Tuesday, May 20, 2008


A mother cries over her newborn. He is barely 22 hours old. He has been born for less than a day.

Why is she crying?
Is he sick?

No, thankgoodness.

But, what is that in his arm?
It is an IV access. Since birth, her newborn has travelled by wheeled bassinet to the NICU for IV antibiotics every 6-8 hours. He spends about 30 minutes in the NICU while he receives his dose; depending on the nursing staff he might be brought back sooner. He is receiving these antibiotics prophylactically, just in case. His mom was positive for Group BetaStrep and received only one dose of antibiotics before delivery. She came into the hospital in active labor and simply delivered too quickly to receive the second dose. Her membranes were ruptured less than 6 hours total, her baby was full term, but still; according to hospital protocol, she should have received 2 doses of IV antibiotics before delivery to protect her infant from the possibility of infection.

Well, isn't she silly to cry like that!

The hospital is simply making sure that her baby is safe and doesn't get a serious infection that has a particularly high mortality rate!


Well, she isn't crying about that. She is actually very grateful about her infant being born healthy and she is grateful that he is receiving such excellent medical attention, just in case he were to be at risk for infection, even if the incident of GBS infection in her case is actually very rare.

So, why the Tears?

The Neonatologist says that her baby needs some Formula supplementation! She is suddenly feeling very inadequate and insecure. This is her first baby. During her pregnancy she decided that she wished to breastfeed. She hoped to be able to avoid formula, at least in these early days after birth, when his digestive system is most sensitive.

Well, why does the Neonatologist recommend supplementation?

When the baby was in the NICU receiving his antibiotics, the doctor observed the baby sucking on his fists and acting irritable!

Did he assess a breastfeeding session?
Did he assess the infant's weight loss since birth?
Did he assess the infants wet/stool diaper output?


Does this kind of thing happen everyday in hospitals?


The NICU nurse returned the baby to the room with formula in the bassinet. The NICU nurse tells the mother that the doctor has recommended Formula.

Now this new mother is worried, concerned, scared.
Maybe she doesn't have enough milk? Maybe the baby really IS hungry and unsatisfied? Maybe his IV access hurts when she pulls him in close to nurse.

She has a healthy baby.

now this mother's head is full of Worries.
now she holds her baby in to nurse Tentatively.
now her eyes are full of Tears.

Monday, May 5, 2008

Crash C-sections

I taught childbirth classes for about a year at the end of my L&D nursing career. Mostly it was groups of couples interested in doing the best for their baby, as long as that didn't entail any bit of discomfort for mom. They were very trusting of their doctor's recommendations.

Class after class, these friendly, smiling couples would come and go. They were excited, eager, full of anticipation. They chatted about baby names and nursery decor. They compared due dates and ankle swelling and lower back aches. It really was a lot of fun meeting all these couples on the verge of such an amazing life change. Mostly we covered "Childbirth Basics" and we never went into any real depth about maternity care management in the US. Of course, I maintained a very professional decorum as a hospital childbirth instructor. I would never have endorsed homebirth and would never have mentioned that I had ever had one myself.

On occasion, I did get the "oddball" couple interested in natural childbirth. They were usually the ones with the most interesting questions about interventions and they also usually asked about ways to avoid a C-section.

One time we were talking about the rising C-section rate and the concern was raised about "dinner time" Caesareans. A father-to-be asked me, "How do you know, if the doctor is recommending a C-section, that it is truly necessary?"

I answered, "If the doctor is sitting at the bedside chatting with you, then you have time to ask questions and discuss the matter and it is totally optional at that point.

However, if the room has suddenly filled up with people in nursing uniforms and the monitors are being removed and the doctor is pushing the bed out of the room and starting down the hallway, then there is no time to talk, the C-section is necessary!"

We went through the usual "Lamaze" type questions to ask when an OB recommends a C-section. "What are the risks of having the surgery? What are the risks of not having the surgery? What are the risk of waiting thirty minutes to decide? " I left my class attendees with the idea that, as long as the doctor was standing at the bedside, taking time to discuss the matter with you, then the C-section "option" is just that: optional!!

