Choices in Childbirth Are Challenging: Ultimately, They Are Still Your Choices

INFORMED CHOICES

This is the story of a courageous mom and dad who became their own advocates, and good consumers of medical care by making their own informed decisions under challenging circumstances. They chose to make informed decisions with their care providers instead of having decisions made for them. This mom had past traumatic experiences with a hospital stay and medical care and was determined to have a safe and healthy birth. They also knew how important it was to make their own informed decisions.

Timeline – the end of pregnancy, the labor, and the birth

39 weeks prenatal check up:
Dr. R: “So we can schedule you for induction next Friday….”
Rich and I: “No thanks!”

40 week check up with different doc because mine is on vacation:
Dr. P: “Ok, so we will go ahead and schedule you for induction next week…”
Rich and I: “Um, no thank you!”
Dr. P: <with utter disbelief> “Why NOT??”

We stated our beliefs.

The doctor worriedly stated the risks and her discomfort with our choice. But it was our informed decision.

We asked:

“Is the baby was okay? – Answer – “Yes”
Any signs of distress” Answer – “No, but you never know when that’ll happen!!!“
“Is there concern that he‘s getting too big for my body?” “Not specifically, but he COULD”

I explained to her my past medical traumas, my anxiety, and my need to let my body do its thing. This seemed to relax her some and I felt she was on board.

And so…Rich and I decided to wait.

Monday 12/26 was truly when my water broke… but I thought, “Am I peeing on myself or did my bag of waters just break?”

So I tried to hunt down some pH strips, but everything was either closed on 12/26 or they had no pH strips! so I could test at home. I didn’t want my doctors office to know just yet. I was determined to stay home until I was in active labor! I went about my day and ignored the fact that I my bag of waters had broken.

Huge Gush of Water in Line at Starbucks!

Then, Tuesday morning, as I was standing in line at Starbucks, a huge gush of water came out. I thought, “Awesome! Ha Ha!” We already had a check up scheduled with the O.B., so we just waited to go to the appointment. Once there, I informed my doctor that my water had broken an hour earlier… so she tested the fluid and confirmed. “It’s pooling inside you, your water definitely broke.” She said there was a slight tinge yellow so perhaps meconium, but she neither sounded alarmed nor indicated anything was urgent. She said she wanted to monitor me in the hospital, since I was 41w and 3 days.

Rich and I kind of looked at each other like ‘here we go down the rabbit hole.’ But I wanted to be a team player on some level. I wanted to give a little, in hopes of getting a little. And we were making another informed decision – our decision.

My intentions were good, but things didn’t go the way I had hoped!

We waited until 10pm to check in to the hospital. I had said to Dr R: “I’m okay with going to be monitored but I need you to be patient and okay with me hanging out there until he decides to come.” She said she was on board… but she never put notes in my chart for the staff at the hospital 😫

En route to the hospital we picked up castor oil and orange juice to help stimulate labor. Before going in I chugged the delectable drink.

We checked in, strapped up to the monitors and hung out. Our nurses were amazing. When Magdalena went to talk induction, and we declined, she courteously asked our reasons and then said, “Okay! We will be checking your blood pressure, temperature, and the monitors diligently for any signs you’re getting an infection!” And we ‘rocked on’ for a few hours.

The contractions finally started around midnight. By 2am they were every 10-15 minutes. They were excruciatingly painful in the right side of my pelvis. Since I was strapped to those stupid monitors, my movement was limited. I used a yoga ball painfully, got in the shower, sat on the toilet, which felt the best, and Rich was applying firm pressure to my sacrum.

Holy crap it hurt!

I could tell my previous car accident was playing a role in my pelvic pain levels, and keeping me from relaxing and just opening up. I felt very hesitant and scared. Mostly I felt a lot of pressure to dilate with the constant checking in on us. Every time that monitor wasn’t placed right or gave a weird reading, nurse(s) rushed in. “Sigh…”

Dr. M – I’d never met – he knew absolutely nothing about me

Dr. M was on call Tuesday night and not part of my medical group. I’d never met the dude, and he knew absolutely nothing about me. At about 4am a group of folks rush in to my room. Rich and I are sleeping, and all the commotion woke me up as they stare at the monitor.
“We need you to move positions”
I wipe my eyes and ask what’s going on… they give vague answers and ask me to change position, so I stand up so I can still face everyone and figure out what the deal is.
“Your baby’s heart rate is in the 60’s… you need to be on your right side…”
Dr. M rushes in. “I need to do an exam”
Me: “Why? My water has been broken almost 24 hours and I’m limiting exams.”
I finally get on my right side after getting more the information, and heart rate improves to 135.
Dr. M, clearly annoyed at my questions, gives me attitude when he says, “I need to assess if the cord is prolapsed or the other option is your baby is pressing on the cord due to low fluid levels.”
Me: Prolapsed cord? Seemed rational… “Okay, let’s check.”
His exam was painful, not connected to my experience, and frankly I felt scared.

