Saturday, April 16, 2016

Rebecca's Birth

Good morning! Yesterday I had the amazing privilege of being with an amazing woman as she labored with and gave birth to her second baby. It actually went into the morning a bit but the bulk of the time was yesterday.
When Maria was born, it was an awful experience. Without going into many details, the nurses were awful, the doctor was awful, the whole experience was awful. This isn’t to say that every single thing the nurses and doctor said and did were awful, just that the whole experience ended up being awful. As in really, really, bad. Worse. Jonathan and Elizabeth would have liked to have a midwife this time but didn’t feel that they could afford one. What a common story that is. What a sad story that is.
This time, because they went to the hospital so early last time, Elizabeth wanted to wait. I of course agreed to be there with them, including the time spent at home. For me, this means being available whenever either of them might have a question or concern. This time, this meant going over to visit for a bit Wednesday afternoon and texting throughout the early hours of Friday morning (a flurry around 3 and periodically after that until I got up at 5).
Throughout the day, things were progressing and contractions kept coming and they were getting closer together and lasting longer. In the early afternoon, I called because I wanted to hear Elizabeth talking during a contraction. I either had to know they needed me before 1:30 so I could call the school to let Cedric and Amena know to take the bus home or I would wait to pick them up from practice and could be over to their apartment no earlier than 5:00. Everything seemed pretty okay so I went to Walmart to get a few things, including an exercise ball, and came home.
There were lots of things to do at home like get a letterbox ready to plant and maybe plant it and read. We did get a letterbox ready to plant and we even went to the place where we want to plant it but there were too many people there to actually plant so we came home and read A Horse and His Boy for 25 minutes. Then it was about time to go pick Amena and Cedric up so I did.
When I got to the school, I saw Cedric standing outside. I pulled around into the parking lot and Amena came to the car and asked where Cedric was. No idea. He’d gone back inside and called me to tell me to pick him up. Seriously? He said he didn’t see me when I got there. That’s funny. Almost. When we got home, I finished getting everything together that I needed and gave Amena and the boys instructions and left.
At Jonathan and Elizabeth’s, I took the ball out and pumped it up. Elizabeth put it to use immediately and loved it! I guess that was a wise investment. I think it might be good to have a couple more because they come in two sizes and I’d like to have one for myself to use at home.
Elizabeth sat on the ball and kneeled, leaning over it. Both were good and she alternated, getting up and walking between times. I had taken some essential oils and used some on her ankles for pain and some in a glass of hot water since they don’t have a diffuser and I don’t have one that transports well. Jonathan was happy I didn’t bring lavender because Elizabeth used some in the bath a few days ago and because she used so much, she smelled of it for a couple of days after. I happily informed him that they have lavender at the hospital and will have to take it upon myself to point out lavender often in the future.
We talked and joked and talked and Elizabeth was able to rest a tiny bit between a couple of contractions. She was concerned about having energy enough to push the baby out but somehow, the energy is always there when needed. (Yes, I realize this is general, and I understand that if women were allowed to listen to their bodies it would happen in many more instances than it currently does. When a woman knows that medical personnel will do whatever they deem necessary to get the baby out, it takes away from her own responsibility and she can allow, even if not by conscious decision, her energy to be depleted.)
It was about 5:30 when I got to the apartment. She was concerned because her water had not broken. With Maria, it broke and that’s when labor really started. Obviously, this was not the case with Rebecca. Elizabeth experienced prodromal labor for two or three days before Friday morning when it became apparent that this really was the real deal. She lost her mucous plug which was encouraging over the course of a couple of hours in the late afternoon and early evening.
At about 7:45 finally her water broke. Unlike with Maria, though, it was not a big gush but a small leak that dribbled. Contractions did speed up at that point and were becoming longer so it was about 9:00 when she decided to go to the hospital.
