February 5, 2011

Childbirth Lessons Learned

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Prologue

Today begins an anxiety attack that could last three days or five weeks. Today my pregnancy is officially full term, meaning my son could arrive any time between now and March 12th.

You may wonder, why the anxiety attack? Women have been having babies since the beginning of time! It's natural. It's what our bodies are designed to do.

Women have also been dying in childbirth since the beginning of time, but nobody talks about that. We have so much faith in modern medicine. As well we should, I suppose, but childbirth remains a dangerous process that often doesn't get the respect it deserves.

Kidney stones are natural. Cancer is natural. Broken legs are natural, and our bodies are designed to heal them.

Okay, so I'm a little bitter. Let's revisit my first childbirth experience for some background on my bad attitude.

Part I: What Was I Thinking?

It started with a book. A month or so into my pregnancy I read the book Pushed by Jennifer Block. It told me all about my evil Ob Gyn's plans to kill me and my baby. My eyes were opened to everything America is doing wrong, and I became a zealot. I realized the only way to safely deliver a baby was in my own home or in a birthing center attended by a midwife. If I went to a hospital they would pump me full of Pitocin in order to schedule my baby around their tee time. They'd strap me down to a bed and hook me up to ten different machines and not allow me to expedite the birth naturally by walking around. When I started to push they'd slice open my perineum with a maniacal laugh.

Did I talk to my sweet, competent Ob Gyn about any of this? No. I frantically transferred care to the midwife. It should be explained that in Ketchikan there is only one Ob Gyn office and one privately operating midwife, or at least that was the case at the time. Let's just say there is no love lost between the midwife and the hospital / Ob Gyn. The midwife is not allowed to deliver babies at the hospital so she started her own "birthing center" in the lower floor of her home.

Part II: The "Birthing Center"

Fast forward to the early morning of June 20th, 2008. Around 1:00 am I woke up with fairly strong contractions. I told my husband what was going on, then went upstairs and watched Roseanne for a few hours. At 4:00 am I was pretty sure This Was It so I hopped in the shower. At 6:00 am my husband left for work with the knowledge that he may need to come home early, and my visiting mom stayed with me. We watched more television for a while until my water broke around 7:00 am. Not a trickle, either, but a full-fledged gush. There went that recliner.

My mom called my husband and the midwife while I cleaned up. After a while I went to the midwife's office to get checked. I was Group B Strep positive which meant I needed intravenous antibiotics throughout labor, so she gave me my first IV at this time. Her hands were shaking like she either had the DTs or advanced palsy. Her digging around for my vein was quite painful, and I got my first glimpse that this may not have been such a great decision.

The midwife, let's call her Elaine Bigg, sent me home for a while to progress. We went to the "birthing center" in the early afternoon. I pulled on my bathing suit and soaked in the jacuzzi tub, which was wonderful until it stopped working. At some point during the afternoon I got another painful course of antibiotics from Madame Tremor.

Not too long after we arrived I told Ms. Bigg that I would be open to pain medication whenever she was able to give it. She grabbed the Stadol and shot me up without further discussion.

The afternoon turned into evening. Ms. Bigg was rarely present, having sent down a hired nurse to take her place. The nurse dozed on the couch and periodically told me to keep walking. Elaine probably could have hired a teenager to do that job for a lot less money.

As the evening progressed my contractions did not. I'd walk until it became too exhausting, then sit on the big rubber ball until the nurse cracked the whip and told me to walk some more. It was practically an eye rolling attitude on her part, like "Geez lady, if you'd just walk we could have this baby out by now." Nobody seemed concerned that my contractions weren't getting any closer after nearly 24 hours in labor, or that I could barely keep my eyes open after being awake (and in labor!) for that amount of time.

