April 13, 2010

This is Why A Change is Needed

It is no surprise to anyone when I say there needs to be a change in they way healthcare is managed. It is no different in obstetrics. The rules, regulations set by the hospitals that are there to help "protect" moms and babies sometimes get in the way of providing humane care. I know that docs, nurses, hospitals really are out to provide safe competent care, but sometimes we forget how the patients feel and we are too quick to jump to a surgical delivery if things aren't running on schedule, or in our attempt to provide good care, we start that cascade of interventions that can lead to c-section. Induction - pitocin - AROM at only 2 cm and no change from the start of the pitocin - epidural - crank the pitocin - internal monitoring - temp - infection - antibiotics - failure to progress - c-section. Elizabeth wrote this about her two birth experiences. Her first birth experience was a c-section for breech. Her second, a VBAC. And while breech is a legitimate reason for a c-section, it doesn't change how a woman feels. We get involved in the process of prepping, draping, counting, etc., that we forget that here is a mother who wants her baby. Mom is taken alone to the OR, waiting for her partner to join her in a sea of strangers. The baby is born and she is frequently last to hold her, then the baby is taken away to the nursery while the surgery is finished and mom waits longer to see her baby. And she feels she isn't taking part in the birth, that she isn't doing what she should and sometimes feels her body failed her. She has not failed, it is the system. And some c-sections for "failed induction" or "large baby", are they really necessary? Some people might say "at least after a VBAC, she is healed". I'm not sure I agree with that. The mother doesn't forget her experience. Yes, while she was able to "prove" to herself, to others that her body does in fact work, that doesn't erase the feelings, the scars from a c-section.

Healthy Baby, Part I

C-Section. IV, cold arm. Surgery. Sign the waiver, "Potential fatality." Hairnet. Yellow Tummy and Razor. Crying. Alone. Where is my husband? Cold. Numb. Can you feel this? Helpless. Fear. Fear of pain. What if something goes wrong? Out of my hands. Nauseated. Relief he’s here. But he can’t help me. Sterile curtain. Waiting. Don’t cut yet. Cutting, pulling, pressure. Suction. Tugging. TUGGING. My bottom half is on a roller coaster. Throw up or pass out. Gurgle. Cry! Relief. Cry! I want to help. There he is, there he goes. Where is he going? I can’t go. Tubes, sucking, screaming, crying. Flashes of pictures. Anger. At least he’s there with him. They must be hurting him. He is scared. I am already not doing my job. I should be with him. He’s leaving. Why? Go with him, leave me. He needs someone. Waiting. Waiting. Terrible waiting. Counting. Why are they counting? Wish I could see something. Anything. Who is even down there? It’s all wrong. I feel wet, numb, and cold, but strangely hot. Surreal and bizarre. Finally, I get to go. In a stupor. They will bring him, I think. I don’t know anymore. Thirsty. So thirsty. I need something. Ice chips. High. Losing time. Looking at the clock. Waiting, sleeping? Clock again. How long? Nurse on the phone. She is there, but I’m not. I am unaware. I’m a pest. I need again. Husband here. Camera. There’s my baby on the camera. Everyone has met him but me. Rejection. Resentment. Finally rolling outta here. He’s beautiful, Liz! I wouldn’t know. He’s here somewhere, I guess. There he is, on the other side of the glass. He is lonely. He has surrendered to sleep. I have surrendered. Acceptance. Rationalization. Buzzed. Hot. Sweaty. Thirsty. Don’t let anyone else hold him before me, okay? Please? Are you ready to see him? Oh God, please let me have him now,
Healthy Baby.