Jonathan made arrangements for Maria overnight and then called the hospital so they would be ready upon arrival. They told him the name of the doctor on call and I have to admit I was somewhat dismayed. No, I was very dismayed. I’m pretty sure I ought not to mention particulars about why so let it suffice that I was very dismayed and that I have my reasons. I was hoping for a good nurse because sometimes that makes up for any trepidation the doula might have.
The hospital was arrived at around 9:45. Jonathan was actually driving over the speed limit which is very out of character for him. I was following so that if Elizabeth thought he needed to pull over, I would be able to help as needed and I would be able.
Elizabeth wanted a wheelchair so we availed ourselves of the use of one. Her presence was noted at the ER admittance desk and they asked if she’d like a nurse to come down to get her. That’s a waste of perfectly good time so I wheeled her and Jonathan carried all their stuff. The only mistake made was taking the elevator up to the 3rd floor so at the other end of the hospital we had to go down one.
She was helped into a room and immediately asked if she had to change into a hospital Johnny. No, of course not. Questions were asked and answers given. The nurse asked if she’d like to use the tub and Elizabeth answered affirmatively. The doctor was informed that she was there and came in for a moment and then left.
The nurse, who ended up being very nice, asked Elizabeth to get on the bed for a vaginal exam and she and Jonathan both very plainly indicated that she would prefer not to have one because they are very painful for her. This did fluster the nurse who went out and spoke with the doctor. They both came in and did their best to get Elizabeth to consent but she and Jonathan stood firm in their decision. The doctor left and the nurse left after comments about Jonathan and Elizabeth being on their own.
In a few minutes, the nurse came back with a consent form and instructions to sign if and when they chose to. She said that the doctor could not in clear conscious allow (I absolutely hate that word when it comes to birth) Elizabeth to labor in the tub if she could not first ascertain her dilation because they do not do water birth and without knowing dilation, they wouldn’t know how close to birthing Elizabeth was.
Jonathan rightly pointed out that dilation is not a set in stone assessment and that you can determine the baby’s position by an external palpation. He mentioned women, in that very hospital, who were assessed at 4 cm and gave birth fifteen minutes later. He may have been shaking inside, but he seemed very confident and sure of himself and what he and Elizabeth wanted. I can do nothing but applaud his actions.
Between contractions, I looked over the form with them. I told Jonathan that he should underline the part that says they can retract their consent at any time and mentioned that he could write on it that they wanted an explanation of any procedure before it was performed. This is supposed to happen but all too often, does not. They did as suggested. I told Elizabeth that she might want to consider letting the nurse attempt a vaginal exam but that she could tell her at any point to stop. Why did I suggest this? Because they were at the hospital and they would keep bothering them until they consented and it could very possibly get really ugly. I would hope that it would not, but you never know.
Elizabeth did this and although the nurse did not withdraw as soon as Elizabeth asked her too, she was able to determine that Elizabeth was dilated between 8 and 9 cm. Yay! At that point, everything seemed to begin going pretty smoothly. The nurse was nice and quiet and not overly intrusive. She did ask Elizabeth to go over to the monitor so the baby’s heartbeat could be heard. Baby was doing really well with a heartrate consistently in the high 140s/low 150s.
Elizabeth actually asked about something for pain but the nurse said that at the point she was at, they really didn’t like to give anything because the birth was usually so close that it wouldn’t do any good. Go, nurse!
The entire time of labor at the hospital, Elizabeth walked with Jonathan between contractions with a couple of exceptions toward the end when she sort of sat on the bed or sat in a rocking chair. She began grunting through the contractions and Jonathan and I kept reminding her to breathe through them and she was just a trooper. Things were very intense and Elizabeth was feeling lots of pressure. The nurse asked where Elizabeth would like to give birth and it was determined she would like to do so standing up. The nurse and I had already put the bar on the bed and this came in handy when it came time for a second internal exam which indicated full dilation and effacement. Interestingly, when she was later noting this on the chart, she mentioned to the second nurse mentioned in the next paragraph that she’d estimate station to be a plus 1 but that had she been laying down the baby would have been higher.