Around midnight I requested more Stadol so that I could rest. Ms. Bigg did some more eye rolling and whip cracking but I told her I could not walk another step. She gave me some Stadol and attempted to administer another course of antibiotics. I refused. The pain of her shaking needle was worse than the pain of labor, and by this time I was so bleary-eyed and exhausted I just flat refused.

Let's take a moment to talk about Group B Strep. Group B Strep is a bacteria that lives in our tummies somewhere. Occasionally, for whatever reason, it is present in the birth canal. When that is the case it can infect the baby and cause serious complications, up to and including death of the baby (15% risk if the baby is infected). Antibiotics administered during labor go a long way toward preventing infection of the baby.

I didn't know any of that. I just knew they had tested me for Group B Strep at 36 weeks, I tested positive, and I had to have antibiotics during labor as a result. Yet I was permitted to refuse the IV after 24 hours of laboring without any explanation or warning about the impact of this decision on my child.

Factors that increase your baby's risk of infection include: maternal fever during labor, delivering prior to 37 weeks, laboring for more than 18 hours after the water breaks... WHAT?! I was just reading about it a few days ago and found that little nugget of information. My water had been broken for 18 hours at 1:00 am on the morning of the 21st. My daughter was born at 11:30 pm on the evening of the 21st.

Back to the "birthing center." I managed to catch some fitful sleep for a few hours, interrupted by painful contractions. When the drugs wore off I was up and moving around again.

Around 6:00 am Ms. Bigg came downstairs to discuss my situation. She told me if I didn't start walking more I'd have to transfer care to the hospital. "THAT'S AN OPTION?!" I wanted to shout. I didn't realize I was allowed to go to the hospital if I had started at the "birthing center." I basically laughed and did a little dance and said yes, please, let's do that. Ms. Bigg wasn't happy, and made a remark about this being my fault because I asked for the Stadol too early. Um... yeah. Because I'm the medical expert. I know *now* that pain medication too early in labor can hinder contractions, but I didn't know (and wasn't told) that at the time.

Part III: The Hospital

Walking into the hospital after having been at the "birthing center" was like arriving in heaven after a night in hell. Caring, competent nurses got me settled into the comfortable room. They checked on the health of me and my baby, administered more IV antibiotics with a blissfully steady hand, and pumped me full of Pitocin to progress my labor. The doctor (let's call her Dr. Ng) arrived after a short time. Dr. Ng was not the same doctor I had originally seen at the Ob Gyn office but that didn't matter to me. She discussed the possibility of a c-section with me. I told her I preferred to deliver vaginally but I'd do what I had to do. She offered me an intrathecal (similar to an epidural) while we waited for my labor to progress. I took it and slept soundly for several hours.

I honestly don't know what the hell happened that day. Stuff. I found out later that the doctor told my in-laws that I "refused" a c-section, which was never the case.

My next real memory starts around 6:00 pm, when Dr. Ng came back in and told me to start pushing. Then she left. The nurse assisted me with pushing. I had no physical desire to push and no idea what I was supposed to do, but the nurse tried to talk me through it. My contractions were around 4-5 minutes apart the entire time I pushed, so there was a lot of waiting.

After a period of time, maybe one or two hours, Dr. Ng came back to see how it was going. She checked me and said "If you were pushing right the baby would be born by now" and left again. Hand to God, that actually happened.

Unbeknownst to me my in-laws were watching Dr. Ng this entire time. When she left she was not with other patients, she was at the nurses' station looking at pictures and chatting. After three or four hours of this my father-in-law went over to her and asked "Aren't you Kim's doctor? Don't you have a patient to deal with? That woman has been in labor for two days, what the hell are you doing?!"

Have I mentioned I love my in-laws?

Eventually Dr. Ng huffed back in and assisted with the rest of the labor. Finally, finally, finally my beautiful daughter was born! She, um, sort of looked really Asian when she first came out. I mean I loved her and everything but after 46 hours of terrible labor the fact that my child was Asian really threw me. Not that Asian-ness is an undesirable trait, but since my husband and I are wholly Caucasian it did raise some questions in everyone's minds (my mom & husband still tease me about my near divorce).