Dr. M: “I want to infuse more fluid around your baby so that’s what we will do next.”

Doula to the Rescue

Doula, Kimberly Johnson – “Hey guys, you can ask if this is urgent or if you can have 5-10 minutes to decide.”

Me: “How does that work?”

Dr. M: Clearly annoyed, “I take a catheter and slide it passed your baby’s head and infuse saline in to cushion him.”
Me: “But by introducing foreign things, doesn’t the risk of infection increase? If we are trying to limit introduction of infection, why would we then place these things all the way in there?”
Dr. M: “Yes it does increase infection risk, but you need this”
Me: “But his heart rate is fine now, and has been for 5 minutes?!”
Dr. M: “Yeah but it might not last…”
Me: “So, kind of like you might introduce infection into my uterus with the procedure?”
Rich: “Doctor, can we get 5 minutes alone to talk this over or are we in an urgent situation?”
Dr. M: Turns away from us, rips off his gloves, shakes his head, and says, “Fine, do whatever you want and risk your baby’s life.”

Wow. That escalated quickly.

I start crying, I feel utterly dismissed and my doctor just unprofessionally walked out on me! I called the nurse over and said, “That man never comes back in my room. He’s fired.” I said, “If he was that worried about me and my baby he would have stayed and fought to convince me to do the procedure. Clearly, it isn’t an urgent situation.”

We spent the night monitoring heart rate, taking castor oil at regular intervals, and hoping for progression of labor. We slept maybe an hour. And, I was relegated to broth and yogurt for sustenance. Day shift arrives.

Dr. P is on call

Dr. P comes in late morning on Wednesday for rounds. She tries to convince me to get an epidural and start pitocin. We decline. She’s clearly annoyed at us. Standing close to the door, she says, “Well, I’m not going to keep coming in to give you the same speech… so I’ll leave you alone. Let me know if you need me.”

I relate my Dr. M experience to her and she says:
“I agree with him. And he actually won’t take you as a patient again when he’s on call tonight. I’ll be responsible for you from home. If an emergency happens he will be the one to handle it but he doesn’t want to be responsible for a patient who is going against all medical advice. He’s scared. It’s two lives we are responsible for and you won’t take any of our advice. We take our work home with us, and if something happens that stays with us. You’re not letting us do our job.”

I’m appalled at her speech, thinking… “Uhmmm, okay? Last I read the paperwork y’all gave me said I had the right to informed decision making and informed consent, including right to decline.” I was so appalled at the level of fear mongering that was being used as a way to get me to have their style of birth.

Now I’m pissed

The day brings fewer contractions, no scary heart rates, and a lot of waiting. A lot. A nurse Diana comes on with the Wednesday night shift and she is an angel. She asks about our birth plan, we give her a copy and comes back 30 minutes later, “I am so sorry you had those experiences. That must have been hard!” And we talk.

She guides us through with ZERO judgement, lots of love, and incredible support. A midwife, Ashley, comes on duty 11-4am. She is privy to my story, because my doula had asked her a question about my stent. We hit it off. She’s not concerned about how long I’ve been ruptured. She’s on board with my hopes for a “natural as possible” birth.

She holds me with words that are couched in respect and love.

At 2am on Thursday she comes to talk to me about the options. I am not dilating… 3.5 cm over 24 hours, with water broken for 45 hours. My contractions aren’t regular enough to get results. She’s okay with waiting longer but wants to offer me some options. I listen.

She says she’s worried about how exhausted I am becoming, and that I cannot relax in to the contractions and may be limiting their effectiveness. An epidural would allow my body to rest, and for my anxiety about the injury pain to be handled. She said we could start that, and see if that allows for dilation. I’m scared. I do not want any more concerns with dropping heart rates for baby.

Choices are so challenging!

An hour later after several excruciating contractions (I must have scar tissue from the car accident), Rich and I agree, to start with the epidural – another informed decision. This will allow me to get rest and push baby out the next day. We also agree to pitocin, but request half of the normal starting dose.

Within an hour the team rushes in and turns off the pitocin. Everything I didn’t want to happen is happening- baby’s heart rate is low. His little body isn’t tolerating the pitocin. My blood pressure is low. I’m crying saying “This is why I didn’t want interventions! I was just fine before!” I’m freaked out thinking about them forcing me to have a c-section, and how this just all went terribly wrong. They turn off the Pitocin and baby recovers. An hour later we try again.

We are elated! I couldn’t believe it.

By 8am I am 9cm dilated and at +1 station. We are elated! I couldn’t believe it. An hour later we are at 10cm and gear up to begin pushing! At 10 I ask for a mirror so I can get a sense of what effect my pushing has and that was a total TRIP! As his head came down and crowned. I say, “This baby is going to be out by 12:30.” Dr. P rushes in as his head is already delivered and gets him the rest of the way out. I feel blood gushing. I see all of them rushing around. I had torn and lost a cup and a half of blood in the end. But I’m fine. Our little man was born at 12:21.