasn't there. I didn't know why, but many telephone calls were going out to friends and family who seemed to be in close contact with the soon-to-be grandmother. Perhaps there wasn't transportation, or enough money for her to get the several hundred miles from her home to her daughter's bedside. That happens a lot on my unit...we transfer mothers in from hundreds of miles, covering three states. A lot of the families of the mothers we care for are desperately poor...too poor to follow the ambulance or Medivac helicopter to our hospital.
I felt sad for her. A woman needs her mother when she is about to give birth...especially such a young girl-woman; but this precious young woman was surprisingly, yet precariously stoic...the kind of stoic that made me caution myself to choose my words...even the inflection of my words carefully...lest I cause her to burst into tears.
Her sisters were lovingly, literally at her beside. When they weren't hovering near the telephone, they hovered over their laboring sister, rubbing, massaging, loving, wiping away the occasional tear. When she balked at the idea of getting an epidural, they encouraged her...gently...to reconsider. "So much pain", they murmured, more to each other than to her..."why take more?"..."especially when there's a choice".
She chose the epidural. While we usually allow only one support person bedside during epidural administration, I broke policy and let them all stay, because I couldn't bear to tear them away from their little sister who seemed to depend on them so. She suffered no untoward side-effects from her epidural, so I placed her foley, tucked her in, and stepped out of the room.
I felt a tap on my shoulder. When I turned around, I faced the oldest sister, who was wiping a tear from her cheek.
"I wanted you to know...we're not purposely being rude to you"...rude??? They had been anything but rude. I thought they had been perfectly lovely, and I told her as much. "Well", she said, "Thanks...but there's so much going on...I just wanted to let you know; She doesn't know...and we're all having a difficult time keeping it from her. Our mother is dying. Literally. Probably tonight. She has breast cancer".
Now, how many times does a nurse hear something like that? Not often, I would imagine, even on a unit prone to as much melodrama as ours. But, indeed, this was the situation, and here we all were: A fourteen year old girl about to give birth to her first child; her four older sisters to whom would soon fall the responsibility for them both; a still fairly young woman, their mother, hundreds of miles away, slowly slipping into that pre-death coma from which she would never wake up; and me, not quite certain how to respond to the sad uniqueness of it all. Instinct took over and I wrapped my arms around the now sobbing sister, as I held back my own tears.
I showed the sister our family consult room...the little room near the back of our unit that is used for physicians to talk to family members when things aren't going as planned with the birthing women they are supporting. It holds an institutional wood and vinyl couch, and two chairs, along with a lamp and a selection of out of date magazines; not much in way of comfort, but at least it's private...and it has a telephone.
The sisters each took turns going into the consult room to check in with the family that was caring for their mother. She was "in and out" they said. She seemed to be aware of what was happening to her "baby" daughter. Through a haze of pain killers, she had been repeatedly asking to speak her, but the family wanted to spare the laboring girl the pain of knowing her mother's death was imminent.
Our little mother slept through most of her labor until she abruptly sat up in bed and called out for her mother. "He's coming now! When will she be here?" I checked her, and indeed, her baby was nearly crowning (pretty rare for a first-time mother). I called out for a "doctor for delivery", and instantly the dark womb of the room became once again a bright, too-noisy hospital room. The sisters took their place around the bed, I "broke the bed down", the resident took her place at its end and began exhorting the girl to push.
She refused. "I won't!" she wailed..."Not until she get's here!" We all stopped and looked around at each other. By now, anyone who was involved in her care new what was happening. Eventually this baby would be born no matter if his mother pushed or not...but as often happens, his heart was slowing with each contraction as her body moved him ever closer to his birth. Most babies do fine, even with this...but it can be unnerving if the birth isn't imminent...if the mother isn't helping things along by pushing...at least a little.
The youngest of the four sisters finally broke rank from the Circle of Women around the bed and picked up her cell phone...you know, that piece of equipment that you're not supposed to use in the hospital because it might interfere with the other machinery? Too bad...she was on a mission, and I wasn't about to stop her. She punched a speed dial number, spoke quickly into the phone and placed it next to her laboring sister's ear.
"I will. I promise. I know. I love you tooooo.....", and her little body twisted up off of the pillow with a powerful involuntary push, and as her sister lifted the cell phone high in the air, a tiny, five-and-a-half pound little girl wailed her way into the world amidst the sobs of joy, surprise, and heartbreak of her mother and aunts (so much for the accuracy of late-term ultrasound). Time of birth...4:01 A.M. Grandma was listening.