Also, I made it very clear that if the baby or mother is truly in imminent danger, NO ONE stands around and discusses it! A C-section that is decided in haste is the really, truly necessary one!


A story comes to mind.....

A first time mommy-to-be was brought in for induction. She was induced with Pitocin, an IV uterine muscle stimulant. She was having really strong, Pitocin induced contractions that were difficult to tolerate, so she decided on an epidural. The mother's BP drastically and suddenly lowered after she had received epidural anesthesia. We call this "bottoming out" and while it's not common, it's also not really that unusual post epidural. Mostly it is prevented by getting a large amount of IV fluids in immediately preceding the administration of the epidural anesthesia. When this mother's BP "bottomed out" her OB happened to be in the room. The baby's heart rate started dropping also. Standard procedure when this happens post epidural is to open of the main IV line "wide open" to give a large amount of IV fluids super fast to counteract the sudden drop in BP. As the baby's heart rate dropped, the MD rushed over to the mother's IV stand and opened up one of her IV fluids to run in "wide open." It was soon discovered that the MD had opened up the mother's Pitocin IV line full blast, causing her body to have a sudden, amazing overdose of this potent uterine stimulant. The mother was rushed for an immediate Crash C-section.


And you know, there are actually a few C-section stories like this buzzing around in my brain, but its late and me and my baby are going to snuggle in bed.

Saturday, April 26, 2008


Sometimes I wonder how I ended up "here" writing about birth. I never set out to be any sort of an alternative birth activist. I do not consider myself a homebirth activist. I don't even think I am a natural birth activist. Mostly, I am just.... mom.

But, I am driven to share some of the horrors I've encountered in working L&D over the years. Why?

I do not want to create any unnecessary fear for expectant mothers. It is not my intention to fill a pregnant woman's mind with scary imagery. Also, new mothers have such a lot to worry and fret over already, it is not my intention to have anyone worrying over how their delivery went, in any sort of past tense. So, what are my motivations in sharing some of my worst moments working L&D?

Am I a fear monger? Am I writing all of this for no good reason? Surely, a pregnant woman would experience fear when reading through some of what I have shared here. Or she may detach and say to herself, "That could never happen to me...."

she might be prodded to ask a few more questions at her prenatals.... she may ask around and talk to other women who have been delivered by her OB and get an idea of how he "really" handles deliveries.... she might be motivated by what she hears to then seek out a Nurse Midwife for her hospital birth.... she might decide that securing a doula to advocate for her during labor is well worth the money.... she might even look into a birth center or home birth for her next time around....
who knows?

And I do not even know if that is what I would want?

I am having doubts. My first homebirth took place in London, England. Homebirth is certainly not the "norm" over there, but it is also considered a safe option for low risk women by the Royal College of Midwives, the Royal College of Obstetricians & Gynaecologists and the Nursing & Midwifery Council. My National Health Insurance covered it completely. In England, as in many European and Scandinavian countries, the Midwifery Model of Care prevails and most births are attended by licensed midwives. Doctors, obstetricians, care for only higher risk women. But, here in the USA, it is a very different system, of course. Midwives are marginalized from the mainstream healthcare system. Licensing and regulation varies from state to state. In some states there isn't any licensing for midwives at all- midwives attending birth in those states do so illegally!

As a result, I went from a country where I had a wonderful homebirth under the watchful eye of licensed, fully trained midwives, well-integrated into the mainstream system to a system where midwives are very much detached from mainstream birth.

And, I must admit that this caused me great doubts during my pregnancy. I was really wanting to run back to merry ole England to have my third baby! In fact, I went to see an obstetrician during my pregnancy at the same time as I saw my midwife and was considering a hospital birth up until my 32nd week of gestation. Why?

Well, if I am totally honest, its because I believe my baby and I were safer in our homebirth in London in comparision to the homebirth that I had here in Texas with a Documented Midwife. The midwifery training in the UK is quite extensive and broad compared to what is required by the Texas Department of Health for Documented Midwives. Also, at the time I delivered in London, the Midwives had the local "ambulance squad" on alert during my labor and delivery, in the event of a sudden complication developing that might require urgent transfer.

