SUA Single Umbilical Artery

Posted on May 23, 2018 by Gloria

SINGLE ARTERY UMBILICAL CORD

About 30 years ago, a baby boy was born at home in a town about 90 minutes drive away from where I lived in Vancouver, BC. All was normal with the birth (first baby for the family). The baby was about 8 pounds and he seemed healthy.

I was taught to inspect every placenta carefully at some point in the hours after birth. One part of the placenta exam was to look at the cut end of the umbilical cord and make sure there were 3 little openings where the 2 arteries and one vein were. Remember, this was in the days pre-internet. Midwifery training was accessed by reading thick obstetric/midwifery text books in those days. This little boy’s umbilical cord had only 2 vessels. Oh no. Where was that third little opening for the second artery? I re-cut and peered at the end of the cord but, no, only two vessels. The only instructions in any of my textbooks about that possibility were to “call the pediatrician”. So, I did. At that time, we had a kind pediatrician who always took calls from home birth attendants. When I told him the situation, he said “Hmmmmm, I don’t know what that means. Could you go in to Children’s Hospital to the library and look it up?” I didn’t like to leave the family’s home without knowing for sure that the baby would be okay and I had that 90 mins between their home and the hospital library. I decided to call a friend who was a long time hospital nurse. She didn’t know either but thought it might have something to do with the heart. The baby wasn’t showing any signs of blueness around the mouth and was a keen breast feeder so, I didn’t see or hear any heart problem indicators. After a few hours, I headed back to town and went straight to the Hospital Library.

Vein larger than the 2 arteries

In those pre-computer days, the hospital Librarian was a God-send. She was very helpful and looked up a bunch of articles for me but they really didn’t tell me much more than “it could mean a kidney problem”. I was feeling frustrated but, then, got an idea. I could find the pathology department in the hospital and speak to a person who had seen babies with kidney problems and maybe get some useful help.

I was a bit nervous going to Pathology because I was afraid I’d see dead bodies but, no, the place was clean as could be. The Pathologist was glad to see me and have someone to talk to. (I think that’s a lonely job). I told him what was going on and the first question he asked was “How much did the baby weigh?” He then told me that babies with kidney problems tend to be very small so he doubted my finding that there were only two vessels in the umbilical cord of an 8 lb. baby. He suggested that I should bring the placenta in so he could take a look. I wasn’t relishing the 90 minute drive back and forth again but I was more than willing to be wrong about my count of the vessels if it meant I could relax about the baby.

One vein, two arteries

I returned to the family home, got the placenta from the fridge and drove it back to show the pathologist. He cut the end of the cord on his marble slab and peered at it and then said “Well, I see what you mean. There are just two but can you see that the vein, which is usually larger than the arteries, and the one other vessel are both about the same size? I think what happened here is that the two vessels grew together. If the baby is pee-ing normally and eating well, I don’t think you have anything to worry about.” He then proceeded to reach up on to his shelf and bring down a copy of a thick text book entitled “The Human Placenta”. He told me that it was a fascinating book by a pathologist who had been a veterinarian before he pursued pathology. When I expressed amazement that there was enough to say about the placenta that it could fill a whole book of its own, he said that a lot of the information was comparing the human placenta to that of zebras, gorillas, and other wild animals. Somehow, I’ve never been tempted to buy the book. . . I like to keep my placenta knowledge on a “need to know” basis.

That little boy did just fine and he’s a big man now. That’s the only 2 Vessel cord I’ve ever encountered in 1500 plus births, so it’s very rare (and, in this case, not even a real finding).
I hope this story is informative and reassuring to parents/practitioners about SUA (single umbilical artery) diagnoses in babies with normal growth.
Gloria Lemay, Vancouver BC Canada

From www.midwifethinking.com
A great blog

A Doula’s Experience with Breech

Posted on February 18, 2018 by Gloria

After a birth, it helps to get a perspective on what could have/ should have/ might have been different in order to learn and grow. Every birth story is different. Gloria

A DOULA WRITES:
The family had a super healthy (first) pregnancy, with opportunities
galore; access to acupuncture, chiropractics, yoga, watsu, massage,
walking, biking, good rest and healthy food (they are both vegan and
eat really well). They chose not to have any ultra sounds and had
her first internal exam at 40 weeks, at her request. She was quite
anxious about having internal exams, learned that it is possible to go
through pregnancy and birth without any fingers up her vagina and
decided that would be best for her. She asked for the exam at 40 weeks
because she felt it would be better to have a ‘practice’ exam in a non
labour situation to see what it would be like just in case she wanted
to have one in labour.