After promising into the cell phone that she would call back soon, the youngest sister snapped it shut and began to attend, along with her older sisters, to her little sister and niece. As a group they dried the baby off, and placed her against her mother's body. The older sisters, mothers themselves, gently encouraged the new mother to hold her daughter close, showing her how to feed her, pointing out every precious, miraculous, infinitesimal little finger, toe, and wisp of downy, copper-colored hair. The baby never cried, not once after her entrance announcement...but curled into her mother's warm body, turned little her head sideways, and watched her aunts smiling down at her.
I moved around the room as inconspicuously as I could, clearing away the delivery paraphernalia, charting, and tidying up between checking on the new mother and baby. Once satisfied that all was in order, I left to give the new family their privacy. A few minutes later, the oldest sister walked up to our reception desk and asked for me. When I approached her, she asked me..."What time was she born?" A tear rolled down her cheek with my answer.
"Our mother died at 4:05".
Now I was crying...and not just a dainty little sympathetic tear or two to streak down a cheek...no, I had to be sniffling with the red nose and blood shot eyes of someone who has had entirely too little sleep...it wasn't pretty...but it was heartfelt, and the sister knew it. She asked that no one say anything to her little sister until she had had a chance to get a few hours sleep, after which they would tell her, and of course we all agreed...but it wasn't easy to stifle those tears and act cheerful while I helped the new mother into a wheelchair and tucked her baby into her arms for their trip to her postpartum room.
As often happens, I never saw this patient or any of her family again. I wonder how she reacted when she learned of her mother's departure so soon after her daughter's arrival. Two souls had literally crossed in the night. Did they reach out to and greet each other along the way? Did that precious little baby feel the warmth of her Grandmother's kiss on her cheek? Will she carry a tiny, almost imperceptible memory of it with her? She will most certainly experience her love through the love of her very young but very special mother and her very special Aunts. She is part of a very special Circle of Women indeed...one that reaches down from heaven, flows through her family, and wraps itself around her.
A bittersweet story...but a very fortunate little girl.
The father of her baby was nowhere to be found. "He's too young for that" his parents had explained to her. I'm thinking...hmmm...well, he wasn't to young to make the baby...and she doesn't get to say "I'm too young for this". Instead, she prepared to raise, with the help of her family, the little boy that she carried.
She had wonderful support though. Her sisters were there...all four of them, all with the same fair skin and curly copper-colored hair. They ranged in age from mid-thirties to late teens. It seems our little mother had been a surprise baby herself, conceived during a rebound relationship of her mother's shortly after her sister's (half-sisters, but sisters, just the same) father's death. It was not lost on her that she was the offspring of yet another absentee father.
Her mother wasn't there. I didn't know why, but many telephone calls were going out to friends and family who seemed to be in close contact with the soon-to-be grandmother. Perhaps there wasn't transportation, or enough money for her to get the several hundred miles from her home to her daughter's bedside. That happens a lot on my unit...we transfer mothers in from hundreds of miles, covering three states. A lot of the families of the mothers we care for are desperately poor...too poor to follow the ambulance or Medivac helicopter to our hospital.
I felt sad for her. A woman needs her mother when she is about to give birth...especially such a young girl-woman; but this precious young woman was surprisingly, yet precariously stoic...the kind of stoic that made me caution myself to choose my words...even the inflection of my words carefully...lest I cause her to burst into tears.
Her sisters were lovingly, literally at her beside. When they weren't hovering near the telephone, they hovered over their laboring sister, rubbing, massaging, loving, wiping away the occasional tear. When she balked at the idea of getting an epidural, they encouraged her...gently...to reconsider. "So much pain", they murmured, more to each other than to her..."why take more?"..."especially when there's a choice".
She chose the epidural. While we usually allow only one support person bedside during epidural administration, I broke policy and let them all stay, because I couldn't bear to tear them away from their little sister who seemed to depend on them so. She suffered no untoward side-effects from her epidural, so I placed her foley, tucked her in, and stepped out of the room.
I felt a tap on my shoulder. When I turned around, I faced the oldest sister, who was wiping a tear from her cheek.
"I wanted you to know...we're not purposely being rude to you"...rude??? They had been anything but rude. I thought they had been perfectly lovely, and I told her as much. "Well", she said, "Thanks...but there's so much going on...I just wanted to let you know; She doesn't know...and we're all having a difficult time keeping it from her. Our mother is dying. Literally. Probably tonight. She has breast cancer".
Now, how many times does a nurse hear something like that? Not often, I would imagine, even on a unit prone to as much melodrama as ours. But, indeed, this was the situation, and here we all were: A fourteen year old girl about to give birth to her first child; her four older sisters to whom would soon fall the responsibility for them both; a still fairly young woman, their mother, hundreds of miles away, slowly slipping into that pre-death coma from which she would never wake up; and me, not quite certain how to respond to the sad uniqueness of it all. Instinct took over and I wrapped my arms around the now sobbing sister, as I held back my own tears.
