It is almost 4 am, and I find myself
awake and hanging my laundry out to dry under a clear starry sky. I
fell asleep hours earlier on the bare mattress, too tired to find a
clean sheet. After talking to KE, JC and NC to calm myself down and
keep me from doing something that would make matters much, much
worse.
The past 2 days have been focused on
self-care attempting to stop loathing my weak body which is constantly betraying me.
I laugh it off publicly and tell everyone that I am a geriatric
mid-30s year-old as I wheeze and cough and have to stop and bend
double from the exertion of walking or just sit down.
I dug out and fixed the Xooter that my
father bought for me after he fell in love with adult push scooters
years ago. It is an easier fix than I had assumed, and I am mad at
myself for wasting 2+ years thinking I had to mail it in to be fixed.
However, after jumping ship to avoid wiping out 4x yesterday, I may
reconsider and at least order some new parts if not mail the whole
mess in to be fixed for good. Or put to sleep... I am so sore. Even
after a long, long soak with epson salts and every self-soothing
technique for relaxation I could do without my muscles screaming in
agony or seizing up.
Walking through the hallowed doors of
Target yesterday and seeing the gorgeous BMW & MSGW has never
made me more delighted to see someone I know unexpectedly. I wanted
to cry when she offered me a ride home. And burst with pride when she
admitted when she heard my voice she thought I was Juju. I looked the
part—wheeling my Xooter while sporting my new-to-me skateboarding
helmet, elbow pads (on my knees), knee pads (on my elbows) and wrist
guards, in my Indian mirror skirt and henna v-neck tee-shirt. I would
like to think my sis would have been proud and not embarrassed to be
seen in public with her weirdo older sister.
So here I am, almost 12 hours later, up
in the night and thinking about one of the very good reasons that I
have for my rage, which often goes unexpressed and then bubbles up
and pops painfully and loudly. This would have been just over 10
years ago, at the 2nd birth that I attended as a doula. I
was going to say that I witnessed, but technically when the baby came
out of the womb I was most likely on the floor of the waiting room,
prone on my yoga mat, sobbing into the phone either to my mentor, JW
or my boyfriend at the time, Mr. O.
And why was I sobbing? Because I felt
personally responsible for the very likely totally unnecessary
cesarean section that was happening in the OR at that moment. And why
was I not in the OR holding the mother's hand and reassuring her that
everything was ok? Because many hospitals, including this one, allow
only 1 support person in the room, and mom had rightly chosen her
husband (& father of the baby) who was even more terrified that
she was.
So I was waiting until I could meet
them, plus their new baby, in the recovery room, so that I would not
feel that I had totally failed them, and because it was my job to do
so. I stay until passed the end, be it good, bad or ugly. Even when
it is already the wee hours of the morning and I will have to take
New Jersey Transit to NYC and then the subway all the way home to the
very Northern tip of Manhattan. Or actually, I think I had just
barely moved to Brooklyn by then. Still, not the optimal time or
method to travel. If only I had known before about the program, very
similar to this one, that was in Brookyn. Oh well.
Mr. O was sympathetic, and said the
right things, although I have no memory now of what those things
were. I think it was he who suggested I call my mentor, the doula in
charge of the program I was in, The Hudson Perinatal Doula
Fellowship. JW was wonderful. She reminded me that I was only one small cog
in a very broken out-of-date machine, and even if I had risked
getting the doulas in the program thrown out of the hospital and
possibly crossed a line in overstepping my scope of practice
guidelines as outlined by Doulas of North America (DONA), I probably
would not have been able to stop the c-section.
So I wiped my tears, calmed and
centered myself, and got ready to meet the couple and the new sun in
their Sky, a beautiful baby girl, in the recovery room. And I cooed
over her, and helped mom hold her on her chest before they took her
to another floor to the nursery. And I bit my tongue when mom said
that it was a good thing they had done the c-section because their
was meconium... yes, a sign that she was stressed in utero, but not a
carte blanche to slice her out...
Then I stayed until mom was settled in
her shared hospital room, and was confident that the nurses were kind
and helpful and well informed. And not in a rush and panic like the
one who insisted on shaving her prior to her consenting to the
c-section. I had spoken up then, and asked if we could wait to do
that until mom had signed the informed consent, which the young
blonde doctor was dutifully reciting to her, with editorial
commentary that ran something like, “legally I have to tell you
that there is a chance that [insert horrible medical issue] might
occur, but that is not going to happen...”
over and over until I almost screamed, “THIS IS NOT INFORMED
CONSENT, THIS IS COERSION!!!” but I didn't. Because I didn't want
security to be called to haul me away. Instead, I asked the nurse to
wait 2-5 minutes before shaving mom's pubic hair. “But it's for the
baby!” she insisted and went right on, not hearing my response,
“but the doctors said that 'it was not yet an
emergency.'”
That line kept
running through my head as I listed to the doctor reel off all the
side effects and risks possible from major abdominal surgery, and
then listened to mom weakly turn to him and ask, “Do I have to do
this?” and him respond, “Yes.” in no uncertain terms while
handing her a pen. The anesthesiologist thought that this woman
didn't even speak English, she was in so much pain when they went to
put in the epidural that she could barely follow her directions, and
I had to help her. I was glad that they considered me a professional
and therefore let me stay in the room while they administered the
epidural. I was glad that dad and grandma were shooed out, with their
hand-wringing. I did not tell anyone that this was my first epidural.