Throughout her pregnancy her various health care professionals
palpated her belly and were sure the head was down. I don’t touch
bellies, I just pay attention to how women are carrying and moving and
what they are saying, and it seemed like a vertex presentation to me
as well. At 39 weeks, her chiropractor and her midwives noticed a
difference, but figured maybe the head was engaged. On her due date
she had an appointment with one of her midwives, who is quite new to
midwifery and she basically freaked out from feeling what she thought
were hands presenting and told the family they must go for an ultra
sound the following morning at 8am. The family was left quite worried.
I asked what she felt about the baby’s position. She said she had been
feeling flutters down below, and figured it was simply mild
contractions. I also asked if she was feeling pressure up in her ribs,
or if she was pushing down on her belly in discomfort, and she said
she had been feeling that way all week. I told her not to worry and
offered to join her for the ultra sound in the am.

Later that night I received a call that labour had started, she had
been contracting since her midwife appointment, but thought it was due
to the internal exam. The contractions were building, so she called
the midwives and they told her to go straight to the hospital for an
ultra sound and one of the midwives would meet them there. The ultra
sound indicated baby was breech and the OB on call was one of the only
in the city who was open to vaginal breech births, although he clearly
stated he was not interested in any marathons and she would have 6
hours to labour (no pressure!) The midwife assured them he was good at
what he does, but he was known to have no bedside manner. That was
pretty clear, but they didn’t care.

At this point their midwife said they could go home to grab their
stuff and take a pause. She was well aware that this was a total game
change from their water birth at home plan, so taking a moment at home
seemed an important part of their birth experience. They called to
let me know the baby was in fact in a breech presentation and that
they were heading home to get their stuff. I was pleasantly surprised
they were encouraged to go home, and told them to keep me posted and
take their time. I said I would meet them back at the hospital when
they returned.

We met at the hospital at 9:45. The midwife did a very gentle and slow
internal exam and found her cervix was 4 cm and stretchy. They had her
on the monitors after that. I asked if she could be on hands and
knees, but they couldn’t get the heart rate as clear, so that was
ruled out. She was laying on her side and after 10 minutes on the
monitor we heard major dips in the heart rate over and over, tried
getting her on her other side and baby was still dipping quite a bit.
The midwife was concerned of a cord prolapse, so the nurse came in and
did a very different internal exam, got right in there fast and
vigorously and felt bulging membranes and what she thought was a cord.
Suddenly two nurses had their hands inside of her, it was terrible.
They said they were trying to push the baby up off of the cord.

You can imagine how intense this was for the mother to be. The room
filled with nurses and it was announced that she would have an
emergency cesarean birth. They wouldn’t let her partner go with her,
this was also terrible. The midwife wouldn’t take no for an answer and
got her scrubs on to accompany her. I stayed with her partner. He was
a mess. We found the only nurse on the floor and asked if she could
keep us updated and I asked if there was any way her partner could go
in. They were waiting for the doctor to come (this whole time with the
nurses hands inside of her…) the doctor would do one more check to
make sure the cesarean was necessary. The nurse grabbed scrubs for the father
and he got changed, but just as he was going to go in the doctor
arrived.

I later found out instead of determining whether a cesarean was
necessary, he yelled at the midwife for having let them go home. One
of the nurses spoke up and suggested they instead focus on the task
at hand and he determined the cord was not presenting, but a foot was,
and her cervix was 8cm dilated. They went ahead and gave her general
and she heard the OB yelling at her midwife as she went under. Her
partner and I waited in the hallway, he made a comment that being the
dad waiting in the hallway while his baby was born felt like we time
warped to the 1950’s.

Baby was born at 10:45pm and dad held him for the first time in the
hallway at 11:10 pm. Apgars 8 & 9, and he was 5lbs 11 oz.

Mom and baby were moved to the recovery room and dad right away took
off his shirt and gave baby skin to skin cuddles until mom was ready.
At 12:45am the nurse said baby’s sugar was low and suggested formula
or glucose water. I asked mom if she was ready to try breastfeeding or
if she wanted me to get on the phone and call her friend who had
offered expressed breast milk if they needed. The nurses were outraged at this
suggestion, said they couldn’t allow it and so she did her best to
try breastfeeding. An hour later they did the sugar test again and it
was way up. The midwife and nurse were both in disbelief (the sugar
level raised from 1.9 to 3.7 in one hour!) The midwife commented how
interesting it was that they had no trouble believing the low number.
I told them it must have been the skin to skin contact with mom and
some colostrum that did the trick. Once they were settled and resting, I
drove home with their placenta and made them some quick prints and a
smoothie. They were happy to have had some of their birth wishes
granted.

Today the family is doing quite well. They are breastfeeding, resting,
eating well, have lots of support and are processing their unexpected birth
experience a little bit each day.

