On a Lighter Note August 17, 2010

Things could be going much better… but I am trying to stay focused on the positive instead of the bad.bad.bad. so that I can keep a smile on my face and possibly trick myself into reducing the otherwise boiling over stress level.

Last night I started a rotation at a different hospital. Where they have a new procedure for labor and delivery. I am still trying to comprehend how they can go from kind of antiquated to WOW without a few pit stops in the middle, but kudos to them!

Before, standard procedure was for laboring mom to leave the labor room and head to the delivery room where she would climb up onto a table, get her feet into the stirrups, experience a traumatic delivery that included a guaranteed episiotomy, a doctor climbing on top of her abdomen and pushing down to force the baby out or use of  forceps, a quick latch from the baby then baby is whisked off to the nursery, stitches, pain reliever/sedation without consent, at least an hour in a recovery room, then off to the OB ward.

Last night, we were enlightened about the way they do it now…

Laboring mom still leaves the labor room and heads to the delivery room where she climbs up on the table and gets her feet into the stirrups, BUT, no more episiotomy, skin to skin immediately after delivery… for at least 60 minutes, no more pain reliever/sedation… while baby is on mom, Vit K and Hep B are administered, and baby is wiped off instead of quickly bathed with soap and water or baby oil.

I know there is still a long way to go here. I haven’t had the opportunity to observe a birth with these new procedures yet, but I was so excited to hear that they are now requiring skin to skin immediately after delivery. This is something that is not even common practice in hospitals in the US yet either you ask for it, or you have an awesome nurse. It just made me happy.

I’m off to get ready for another duty shift now, so I will leave you with this picture snapped by the Manchild…

The Cesarean Complex September 4, 2009

There is a lot out here on the interent about birthing; especially natural birth and the birthing experience.   Having wanted a natural birth experience for all three of my littles, I was quite disappointed to have each of them end in cesarean sections.  For a long time I felt that I was missing the experience of natural birth, that I had been robbed.  Over the last year or so, I have come to a peaceful place with the experience that I did have, the experience is mine.  A lot of that is from being able to read the experiences of others and how they got through them.  Some insight that helped me greatly was from Morgan over at Adventures in Diapering.  I have come to realize that it is OK for me to miss that experience, as long as I can still look at the big picture and remember that the pregnancy and birth are probably about 1% of the entire parenting experience, and the parenting experience is what really matters. 

 

Another thing that I have come to realize is that there are some women (men too…) who really put a value on the natural birth experience, and in talking about that value as a whole (medically and emotionally speaking), focus on the areas in which our current maternal care system is lacking.  There is not a lot of discussion of situations where cesarean sections were a legitimate medical necessity.   I believe that for most women who have experienced something different than they were hoping for, this does nothing but perpetuate feelings of loss, sadness, and possibly inadequacy.

 

While this is something that has been of interest to me for over a decade, it has been more of recent that I have been doing more reading and research on the issue.  I am fully aware of the sad state of our maternal care in the U.S., both from my readings, and from personal experience.  I know that there are many (too many)  situations where a  woman who intends on having a natural birth experience ends up with an epidural, and eventually lands on the OR table while her child is born through a surgical incision for reasons that could have been avoided.  I know that there are OBs who want to practice 9-5 medicine and will induce labor or schedule ‘elective’ cesareans so they can be home in time for dinner.  I also know that many women head into the hospital thinking that they are going to have the birth experience that they dreamed of, not ever having had a direct conversation with their doctor about his or her practices, or doing any of their own research outside of taking the child birth classes taught at the hospital.  The problem is not only the fault and/or the responsibility of medical providers, but also that of women.

 

I believe that there is more than one issue at hand here.  The fist is making a change in the system so that pregnancy and birth are treated as a natural process and not a disease that needs to be cured.  The second is that we need to develop a true understanding of what (some) women who have had cesarean sections go through in the recovery process emotionally, and provide better support for them.