Instead I stood in front of mom, my hands on her shoulders, and
quietly told her what she needed to do so that she could do it. And
then she was one of the lucky 15% who get incomplete relief, in this
case almost none, from the epidural. And she had wanted a natural
birth. But I wasn't going to push that point when her husband and
mother were so desperate to not deal with the pain that she was in to
honor her wishes from before the pain started. And I was too
inexperienced at that point to gently take her hand, which was tensely gripping the metal rail of the bed, and reminder her that tightening
against the pain would only make it worse, that she should do her
best to breathe deeply for her baby and herself and open up to the
sensations, painful as they seemed.
What a contrast to
my first birth, where it was the couple's second child, they were
having a home water birth with a famous midwife, and the only tragedy
was that we ran out of mom's favorite food, crème of wheat... it was
a stormy June day and the midwife came and sat in her car outside the
building doing paperwork so that when we called her she wouldn't get
stuck in traffic or rain.
This mom, my doula
partner and I had not even discussed c-section, beyond establishing
that she didn't want one. This is the one redeeming point for me in
the story. I can almost forgive the human rights violations,
including “restraining the patient against her will” i.e. keeping
her in bed with continuous fetal monitoring (which has been proven to
be less effective than intermittent) and then inserting an internal
fetal heart rate monitor, through mom's vagina and screwed into
baby's scalp, during the 2 minutes I left her side to use the
rest-room, because of the hard lesson I learned and have passed on to all my following clients and students. I was pondering the
difference between the patient bill of rights on the back of the
restroom door in her suite and what was happening on the other side
of that door at that moment just before I came out to that beautiful
site. Don't tell me that was an oversight. Then I had to enduring listening to the young residents huddle
around the machine that was recording the baby's heartbeat and talk
loudly enough that you couldn't help but overhear while they acted as
if none of us was in the room and spoke English. They never once
turned and looked at the mother when they expressed concern over the
baby's heartbeat not recovering “fast enough” between
contractions. Their young, blonde spokesman finally came over and
addressed the woman who was, in fact, birthing this baby. “It is
not an emergency yet, but we don't want it to become an emergency,”
he informed her and her husband and the invisible doula who's eye he
would not meet. He explained that the baby was stressed, as could be
seen by the tracings on the machine, that her (did we know yet that
it was a her? I don't remember...) heartbeat was dipping very low
during contractions and not getting up high “enough” again during
the breaks.
Was that the point
at which dad vomited? I don't remember, but my image is of him
wringing his hands, unsure what to do to help support his wife and
the mother of his child. He just wanted her pain to stop, even if it
meant inflicting a larger wound. At least he let her make the call to
sign the forms consenting. I don't remember him asking any questions.
I'm not sure if he was even still in the room or if a nurse had asked
him to sit down in the hall. I'm not trying to belittle him. He was
doing the best that he could under trying circumstances. Oh, I
remember. A nurse had taken him out to get a gown and scrub up to be
in the OR, not an easy task. To hold his wife's hand and try not to
think what was happening as he smelled the burning of cauterized
veins in the incision... Grandma was useless at that point, although
she may have been doing all that she could think to do, praying. We
were a team and I was the one that would not let go of mom's hand
until I had to so that they could wheel her into the OR, where I
could not follow.
I made it home in
the wee hours of the morning. Later I looked up reasons to do a
c-section and vowed never to let another woman I worked with go into
labor unprepared, without knowing what was a valid reason to have a
c-section, and what questions to ask to find out how urgent it really
was. Turns out that fetal distress, as measured by continuous fetal
heart monitoring, is a very controversial reason. Letting mom get off
the monitors and move around and switch position can be enough for
baby's heart beat to recover. Also, the man who invented fetal heart
rate monitoring as used in our hospitals today feels they are being
overused and abused... a poor substitute for real human care by
doctors and nurses. But what is done is done. More c-sections are done after 10 pm at night, and on weekends. Utah has a hospital that went from a very high rate of c-sections to a much lower one, by simply making a rule that a 2nd physician must sign off on the medical reason for the procedure. The ideal c-section rate is between 7-15%. That has been found to mean that the women who need them are getting them, while those who don't need them are getting them.
Here are some
resources to learn more for yourself:
https://play.google.com/store/books/details?id=ZrYjMSIQd8oC&source=productsearch&utm_source=HA_Desktop_US&utm_medium=SEM&utm_campaign=PLA&pcampaignid=MKTAD0930BO1&gl=US&gclid=CJjT1Muz1MwCFU62fgod42UG-w&gclsrc=ds
“That
research includes evidence that women can have a vaginal birth after
having delivered by Cesarean; that it’s okay to eat and drink while
in labor, and that babies should not be separated from their mothers
immediately after birth.
“We
want quality care, but we also need co-operative care,” said Dawn
Thompson, founder of improvingbirth.org. “You know, our physicians
should be having discussions with their patients, not just telling
them what they’re going to do and when they’re going to do it.”
http://www.nbcsandiego.com/news/local/Group-Rallies-for-Labor-Awareness-168409126.html