QUESTIONS:
– Could we have avoided those low decels if she could have been up on
her hands and knees?
– What happened when that nurse felt bulging membranes? Did she cause the membranes to release?
Or is it possible to feel a prolapsed cord through the bag?
– Could a baby with apgars 8 & 9 have been in such distress moments
before? (or was it that they were worried baby couldn’t handle two
more centimeters as well as pushing?)
– Was this the only way it could have happened? In general it felt to
me like everything happened as it had to, except those few questions
above that leave me feeling a bit curious.

I have never attended a cesarean birth (I have been a doula for four years).

Any way in which we can learn together from this story would be great.
Comments and feedback are very welcome.

Ruby

Gloria’s thoughts

Dear Ruby, It’s getting to be hopeless to have a primip give birth vaginally to a breech.
You must be traumatized/grieving about all this. Thank goodness you were able to give them some measure of getting their wishes met.:

When the adrenalin gets going at a breech birth, they basically find reasons to head to the surgical setting. The cord wasn’t causing problems so, in hindsight, the heart tones were fine.

Don’t know what the nurse doing the exam was intending but I would hope she was being careful NOT to rupture that membrane with a breech. Did she break the water bag? You would have seen amniotic fluid with clear poop coming out of the woman’s vulva after that exam if the membranes released.

As far as diagnosing a prolapsed cord through the membranes with a footling breech, it might be possible because the bag is thin but it’s highly unlikely and, we know in this case (again, good hindsight), it wasn’t there.

Apgars of 8 and 9 indicate a healthy, well grown term baby (again, golden hindsight). We do know that monitoring increases the risk of cesareans without any evidence that it is helpful in improving health.

From what that dr with no bedside manner said, the woman wasn’t going to be given much of a chance to give birth vaginally. Since she hadn’t had previous uterine surgery, it would have been nice if someone with the skill to do a cephalic version had been there when she was first at the hospital. The baby presenting by the feet is the easiest to turn, especially if the baby is small and it’s early in the birth process. To be fair, a first birth with feet presenting is not a good vaginal birth risk to take. Luckily it is a rare situation to have so the numbers should be very low.

If the caregiver is palpating bellies and listening with a fetoscope (instead of doppler) in the prenatal period, the caregiver should be picking up when it’s breech at 36 weeks gestation (if in doubt, the woman can have a one-swipe quickie ultrasound to double-check). At that point, if it’s discovered, there’s time/space to get baby turned to head down. As I said, a footling breech is easiest to get turned. Frank breech is a more optimal position for safe vaginal birth of breech but not for turning baby to cephalic. Querying rib pain, listening in the 4 quadrants with a regular fetoscope (and finding the true fetal heartbeat low in the pregnant belly) and observing the shape of the pregnant belly are your best tools for early diagnosis.
Thanks for being there for this family. Gloria

Group B Strep: what you need to know

Posted on September 15, 2011 by Gloria

We are told that the concern about Strep B involves two groups at high risk of infection:
1. Premature infants under 37 weeks gestation
2. Any infant in utero with membranes released longer than 18 hours

Contractions are a possible indicator of infection, but this situation is a concern in weeks 0-36. After 36 weeks, Braxton Hicks are normal and a good sign of a healthy toned uterus getting ready to push a baby out.

A culture that shows Strep B in the vagina is not necessarily illness related. Just as we commonly have Strep A in our throats on a swab and have no sore throat symptoms (no strep throat), from one day to the next we can all culture positive for Strep B without any symptoms or danger to our unborn babies. This is why many practitioners refuse to test for it and simply wait to test until such time as the above two “at-risk infant scenarios” show up. One day a woman might test positive and the next be negative. To treat with antibiotics before labour would NOT be recommended. Why?
The woman’s body could build up a resistance to the antibiotics and so could her baby’s body. Then if either got a more serious infection after the birth, the antibiotics might be ineffective.

Taking antibiotics can also lead to thrush, vaginal yeast and severe colic in the months after birth. There is some indication that antibiotic use can lead to Vitamin K deficiencies in the baby.

I would advise pregnant women to do as many things as possible to minimize their risk of ANY infections and maximize their immune systems. Some safe suggestions:

1. Boost vitamin C in your diet—e.g., eat 2 grapefruit per day. Other good sources of Vitamin C are red peppers, oranges, kiwi fruit.