Healthy Baby, Part II

Pain wakes me. An owl outside the window. Sleep. Small pain. “I think I’m in labor.” Excitement. Anticipation. Try to rest. I’m up. Must eat. Must shower. Pause to breathe. Ah, shower. Eat and drink. Nightgown. Relax, there is no rush. I like to stand. He holds me and we breathe together. Goosebumps. Clock. They are getting closer. Time to go. Favorite blanket. Waiting outside in 50 degrees, exhilarating. Hugs. There is no rush! It will be a while, I know. Long car ride. Closed eyes, music on the radio. Good songs. We arrive. Welcome! No IV or EFM here. Sanctuary. Toast and morning TV. Joking around. Bathroom. My body is working. Stand and breathe, time. Serious. I need the shower. Come with me. I hold the wall. This is working. Need to get out. I must give in, not try to escape. Bed. Try to rest. Lying down hurts worse. O.J. Vomit. Heating pad. Wet rag. Nice. Is it slowing? Shower will help again. No, stay out this time. Holding friend the wall. Swaying. Moaning, who cares? Is this really working? There is a balloon in there. Wow. That is truly amazing! I get out and he comes. Dry me off. I felt it! I’m happy. Hot. Wall. Focus. Pain. Tense. Don’t get tense! Pain. PAIN. Don’t touch me. My thoughts are consumed by my body’s work. Concentration. Ow! Obscenities. Try different positions, but don’t want to move. Vomit again. They are close. It has taken over. Sit on the bed. Why am I pushing? POP! Warm and wet. It’s not clear. Oh, God! Panic. I knew it! Can’t go NOW! He dresses me. I cry. I feel stuck. Ambulance. Lay down. NO! I need drugs! No, I really do! I need help. I scream. I am pushing. Don’t push. I’m not! It just is. Complete. I already knew that, somehow. Gurney. No shame. Too much pain. Pushing. They will help. Sirens, honking. Eyes closed. Talking. Where is he? He’s there in the cab. He tells me he’s here. Love! Laying down is horrible. Familiar voice. I can push now. They help. A woman tells me, this is normal. Relief. I can do this. They will not cut me this time! Push through the pain. I’m working. Feel his head. Wrinkly. Amazing. Thrilled, but not done. It’s warm and numb, I’m tearing. He’s here. Don’t you dare take him! He is just over there. He is looking for me. They bring him. He is wet and messy. I’m not worried. I worked. I birthed. He is here and the pain is already forgotten. I’m a healthy woman alongside
Healthy Baby.

Birth should be more like Part 2. I don't really need to say more. Elizabeth's writing is honest, and very emotional. Now, I know that not everyone who has a c-section is affected this way, my experiences were good as far as c-sections go, but how many women are traumatized by their c-section experience? Just one is unacceptable, and there are probably more women than we realize. Something needs to change. We need to remember that the patient on the table is a person, a new mother, and while it is important to make sure that the sterile field remains sterile and that all instruments and sponges are accounted for, we need to remember the person. The national c-section rate is unacceptably high, and we need to work to figure out how to bring that number down. VBAC's shouldn't be an unattainable goal, it should be encouraged. Too few people are given the opportunity to do what Elizabeth was able to do...to participate fully in her birth, to allow her body to do what it was meant to do. We need to remember that a due date is an estimated day of delivery, not an expiration date. We need fewer scheduled elective inductions, less interventions for moms with healthy babies, more patience, intermittent monitoring, freedom to move around in labor. And for those who do have/need a c-section, things need to change. I have been working with our processes to change how we manage c-sections. It's not much, but it's a start. The partners are now allowed to come back with mom while the spinal is placed. We are working on keeping baby in the OR...all assessments can be done there, baby can go with mom to recovery and that way mom doesn't feel quite as disconnected. We aren't using the arm straps (thank God) so mom's hands are free to touch and hold her baby. Like I said, it's a start. And to Elizabeth, thank you for being a voice for women out there who are affected negatively by their c-section, and for sharing your moving VBAC story.


apvegmama said...

Thanks for posting my poems, Nurse L! I completely agree with you. Keep fighting the good fight.

Caro said...

Once again I am reminded how lucky I am to live where I do where minimum intervention is the norm and pregnancy and labour is seen as normal rather than a condition to be treated.

Hope you are doing ok.

Becky said...

It's so heartening to know there are people within the OB field/industry who know the C section rate is too high.

I had my first two kids in the most litigious county in America (Wayne County, MI) and that's why ALL - and I mean ALL - my friends ended up with c sections. Insisting on a natural birth, at 37 weeks my ob told me I needed to find another dr and hospital because I wasn't going to be able to have the birth I wanted in Wayne County. What a thing to tax a person with just 3 weeks from my due date! I was so scared!

