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.


Pinky said...

Wow. That sucks. You did the right thing by filling out the incident report. Actually, that Doctor is guilty of assault. If someone says, no to a proceedure, by law you cannot proceed with the proceedure. It is that simple.

I came by to thank you for posting on my blog. I appreciate your comments whether you agree with me or not.

I have been a labor nurse for 8 years. And where I work, if they piss me off, I am going to page them to all areas of the hospital in the middle of the nights at hourly intervals!

I stay working in labor and delivery because I think we can make things better. Most Doctors no longer do routine epis. Nobody shoves their fist up anyones rectum. At least not while they are on the clock!

You are correct, I have never read anything by Michale Odent. I have read a lot by Sheila Kitzinger. And House of Harris sent me a bunch of stuff on Marsden Wagner. Burning anyones effigy is a joke amongst friends. I am sorry if you are ofended. Well, no not really. I like to joke around. Many of the folks who visit my blog are L&D nurses. We have a strange sense of humor but it works for us.

No. I am not happy with the medical establishment as it is. I think we do way too much paperwork which distracts us from taking care of patients. I am happy to take care of folks who want a NCB or folks who have decided they want an elective c-section. Part of being a professional is respecting other folks opinions about their birth. What really bothers me is the when other folks force their opinions onto the patient.

Mary the Birth Goddess said...

Pinky, I respect your many years of OB experience! And I have really enjoyed reading through your blog. You sound like a great nurse, in that you can support the mother's choices/preferences within the hospital's guidelines for safety. For me, I was just getting more and more conflicted working in L&D the more I learned about evidence-based practice. And then, I was exposed to other countries/systems/models of care, I just becamse more and more dumdfounded by the practices I found in L&D. Anyway, I currently have found a way to stay in women's health-which I LOVE- and work within a place of ethics that helps me sleep better at night. Unfortunately, you might refer to me as a Lactivist- but really, I just help the moms who ask for help, I got not time for lectures or guilt trips!

AtYourCervix said...

My mouth was on the floor, from this story of the doc cutting the epis like that. Oh my freaking goodness!! I don't know what I would have done, if I had witnessed that. More than likely, I would have spoken up - loudly - that the woman need some local first.

That was horrendous, what that mother had to endure, from that OB.

Doreen said...

Hey, found your blog through a link on someone else's, and I just had to comment on this story. That gave me chills. It's sickening to hear about doctors treating women like that when they are so vulnerable. It's wrong. My first two babies were both "weekend babies", with, you guessed it, on-call OBs. Both OBs were women, and they both were impatient, disrespectful, and condescending. The first cut an episiotomy when 10 minutes of pushing was taking too long for her (nothing was wrong!). The second broke my water, against my will, and treated me like I was a child who didn't know left from right. What's really interesting to me is the reaction of the mom you wrote about, actually apologizing for making a fuss. It seems so strange to me now how I felt so thankful to those doctors who attended my births. I thought episiotomy just was a normal part of birthing. I thought it was normal for the doctor to yank on the baby's head. I thought it was normal for babies to have scratches on their heads, from amniohooks. I thought it was normal to be treated the way I was, because hey, the doctor went to medical school, knows all there is to know, and what do I know? I've learned a lot since, and part of me is very angry about those experiences. Another part of me just wants to get the word out there, that there are other ways to experience birth, that a normal, healthy birth doesn't have to be traumatizing. I had my third baby with a CNM, and my fourth at home with a midwife. Those experiences have taught me that I do know, and that all I need is someone to watch over me, not to intervene left and right when intervention isn't warranted. It makes all the difference in the world when you have a care provider who is patient and willing to watch over a birth, instead of being the main actor/actress. Regardless of birth setting.