birth two - the other end of the spectrum
This turned into a busy week for births. I shadowing a midwife on Friday and another woman was admitted for labor. From the moment I saw her, I knew this would be a very different birth.
Her visit to the midwives late in pregnancy were frequent, lots of false labor. She arrived that morning, just barely in labor and already looking miserable.
I shadowed until about 4pm. When I was about to leave for the day, I went up to ask the pregnant woman if I could observe her birth. She agreed. She’d been in bed all day the baby was having “D-cells”. When the baby’s heart rate drops and then goes back to normal. She was a heavy smoker and had traces of opiates in her urine that day (she was not in the drug treatment program).
I left for dinner and came back around 7pm. When I arrived she was about 4 centimeters and getting an epidural, but she could still feel a lot of pain. I asked the midwife how well the epidurals work, she said that in the past she had seen a 90% effective rate. Here in Hyden, it was closer to 50%. And that maybe the lower rate is due to patients previous use of drugs, blocking the effectiveness of this drug. The woman cried and moaned for hours. With the epidural she is unable to move from the bed, unable to do anything physical to cope with her pain.
The midwife gave her pitocin to increase her contractions. She started making changes or progress. In an hour she was at 5 centimeters. Thirty minutes later she was close to 6, with the inclination to push. If the woman pushes before the cervix is fully open, the cervix swells and the possibility of a vaginal birth is delayed or eliminated. They turned the pitocin down. This whole time she wept and wailed. For much of the time I stayed by her side, encouraging her to breath, telling her it would be ok. Nothing really seemed to calm her down. Her mother and partner were in and out of the room. Trading off providing support and taking smoke breaks.
For hours the midwife went back and forth with the pitocin, trying to promote progress, then turning it down. From the nurses stand the woman cries were loud and clear. She continued to groan and whimper. This process lasted almost 5 hours. After her cervix had not changed from 6 centimeters for over 2 hours and they had given her all the drugs they could offer, the midwife called the OB to come in and consult. The midwife wanted the doctor to come on sight so she could turn up the pitocin again. She knew the baby was small and the mother should have no problem with a vaginal birth.
The OB did not answer his pager or phone, which is very out of character for this physician. The hospital night manager drove to the doctor’s apartment to wake him and get him over the hospital.
At 2:30AM, the doctor arrived, consulted, and sent everyone downstairs for a Cesarean Section (C-Section). I put on scrubs and followed the crew into the Operating Room. I had been in the OR before, but nothing I have seen compared to this type of surgery.
The anasthesialogist gave her a spinal block. I watched him act with precision as he pushed multiple needs into the middle of her back. Spinal fluid light rolled out of the hole he poked into the column.
They covered her in a blue sheet with a clear plastic square over her belly. Her partner sat beside her. Neither could see the operation.
I stood at the end of the bed. The doctor worked with incredible speed and accuracy. First he made a long incision above her pubic line and proceeded to reach in with both hands and PULL her skin and muscle/tissue layers apart. Once he located the uterus, he cut the bottom of is and reached into her, and pulled out the baby. All these steps occurred in a couple minutes. The doctor used a baster to get the liquid out of the baby’s mouth, cut the chord, and briskly handed the baby to a nurse. The nurse left the room to clean and evaluate the baby. At this point the doctor pulled the uterus out of the body, ripped the placenta out, and began sewing the uterus back together. The uterus was thick and purple and the size of an extra large grapefruit. I started to feel a little queasy with all the rough movements and abrupt request for metal instruments (never has this happened to me before, I’m generally great with blood and guts). I stepped out of the room (trying to avoid the embarrassment of passing out) to take a look at the new-born girl. I watched the doctor sew the tissue back together and staple the skin on the stomach through a window.
And people wonder why surgery resolves in such a painful recovery. Six weeks of healing while trying to care for a newborn. I recognize that C-sections save lives and often are necessary. I think that everyone who elects to have a C-Section should watch one first. On some level I feel traumatized.
Before we left early that morning, the midwife expressed her disappointment in the doctor not trying for a vaginal birth. She said, “he could have just slept in the call room, while we turned up the pitocin. I just needed him here to monitor”.
This birth was on the complete opposite end of the spectrum from the one I’d seen 2 days before. The midwife told me that once you start with medical interventions, they almost always escalate over the course of labor. That’s what happened here. It seemed the pregnant woman was not interested in taking responsibility or an active role in her labor. She wanted to come to the hospital and be treated. Labor cannot be controlled. When the person cannot fully detect what their body is telling them, I think it is even harder to react to the labor in the best way.
I left the hospital at 3:30 that morning still nauseated and a little confused. What I saw did not even seem like a birth. It was a procedure.