 

There are amazing nurses, midwives, and doctors out there that realize we have come to a place where change needs to happen.  Many are trying to make that change even if it is only in the smallest things that they can do as individuals (maybe a nurse standing strong in supporting a women’s wishes when she is being bullied by a doctor).  Some know we need a change but have no idea where to start, and there are others, unfortunately, that don’t realize anything is wrong.

 

I believe that as a woman, I have a responsibility to myself and other women, to be an educated consumer’ of all things.  Number one on the list of all things is health care.  Change doesn’t come easily or quickly, but with time, persistance, and hard work, we can make it happen.  It is my responsibility to be open and upfront with my doctor regarding my expectations.  It is also my responsibility stand up for myself if I believe that I am not getting what I deserve.  Remember that even in the doctor’s office, you are paying for a service, and you deserve to be treated fairly and with respect.  You can question things without being rude or pushy, and it is OK to say no, or I want a second opinion.  It is your body, and what happens to it is your choice.  Don’t let that choice be taken away from you.

 

 

The Baby May 26, 2009

There are only 14 months between the birth of Popo and ‘The Baby’.  So I have the Manchild who is now 12, Popo who recently turned 2, and The Baby who recently turned 1.  After the birth of Popo, I was nervous about what this pregnancy might bring for me, and had many open and helpful conversations with the doctor through the months. 

 

At my first prenatal appointment, I asked about something that had been weighing on my mind; what was really considered to be a reasonable/safe number of c-sections before mom should call it quits.  The doctor said that generally they recommend that you have no more than 3 c-sections, but that if a mom feels strongly about it, it is possible to have more.  She said that she has moms that have had 5 c-sections and they have been fine.  We also discussed the subject of VBAC, but since Popo and The Baby would be so close together, we decided that a planned c-section for The Baby was best.

 

We also talked about what the liklihood was of the recurrence of HELLP Syndrome, and what I could expect as I came closer to my due date; she would be monitoring me very closely, and she said that my treatment would be very conservative;I should expect frequent appointments and regular non-stress tests (NST) along with regular blood work.

 

Throughout this pregnancy, I felt much better than I had with Popo, nothing out of the ordinary, not even any swelling, so I can say that I was more than surprised when I went in for a regular check up at 30 weeks to find that my blood pressure was 140/90!  Needless to say, the nurse pratitioner I had been scheduled to see sent the Dr. in, and I was sent right over to the hospital for an NST and blood work.  She also asked me that dreaded question, “are you working?”  That was the day I was ordered to spend the remainder of this pregnancy on my left side.

 

For 7 weeks I complied; I made weekly trips to the Dr, and bi-weekly trips to the L&D unit for NSTs.  I became a frequent flyer, and counted down the weeks then days until I knew that I was at the point where I knew I wouldn’t have to transfer to The Big Hospital if things started to make a downhill turn.  My blood pressure stayed within a ‘normal’ range all along until about 37 weeks. 

 

I had a horrible cold that I just couldn’t seem to shake; over the weekend I had made one trip into L&D for an unscheduled NST due to lack of baby activity, and another trip into the ER because I was severely dehydrated, and no matter how much I drank, I just couldn’t get myself hydrated.  On both visits the end result was the same; I was fine and The Baby was fine.  Even though I begged to differ on both trips, I went home and tried to keep myself hydrated and make sure The Baby was still moving, I knew I had another Dr. appointment on Tuesday anyway.

 

Tuesday came and to the Dr. we went.  I had a scheduled ultrasound scheduled that day to check growth and fluid level; the uldtrsound tech said that my fluid level was low and that I would have to talk to the Dr. about it, lucky for me I would not have to wait to hear what that meant (though I knew what it meant, ultimately).  My blood pressure was checked and my urine was dipped, and the Dr. came in to the examination room to tell me that she had called the hospital to schedule the anesthesiologist, and The Baby would be delivered the next morning… the fluid was low, the BP was high, and there was protein present in my urine.