Boost Your Vitamin C

2. Drink a cup of echinacea tea or take 2 capsules of echinacea every day.

3. Get extra sleep before midnight. Slow down your schedule.

4. Take 1 tsp colloidal silver per day. Take it between meals. Hold the liquid in your mouth a few minutes before swallowing. Colloidal silver can be purchased in most health food stores. It is silver suspended in water. It is antibiotic in nature and safe in pregnancy if you limit the daily intake to 3 tsps or less. Do not take more because there is a danger of turning your skin permanently blue by overdosing.

5. Plan ahead for extra warmth after the birth for both the mother and baby. Hot water bottles, heating pads, hot packs, big towels dried in a hot dryer during the pushing phase all help keep the mamatoto extra toasty after birth and reduce stress. Have a friend or family member assigned to be in charge of the mother/baby warmth team. Colostrum is the best antibiotic treatment the baby could ever get.

6. Other good prevention tips: Keep vaginal exams to a minimum — 0 is best. Do not allow membrane stripping to start the birth (a.k.a. membrane sweeping). Do not permit artificial rupture of the membranes. Do not allow children of other families to visit the new baby for the first three weeks. Keep the older kids healthy so they are not sneezing and coughing on the new baby.

I often think we must have had a lot of women who were Strep B positive in the 1000 plus births I have attended. We do not test unless we have long rupture of membranes and/or a preemie. Once the baby is born, we keep all women warm and baby skin-to-skin with the cord intact and, of course, all our mothers breastfeed. I have never had a baby sick with Strep B in thirty years. Unfortunately, the use of high dose antibiotics on so many pregnant women has resulted in an increase in infant deaths due to E Coli. * Group B strep/antibiotics

Prevent the diagnosis of positive for GBS: If your care provider wants you to go for GBS testing at 36 weeks gestation to comply with protocols, read this article by a Certified Nurse Midwife about the use of garlic in the vagina to knock out bacteria. Do this regimen prior to testing.
https://pubmed.ncbi.nlm.nih.gov/15651446/

Scroll down to the end of these references for newer info from Cochrane Database and other sources.

*References:
(1.) E. M. Levine et al., “Intrapartum Antibiotic Prophylaxis Increases the Incidence of Gram Negative Neonatal Sepsis,” Infectious Disease Obstetric Gynecology 7, no. 4 (1999): 210-213.
(2.) C. V. Towers and G. G. Briggs, “Antepartum Use of Antibiotics and Early-Onset Neonatal Sepsis: The Next Four Years,” American Journal of Obstetric Gynecology 187, no. 2 (2002): 495-500.
(3.) C. V. Towers et al., “Potential Consequences of Widespread Antepartal Use of Ampicillin,” American Journal of Obstetric Gynecology 179, no. 4 (1998): 879-883.
(4.) R. S. McDuffie Jr. et al., “Adverse Perinatal Outcome and Resistant Enterobacteriaceae after Antibiotic Usage for Premature Rupture of Membranes and Group B Streptococcus Carriage,” Obstetric Gynecology 82, no. 4, pt. 1 (1993): 487-489.
(5.) T. B. Hyde ct al., “Trends in Incidence and Antimicrobial Resistance of Early-Onset Sepsis: Population-Based Surveillance in San Francisco and Atlanta,” Pediatrics 110, no. 4 (2002): 690-695.
(6.) M. L. Bland et al., “Antibiotic Resistance Patterns of Group B Streptococci in Late Third Trimester Rectovaginal Cultures,” American Journal of Obstetric Gynecology 184. no, 6 (2001): 1125-1126.
(7.) M. Dabrowska-Szponar and J. Galinski. “Drug Resistance of Group 9 Streptococci,” Pol Merkuriusz Lek 10, no. 60(2001): 442-444.
(8.) R. K. Edwards et al., “Intrapartum Antibiotic Prophylaxis 2: Positive Predictive Value Antenatal Group B Streptococci Cultures and Antibiotic Susceptibility of Clinical Isolates,” Obstetric Gynecology 100, no. 3 (2002): 540-544.
(9.) S. D. Manning et al., “Correlates of Antibiotic-Resistant Group B Streptococcus Isolated from Pregnant Women,” Obstetric Gynecology 101, no. 1 (2003): 74-79
(10.)Cochrane Database: Jan. 2013 “Maternal colonization with group B streptococcus (GBS) during pregnancy increases the risk of neonatal infection by vertical transmission. Administration of intrapartum antibiotic prophylaxis (IAP) during labor has been associated with a reduction in early onset GBS disease (EOGBSD). However, treating all colonized women during labor exposes a large number of women and infants to possible adverse effects without benefit.”
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007467.pub3/abstract

