Sunday, June 25, 2006
Why Women Can't Give Birth
Well, I just spent the last 24 hours with my son and his wife as she delivered her first child, (my son's third). Gabrielle Gregory was born yesterday at 5:32pm and weighed 8 lbs, 13 oz. He is beautiful and healthy. I am joyful and grateful at his being here, and yet feel a deep sense of loss. Gabrielle, like my son's other two children was born by cesarean. Here's how it happened. I got a call from them early Friday morning at about 3 am. I had just been dreaming that they were about to call me, so when I heard the phone ring, I woke right up and answered it. My son told me they were still at home and asked me to come over. When I arrived a little while later, the doula was already there. My daughter-in-law was having good ctx about 5 minutes apart and sitting on the birth ball. I thought this doula was fabulous. I had known her for a long time, but had never been at a birth with her. She is also a massage therapist so has a fine understanding of anatomy and physiology that she uses as she helps the mother adapt to the changes and sensory experiences of labor. Throughout the long day, I saw her use movement, repositioning, aromatheraphy, music therapy, verbal encouragement, counter pressure techniques, hydrotherapy, massage, homeopathy, and other tools in her arsenal of care. We were at their house about an hour before my daughter-in-law stated that she wanted to go to the hospital. Her ctx were so good and steady that I was hoping she would be dilated to 5 or 6. Her ctx had started about 8pm the previous evening, but I didn't want to be overly ambitious about a first time mom. I had reminded them repeatedly to pace themselves because first babies take a lot longer. The doula at one point pulled me aside and asked if I were willing to check her [cervical dilation]. I had thought of this just the other day, and decided that it was not something I was comfortable with. It was important to me to maintain my mothering role and not put on any other hats if I could help it. I told the doula this, but would do a check if they insisted. They never asked me to. So, an hour later, we headed to the hospital, about a 20 minute drive away. When we arrived and she was checked, she was dilated to 3. My heart dropped. My number one rule for a good birth experience had been violated. Don't arrive at the hospital too early. Getting there at 5-6 would have been better. But we were there now, so they immediately got back to the process of laboring. After a few minutes of monitoring (baby looked good) they went back to the birth ball and my son and the doula took turns giving counter pressure and massage. I hung back and observed giving encouragements here and there. It was strange for me to be in this setting in this role. It was important to me to hold my boundaries. This was not my birth. The doula told me later that she thought my son needed me there for him, more than for his wife. I think she was right. Several times throughout the day, I was asked for my opinions. I think he thought that my being a nurse would offer them some protection or special insight. It was an honor to be asked to be present at this sacred occassion. I offered opinions only when asked, and had to tread more carefully as the day went on. After two hours, my daughter-in-law was dilated to 4, and asked for an epidural. We had discussed the slippery slope of interventions, previously, but she said she felt as if she couldn't continue laboring the way she was. Her request caught me by surpise. We had used practically all the therapies mentioned above in those two hours. We were all working together as a team so well. Hearing her ask for the epidural was like hearing that it wasn't enough. Her midwife immediately granted her request. The midwife was a lovely and supportive person, several times during the day she came in and simply sat with us. However, I never saw her say or do anything that a physician wouldn't say or do (except for the sitting of the labor) throughout that long day. I could not pinpoint any difference in practice. Before the epidural could be placed, she need an IV placed (of course). She would now be confined to the bed, place on the fetal monitor continuously, and have her vital signs monitored every 15-20 minutes. After the epidural was in, a bladder catheter was placed to measure urine output, (and because she could no longer go to the bathroom). Her labor stalled. (Surprise, sursprise.) After another two hours, she was still dilated to 4. The midwife offered to break her water (the gravest error yet in my opinion) "to speed things up." The baby was OP (sunnyside up) and the head asynclitic (sideways) (we found this out later) so to my way of thinking, removing the cushion of fluid would only inhibit the ability of the baby to reposition itself. But this all occurred while I was out getting breakfast and when I returned, it had already been done. I sighed and sat back down. Time passes and she is dilated to 5. More hours pass and she's still dilated to 5. The midwife does sit her upright in the bed, and later positions her from side to side in an effort to reposition the baby. The midwife and nurse won't try the in-bed positions the doula and I suggest because her legs are too numb to hold her up. They have a point, our positions do require some use of her legs- hers are completely numb. More hours pass without change and her cervix has begun to swell. The midwife tells them they can try a pit augmentation, but my son says no. She already has a good ctx pattern every 2-3 minutes and he doesn't want to risk taxing the baby. (We knew this because the midwife had earlier put in an internal monitor.) Her other option was of course a cesarean. After the midwife and nurse left the room for us to powwow, I told them they had a third option of doing nothing and giving themselves more time. The midwife agreed to give them another hour. It was evening by this time. I had to leave again to pick up my three girls from a birthday party. I was glad to have to go (a cowardly thing to say, I know). I knew when I got back the cesarean would be over and done. It was a foregone conclusion from the time they broke the water, maybe even from when they did the epidural. I had seen this whole scenario played out 1,000 different times as a L&D nurse. My daughter-in-law fell right into a typical delivery. I really thought that teaching them childbirth ed myself, getting them a doula, and encouraging them to select a midwife would make a difference in their birth. It made no difference at all in how things played out. I realized then, as I returned to the hospital and they were rolling her back to her room from the OR, that birthing women themselves have to want a change, and are in the best position to make the change. My wanting things for her, made no difference at all. She had to want it for herself. My daughter-in-law knew she didn't want a cesarean (they told me she cried when the midwife came back and told her time was up and they were out of choices) but she didn't know what she wanted instead. How could I explain to her that she would have had an entirely different labor if she hadn't had the epidural that began the cascade of interventions and robbed her of her ability to reposition and be mobile in ways that could have made a real difference in the baby's positioning. I don't think she failed. I think the system has failed her. As they wheeled her back to her room, I thought of a whole generation of women who would not know the experience of vaginal birth and the impact it would have on the next generation of women. I felt almost doomed. I only perked up after a private conversation with the doula in which I could see my role more clearly. I have to write this book and make my documentary on birth. I stopped being a doula, and an OB nurse, and a childbirth educator and I stopped pursuing midwifery as a vocation. None of those was ever a good fit for me, but I am beginning to see my place in the grand scheme of things. My role is in advocacy and policy change. I feel powerless at the bedside. I'll never be an insider. I've been inept at causing change from within. Perhaps my book and film can help women internalize the need for change. At this point I feel it's all I have to offer to the cause.