I showed the sister our family consult room...the little room near the back of our unit that is used for physicians to talk to family members when things aren't going as planned with the birthing women they are supporting. It holds an institutional wood and vinyl couch, and two chairs, along with a lamp and a selection of out of date magazines; not much in way of comfort, but at least it's private...and it has a telephone.
The sisters each took turns going into the consult room to check in with the family that was caring for their mother. She was "in and out" they said. She seemed to be aware of what was happening to her "baby" daughter. Through a haze of pain killers, she had been repeatedly asking to speak her, but the family wanted to spare the laboring girl the pain of knowing her mother's death was imminent.
Our little mother slept through most of her labor until she abruptly sat up in bed and called out for her mother. "He's coming now! When will she be here?" I checked her, and indeed, her baby was nearly crowning (pretty rare for a first-time mother). I called out for a "doctor for delivery", and instantly the dark womb of the room became once again a bright, too-noisy hospital room. The sisters took their place around the bed, I "broke the bed down", the resident took her place at its end and began exhorting the girl to push.
She refused. "I won't!" she wailed..."Not until she get's here!" We all stopped and looked around at each other. By now, anyone who was involved in her care new what was happening. Eventually this baby would be born no matter if his mother pushed or not...but as often happens, his heart was slowing with each contraction as her body moved him ever closer to his birth. Most babies do fine, even with this...but it can be unnerving if the birth isn't imminent...if the mother isn't helping things along by pushing...at least a little.
The youngest of the four sisters finally broke rank from the Circle of Women around the bed and picked up her cell phone...you know, that piece of equipment that you're not supposed to use in the hospital because it might interfere with the other machinery? Too bad...she was on a mission, and I wasn't about to stop her. She punched a speed dial number, spoke quickly into the phone and placed it next to her laboring sister's ear.
"I will. I promise. I know. I love you tooooo.....", and her little body twisted up off of the pillow with a powerful involuntary push, and as her sister lifted the cell phone high in the air, a tiny, five-and-a-half pound little girl wailed her way into the world amidst the sobs of joy, surprise, and heartbreak of her mother and aunts (so much for the accuracy of late-term ultrasound). Time of birth...4:01 A.M. Grandma was listening.
After promising into the cell phone that she would call back soon, the youngest sister snapped it shut and began to attend, along with her older sisters, to her little sister and niece. As a group they dried the baby off, and placed her against her mother's body. The older sisters, mothers themselves, gently encouraged the new mother to hold her daughter close, showing her how to feed her, pointing out every precious, miraculous, infinitesimal little finger, toe, and wisp of downy, copper-colored hair. The baby never cried, not once after her entrance announcement...but curled into her mother's warm body, turned little her head sideways, and watched her aunts smiling down at her.
I moved around the room as inconspicuously as I could, clearing away the delivery paraphernalia, charting, and tidying up between checking on the new mother and baby. Once satisfied that all was in order, I left to give the new family their privacy. A few minutes later, the oldest sister walked up to our reception desk and asked for me. When I approached her, she asked me..."What time was she born?" A tear rolled down her cheek with my answer.
"Our mother died at 4:05".
Now I was crying...and not just a dainty little sympathetic tear or two to streak down a cheek...no, I had to be sniffling with the red nose and blood shot eyes of someone who has had entirely too little sleep...it wasn't pretty...but it was heartfelt, and the sister knew it. She asked that no one say anything to her little sister until she had had a chance to get a few hours sleep, after which they would tell her, and of course we all agreed...but it wasn't easy to stifle those tears and act cheerful while I helped the new mother into a wheelchair and tucked her baby into her arms for their trip to her postpartum room.
As often happens, I never saw this patient or any of her family again. I wonder how she reacted when she learned of her mother's departure so soon after her daughter's arrival. Two souls had literally crossed in the night. Did they reach out to and greet each other along the way? Did that precious little baby feel the warmth of her Grandmother's kiss on her cheek? Will she carry a tiny, almost imperceptible memory of it with her? She will most certainly experience her love through the love of her very young but very special mother and her very special Aunts. She is part of a very special Circle of Women indeed...one that reaches down from heaven, flows through her family, and wraps itself around her.
A bittersweet story...but a very fortunate little girl.
Transitioning Back
Four and a half months????? How can that be? How could I get so sidetracked with the holidays, the boys, the relationship, the job, the house, my workouts, meal planning, (slowly) shrinking profile, and all the other things I use to distract myself from climbing the stairs to my little study and writing?
Of course my family are not distractions...they are priorities...but the other things? Well, I've got to find a way to motivate myself to get back here more often.
