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.