UPDATE: Cochrane Library, June 10, 2014
Intrapartum antibiotics for known maternal Group B streptococcal colonization
Women, men and children of all ages can be colonized with Group B streptococcus (GBS) bacteria without having any symptoms. Group B streptococcus are particularly found in the gastrointestinal tract, vagina and urethra. This is the situation in both developed and developing countries. About one in 2000 newborn babies have GBS bacterial infections, usually evident as respiratory disease, general sepsis, or meningitis within the first week. The baby contracts the infection from the mother during labor. Giving the mother an antibiotic directly into a vein during labor causes bacterial counts to fall rapidly, which suggests possible benefits but pregnant women need to be screened. Many countries have guidelines on screening for GBS in pregnancy and treatment with antibiotics. Some risk factors for an affected baby are preterm and low birthweight; prolonged labor; prolonged rupture of the membranes (more than 12 hours); severe changes in fetal heart rate during the first stage of labor; and gestational diabetes. Very few of the women in labor who are GBS positive give birth to babies who are infected with GBS and antibiotics can have harmful effects such as severe maternal allergic reactions, increase in drug-resistant organisms and exposure of newborn infants to resistant bacteria, and postnatal maternal and neonatal yeast infections.

This review finds that giving antibiotics is not supported by conclusive evidence. The review identified four trials involving 852 GBS positive women. Three trials, which were more than 20 years old, compared ampicillin or penicillin to no treatment and found no clear differences in newborn deaths although the occurrence of early GBS infection in the newborn was reduced with antibiotics. The antibiotics ampicillin and penicillin were no different from each other in one trial with 352 GBS positive women. All cases of perinatal GBS infections are unlikely to be prevented even if an effective vaccine is developed.
Source: http://summaries.cochrane.org/CD007467/intrapartum-antibiotics-for-known-maternal-group-b-streptococcal-colonization

UPDATE April 2016: From the (30th Anniversary Special) copy of Midwifery Today Magazine. Quote: “Unlike the US, the UK does not recommend universal screening because, while GBS disease is the most common cause of infection in full-term newborns, it is statistically still quite rare.(Wickham discusses these numbers in depth.) The Royal College of Obstetricians and Gynecologists (RCOG) firmly states that it will not support routine screening for GBS “until it is clear that antenatal screening for GBS carriage does more good than harm and that the benefits are cost effective” –two factors that have yet to be affirmed in any research done to date.” End Quote

This was part of a book review in Midwifery Today Magazine, Spring 2016 for “Group B Strep Explained” by Sarah Wickham, Midwife, 2014, paperback, pub’d by AIMS

What’s a Poor Midwife To Do?

Posted on June 9, 2010 by Gloria

This question came in to my blog in response to my archived post on the use of Castor Oil. Since it is a subject I seem to deal with daily, I’ve answered it where everyone can join in the discussion. Gloria

QUESTION

Hi Gloria! I am a student midwife, and in my state, women must be transferred to an OB if they have not given birth by 42 weeks. The local midwives (my preceptors) use castor oil as a last resort induction method. They don’t like doing it, from what they tell me, but they feel that, if after nothing else works (walking, sex, black and blue cohosh), it would be better to try castor oil and breaking the woman’s water, than to have a perfectly healthy woman transferred to the hospital.

What is your opinion on this? If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I do not plan on practicing here in Florida when I graduate from midwifery school, but I’d like to pass along some information to the midwives that I work with. Florida Student

RESPONSE

I am faced with a similar situation in my province. We have registered, government paid midwives who have to play nice with the doctors in order to have hospital privileges, a government salary, and publicly funded malpractise insurance. They have the same complaint “We hate to induce naturally but it’s better than what they are going to get in hospital. . . .” We also have the same mess here in B.C. as the rest of North America. Those membrane stripping, castor oil, acupuncture, herbal inductions don’t work because the woman isn’t ready to have the baby and, then, she gets on the prostaglandin/pitocin intervention-cascade train and the midwife feels so bad. . . but, hey, what could she do?

Canadian midwife with client

Every day, I thank my lucky stars that they used me as an example to the government of what a “renegade” midwife was. Midwives in my province could only become a professional body if they proved there was a “danger to the public” by NOT having a profession. I got to be the designated “danger” because I had proven for years that I would not lie down with the doctors and side with them against my clients. Obviously, the midwives organization would never have given me a license, even if I applied, so I didn’t have to bother applying. A few of my friends did and they were bankrupted and humiliated by the “professional” body. As soon as the government registrations were issued, we saw these inductions start. So many women in my community have been fooled by this cruel trick.

