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." 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!

Thursday, April 3, 2008

The sinking feeling in the pit of my stomach

This will be difficult to read.

If you have eaten recently you might even want to wait a few minutes before continuing.

Onc time, I learned something about a younger OB(obstetricians) that really got to me. While chit-chatting around the nurses station, I heard one of L&D(Labor & Delivery) RN's lamenting about her poor patient's bottom. Well, we've all seen terrible stitch-ups post episiotomy, so I wasn't that alarmed. But, this nurse just kept going on and on about it.
What's the big deal? I asked.
She's probably going to be fecal incontinent forever, or atleast for a really long time!
WHAT? What's up, what happened? I asked.

All the nurses just stopped and stared at me, Don't you know how Dr. X delivers? I was quizzed.
No, I replied, I guess not.

He inserts his entire hand inside the rectum to push(from inside) the baby's head along the curve as it's about to deliver!! Not just a finger, not a couple of fingers, he inserts his entire hand up to the wrist inside the mother's rectum just prior to delivery.
I countered, well, surely he only does this "intervention" if the mom has been pushing for hours, is fatigued, baby's having trouble descending, etc...

NOPE! I was quickly corrected by all the L&D nurses surrounding me, this is standard procedure. He does this with EVERY delivery. This is Dr X's special quirk.
What? This can cause terrible trauma to the delicate pelvic floor and the anal sphincter!!!
WHY would this ever be done routinely???
No one had an answer. I stood there in a circle of 5 women, all RN's with college degrees. None of us had a good reason for this doctor's abusive practice. None of us could stop it either. I had learned that "golden rule" of Obstetrics years earlier, the Doctor is always right.

For a long time after that day, I had a sinking feeling in the pit of my stomach. A few weeks after learning this, I was discussing postpartum mother-baby care with a woman delivered by this particular Dr X. She was embarrassed because she was having incontinence issues. I wanted to scream from the rooftops that her idiot doctor is the one who should be embarrassed for his battery and abuse.

Women need to be warned. Women need to KNOW about this sick man and his sick "trick" to deliver babies just a few seconds quicker. Is his time so precious? Is his 60 seconds saved worth a lifetime of incontinence?

Women need to be told that "routine interventions" range from harmless to harmful to deadly and they need to be told the truth about birth in Hospitals.

I am creating this blog to tell the truth about what I have witnessed in hospital birth. I have been a Registered Nurse for 8 years. I have worked at 3 different hospitals in Texas in Obstetrics. I have worked with Certified Nurse Midwives, Obstetricians and Doctors of Osteopathy. I have sat with women as they breathed, screamed, cried and pushed with all their might. I have met many brave and beautiful women over the years. While I have attended many joyous moments of birth, I also have many painful stories to tell. Stories of unexpected C-sections, babys and moms separated, mothers in tears.

For me, each story has a face behind it, a face that is asking for the truth.