I'm so impressed with At Your Cervix...despite all of her obligations, and now graduate school, she manages to keep up her blog. Me, well, I'm wondering if I just don't particularly like always being so far away from my family when I'm writing. I love my little study. It has all my books, my favorite photographs and art projects, my professional journals and texts, along with piles of yarn, fabrics, and other needlework supplies stashed in the closet. Maybe I need a studio too, someday...when the 19 year old finally decides to move out of the bonus room over the garage that I had targeted for it. But back to my study...I've decorated it in my favorite colors. I love the huge old rolltop desk (my husband calls it my womb), overstuffed chair and ottoman, and bookshelves I've managed to squeeze into the tiny space. It's mine...it says me, and me alone to anyone who walks into it. There are times I just want to shut the door on the testosterone chaos (even the pets are male) in my house, pour a cup of tea, wrap up in one of my throws, and read, knit, write, journal, listen to music, and sometimes even drowse off in that wonderful chair...but not always; and with the amount of ideas for writing rolling around in my brain, all of the experiences I want to process, I could spend days...weeks up here getting it all out in text. I've tried sneaking in to my husband's office to write while I'm down in the thick of family life...but invariably he needs to get on the computer or I become an unwilling partner in his engineering business, taking calls, filling, or chasing receivables...shudder!
So what's a reticent writer/blogger to do?
I may try to work some extra shifts and get a laptop...something I could keep downstairs, in the middle of all the family mayhem, and use when the spirit strikes me. I could keep my recipes and meal plans on it; I could keep my food and exercise logs on it; I could fiddle with my fledgling photography hobby on it; plan my grocery trips while perusing all the coupon sites...fritter away time on Facebook...well, ok, I'll need to try to curb the temptation to do that...not easy when just about everyone I work with...nurses, techs, attendings and residents alike...use it to unload on each other after shift upon shift of craziness ( I guess if we can't debrief at work, we can do it online).
So; until that laptop shows up, I've got to find a way to spend more time, at least every few days, back at this computer.
Here's to good intentions!
Of course my family are not distractions...they are priorities...but the other things? Well, I've got to find a way to motivate myself to get back here more often.
I'm so impressed with At Your Cervix...despite all of her obligations, and now graduate school, she manages to keep up her blog. Me, well, I'm wondering if I just don't particularly like always being so far away from my family when I'm writing. I love my little study. It has all my books, my favorite photographs and art projects, my professional journals and texts, along with piles of yarn, fabrics, and other needlework supplies stashed in the closet. Maybe I need a studio too, someday...when the 19 year old finally decides to move out of the bonus room over the garage that I had targeted for it. But back to my study...I've decorated it in my favorite colors. I love the huge old rolltop desk (my husband calls it my womb), overstuffed chair and ottoman, and bookshelves I've managed to squeeze into the tiny space. It's mine...it says me, and me alone to anyone who walks into it. There are times I just want to shut the door on the testosterone chaos (even the pets are male) in my house, pour a cup of tea, wrap up in one of my throws, and read, knit, write, journal, listen to music, and sometimes even drowse off in that wonderful chair...but not always; and with the amount of ideas for writing rolling around in my brain, all of the experiences I want to process, I could spend days...weeks up here getting it all out in text. I've tried sneaking in to my husband's office to write while I'm down in the thick of family life...but invariably he needs to get on the computer or I become an unwilling partner in his engineering business, taking calls, filling, or chasing receivables...shudder!
So what's a reticent writer/blogger to do?
I may try to work some extra shifts and get a laptop...something I could keep downstairs, in the middle of all the family mayhem, and use when the spirit strikes me. I could keep my recipes and meal plans on it; I could keep my food and exercise logs on it; I could fiddle with my fledgling photography hobby on it; plan my grocery trips while perusing all the coupon sites...fritter away time on Facebook...well, ok, I'll need to try to curb the temptation to do that...not easy when just about everyone I work with...nurses, techs, attendings and residents alike...use it to unload on each other after shift upon shift of craziness ( I guess if we can't debrief at work, we can do it online).
So; until that laptop shows up, I've got to find a way to spend more time, at least every few days, back at this computer.
Here's to good intentions!
Tuesday, October 14, 2008
C-Sections are Births Too!
After writing my last post, a "block" seemed to have been moved; story after story of amazing births I've been privileged to attend just seem to tumble from my memory; I sat down at my computer to start writing about them, and then I thought about E.
E. gave birth to her third child, a precious little girl, several weeks ago. It was E.'s third C-section, her second attempt at VBAC, her third attempt at a vaginal birth. With both of her previous birth experiences, the argument could be (powerfully) made, that mismanagement of her labor led to each C-section. With her third birth, only God knows why events unfolded as they did, and led to a third surgical birth, this one an emergency situation, that occurred with E. under general anesthesia.