When the local midwives first obtained registration, there was a lot of righteous conversation about “evidence based” midwifery. The large multi centre trial about 41 week inductions conducted by Mary Hannah of Toronto (1) was pointed to by midwives to frighten women into being induced at 41 weeks. We had never seen this in our province prior to regulation. We had twenty years of experience as lay midwives with many post dates women and had not seen any problems but that experience was set aside in favour of the “evidence base”. Even though the midwifery empirical knowledge did not support Ms Hannah’s conclusions and even though the midwives were extremely conflicted and frustrated by the results of their labour inductions, they still obeyed the medical “evidence”. Then, the “evidence” was shown to be without merit. In 2002, Hall and Menticoglou published a paper in the British Journal of Obstetrics and Gynecology proving that Hannah’s study was wrong (2). Has that meant that midwives in my province are now encouraging women to relax up to and past 42 weeks gestation? Oh no, because now the doctors have kept on with their aggressive policies of inducing everyone at 41 weeks and, evidence- be- damned, they’ll make the midwives do the same thing. Science is trumped by community “standard of care” which basically means “we’ll all follow like sheep and hope the wolf doesn’t catch us”. Now, I don’t hear too much rhetoric about “evidence based practice” among local midwives. There is still a lot of lamenting about “how bad they feel” but the inductions continue unabated. Of course, the midwives don’t feel even 1/100th as bad as the woman who has had major abdominal surgery thanks to their aggressive policies.

I’ll post a link here to the B.C. Government Vital Statistics chart (click on Item 11) which shows that, prior to regulating midwives in 1998, there was an up and down pattern to cesarean rates and the rates remained below 25%. For the last reported year (2011) the rate was over 30%. This means that, since midwifery regulated on January 1, 1998 the cesarean rate has risen and the pattern has been a steadily upward climb. The cesarean rate is the score card of what is happening in obstetrics in any given jurisdiction. We’re obviously not doing so well here in B.C. When the registered midwives were soliciting the government for a professional designation, one of the cornerstones of their bid was that they would save the government money by preventing cesareans.

Cesarean Rates in British Columbia Before and After Midwifery Regulation

So, in answer to your questions: a)What is your opinion on this? I think it is disgusting that midwives are so cowardly and turn perfectly healthy pregnant women into wounded mothers. And (2) If you were faced with a similar situation (I should mention that midwifery licensing is strict in Florida, and midwives may lose their license if they do not follow the “rules”), what would you recommend? I will not be faced with a similar situation because I would not join an organization where I was made to go against my conscience, my common sense and my promise to my clients. If I was in such an organization and realized that I could not do my work with integrity, I would not be complaining about these ridiculous “protocols” I’d be changing them or resigning in protest.

(1) Hannah ME et al. Postterm pregnancy: putting the merits of a policy of induction of labor into perspective. Birth 1996;23(1):13-9.
(2) Menticoglou SM and Hall PF. Routine induction of labour at 41 weeks gestation:
nonsensus consensus. BJOG 2002;109:485-91.

related post: Castor Oil Inductions
This post was updated on Sept 5, 2014 to reflect B.C. Vital Statistics to 2011
Updated Dec 30, 2014 to include link to “Nonsensus Consensus”

The "Slow Birth" Movement

Posted on December 29, 2009 by Gloria

Somehow, we all got hooked into thinking that “quick was better” when it came to birth. When women tell their birth stories, it seems to be a point of pride to be able to say “I gave birth in 5 hours”, “I barely made it to the hospital”, “even with my first, it was so fast”. We hear these stories and may envy the women thinking that they performed in a fast, efficient manner and we view them as having a coveted talent.

I’ve been observing women giving birth for thirty years and I have given birth three times. From my experience, I don’t think that quick is necessarily a good thing when having a baby. Often fast births afford the woman no time to get her breath and regain her strength. Some women describe their fast births as feeling like they have been whipped around in a blender. In a rapid birth, the woman’s body sometimes displays the symptoms of transition after the birth of the baby (shaking, feeling hot/cold, vomiting). When a baby comes slower, there’s a building up of the intensity of the sensations so that the woman can adjust herself to the process that’s happening and, even though most women would like to shave a few hours off the whole thing, nevertheless, they know they can cope and that they will get to the finish line of birth. When the baby comes slower, the woman often dozes between her pushing sensations and seems to derive a great deal of energy from those short snatches of sleep even though they are interrupted often. The hormones of birth seem to allow the woman to operate in a different domain of sleep, energy and strength. I’m fond of telling women who are tired and discouraged at transition “You’re going to get a big burst of energy when you get the reflex to push” or “you’ll get an energy rush when you feel the baby’s head at your perineum”.

This trust in the process and knowledge that energy can ebb but then be regained in the birth process seems to be greatly lacking in today’s Western obstetrics. Slowing down or taking a long time to dilate is simply viewed as a problem and it’s a problem to be fixed by hurrying the woman’s body along. There’s no such thing as a resting phase, going in and out of the process, or simply a looooonnnnngggggg, slow birth process. This is not allowed and it’s viewed as pathological.
It hasn’t always been that way.