I only got to hold her for a few minutes and then she was taken away. I laid there idly wondering why my daughter was Asian while people rushed around doing stuff. My mom left and my husband came in. The doctor had her whole freaking arm inside me for some reason. People kept jabbing needles in my legs. This went on for quite a while and it was really annoying because I was tired! Why wouldn't they leave me alone?

That's the part where I hemorrhaged and lost a lot of blood. I didn't realize it until days later. Dr. Ng discussed the possibility of a blood transfusion with me that night which I refused. Ew! Why would I want a blood transfusion? Oh, I needed it? I guess I was supposed to magically be able to give informed consent when (again) I wasn't told the implications of my decision.

After they got me stabilized people came and went all night long, checking readings or something. At some point I woke up. My mom brought me a Polaroid picture of Bethany and it was the sweetest moment of my life - my first lucid look at my precious daughter. I will always remember how it felt to look at that picture and cry because she was so beautiful. A short time later they wheeled in the real deal and I began the thrilling process of falling in love with my child.

Epilogue and Conclusions

I stayed in the hospital for four days and Bethany stayed in the hospital for five days. She had to be on IV antibiotics constantly because of the Group B Strep issue.

I tried to breastfeed for a couple of months. My baby was losing weight so I was forced to switch to formula but I kept pumping. Unfortunately I was just too anemic (from the postpartum hemorrhage) to nourish her. I didn't have any breastfeeding support so I was going by what the pediatrician told me. I gave it my best shot but I didn't see any point in continuing to pump after she began thriving on formula.

A year later we were still getting bills for the birth from Ms. Bigg. I couldn't face her so my wonderful husband went in to deal with it. He took with him a list of reasons why she was lucky we weren't suing and convinced her to call it even.

There are questions I'll never be able to answer, and errors were made that can never be reversed (but thankfully caused no harm). Why did the midwife and the doctor let me make decisions without being informed of the consequences? Why was I allowed to labor so long after my water broke when I was Group B Strep positive? Why didn't Dr. Ng just give me a c-section instead of allowing me to labor for nearly an entire second day? Did Dr. Ng have a chip on her shoulder because I had transferred to the midwife, is that why she gave me half-assed care?

I still believe there are many things wrong with the US maternity system. Labors are induced way too frequently. Episiotomies are routine when they should be rare. Most women are treated with unnecessary interventions of one kind or another when they go to the hospital to deliver a baby.

Doctors are so overwhelmed with malpractice insurance costs that they have to take on heavier patient loads to compensate. This, in my opinion, is the cause of most of the unnecessary interventions. The doctors just don't have the time to allow for natural births so they utilize c-section and induction in order to fit all their patients into their schedule.

I believe our entire healthcare system is dysfunctional, not just the maternity part. But I really don't care anymore. I've lost faith in my convictions.

This time around I'm going to the hospital. I'm getting an epidural. I've got two fibroids in my uterus which may inhibit the labor process. Whatever. Maybe they'll give me a c-section. I am glad we are back in civilization with multiple hospitals and healthcare providers.

I know what's NOT going to happen this time. Medical professionals telling me what an incompetent woman I am. "If you were walking more the baby would be born by now." "If you hadn't asked for Stadol your contractions would have come faster." "If you were pushing right the baby would be out already."

My uterus contracted so poorly that it couldn't even expel the placenta or recover itself after the baby was born. My body wasn't necessarily designed to do this. I envy those who are able to deliver naturally with ease.

And that's why I'm having an anxiety attack, but I know from experience that it's all worth it in the end. I'm excited to meet my son and be done with this childbirth crap once and for all.      -Kim
Update August 11, 2011: New question - Why am I just finding out today about Sheehan's Syndrome? In layman's terms the blood loss from severe hemorrhage after chidbirth can cause oxygen deprivation and do permanent damage to the pituitary gland. One of the earliest symptoms can be inability to breastfeed. I've now hemorrhaged and been unable to breastfeed two children, and I had to hear about this potentially deadly disease from a friend instead of one of my caregivers. Awesome.