A second nurse came because they like to have one for the mama and one for the baby. The nurse who came is one I’ve worked with and in general I really like her. In this instance, I was not really feeling so optimistic because she’d been one of Elizabeth’s nurses before and there were a few times when I felt she was overly rough and once when she was downright rude. I didn’t say anything though, deciding to just go with the flow and keep open to the situation.
Eventually, because it had been several hours since Elizabeth used the bathroom and she’d been drinking water pretty consistently, I suggested that she try to pee because a full bladder can get in the way. She didn’t want to but agreed to try so after the next contraction she and Jonathan went in and closed the door.
The nurse asked me about Elizabeth’s first birth wondering if perhaps it had anything to do with their adamant hands off stance. I said bluntly that it was awful and that it had a great deal to do with their thoughts and desires. I’m really quite glad that she recognized that there might have been a connection. I wish the doctor and nurses the first time would have recognized that their actions might have such an impact on a woman. Women experience birth trauma all the time. It’s honestly a miracle that many of them are willing to have a baby after having such horrific experiences.
Elizabeth let out a pretty good yell while in the bathroom and the nurses both gravitated in that direction. Within another minute—seconds?—Elizabeth let out another pretty good yell and the nurse went in. Elizabeth was wide-eyed and said, “I feel something wet!”
The nurse took a look and said, “It’s your baby! The head is out.”
There was a mad dash for something for the floor and then the baby was out and in Elizabeth’s arms.
Rebecca was in Elizabeth’s arms when the doctor came in and the nurse asked where she, the doctor, would like her, Elizabeth, for the delivery of the placenta. “Well, she had the baby in the toilet, she can deliver the placenta there, too.” I don’t know this doctor well but I would guess that she was less than pleased by one, Elizabeth’s choice to give birth standing up, and two, the fact that she gave birth in the bathroom. The facial expressions and body language all indicated this.
Elizabeth did choose to go to the bed before the placenta came out but the second nurse checked the cord and cut and clamped as it was no longer pulsing so it would be easier to get to the bed. The placenta came with little effort although when the nurse was cleaning Elizabeth up she noticed some of the membrane hadn’t come out. She tugged on it gently and called for the doctor to take a look. The doctor pulled it out and left the room and as the nurse was checking Elizabeth’s uterus, a bunch of clots and blood came out. My opinion, unprofessional as it is, is that the retained membrane, which was much more substantial than the doctor said, made a dam around which the blood was not able to flow. Once the membrane was out of the way, everything could proceed in a more normal fashion.
I stuck around for another couple of hours, until they were all situated in their recovery room, and went home.
My plan is to pop over to the hospital at some point this afternoon and see how everyone is adjusting.
Thoughts:
Watching the second nurse, I have to come to the conclusion that in most cases, doctors really are not needed during the birth process. Every birth I have witnessed that has been presided over by a doctor has resulted in an almost immediate clamp and cut of the umbilical cord along with traction to get the placenta out. Those births when the doctor doesn’t get in the room quick enough result in delayed clamping and typically letting the placenta come on its own. The nurse this morning did tug gently on the cord and when the placenta obviously wasn’t coming, she let it be.
Watching the first nurse, after the initial shock of having to deal with a laboring woman and her husband who were obviously not going to just go along with the typical routine of the hospital, she pretty much took everything in stride. I’m not sure she was entirely happy about the situation because her attitude was at times slightly mocking or condescending but as time went on this seemed to improve.
Birth in a hospital does not have to be bad but if you blindly follow hospital routine, it is more likely to. If you know what you want, have sound logic to back you up, and aren’t afraid to speak up, you are more likely to have the experience you choose. Unless, of course, you are dealing with complete morons who are unable to accept the fact that hospital protocols aren’t the word of God. Then you might as well plan on visiting Hades.
And there you have it. It is four hours and ten minutes later because I’ve been busy with other things while I’ve been working on this and I’m afraid I don’t have any pictures for you at the moment so if you don’t like to read, you probably won’t even get this far.

Have a wonderful day!