You see, I am not a frilly-fruity "trust birth" "birth is as safe as life gets" sort of person. I chose a homebirth based on an extensive review of the current research available to me. I considered the risks and my husband and I talked about the risk of a sudden, unexpected complication occurring quite often. I maintained an impeccable diet and exercise regimen during my pregnancy to be as physically fit for the birth as possible and to minimize any nutrition related complications as much as possible. In other words, I did not take the decision to birth at home lightly. To look modern medicine and its lifesaving technologies in the face and say, "No." that’s quite a decision. But, I made it. I did. Why?
I made the best choice I could at the time. I believe that every woman needs to consider their place of birth and choice of provider and all the various details involved very carefully.... that I do know with any doubts.
Because... the person standing at the foot of the bed when you deliver in the hospital has a lot of control, total control really, especially if you are numb from the waste down. I have witnessed that total control be abused.

I have stood beside a Medical Doctor as he manually removed the placenta post delivery as the the mother was writhing and screaming in agony. I have stood beside this same doctor as he did this countless times and I learned with each new time it occurred that this was his "routine." Anyone who works in obstetrics knows that this is not "routine" unless the mother is bleeding to death or the placenta is in danger of being retained beyond thirty minutes, or so. Immediately after delivery, this doctor would quietly reach inside the womb, his arm up almost the elbow and scrape the placenta away with his gloved hand. The mother would always be screaming as this is an acutely sensitive time for the uterus. I was a "new" nurse and too afraid to say anything. Later I talked to my charge nurse about him and was told that he hates women and this is his way of getting back at them. I was told to encourage his patients to get epidurals. I wish that I was making this stuff up. If you only knew how badly I wished that.

So.... back to why I chose homebirth.... it was the best place for me to have an unmedicated, normal, safe birth.

But, I truly do have doubts sometimes, because I truly believe that homebirth practitioners need to be integrated into the mainstream system for optimum safety. I long for the days when we can merge the modern, lifesaving technology a hospital offers with the care providers and the atmosphere for normal birth. Carpet and curtains don’t do it! We need to reinvent the mainstream healthcare system to respect mothers more. Mothers need to talk about their births and share their stories. Women, in the form of obstetricians, nurse midwives and doulas need to maintain normal, healthy birth standards to keep mother's and babies safer within hospital settings. If anything close to that began to happen in hospitals where I live, I would gladly return to L&D and work "with women" again!

Wednesday, April 16, 2008

Free Advice

Free advice. You get what you pay for, right?
When it comes to birthing, feeding, mothering issues, we just need to pay people to keep their free advice to themselves.
It hurts mothers. It does no good.

For instance, there are some interesting rants going on right now in bloggerland about how important is it, really, to breastfeed your infant. These discussions are sparked by a study recently published in the March 2008 issue of Pediatrics. It is a large randomised, controlled study whose authors acknowledged surprising few wellbeing/attachment differences in older children based on how they were fed, breast or bottle. A much smaller study recently found lower than expected margins of difference in breast vs bottlefed infants in illness such as ear infections and diarrhea. Because of these recent findings, some breastfeeding mothers are being labeled as self-righteous,sassy mommie-martyrs, accused of looking down on bottlefeeders from a pedestal, falsely flying their "breast is best" flag in the face of poor beleaguered bottlefeeders. There have been a lot of ruthless comments.

And then there is this outrageous amount of activity going on at the Wall Street Journal blog about Jennifer Lopez not breastfeeding her twins. I mean people are getting downright mean about it!

My point is this: people have a lot of condemning, judgemental things to say about other mother's feeding choices, birthing choices, etc. It just seems like people can't keep their opinions on these mothering issues to themselves. Kind of like some people can't keep their hands to themselves! You know how some people are always wanting to touch and rub a pregnant woman's belly? People will just reach out a pat a pregnant woman's belly- a woman they may hardly know! It's like babies are this universal connection in an otherwise very isolated world.
When you gaze at a pregnant woman's belly you are connecting to the baby that is beneath. The boundaries that are usually there(that would keep us from caressing a mere acquaintance's abdomen) just disappear and people just go a rubbing and a patting away! We want to connect, for just a few seconds, to that human potential floating safely within!