 

Even though at this point I expected her to tell me this, I still started crying because I still hadn’t really expected to hear this today.  We went home and packed and headed over to the hospital because I had to have another NST and the Dr. had decided it would be better if we stayed overnight to be monitored.

 

The next morning I was prepped and rolled into the OR for delivery.  I was absolutely terrified of the spinal, (my close friend had said that was the absolute worst thing she had ever experienced in her life, and I am not to keen on needles), but the anesthesiologist and the nurse were amazing.  DH was right by my side the entire time snapping pictures and talking to me while Teh Baby was delivered.  The ansethesiologist was so patient and absolutely wonderful in answering all of my questions and telling me what was going on the entire time (as a nursing student, I have seen a few scary things in clinicals, and I was afraid I would be too focused on the monitors or what was going on in the OR). 

 

It was such a wonderful experience to be awake for the birth of The Baby; so different from my previous births with The Manchild and Popo.  She was born healthy, but had a lot of fluid in her lungs (she required a lot of suctioning) and was having a little trouble breathing after a bit, so she was taken to the nursery for some oxygen and closer monitoring.  After a few hours she passed some meconium and was as good as new!  The brought her into my room and there she stayed until we went home. 

 

While this is not the birth that I would have ‘chosen’ if the ‘choice’ was available, I am grateful for the final outcome, which is that I had a birth where both baby and mom were healthy.  I had a very hard time dealing with the birth of Popo, especially because I truly had a different experience in my mind, and not only was it completely differentthan what I had in mind, but the disappointment was compounded by the fact that I left the hospital without my baby, and although she didn’t have any major complications, she was not able to join the family at home for a month.  I recently came across a great blog of a mom who has had 4 c-sections, and this post that she wrote really helped me realize that it is not the experience per se that matters, but the overall outcome and how you choose to move forward after the fact that is important.  I completely agree that society puts too much emphasis on the experience of birth, and surely this interferes with the emotions of many new mothers who are already dealing with so many changes (both internally and externally).

 

I was by far the most prepared for this birth as far as having educated myself as a patient, as well as making sure that the Dr. and I were on the same page throughout the entire pregnancy.  As women we need to educate ourselves; we need to be aware of all options that are available, and we need to ask questions, and sometimes stand up and say no.  We should be more prepared for truly necessary interventions.  Pregnancy and birth should not be treated as an illness, but as a natural life occurrence.  We need to help other women understand it as that.  We need change, but it will not come without work from all of us.

My Little “Lucy” May 14, 2009

The Man Child would be 10 years old soon after the birth of my second baby.  While the years passed between the birth of The Manchild and my little “Lucy”, I went through many changes myself; I had moved several times, quit a job I stayed at for several years even though I was miserable, went back to school full time, got married, earned my associate’s degree, and enterered a nursing program in order to earn my bachelor’s and start working as a nurse.  Little did I know that there were other things planned for me, and while my daughter is now 2 years old, I am still trying to get through nursing school 4 years later!

 

My Daughter’s Birth Story

After The Manchild was born and time passed, I knew that things would be different if I had another child.   I would be more educated in my options, and have a better, more open dialogue with my doctor throughout the pregnancy.  I would not just blindly accept whatever was given to me.

 

The pregnancy went as well as we could have hoped for; no complications, I had started CBE classes, including Hypnobirthing, talked to my husband and mother about what I wanted and how they could support me through the process, wrote a birth plan and discussed it with my Dr., who was supportive of what I had written.

 

When I was around 25 weeks, I just didn’t feel good and I started to swell.  “That’s normal,” they said, “yes, even this early.”  In the next week or so I had a few extra trips to the Dr.’s office to check the blood pressure because I had a few headaches in addition to the swelling.  “Still normal,” they said.  I was sent for some blood work, just to be sure and get a good baseline, just in case.  In the few weeks that followed the swelling became worse and worse, and overall I just didn’t feel good.  At my 30 week appointment, my blood pressure was somewhere in the range of 130+/90 which was quite a jump for me, and there was a little protein in my urine.  I waited for the doctor to come in.  “Are you still working?” she asked as she entered the room.  “Yes,” I said cautiously.  “Not anymore,” she said.  I asked about school, I had just started my second semester of my junior year.  She shook her head and told me that I would spend the rest of this pregnancy on bed rest, that is, after a trip to the hospital for some testing.