Waiting for the baby

In his book “The Farmer and the Obstetrician”, Michel Odent does a comparison of big agri-business to modern hospital obstetrics. When we see the environmental disaster that large scale agri-corporations have produced and we know that the hospital obstetric system has produced a North America wide cesarean rate of 30% and rising, it’s clear there’s been a severe skewing of priorities and principles. We have to re-order our thinking about farming in order to survive: local organic farms, 100 mile diet, moratoriums on genetically modified crops, co-op gardens, raw diets—all these things have grown in the past few years as the few who knew they were important have held onto the knowledge (and the seeds) for the ones of us who were slow to catch on to the urgency.

Instead of talking about “fast food” that seemed so sensible a while back, we’re talking about slow food. Food that takes time, patience, work and integrity to grow, sow and cook. Some are even talking about “slow money” to fund “slow food”, the kind of financing that doesn’t look for a quick return and a scheme but rather looks to the quality of neighborhoods, children, the air we breathe and the long term future.

For those of us who know there’s something terribly wrong with the state of obstetrics in North America, we must call for a return to SLOW BIRTHING. Birth which understands that some women will wait for several days after releasing their membranes and have no pathology. Slow birth means returning to a time when induction of birth was reserved for very seriously ill women and undertaken with great trepidation. Midwifery would be patient beyond all known limits . . . practitioners only steering the birth process in the most rare cases. We would return to a time when practitioners used to say such expressions as:

“Every birth is different, every woman is different and every baby is different.”
“Don’t let the sun set twice on a woman who is in active labor (past 4 centimeters dilation).”
“Don’t practice “meddlesome midwifery”.”
“A good obstetrician does not pick unripe fruit.”
“A good practitioner has two good hands and knows how to sit on them.”

These are all things I heard when I first started attending births 30 years ago and, now, I never hear them. We must get back to those times when the cesarean rate was below 15% or we will perish. As a society, we cannot withstand the damage that is being done to large numbers of women, babies and their extended families. The idea that we can “turn hospital beds” in order to make maximum use of the dollar cost of that bed is insane when it comes to giving birth.
The notion that a woman can be induced with all the pursuant cascade of interventions simply for the convenience of scheduling staff or room availability is a crime. We must wake up and recognize that giving birth to a baby is one of the most powerful transformative events in a woman’s life. This process is so important to the family and the rest of society that all efforts must be made to have it flow normally. Our priority must be the well being of the newborn baby and the conditions that are favorable to a long, satisfying breastfeeding experience. What we are doing right now with inductions, surgeries and the mass use of narcotics in childbirth is as harmful to the planet as fish farms and DDT. The small band of people who have kept the notion of SLOW BIRTH alive so that society at large can get back to what we know is the holistic way to treat new mothers and babies must be listened to and appropriate action taken. Childbirth is not a frill, it’s not an expendable experience, it’s a fundamental lynch pin in forming the family and, without it, we are doomed to being a sick society.

Helping your client avoid a Gestational Diabetes diagnosis

Posted on October 8, 2009 by Gloria

There is controversy in obstetrics about the diagnosis of gestational diabetes and the testing that is done to ascertain which women are at greatest risk. Dr. Michel Odent has written an article GESTATIONAL DIABETES: A DIAGNOSIS STILL LOOKING FOR A DISEASE? which can be viewed online at http://www.gentlebirth.org/archives/gdmodent.html

Pregnant woman testing blood sugar levels

Until all the controversy is resolved and a more scientific test can be offered, we are stuck with the glucose tolerance test at 28 weeks gestational age. The mother can look at the list of who is at greatest risk and decide to decline the test if her risk is low.

Women at risk:
– maternal age over 25
– – obese woman prior to pregnancy
– – previous birth of baby weighing over 10# at birth
– – previous unexplained stillbirth at term
– – family history of diabetes (esp. close relatives who became diabetic at a young age
i.e. juvenile onset diabetes)
–previous history of recurrent miscarriages
–extremes of heaviness or thinness
–history of alcohol abuse
–history of anorexia or bulimia

This risk factor screening will only pick up 50% of women who are GD. Therefore, we would be wise to treat everybody “as if” they are GD because the diet and lifestyle changes are good for everyone (preventive health care).

If your client has any of the above factors, urge her to follow a GD diet and exercise program as early as possible and then, if she does take the 28 week test, she will usually sail through it with flying colors.

This doesn’t mean that she can start eating junk food though. I tell my clients that ice cream and chocolate are toxic to unborn babies–there is way too much fat, salt, sugar and caffeine in these products for a baby in utero to cope with.