E. had tried so hard to "do the right thing". She takes excellent care of herself. She's well educated, seeks out the right support for herself, does everything she can to have a safe, healthy birthing for her children and herself. For her first birth, she chose to be attended by very well-known Certified Professional Midwives; for her second, she chose to attempt VBAC with a physician who works very hard to be "hands off" and encourage her patients to give birth on their own terms; for this third birth, E. was fortunate enough to live in a city in which a prominent (it could be argued the national expert) physician-researcher (responsible for probably the most comprehensive study on VBAC ever published) practices. She chose this physician to attend her for her third pregnancy and birth, and together, this patient/physician team worked very hard to secure a healthy pregnancy and safe birth. In the end, that is exactly what they did...although with a significant "hitch" that both of them would rather not have experienced.
After an uneventful pregnancy and smooth first few hours of labor, no pain meds, no epidural, with an attentive husband and doula at her side, E. had progressed smoothly to nearly transition labor. I was so pleased for her! Having popped my head into her labor room to welcome and encourage her, and a share a quick hug with her doula, a close friend of mine, I picked up my bag and clocked out for the day (she had arrived near the end of my shift, and I would not have the good fortune to be her nurse). There was a celebratory mood in the room, and I was nearly floating on air out of happiness for her.
On my way off the unit, a barrage of nurses, residents, and the prominent attending physician suddenly came barreling out of the nurses station, clamoring towards E.'s labor room. The flurry of activity, calls for help and surgical preparations (anesthesia! OR!) that were occurring made it clear that something had gone wrong. The amazing emergency "machine" of our unit had mobilized. When a true emergency occurs, this is a thing to behold. The nurses, techs, clerks, anesthetists and physicians on the unit truly become a single entity, each individual a cog in a wheel that is rotating furiously, each performing nearly automatically, and almost always expertly, their own function, with the goal of getting the mother into surgery, and keeping her and her baby safe. While I admit that the "adrenaline addict" in me gets a bit of a "high" from situations like this, and while my main goal is to avoid having any of our mothers go to the OR, times like this make me feel grateful, and humbled to be able to call myself a part of this amazing team.
Already out of my scrubs, and off the clock, I felt helpless and powerless as I watched in dismay the "machine" thunder down the hall towards the OR with E., hunched over in "knee-chest" position in her bed, her doula and her husband running behind as they pulled on the white, zip-front "bunny suits", caps and masks they would need to accompany E. in the OR. I knew she would be OK. I knew the baby would survive...because I know that machine; but I ached that she seemed to be losing her last chance to have the vaginal birth she had always dreamed of having.
After the commotion had settled, the baby was out, and both she and her mother were deemed safe, I learned that E. had experienced a uterine rupture! This blew my mind. Why her??? She had worked so hard! She was well nourished, it had been several years since her last birth, plenty of time for good tissue healing, and from her previous op reports, she had had a strong, "double layer" repair after her second C-section. She had labored naturally, without the aid of Pitocin, and had (gratefully, in retrospect), had no pain medication or epidural to mask the symptoms of uterine rupture. She had labored to almost complete dilation. The odds were so in her favor for a vaginal birth that this occurrence was a true stunner.
Fortunately, the tear in E.'s uterine wall was repairable, and with the skill of what I am convinced is the best surgeon and surgical team in the country, E. was safe, her baby is healthy, and I know she will heal well.
Physically, at least.
But emotionally?
E. knows that what happened to her was a random, unlikely occurrence. She is grateful and happy to be alive, and to have a healthy daughter to love and raise; but still she grieves for her lost opportunities to experience birth as she had always expected she would; to give birth the way she was designed to. To give birth the way most mothers take for granted. To feel her baby emerge from her body as she worked and pushed to bring her forth under her own incredible power.
Everything had happened so fast. It must have taken quite a bit for it all to sink in, for E. and her husband. This is a couple that has always wanted a big family. Even as they counted their blessings from this averted tragedy, I heard that E.,s husband had asked their doula if they would ever be able to have more children. "Maybe...but only if you schedule a C-section at 39 weeks", she had replied...and this coming from a woman one of whose main missions in life is to help get our country's C-section rate down from it's current outrageous high of 33 percent. For a while I worried that E. just was not coping with her loss...that she was so focused on having a vaginal birth that she was letting the first precious weeks with her new daughter slip away ruminating about her lost opportunities and planning for a future VBAC. While most would feel that decision would be unsafe (and I even include myself in that number), there are midwives (who's judgement I reject) out there who might accommodate such a request. Indeed, well meaning posters on our local birth-support email lists tried to encourage E. by questioning whether she experienced a "true" rupture (she did) rather than "just a dehiscence", by questioning the decision to perform the surgery (!!??), by questioning her memory of the events, and by encouraging her to look forward to a VBA3C in the future. After a couple of unreturned telephone messages to her, and several emails without response, my worries increased...for a while.