 

As I headed over to the hospital, I called work to let them know I would not be in… for a while.  I wondered what would happen with school, I was so close to being done!  I spent the day in the hospital hooked up to the monitor with regular BP checks and waited for blood work to come back from the lab.  No, I didn’t have a headache, and no I didn’t seefany floaters.  I was sent home with a 24 hour collection bottle, strict orders to stay on my left side, and no, there wasn’t a need for me to monitor my blood pressure at home.  This all happened on a Friday.

 

I went home and stayed on my left side, and monitored my BP anyway.  By Wednesday, I decided to call the Dr.’s office as it was getting worse.  I had bought myself a trip to the L&D floor for a non-stress test and more blood work.  It was around 5 p.m. when I arrived there, and the Dr. working that evening was one who was on staff at my regular Dr.’s office, but I had only seen once or twice.

 

This Dr. was pretty abrasive this evening; after the lab tech came up and drew some blood, she decided to talk to me about my birth plan.  She told me that it was nice that I had taken the time to write the birth plan, but I needed to understand that things change, and it is normal to experience pain and use medication during labor and delivery.  I told her that I understand that I may not have everything I am hoping for due to emergency situations that may arise, but I had talked to the other Dr. about it already, and she was comfortable with the plan I had written.  My pressure was reading around 150/100 on the monitor, and the Dr. asked the nurse to get another reading with a larger, manual cuff.  The nurse came back with a bariatric cuff that was sizes too large for my arm, and got a reading that was lower than my ‘normal-not-pregnant’ BP.  The Dr. said that since my blood work was normal and she was more comfortable with this pressure, she was going to send me home.  “But that BP is not right,” I said, “It is lower than anything I’ve had ‘normally’ in years”.  She pretty much ignored what I said and told me that she was comfortable with sending me home, and I should just call if I have any more problems.

 

After arriving home, I continued to monitor my BP, which still lingererd around 150/100, both with a wrist cuff, and my manual cuff which definitely fit me.  I parked myself in bed on my left side, and watched some TV.  Shortly after 11 p.m. I began vomiting, so I called in to the Dr. on call.  I told her that my pressure was still up around 150/100, and I was now vomiting.  She told me to head in to L&D at the hospital.  I called my husband (who worked second shift) and told him he needed to come home and take me in.

 

After some time in triage, they transferred me to a room and monitored the baby and my BP, still getting readings around 150/90.  They called in to the Dr. with a report, and she asked them to use the larger manual cuff again.  I explained to the nurse what had happened earlier and I was not comfortable using the larger cuff, and I had brought my own that had markings that confirmed that it was the appropriate size.  She seemed to agree that the larger cuff was not giving an accurate reading, but the shift changed and a new nurse came in and told me that I seemed to have a stomach virus and I would have a liter of IV fluids.  She had an extremely difficult time getting the IV in, and ended up placing it in the antecubital area, which was quite uncomfortable.  After the first liter went in she said I could have another liter, or go home.  Since I was frustrated, exhausted, and miserable, I decided to just go home to the comfort of my own bed. 

 

When she removed the IV, my arm started to bleed… a lot.  The nurse thought this was unusual, and asked me if I have ever had trouble with IVs before.  I said no, and just held the cotton ball with a lot of pressure to try to get it to stop.  15 minutes later, after we arrived home, the IV site was still bleeding, and I told my husband I thought this was very strange.  After finally getting it to stop bleeding, I decided I was going to have a conversation with my regular Dr. the next day, and went to bed.