My fear of going down the road to a c section propelled me through 25hours of labor without so much as an aspirin. Two full hours of being told not to push even as my body was trying desperately to get the baby out, then another full two hours of actual pushing - all with no relief. Finally, a healthy baby and a feeling of euphoria that lasts me to this day, almost 7 years later. I DID IT!!!! I CAN DO ANYTHING!!!

Anonymous said...

I'm sick of scheduled inductions and add on inductions! How do you tell a pt that their induction is unnecessary without alienating the doctor? How do you tell a pt to wait for labor to start when she has been begging the MD for an induction? How do you tell an independently practicing MD that the number of inductions after 39 weeks w/ unfavorable cervix on primip is unacceptable? If you have good answers than we can get the c-section rate reduced.

Carrie said...

Thanks for sharing this! I had a section with my first (before I was an OB nurse and knew better) and my second was born at home. My section was for FTP and fetal intolerance to labor, that is pitocin. The second time around I was first to hold my baby, nobody took her from me. Where I work, we keep baby in the OR until we take everyone back to the room..but our c-section rate is around 33%...totally unacceptable!

Amber, said...

I have a 15 month old son who was born via c-section due to failure to progress, which now that I look back is humorous, because my induction started at 8am and by 7pm, I was being wheeled into the OR, so I was given barely 13 hours to "progress". That's a story for another day, but anyways, just wanted to thank you for your words about how the woman on the operating table is still a new mother.

My c-section was HORRIBLE and I still have nightmares about it. The anesthesia didn't work, and I felt everything- EVERYTHING. They eventually knocked me out as soon as the baby was taken out of me, because I was literally thrashing (as much as I could, anyways, because they strapped my arms down before they even began) in pain. I suffered depression, anxiety, and still do over the experience. As much as I love my son, and know he was worth the experience, it has definitely scared me from thinking of having another baby.

mandbrid said...

This was a great post. I felt like I could really relate to her poems. I have 5 children. With my first, my water broke on my due date and with the help of pitocin (augh!) I delivered him vaginally.
My next pregnancy was twins and when I arrived at the hospital at 35 weeks they discovered that my daughter's heart rate kept slipping into SVT. I was dilated to an 8 when they took me back for the c-section. I felt similar feelings as Elizabeth...although not as severe. Added to my struggle was a two week stay in NICU.
With my last pregnancy I had another set of twins (36 weeks) and with the help of a fabulous OB I was able to deliver them vaginally. YAY! Baby B was transverse but she was able to do an external version and let me deliver him vaginally also. She was as excited as I was! I really appreciate that they were willing to let me try to deliver them without a c-section.

apvegmama said...

Thanks everyone for your great comments!
Amber, I would advise that you seek therapy for your birth trauma. There is no shame in asking for help with this sort of problem. It can be difficult to heal. Your symptoms may merit a diagnosis of clinical depression, anxiety, PDD, PTSD, or all of the above. Sometimes women don't realize at the time how bad it is are until they are out of it. For me, the healing still continues by trying to help other women in this situation. Now you know what you want done differently in your next pregnancy, so do some research. Just keep telling yourself, "That was unacceptable. Never again. It does NOT have to be that way." Do not feel guilty for their wrongdoing. Having a second baby can be a very healing process, but IMO you need to sort out your feelings and make a plan before you think about conceiving again. Take care.

NHMomma said...

What a wonderful post from an L&D nurse! Glad I stumbled upon your blog.

I too have suffered from what was probably an unecessary cesarean. OB fear of big baby, post dates (40w3d), automatic c/s w/o labor. I was told all went textbook well, however emotionally I was not well. PTSD, PPD. I did get professional help and years of ICAN support.

Eventually we decided to try again, even though the fear of another c/s chilled me to the core. I knew we had moved states, and although finding a VBAC provider was extremely difficult, I found one, 45 minutes away. To keep it short, I did not make it to the hospital. I had mild irregular contractions for a few hours, then my water broke. I was involuntarily pushing within 2minutes, baby born in 20. She was 9lbs9oz (my monstrous c/s baby was 8lbs14oz).

Yes, my VBAC put me on an emotional high I have never experienced before, hormones, whatever, it was great! But at the same time it also magnified what I lost from my c/s.

Thank you so much for your continued work to advocate for the mothers, not to be confused with bodies on surgical tables.

Mama to Monkeys said...

Keep up the great work and the awesome writing!