My worries were unfounded. As much as I know she cares, I think right now I'm a reminder to E. of her lost dream of a vaginal birth. I understand that, and I won't pursue contact that she might be uncomfortable with, even though I mean only to support and care. Through the community of women who support birthing women in my city, I've learned that E. is doing well. From time to time I will see a post from her on our local ICAN (International Cesarean Awareness Network) email list, and I can tell that she is working through her grief in her own way. One post in particular that she made, was an impassioned plea to the leaders of ICAN in our community to provide more support for "those of us who will never have a vaginal birth".
My heart goes out to her. She is correct to make such a plea. While I support the work that ICAN does both nationally and locally, I've been concerned for a while that the focus on avoiding C-section, and the focus on VBAC neglects those women who may never experience another pregnancy after their C-section; that those whose C-sections were truly life saving or health-preserving might doubt their caregivers, or more importantly, their acceptance of their care-giver's decision. What aggravated me most in this particular situation, was how quick E.'s "supporters" were to second guess both her trust of her medical team, after she had put so much time and effort in choosing it, and in that team's decision, particularly when those supporters were so far removed from the situation. Hindsight is not always 20/20, and I did not consider that support.
I don't think this is or was intentional; but I think some of the printed materials, and particularly those mothers who were able to achieve a successful VBAC after a truly unnecessary c-section can inadvertently give off the "vibe" that ICAN is only for those mothers who are recovering from, or avoiding abuses of the medical system. Knowing that it will be a fine line to toe, I would like to see the group, while avoiding the risk of "normalizing" the procedure, provide more overt support to mothers who, as E. has so passionately phrased it, will never have a vaginal birth.
C-Sections are Births, too. No one would deny that, but I think in our zeal to reduce the c-section rate, to avoid that first c-section, and to promote VBAC, we have inadvertently minimized that. We in the medical community, in our rush to protect the safety of a mother and baby needing an emergency or emergent c-section, or to keep a busy, even over-loaded maternity unit running efficiently, are guilty of the same. That "machine" I spoke of, the one that I so admire and am so proud to be part of most of the time, continues to, on a calmer level, run much the same, even when the surgery is planned. It's what we do; it's our culture; it's what we are accustomed to; it's our turf!
Well, it may be so, but it's also the birth of a human being. A woman becomes a mother, a couple becomes a family, or a family grows by one (or two, or more ;-}). I've read about calm, quiet, lowly-lit (for the emergence the baby) surgical births where the baby is delivered slowly, in full view of the mother and her support person(s), sometimes even to be placed on her upper chest before being whisked over to a warmer to be dried off, examined and bundled up by nurses or pediatricians; of babies who have even breastfed while the mother was being sutured post-delivery. Even in my own experience on a unit made sometimes over-conservative as a result of being a referral center for high risk pregnancies, I know of at least one physician, one who is conservative himself, who is frustrated at the business-as-usual way in which our cesarean deliveries are usually carried out. I suspect he would balk at the slow, dimly lit delivery with a newly born, wet baby being placed immediately on the mother, or of baby nursing during surgery (I can also envision the hysterics of our very conservative chief anesthesiologist, LOL), but I know he would prefer that we keep baby with the mother and her support people during recovery, and get breastfeeding initiated, rather than whisk baby away to the nursery after a few moments in Dad's (or whoever the mother has chosen for her support) arms, while he (or she) sat next to the mother. On a busy unit such as ours that can be a challenge...particularly because our recovery room has limited space and no infant warmers...but we have done it from time to time, for those assertive mothers who have requested it. It can be done. I'd like to see it done more often.
Likewise, I'd like to see members of ICAN be more conscious (although I know they already try to be) of the feelings of mothers who have given and will continue to give birth surgically. I understand the triumph of a woman who has "beaten the system" to have a VBAC; but that is not reason enough to, even unintentionally, and even sympathetically, view a woman who has had a c-section as a woman who has had a negative birth experience...who has not researched all of her options...who has "given in" to the system.
No, we don't want to risk normalizing surgical birth; but we certainly could benefit from humanizing it much more...both those who perform surgical births, and those whose (admirable) goal is to avoid it.
