Friday, October 27, 2006

Ceserean Section

Not a term anyone wants to hear. For me it was a moment in time I had realized was very much possible. My questions about it started about two weeks after my experience with it.
For me and my baby the c-section was medically necessary but that wasn't explained to me until 9 weeks after the surgery. Those nine weeks filled themselves with self doubt and feelings of failure as a woman. I know I am not alone in these feelings. What I didn't know and have begun to learn is that each woman’s story is entirely different from another’s. In addition to this I haven't heard a story quite like mine yet. I'd like to share it to spare someone else the same experience.
In the beginning, actually before the beginning I was committed to delivering my baby with the help of a midwife and a doula. Midwives believe in avoiding unnecessary medical interventions, and only intervening when medically indicated. Doulas are proven effective in reducing the use of narcotics and reducing the overall drama of delivery.
The essence of my story is that despite the fact that I had made many educated choices and chosen medical professionals that suited my needs I still did not receive the level I care I had work very hard for. So, to those who might think this is a complaint about cesarean, it is not. It is not a compliant that I stayed pregnant for three extra weeks.
I am disappointed that I was unable to deliver naturally, but I have become more disappointed in my midwives and how they handled my care in a hospital setting.
The midwives I chose to work with were recommended for natural birth and predominantly delivery babies at their own facility, a birth center, and carry on a partnership with an area teaching hospital.
I was advised to go the hospital for induction when I was 42 weeks and 6 days pregnant. By all accounts my due date was accurate and labor was not beginning on its own. We had tried membrane sweeps, primrose oil, sex nipple stimulation (which can increase the body's oxytocin output, thus inducing labor), long walks and finally two rounds of castor oil (which by aggravating the intestines can sometimes successfully aggravate the uterus to contract). I was disappointed to not be delivering at the birth center but I was assured vaginal delivery was still an option. The biggest obstacle was in fact my cervix which had failed to dilate past 1 cm.
At the hospital the midwife inserted a Foley Bulb and the nursing staff hooked me up to the cursed IV and pitocin (I curse the IV because the swelling it causes is uncalled for!). I was hooked up to the trusty fetal monitors. Then the midwife left the room. She remained absent till the Foley Bulb fell out, roughly two hours. She checked me and I had dilated to 4 cm. Then the midwife left the room.
It is then I began to wonder what the hell was going on. Why was I being abandoned? When I saw midwives on videos, on TV, they had stayed in the rooms, hadn't they? A pattern was established and the wise female protector and guide I thought I was guaranteed by seeking out midwifery care vanished. There was no sense of grounding for me in the room.
I was checked in around six pm and the Foley Bulb was falling out around ten, maybe nine pm. Sometime around midnight, maybe eleven the midwife who was handling my case made an appearance to let me know she was taking on a case that was transferring from the birth center to the hospital. She'd be down the hall.
At one point, as I tried to cope with wave after wave of pitocin without any pain medication whatsoever I asked the nurse to cool it with upping my pitocin. Nurse Ratchet replied that "this was how people have babies". (AAAaahhhhhhhh!)
I called for my midwife who came back into the room (a huge hint she wasn't in the room much). I told her I didn't like the nurse, that she was being condescending. To this my midwife implored me to have patience with the nurse she was tired and just following orders.
Think about it, I was having a contraction every 30 seconds or so, no joke, and my midwife - my Gia - was asking me to empathize with the nurse. Sometime after that my midwife checked me again, I was five cm, and then she disappeared down the hall until two am.
I labored, I squatted, I bled. My husband held on for dear life and attempted to help me manage the pain (thank you honey!). My doula watched and swore she saw me progress into active labor. My contractions were on top of each other and there was no midwife for hours. Why wasn't she there holding my hand, reassuring my husband? Why was she avoiding me? Was I disappointing her? Was I not interesting enough?
At two am I was checked and my dilation had failed to progress. I could no longer handle the void and the pain. I asked for the epidural. I cried. I sobbed. My doula went home. Later she told me she cried for me, for that voids she kept seeing in my care all evening.
I woke up around seven am I think. The epidural was wearing off, so I requested a boost, a bolis was added. The epidural continued to wear thin every two hours or so and additional medication was added each time. I developed a fever and had to be put on antibiotics. I had to have a catheter inserted to manage all those fluids. I had an internal monitor inserted to monitor the contractions accurately. Gone were my hopes for a delivery without intervention, dashed were my dreams of a midwife guiding me through it all. Eventually I had to have Tylenol inserted (guess where) to manage the fever and an oxygen mask to assist the "fetus" (why do they use such a cold word during such a momentous precipice?) who had experienced a minor deceleration.
I had tubes coming out of me everywhere. And that little "fetus" was taking a beating as my body was being forced to contract every other minute. I was checked at one pm (about 18 hours into the ordeal) and I was still only five cm dilated. The midwife in charge of my care went off duty and a new midwife took her place. She said hello and left the room.