 

Thursday morning I called the Dr. and expressed to her my serious discontent with the way things had been handled the previous evening, and told her that I would not be going back to L&D if the Dr.s on call and nurses could not figure out how to take an accurate BP.  She said she would note my file and suggested that I bring my own manual cuff to future visits so that there would not be any questions, and she would call a prescription in to the pharmacy that would hopefully help get the BP under control.

 

Friday morning came, and I got up to head in for my regular weekly appointment.  I felt miserable, and started vomiting in the shower.  My husband and I headed right in to the Dr.’s office (I had an 8:30 a.m. appointment).  As soon as we walked in I told the receptionist I had been vomiting, and could they go ahead and send me back to an exam room, and she said, “I can see you aren’t feeling well.”  They sent me back to the exam room and we waited for the nurse practioner to come in.  When she came in she said that I was reading +4 for protein in my urine, and she was sending me right over to the hospital for labs. 

 

Because I had not been feeling well for weeks, and I had been brushed off a few days ago as still being fine, I guessed that the lab work would come back and I would just be sent home, so I told my husband I would try to find someone to pick me up so that he could go to class.  my husband waited with me while they drew some blood, and I called my father to see if he would be able to come pick me up.

 

There was a different Dr. on call this day, and he said he wanted to check the lab work to see what was going on, and there was a possibility that I may need to be transferred to the larger hospital.  I don’t remember a conversation with the Dr. or the nurses where they specifically told me, even after the blood work came back, how sick I was.

 

The Dr. left, and I heard the nurses chit-chatting at the nurse’s station that she would expect it to be a lot higher than 75, especially with the dehydration… she came in and told me that my labs were back and she was going to have the Dr. come back and take another look at me.  When he came back he said that he had called ‘the big’ hospital and I would be transferred, and he explained that I was going to have an IV of magnesium sulfate started and get a shot of steroids that would hopefully help the baby’s lungs develop, just in case they had to deliver the baby early.  I would have one shot today, and another in 24 hours.  The ambulance came, and transferred I was… thank goodness my husband stayed with me!

 

When I arrived at ‘the big’ hospital, I had another non-stress test, another set of labs, and an ultrasound.  I asked the Dr. what the bottom line was, becuase up until this point, I didn’t really know what was going on, other than I was sick.  He said that the bottom line was that I was not going to be pregnant fro much longer (I thought to myself, not much longer, so now I’ll have to stay here a couple of weeks on bed rest?).  I asked him what “not much longer” meant, and he said that hopefully they would be able to hold the delivery off at least another 24 hours so that I could get the second shot of steroids, but it was all dependant uopn my lab results. 

 

Shortly thereafter, the Dr. returned to my room with a brood of other Dr.s and said that as soon as an OR opened up, I would be having an emergency C-section… my platelets were at 62,000… I thought for a second… platelets, they should be 150,000+… and I looked at him and asked him if I was going to bleed out when they cut me open.  His response was that it was a serious concern, and I may need to recieve blood products.

 

I talked to the anesthesiologist who said I would have to be under general due to the risk of bleeding with a spinal, and the NICU Dr.’s came in to explain the baby may need respiratory support since I was only at 31 weeks, and what I should expect when I came out of surgery.  It all happened in a whirlwind.  It was like a dream… the next thing I knew I was being wheeled in to the OR joking with the anesthesiologist about making sure I was really asleep.  When I woke up they told me I had a baby girl who was doing well in the NICU, only needing a CPAP at this point.

 

I had to stay in bed for the next 24 hours, because of the magnesium sulfate, so I didn’t see my DDD until she was a day old.  When my wonderful nurse wheeled me in to the NICU to see her, it was amazing.  The intensity of everything that happened did not hit me until the next day when I went into the NICU by myself to see my beautiful baby, and I was overwhelmed with emotions and just cried and cried.  Her nurse came over to me and said, “she is doing great, you know that, right?  She is OK.”  I nodded yes, regained composure, and started to learn about what I should expect in the days to come.