I suppose people see the unborn, beneath that heavy belly, as an innocent that deserves this universal protection. We are all represented in that new life. Our possibilities, our potential, are somehow budding anew in that belly. We long to protect it, to save it, to rekindle it! Of course, when that freedom from restraint allows people to let lose with unsolicited advice/condemnation that is when it can get ugly.

The worst comments often come from older women, many years past their childbearing stage. Perhaps their voice is lost to their own children? They must shout out their stories to any new mother they chance to encounter?

While I was pregnant last year, I tried to avoid painful comments from critical coworkers regarding my birth plans. I was happy to engage my friends and family regarding my plans to birth at home. I was never afraid to discuss homebirth, safety issues, prenatal checkups, health issues, etc with anyone close to me. But, what I intended to avoid was any debates/discussions regarding homebirth with my work colleagues for the duration of my pregnancy. This was a special time in my life and I did not feel the need for me and my growing baby to bear the brunt of anyone's "hospital birth is safe-homebirth is deadly" agenda. Bear in mind, I was working in Labor & Delivery and was well aware that the attitudes of the majority of my coworkers regarding out-of-hospital birth was quite negative. Having worked alongside L&D nurses for years, I had gotten used to the "we make birth safe with all our gadgetry" mantras. It's just part and parcel of working in obstetrics, the nurses need to feel justified in all the disruptive things they do to women and babies- they need to cling to this idea that they make women and babies safer!

You see, over the years, I had learned that the vast majority of nurses working in L&D would argue tenaciously that their work made moms and babies safer, no matter the evidence based practice that was to the contrary. Every so often, I would mention that in thirty years continuous Electronic Fetal Monitoring had never been shown to improve fetal/maternal outcomes and in fact SEVERAL studies had demonstrated that it worsened maternal outcomes by causing unnecessary C-Sections and I would get frustrated looks/blank stares/eyes rolling. Most of the staff working within a Hospital Birth Setting just isn't prepared for the paradigm shift that challenges the Hospital Birth Birth Machine. It turns their world upside down. And no one wants that!

Throughout my pregnancy, as I was seeing my midwife for prenatal care, I was also seeing an OB as a sort of "back up" for ultrasounds, as needed, and bloodwork. Whenever a coworker asked about my doctor, I answered honestly. If they asked where I was going to deliver, I also answered honestly that I didn't know. This worked up until I was about 6 months along and then people expect you to have the hospital picked out by then. So, slowly, only if asked directly, did I begin reluctantly revealing to coworkers my plans for homebirth. I was truly amazed at the variety of responses, and was relieved to hear a wonderful, refreshing amount of positivity and congratulations. Many were skeptical and outwardly shocked, but they weren't unkind. I did receive my share of unsolicited advice, however, and one older nurse's tidbit was exceptionally hurtful. I was at the nurses station talking with a friend about my pregnancy and this older nurse, a woman I hardly knew, walked over and was listening from the periphery. She had obviously heard about me through the nurses gossip chain and seeing me already chatting about my pregnancy with someone saw her chance!
She asked, "So, are you the one who's planning a homebirth?"
"Yes," I replied.
" I guess some people just like Russian Roulette" she snapped hatefully and then she briskly walked away leaving me stunned.

I was left there wondering.... why?

Why did she feel it so important to say that hateful, insulting remark to me? Did she think I was going to change my birth plans after hearing it? Was she earnestly trying to save my baby from harm?
No.... the more I thought about it, it appeared that she only wanted to hurt me. She just needed to get that "dig" in to let me know she did not approve of my birth plans with the most extreme metaphor she could imagine. She was motivated by malice stemming from her ignorance and fearful attitudes about birth.

So, here's my free advice to all those brimming with free advice.

Stuff It.