She came back at two and checked me, I was still five cm dilated and she said the baby's head was still molding.
"Molding?" I asked.
Yes, hadn't the other midwife mentioned it?
No.
Yes, well the baby's head is misshapen, molding, significantly and your cervix is swelling. Given your fever it is "my professional opinion" that you receive an immediate cesarean.
Of course we consented and I was rushed to the OR. Meanwhile my midwife caught up on old times with my nurse, an old acquaintance of hers. They chatted in the OR, and when I tried to solicit an opening for my midwife to pay some attention to me she quickly answered my question, wouldn't come near me, and went back to her conversation. So... women who fail to deliver naturally don't interest their midwives?
The surgeons and nurses all introduced themselves to me, the only request left intact from our written birth plan (no cord cutting, no tubs, no med free birth). The blue sheet was put up in front of my face and I began shaking from the medications. I begged for my husband. I was clearly emotional. The nurses in the room told me it would be "OK" (not much came from my midwife who stood away against a wall). He finally arrived and we talked and my void was partially filled.
Our son was born, and they did not hold him up and show him off (should I have written that into my birth plan?). His hand and feet were blue and he had a nasty little cone head from all that "molding" I had been unaware of. Soon enough he was whisked off and so was my husband to keep a watchful eye on him. I was good to know the baby had a protector if you will.
Postpartum rooms were all full. Recovery is basically a hallway intersection with three sets of double doors. There I met my baby - greatest is the moment you say hello and they look right at, know your voice instantly. We nursed a little, bonded. Then my husband and baby left again and went to the nursery.
He was born at 4pm, so I had been in labor for 21 hours. I was still in recovery when my nurse gave me an injection for the pain, told me there would be a second injection in five minutes. Then she clocked out for the day. Around seven pm I was alone in the hallway, "Recovery" and the pain was kicking in. No one came to see me, I had no nurse.
Someone, a blond nurse, who was covering stepped in and I asked for pain medication. She left. Moments went by (notice I suddenly have no midwife, no one to advocate for me). Another nurse, Nurse Ratchet (can you believe it?!) came in and asked what I needed. I said pain medication.
She wandered around looking for something and went back to the OR (I later realized) and came back with something and began to add it at my wrist where the IV lines entered. The blond nurse then walked in and asked her what she was doing, and Nurse Ratchet said she was giving me pain medication. The blond nurse asked her what medication?
"250 cc of le" Lepto- or Leso- something. I couldn't take in the full name, but I surely took in the awkward silence, the looks and the sudden change of action on Nurse Ratchet’s part. She stopped injecting, and they both quickly left. As the doors shut I realized I couldn't swallow. I was alone with no call button and was deliberately left by two nurses; there was no one to help me.
Sure I felt pretty scared, panicked. Honestly I'm not sure I could have spoken or called out. I just tried and tried to swallow. I didn’t regain an ability to swallow for over an hour.
Around 7:45 pm a completely different nurse came and took me to my room. There was my husband and sister and baby. I didn't let him out of my sight for very long.
The following day I received a phone call from my primary nurse midwife telling me she would come see me but she couldn't. She promised the secondary midwife would visit the next day. The next morning I decided two days was long enough and we committed to leaving the hospital that evening. I received another phone call, this time from the secondary nurse midwife telling me she just was too busy or whatever to come see me.
The OBs were great, the pediatricians friendly and the birth certificate processor was the first person -two days after the fact to tell us that the baby's cord had been wrapped around his neck twice, a complication listed in record next to my fever.
So...
As I ask why I never dilated it is said that my body was protecting my child. At least someone had been doing their job. Sadly I still battled self doubt and failure well after the fact and only recently have begun to feel better about myself.
Conclude...The title Nurse Midwife does not guarantee any specific caliber of care. It may sound nurturing but nurturing is not promised. In the future I advise a discussion with your provider about the level of presence the birth mother wants during that time.

1 comment:

Stephanie said...

Hi Amanda-This story is familiar to me. Not all of of it but the beginning certainly is. One thing I don't understand is why your doula left after your epidural. I'm a birth doula and once I'm there, I don't leave until after the baby is born and the baby and mother are nursing well. Why did she not come back? I agree that your midwives did not behave as advocates, but that is where having your doula present would have been a blessing.I'm so sorry that this is the birth experience you had. At least you can live peacefully knowing that you were one of the women who indeed DID NEED a cesarean. It is too bad your midwives didn't have more intuition into what kept your body from going into labor and then what kept it from progressing once it was forced to. I found your blog from a comment you made on a post on MDC. Are you planning any more children? If you are, I hope next time is a world away from this experience.