 

I was blessed to have a wonderful nurse when I was transferred to the ‘big hospital’, and we were even more blessed that our Little “Lucy” had ABSOLUTELY AMAZING nurses her entire stay in the hospital.

 

This birth experience could not have been any more different from what I was hoping for, but I learned a lot through it, and am grateful that we were blessed with a healthy baby who just needed some time to grow and learn to eat before we could take her home with us!

The Manchild April 9, 2009

I recently wrote a post on becoming a doula.  Since that post, I have been very focused on exactly what it is that I want to do, and what my long term goals are.  Over the last few years I have become more and more interested in women’s health; I would love to not only help women have the experience they want to have while birthing, but also to educate women in general on how they can take control of their own health care and realize that they have choices.  This all stems from my personal experiences with the births of my three children, and what I have learned over the years, not only as a patient, but also as an advocate.

 

My Son’s Birth Story

My oldest child is a boy who I lovingly call the Manchild.   He was delivered by an emergency cesarean section almost 12 years ago.  My plan was to have a birth as natural as possible, but there were other things in store for me. 

 

I woke up the morning before with a sore back, and called out of work becuase I generally wasn’t feeling great.  My mother commented that it was likely a sign of the new arrival coming.  I spent the day hanging around the house, nothing eventful happening.  In the evening I watched some tv and went to bed, when I realized I was having contractions (maybe around 10 p.m.).  I called the Dr. when they seemed to be close enough that I was concerned, and she instructed me to wait a little longer, they weren’t close enough together.   Around 11:30 my water broke, and the Dr. gave me the OK to head into the hospital.

 

I distinctively remember arriving on the L& D floor, heading into triage, and having that first exam… where they tried to convince me that I had actually wet my pants, because my bag of water was in fact intact.  I knew that this was not the case, and it took some time to finally convince them otherwise.  Finally they transferred me into the room where I would labor for the next 20 hours.

 

What I had in mind for this experience was not even remotely close to what happened in reality.  As my labor seemed to be progressing as slowly as possible, I was hooked up to a pitocin IV drip to help things along.  What I remember about this is that it made the contractions come much closer together, bringing with them much more pain, and an unbelievable desire to push, even though I was not even dilated to 5 cm.  I was not allowed to eat or drink anything “just in case”, I was not allowed to leave the bed, and I was not getting a lot of support or information from the nurses.  After the pitocin kicked in, they convinced me that I needed some pain medication and out came the demerol, and then they later convinced me that I would benefit from an epidural (which they were unable to administer).

 

After laboring for several hours with visits from the nurses here and there and internal exams galore, I was informed that if this labor did not begin to progress, I would be moved to the OR and have a cesarean.  The doctor came back in after what seemed like forever and did an ultrasound, and told me this was it, and to the OR I went.  I was put under general anesthesia, and woke up with the nurses calling to me that I had delivered a baby boy, and everything was well.

 

I wasn’t an educated patient; I didn’t know I could ask questions, and I certainly didn’t challenge anything the Dr. or nurses said.  I wasn’t encouraged to use the breathing techniques I had learned in the childbirth education class I had taken at the hospital, or to try different positions.  I didn’t get support from the nurses.  I was never told that the reason I was finally wheeled into the OR for an emergency cesarean was not because after 20 hours I never dilated past 5 cm (failure to progress), but because in fact my baby was in distress, he was delivered with the cord wrapped around his neck… twice (I am COMPLETETELY CONVINCED that the pitocin I was given caused my uterus to become hyperstimulated, causing my little manchild to be in distress).

 

Luckily there were no complications, but as the years went by, I became more aware that there are options other than just saying OK.  I decided that if I had another child, I would certainly do a better job as a patient, and a parent; educating myself and standing up for what I wanted.

 

While my medical records do reflect that the baby was in distress, the documented reason for the cesarean was “failure to progress.”  I found with my next child that this was like having an “X” stamped on my forehard as far as the willingness of Dr.s who would consider letting me try having a VBAC.