Wednesday, April 9, 2008


There seems to be this idea that Homebirth Advocates are irrational, angry, loopy, emotional creatures. That we don't understand or respect scientific fact. That we toss reason to the wind and rely on instinct or touchy-feely imagery to drive our birth decisions.

To these criticisms I would ask,

Who is more Rational?

....the Doctor who blithely chooses an elective cesarean for a patient for his own personal convenience? ....or the Mother who through months of painstaking research and careful consideration chooses homebirth to avoid the risks of unnecessary hospital interventions which significantly increase morbidity and mortality for both mother and baby?

and, Free of Charge, Here's An Example of aforementioned "Medical Irrationality"

Sitting at the nurses station, I overhear a pediatrician questioning a nurse, "what was the reason for this c-section?" The nurse looks over the chart, "Hmmm, let's see, she's a primipara(first baby) and, let's see....she wasn't induced. She wasn't in labor"

"Was it elective?" asked the Pedi. "No," responds the nurse, "I think she was breech."

"Yes, here, on her prenatal records, it states that the baby was breech."

The Doc countered, "But this delivery record shows the baby as vertex(head down) at the time of delivery."

"Oh, yeah!" the nurse responded, "The baby turned head down at the last minute!"

As it turned out, the OB was surprised by the mother reporting for her scheduled C-section with a baby head down and in good position for vaginal birth. Undeterred, he promptly talked the trusting woman into going ahead with the surgery anyway, since her baby was probably too big for her to deliver vaginally. She, like a good patient, did as her Doctor recommended.

The baby weighed 8 pounds 2 ounces.

The Good Doctor was back in his office in time to finish up his afternoon prenatal visits without the distraction of a laboring woman to bother with. The patient spent the rest of her day recovering from a completely, irrefutably unnecessary surgery.

Sunday, April 6, 2008

I can still see the HATRED in her eyes

Oddly enough, the most disgusting exhibition of disdain for women I have ever witnessed in Obstetrics came from a female OB. This one gave me nightmares for weeks. After this delivery, I decided that I had to find a way out of OB nursing. This was the delivery that taught me a valuable lesson- the DOCTOR is in charge in that delivery room. And don't you forget it.

I was known on my unit as the "natural" nurse, and so I was often assigned to mother's who were pursuing a natural birth when they came in to deliver. I got assigned to a lovely mom who was committed to a natural, unmedicated birth and throughout her labor we developed a bond. She was a true inspiration to observe. She dug deep within for strength in the face of a difficult labor. She had a profound faith in her God and was often praying out loud during contractions. We kept the lights low in the room. We kept it very quiet and peaceful. I did my very best to monitor her as unobtrusively as I could. Her husband was loving and supported her beautifully. Everything was calm and even joyful at times as we anticipated the delivery of their firstborn. Until the Doctor arrived....

This Doctor was not her primary caregiver, but was only on call for the weekend. This mother had made the mistake of having her water break on a Sunday when her primary physician was "off duty." Well, that was her first mistake. Her second mistake was that she did not follow instructions very well.

This mother was educated. She had planned carefully for a natural birth during her pregnancy and had talked with her OB about it extensively. When her water broke on Sunday morning there were no contractions. She new that the clock had started ticking but she didn't want to come in to be induced artificially without giving natural labor some time to "kick in" on its own. When she called and notified the doctor about her water breaking, she was given instructions to come in to the hospital immediately. She went to the local shopping mall for a walk instead.

Four hours later she showed up at the hospital. What audacity! I spoke to the doctor over the phone and updated her about the patient, telling her that mom and baby were fine, reminding her that she desires an unmedicated birth. I was given orders to start Pitocin and antibiotics immediately. The venom in her voice was creepy.

As I mentioned already, this mother was physically and spiritually incredibly sound and in the face of Pitocin augmented contractions she labored courageously. As the hours went by, myself and this lovely brave couple, kept a vigil in her labor room. The Doctor never came into the hospital until I called her for the delivery.