E. gave birth to her third child, a precious little girl, several weeks ago. It was E.'s third C-section, her second attempt at VBAC, her third attempt at a vaginal birth. With both of her previous birth experiences, the argument could be (powerfully) made, that mismanagement of her labor led to each C-section. With her third birth, only God knows why events unfolded as they did, and led to a third surgical birth, this one an emergency situation, that occurred with E. under general anesthesia.
E. had tried so hard to "do the right thing". She takes excellent care of herself. She's well educated, seeks out the right support for herself, does everything she can to have a safe, healthy birthing for her children and herself. For her first birth, she chose to be attended by very well-known Certified Professional Midwives; for her second, she chose to attempt VBAC with a physician who works very hard to be "hands off" and encourage her patients to give birth on their own terms; for this third birth, E. was fortunate enough to live in a city in which a prominent (it could be argued the national expert) physician-researcher (responsible for probably the most comprehensive study on VBAC ever published) practices. She chose this physician to attend her for her third pregnancy and birth, and together, this patient/physician team worked very hard to secure a healthy pregnancy and safe birth. In the end, that is exactly what they did...although with a significant "hitch" that both of them would rather not have experienced.
After an uneventful pregnancy and smooth first few hours of labor, no pain meds, no epidural, with an attentive husband and doula at her side, E. had progressed smoothly to nearly transition labor. I was so pleased for her! Having popped my head into her labor room to welcome and encourage her, and a share a quick hug with her doula, a close friend of mine, I picked up my bag and clocked out for the day (she had arrived near the end of my shift, and I would not have the good fortune to be her nurse). There was a celebratory mood in the room, and I was nearly floating on air out of happiness for her.
On my way off the unit, a barrage of nurses, residents, and the prominent attending physician suddenly came barreling out of the nurses station, clamoring towards E.'s labor room. The flurry of activity, calls for help and surgical preparations (anesthesia! OR!) that were occurring made it clear that something had gone wrong. The amazing emergency "machine" of our unit had mobilized. When a true emergency occurs, this is a thing to behold. The nurses, techs, clerks, anesthetists and physicians on the unit truly become a single entity, each individual a cog in a wheel that is rotating furiously, each performing nearly automatically, and almost always expertly, their own function, with the goal of getting the mother into surgery, and keeping her and her baby safe. While I admit that the "adrenaline addict" in me gets a bit of a "high" from situations like this, and while my main goal is to avoid having any of our mothers go to the OR, times like this make me feel grateful, and humbled to be able to call myself a part of this amazing team.
Already out of my scrubs, and off the clock, I felt helpless and powerless as I watched in dismay the "machine" thunder down the hall towards the OR with E., hunched over in "knee-chest" position in her bed, her doula and her husband running behind as they pulled on the white, zip-front "bunny suits", caps and masks they would need to accompany E. in the OR. I knew she would be OK. I knew the baby would survive...because I know that machine; but I ached that she seemed to be losing her last chance to have the vaginal birth she had always dreamed of having.
After the commotion had settled, the baby was out, and both she and her mother were deemed safe, I learned that E. had experienced a uterine rupture! This blew my mind. Why her??? She had worked so hard! She was well nourished, it had been several years since her last birth, plenty of time for good tissue healing, and from her previous op reports, she had had a strong, "double layer" repair after her second C-section. She had labored naturally, without the aid of Pitocin, and had (gratefully, in retrospect), had no pain medication or epidural to mask the symptoms of uterine rupture. She had labored to almost complete dilation. The odds were so in her favor for a vaginal birth that this occurrence was a true stunner.
Fortunately, the tear in E.'s uterine wall was repairable, and with the skill of what I am convinced is the best surgeon and surgical team in the country, E. was safe, her baby is healthy, and I know she will heal well.
Physically, at least.
But emotionally?
E. knows that what happened to her was a random, unlikely occurrence. She is grateful and happy to be alive, and to have a healthy daughter to love and raise; but still she grieves for her lost opportunities to experience birth as she had always expected she would; to give birth the way she was designed to. To give birth the way most mothers take for granted. To feel her baby emerge from her body as she worked and pushed to bring her forth under her own incredible power.
Everything had happened so fast. It must have taken quite a bit for it all to sink in, for E. and her husband. This is a couple that has always wanted a big family. Even as they counted their blessings from this averted tragedy, I heard that E.,s husband had asked their doula if they would ever be able to have more children. "Maybe...but only if you schedule a C-section at 39 weeks", she had replied...and this coming from a woman one of whose main missions in life is to help get our country's C-section rate down from it's current outrageous high of 33 percent. For a while I worried that E. just was not coping with her loss...that she was so focused on having a vaginal birth that she was letting the first precious weeks with her new daughter slip away ruminating about her lost opportunities and planning for a future VBAC. While most would feel that decision would be unsafe (and I even include myself in that number), there are midwives (who's judgement I reject) out there who might accommodate such a request. Indeed, well meaning posters on our local birth-support email lists tried to encourage E. by questioning whether she experienced a "true" rupture (she did) rather than "just a dehiscence", by questioning the decision to perform the surgery (!!??), by questioning her memory of the events, and by encouraging her to look forward to a VBA3C in the future. After a couple of unreturned telephone messages to her, and several emails without response, my worries increased...for a while.
