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.