When she walked in the room, I started getting weird chills. She was looking at this woman very strangely. This mother was ready to deliver, had been pushing for about 30 minutes or so and the Doctor could visualize the fetal head at the perineum. Yet, she took a lot of time to wash and gown and glove. She was in no hurry. She seemed to enjoy the fact that this woman was in pain, trying to control her natural impulse to push the baby out. As the Doctor got into position for delivery, the mother began actively pushing again and the baby's head was descending beautifully. Myself and the other nurses and staff in the room were saying encouraging things like, "You are doing it!" "Here the baby comes!" And this mother kept pushing, quietly and serenely, she was in this calm, laborland, trancelike state. I glanced over at the doctor and actually almost gasped at the look of HATRED that was in her eyes as she looked at the mother's face.

Then, I saw the Doctor reach over to the sterile field and pick up the episiotomy scissors. I was thinking to myself, "OK, she knows this mother doesn't have an epidural." and I said, "Do you want some lidocaine." She cut me a look. She did not respond. She watched as the baby's head came down and the perineum was bulging and she said to the mother, "You're probably going to need some room down here." And then she waited for the mom to finish pushing. The perineum relaxed.... the mom relaxed into a rest in between contractions.... and then the Doctor reached down with the scissors and began cutting, cutting, cutting. The scream that woman let out was terrifying. This mother, who had been in a calm, almost peaceful pushing phase at the end of a marathon of natural labor, was completely hysterical with pain from that moment on. The shock of that sudden ripping of her flesh from the scissors was unbearable.

Let me explain. With every other episiotomy I have seen (and I have seen quite a few) the OB begins the cut when the mom is doing a sustained push, when the skin in taut with baby's head applying pressure. Especially when a mother does not have an epidural and lidocaine is used, the cut is made during a contraction. This Doctor very deliberately picked up a pair of surgical scissors and very deliberately chose not to use an anesthetic and very deliberately cut into this woman's skin at the most painful moment possible, when she was not actively pushing.

It was a horrific moment. Finally the baby was delivered. The mother was shivering uncontrollably. She could hardly calm herself to welcome her baby. The beautiful birth that she was so close to achieving had been stolen from her from a vindictive, malicious Doctor. But this poor mother didn't know what I knew. She thought she had just experienced NATURAL childbirth. She actually apologized to the doctor for crying.

As for me, what could I do? What should I have done? That moment haunts me to this day. I re-live it and imagine myself knocking the scissors out of the Doctor's hand. I would have been fired that day. But this mother wouldn't have had to feel that agonizing cut.

I did go into the patient's room the next day and mention that she should have had an anesthetic for the episiotomy. I also wrote an incident report. But I never spoke to the Doctor about it. What could I say to her, "You bitch! You butcher! You Lunatic!"

I no longer work in labor & delivery because I don't ever want to be in that sort of situation again. I cannot be an accomplice to that sort of evil.

Friday, April 4, 2008

And Now Some Good News

It's a beautiful, green, rainy afternoon. My Benjamin is napping, the dishes are done and the soup is stewing. I wanted to share something positive after my previous post. Perhaps this can be a trend, alternating painful stories with something cheerful. I wouldn't want my blog to be such a depressing place to visit!

Today was Park Day for my local homeschool group. (That's right.... I birth at home.... I breastfeed.... and I homeschool my children!! Pretty Crazy, eh?)

Well, the forecast was 50% chance of rain. One time, when I said that in front of my 4 year old daughter she looked up at her daddy and asked, "50% chance of rain, what does that mean, daddy?"

He answered her succinctly, "That means that it might rain. Or it might not."

Today....it rained!

And in true homeschooler fashion we made the most of it.

Muddy wet feet.
Slippery slides and swings.
Oatmeal cookies shared between sandy, damp hands.

And, after the clouds had cleared and the rain had slowed, everything in the park glowed in that vibrant green that only exists after a "good" rain. Such a beautiful green glow.

With cheerful children's laughter in the background, I thought to myself:

Birth brings with it more than the New Baby. For the New Mother, Birth brings the opportunity for growth and renewal just as a Spring Rain offers a cleansing and a new hue to the landscape.

May more New Mothers realise the opportunities that Birth can Bring!