7 comments:

  1. I'm sorry you had such a rough go of it with Bethany. Here's hoping that this time around it is a breeze. *Well, as much of a breeze as physically possible!*

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  2. {{KIM}}

    I'm so very sorry, Kim. Honestly, I am. I had an incompetent OB my first time around and he bordered on malpractice, but it was never so bad as all that.

    Fortunately, God blessed me with an amazing OB thereafter - and when she was on maternity leave when I had #2, her replacement was outstanding as well. With #3, my labor didn't start when my water broke, so they did pitocin to get things moving. [#2 I was at the hospital for 45 minutes b/c things progressed so rapidly.] I too was Strep B positive, though #4 was born before they did the test - they gave me the antibiotics since I had tested positive in the past. Stadol and epidurals were my friends - they never slowed me down, thank God. In fact, epidurals sped me up with the last two.

    Let us know when you go into labor. I'll be praying for a much better process this time.

    Love ya lady!

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  3. Thanks for sharing this Kim. I can't believe how bad your first labor/delivery went. I'm so very sorry. I often wondered about Ms. Bigg while in Ktn... I'll leave it at that, but there were certainly some questionable things I heard through the grapevine.

    It's interesting because the military health system forces you to have a midwife as your primary care provider during your pregnancy. Unless - like me with the twins - you are considered high risk. The midwives that I spoke to prior to the babies being delivered were all wonderful, attentive, and well-informed, pro-breastfeeding, - AND able to deliver in the hospital of course. They also knew the extent of their expertise and were quick to refer to an expert (Maternal fetal specialists, High risk OBs, etc) for complicated issues, which was wonderful.

    I had a c-section with the twins because Baby B and was breech, and her brother (baby A) was smaller than she was. There was some concern that she could go into distress if they weren't able to turn her or deliver her breech. The risks were explained to me in detail - I'm so glad that I had competent physicians who understood this. The c-section was, for us, a less risky option, though I was given every opportunity to *try* for a vaginal birth.

    I feel very lucky to have access to high quality healthcare. For free, no less, as the military covers all costs when you deliver in a military hospital.

    Take deep breaths and remember that you are now among the best health care providers in the world. And now you know how to be your own best health advocate. This time around it's going to be great. And even if you have a c-section, you'll (most likely) be able to breastfeed. (P.S. Have you read the Womanly Art of Breastfeeding? By far the best book on breastfeeding I've read, really gives you the tools to start off with as few barriers as possible at the beginning.) :)

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  4. Sara -

    I'm very excited at the possibility of breastfeeding my son. I loved it with Bethany, but since she was losing weight I didn't have much choice. I'll have to check out that book, thanks!

    And I definitely want to clarify that I have no problem with midwives, any more than I have a problem with the entire medical establishment in general. I have many friends who have had great experiences with midwives. I know Ms. Bigg was one of a kind.

    I felt like both she and the doctor gave me equally poor care. The nurses at KGH, however? Incredible. I have never felt so grateful to a group of people in my life. I sent them a huge Harry & David basket after we got home.

    Carol & Kari -

    Thanks so much for your good wishes. I know this time around I'll be in better hands and hopefully it will go a lot more smoothly.

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  5. Kim -

    I've had just about every problem possible when it comes to nursing [almost all]. Holler if I can help at all.

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  6. I'm so glad you are not in the hinterlands for Boise Boy. Jerry will be even more attuned than before, so that nothing will endanger his beloved.

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  7. Considering the history, I'm impressed you were willing to go through it again! The anxiety was fully valid.

    Well, of course now I'm eager to hear how it went with K. You had savvy on your side this time.

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