My worries were unfounded. As much as I know she cares, I think right now I'm a reminder to E. of her lost dream of a vaginal birth. I understand that, and I won't pursue contact that she might be uncomfortable with, even though I mean only to support and care. Through the community of women who support birthing women in my city, I've learned that E. is doing well. From time to time I will see a post from her on our local ICAN (International Cesarean Awareness Network) email list, and I can tell that she is working through her grief in her own way. One post in particular that she made, was an impassioned plea to the leaders of ICAN in our community to provide more support for "those of us who will never have a vaginal birth".
My heart goes out to her. She is correct to make such a plea. While I support the work that ICAN does both nationally and locally, I've been concerned for a while that the focus on avoiding C-section, and the focus on VBAC neglects those women who may never experience another pregnancy after their C-section; that those whose C-sections were truly life saving or health-preserving might doubt their caregivers, or more importantly, their acceptance of their care-giver's decision. What aggravated me most in this particular situation, was how quick E.'s "supporters" were to second guess both her trust of her medical team, after she had put so much time and effort in choosing it, and in that team's decision, particularly when those supporters were so far removed from the situation. Hindsight is not always 20/20, and I did not consider that support.
I don't think this is or was intentional; but I think some of the printed materials, and particularly those mothers who were able to achieve a successful VBAC after a truly unnecessary c-section can inadvertently give off the "vibe" that ICAN is only for those mothers who are recovering from, or avoiding abuses of the medical system. Knowing that it will be a fine line to toe, I would like to see the group, while avoiding the risk of "normalizing" the procedure, provide more overt support to mothers who, as E. has so passionately phrased it, will never have a vaginal birth.
C-Sections are Births, too. No one would deny that, but I think in our zeal to reduce the c-section rate, to avoid that first c-section, and to promote VBAC, we have inadvertently minimized that. We in the medical community, in our rush to protect the safety of a mother and baby needing an emergency or emergent c-section, or to keep a busy, even over-loaded maternity unit running efficiently, are guilty of the same. That "machine" I spoke of, the one that I so admire and am so proud to be part of most of the time, continues to, on a calmer level, run much the same, even when the surgery is planned. It's what we do; it's our culture; it's what we are accustomed to; it's our turf!
Well, it may be so, but it's also the birth of a human being. A woman becomes a mother, a couple becomes a family, or a family grows by one (or two, or more ;-}). I've read about calm, quiet, lowly-lit (for the emergence the baby) surgical births where the baby is delivered slowly, in full view of the mother and her support person(s), sometimes even to be placed on her upper chest before being whisked over to a warmer to be dried off, examined and bundled up by nurses or pediatricians; of babies who have even breastfed while the mother was being sutured post-delivery. Even in my own experience on a unit made sometimes over-conservative as a result of being a referral center for high risk pregnancies, I know of at least one physician, one who is conservative himself, who is frustrated at the business-as-usual way in which our cesarean deliveries are usually carried out. I suspect he would balk at the slow, dimly lit delivery with a newly born, wet baby being placed immediately on the mother, or of baby nursing during surgery (I can also envision the hysterics of our very conservative chief anesthesiologist, LOL), but I know he would prefer that we keep baby with the mother and her support people during recovery, and get breastfeeding initiated, rather than whisk baby away to the nursery after a few moments in Dad's (or whoever the mother has chosen for her support) arms, while he (or she) sat next to the mother. On a busy unit such as ours that can be a challenge...particularly because our recovery room has limited space and no infant warmers...but we have done it from time to time, for those assertive mothers who have requested it. It can be done. I'd like to see it done more often.
Likewise, I'd like to see members of ICAN be more conscious (although I know they already try to be) of the feelings of mothers who have given and will continue to give birth surgically. I understand the triumph of a woman who has "beaten the system" to have a VBAC; but that is not reason enough to, even unintentionally, and even sympathetically, view a woman who has had a c-section as a woman who has had a negative birth experience...who has not researched all of her options...who has "given in" to the system.
No, we don't want to risk normalizing surgical birth; but we certainly could benefit from humanizing it much more...both those who perform surgical births, and those whose (admirable) goal is to avoid it.
Monday, October 6, 2008
A Beautiful Birth
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.
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.
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
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