Published by sylvia on 25 Aug 2010
I got involved in a Facebook discussion on home-vs-hospital childbirth that made me want to share my own stories in more detail.
I became pregnant with my first child in 1988 at age 34. I was a registered nurse working in chemotherapy research and very familiar with reading research studies in medical journals. My first OB was selected on the recommendation of a friend who was an OB nurse and was a terrible mismatch. She was a fine OB for high-risk births, but although I was classified as “advanced maternal age” there was nothing else to make me high risk. Yet she was stuck in the rut of wanting all the tests that would be indicated for a high-risk pregnancy and that I didn’t want, many because they were just too new to know if there would be long-term effects for the baby. At 7 months I went looking for another OB.
I’d done quite a bit of research by then and took it and my list to interview the prospective new OB. I explained why I wanted to change OBs that late in my pregnancy and gave him my list of interventions I wanted avoided, including no episiotomy and no internal fetal monitoring. I briefly reviewed the research I had found, published in reputable medical journals, showing those interventions did NOT lead to better outcomes for mother or baby, only to increased complication and/or C-section rate. The OB agreed with me on the research but explained he couldn’t promise to not use those interventions because they were “standard of care” and IF something went wrong and IF he hadn’t used those interventions and IF there was a lawsuit, he would be crucified. And, he pointed out, I couldn’t even promise there wouldn’t be a lawsuit, if the absolute worst happened and I wasn’t around any more and my husband was guided/pressured into filing suit. And I knew the OB was right about that. But I liked his honesty and switched to him for the duration of that pregnancy.
Labor was … interesting. Peter and I had attended Bradley method classes and I’d delivered four babies myself when I worked on an ambulance, so I thought I knew what to expect. And I knew the statistics about laboring more than a few hours in the hospital leading to panicky OBs laying on the pitocin to “speed up” the normal process, so I determined to labor at home until I thought I was in transition. So labor started … and went on … and went on. After about 24 hours, I thought the pains were bad enough that I must be getting close to transition, so we went to the hospital. Turned out I was only 2 cm dilated! And I had a nurse who was totally supportive of my stated desire (BEFORE I actually experienced labor pains) to have a natural childbirth. When I actually decided I needed something for pain, the nurse tried to talk me out of it, telling me it was just natural doubt! I couldn’t convince her it was natural PAIN and that I was a wimp. She finally called the anesthesiologist to give me an epidural, but by the time he arrived, he said it sounded like I was in transition, which the nurse confirmed, AND THEN HE LEFT! Without doing anything for me! I was livid and in agony. Dadgum nurse told me pushing would feel good. She lied. It took another two hours before I could convince them that I didn’t have any energy reserves left, and I couldn’t fight the pain AND push. Anesthesiologist came back and FINALLY set up a great epidural – I could feel the contractions so I could push at the right times but it wasn’t hurting. Irene came out about 20 minutes later, with me yelling “No episiotomy!” and the stupid doctor-on-call letting me tear. Then the fun started.
During the pre-delivery tour, the nurse giving the tour had said that the baby would be monitored for 6 hours after delivery, either in the recovery room or in the nursery. I didn’t say anything but I was determined I would NOT be separated from my baby. So we had about 20 minutes together, and then the nurse cheerily announced I would be going to my room and Irene would be going to the nursery. I said “no, she’s not. We are staying together.” The nurse was floored. (That’s what happens when you know what they can and cannot do – and I knew they could not do anything to Irene without my permission.) She said they didn’t have the staff to monitor me in the recovery room; I said that was fine, I was an RN and would monitor her closely. She said “do I have to call a supervisor?” (The velvet glove didn’t work, now here comes the iron fist.) I said to call whoever she wanted, but Irene was not leaving me. So they left me on a less-than-totally-comfortable recovery room bed for the six hours, but I didn’t care; I had my little daughter and we talked and I watched her sleep. It was wonderful.
The day-and-a-half we stayed was interesting, too. Peter was there most of the time and both days, at midnight, someone came and took Irene to the nursery “to check on her.” I gave them 10 minutes and then went down to the nursery to get her back. Peter asked why they had to take her and the nurse hemmed and hawed. I explained that they had to justify the nursery charge that would be on my hospital bill, and Peter (poor innocent) asked “why didn’t they just say so?”
Things went differently with Daniel. I was 37 and NOT classified as advanced maternal age – the definition had changed. I had realized that I am not a good candidate for natural childbirth and discussed with my OB when I should go to the hospital to be able to have an epidural when I was ready for it. I still refused routine ultrasounds, although I made it clear to the OB that I would certainly agree if there was a clinical reason for the ultrasound and that just having a feeling that one was needed would be an adequate reason – she was very experienced and good clinicians can’t always point to specifics that make them suspect something is going on. So when I was a week post-due, I had an ultrasound showing there was very little amniotic fluid. OB scheduled me for induction, and I’d researched inductions and found there really was evidence that going over 42 weeks produced bad outcomes for the baby. I finally went into labor 36 hours before my scheduled induction, but he was stuck at station +5 and I could NOT get him out. Every time the OB urged me to have a C-section, I begged for more time to push. Finally, I heard the nurse tell the OB that the baby’s heart was showing early decelerations. Late decelerations are normal; early decelerations are not. OB didn’t even have to say anything, she just looked at me. I sighed and said “I know, we do the C-section.” Five minutes later, I had a big gaping hole in my belly and Daniel was on the way to an oxygen tent with a spontaneous pneumothorax (which no one except me seemed particularly concerned about, the pediatrician said it would probably heal without further intervention in a day or two, and that is what happened). I didn’t get to have him room in with me, obviously, so I went to the nursery as much as I could. They were worried because his breathing rate was too fast, but when I held him, it slowed to normal. Maybe that’s because a newborn baby is SUPPOSED to be in Mama’s arms? Anyway, we both went home at the end of the usual three days.
While I have to admit I like the idea of home births, my children and I could have died from either of my deliveries. I couldn’t get Irene out because of the pain and I couldn’t get Daniel out because the amniotic fluid cushion was gone. If I hadn’t been in the hospital, I wouldn’t even have known that Daniel was in danger, and I don’t know if I would have had time to get to the hospital and get an epidural with Irene.
I was in an unusual position because I was already an experienced registered nurse before I started having kids. I’d worked in hospitals (although not OB) so I knew what the hospital could legally do. I also knew enough to recognize was was really for the baby’s safety and what was just for the hospital’s convenience, and I was prepared to fight intimidation if necessary while actively advocating for my baby’s best interest. But any woman can shop around; babies are revenue-producers for the hospital and hospitals woo pregnant women. Never mind which hospital has the best steak dinner, look for which has a bath to labor in or works to keep mama and baby together or whatever is most important to you. If you have a feisty nurse friend who is willing to advise you, take him/her along when you go into labor. Don’t fight with the hospital ahead of time, it just wastes your energy and alerts them that you may be an uncooperative (i.e., not willing to do whatever they say) patient. Remember, they cannot do anything to you or your baby without your permission, but they WILL assume your permission is implied if you don’t specifically refuse something.
Note: comments have to be approved because this site gets way too much spam each day. I’m eager for comments pro or con, but please Email me at mamasylvia at mamasylvia dot com to tell me you left a real comment, otherwise it will probably get deleted with the unread spam.