Whole, organic foods, fresh water, and love are the ingredients to grow a healthy baby.

How can we best serve the health interests of mother and baby?

If you meet your client prior to the 28 week test, you can let her know that she can improve her chances of passing the test by eating healthy, unrefined food for the week preceding the test and exercising every day (a 20 minute brisk walk that elevates her heart rate). You can explain to her that some healthy women who just ate badly (lots of sweet desserts and junk food) prior to the 28 week test have tested positive for risk of GD and then had to undergo the more unpleasant fasting 3 hour blood tests.

If you meet your client after she has been diagnosed as GDM (gestational diabetic mother), I would encourage you to attend with your client at the diabetic clinic where a nurse will give her counseling and nutrition advice. Usually, the woman will be asked to maintain a food diary and daily ‘exercise after meals’ regimen. She will be shown how to test her own blood and may be asked to count the number of times her baby kicks in a 12 hour period.

The philosophy behind the diet is that the GDM needs to control her blood sugar levels at an even rate (also known as staying in the Zone–not getting stuffed or starved) and can do so by “grazing” on small amounts of wholesome food, eaten often.

What foods should your clients avoid?
*sugar (white or brown)
*honey, molasses, syrup, jams, jellies, marmalade
*chocolate, candy
*puddings, Jell-O, fruit yogurts
*desserts—cakes, pies, pastries, iced cookies, etc.
*soft drinks, tonic water
*sweetened condensed milk
*sweet sauces—oyster sauce, teriyaki, plum, sweet & sour, ketchup

Caffeine has been shown to make the body more resistant to the effects of insulin so tea, coffee and all soda pop should be avoided.

Fruit sugar should only be consumed in small portions. ½ a banana, 10 grapes, a small apple are the serving sizes. Milk products are also high in sugar and should be used in moderation according to the advice of a diabetic nutritionist.

Update: June 16, 2015

Nice compilation of articles about Gestational Diabetes by an Australian doula http://www.themoderndoula.com.au/g-is-for-gestational-diabetes/

A Proven Method for Lowering the Cesarean Rate

Posted on August 9, 2009 by Gloria

Another article in my local newspaper last week bemoaned the fact that the cesarean rate keeps rising and physicians are concerned not only about the high rate of surgery but also the future complications that increase after cesarean surgery. It’s a well-documented fact that a cesarean can adversely affect a woman’s health for the rest of her life and can lead to catastrophic complications in future births. That’s one reason why, 40 years ago, doctors did everything in their power to prevent that first cesarean from being done.

What if there was a tried method of reducing the cesarean rate within hospitals? What if it involved some truly innovative thinking? What if it had a proven track record and had resulted in a significant drop in the rate of surgeries for first-time mothers? What if it saved money, recovery time for the patient, and better health for the babies? Would you think that method would be adopted all over North America right away? Yes, that would be a reasonable assumption. Unfortunately, this project was undertaken at B.C. Women’s Hospital, it was a success, and it was dropped once the project was complete with a resulting re-increase of the cesarean rate. No reason for discontinuing the project has ever been given but i will speculate at the end of this post.

A cesarean is major abdominal surgery

The results were published: Grzybowski S, Harris S, Buchinski B, Pope S, Swenerton J, Peter E, et al. First Births Project manual: a continuous quality improvement project. Vol 1. Vancouver: British Columbia’s Women’s Hospital and Health Centre; 1998.

It was the first phase of a Continuous Quality Improvement project with the aim of “Lowering the Caesarean Section Rate“. Start date was January of 1996. The target objective was to lower the caesarean section rate by 25% for nulliparous women, while maintaining maternal and infant outcomes, within 6 months of implementing solutions.

Staff from all departments of the hospital were brought together in a brainstorming session to share hypotheses on what was causing the high rate of cesareans. Many of the ideas thrown out were not under the control of the hospital but, in the end, four practices were identified as possibly contributing to the high rate of surgical births.

1. Women were being admitted to hospital too early (before reaching 4 cms dilation, active labour).

2. fetal surveillance by electronic fetal monitoring (continuous electronic fetal monitoring has been proven to increase the cesarean rate with no improvement to the health of the baby)

3. too early use of epidurals (women who get an epidural before 8 cms dilation are at increased risk of surgery)

4. inappropriate induction (inducing birth before 41 weeks gestational age with no medical indication).

Teams of nurses were assigned to do an audit of hospital records to see if these hypothetical practices were, in fact, as widespread as some of the staff thought. The audit confirmed that these 4 areas were ones that needed attention. Task forces were created in each area to use the best evidence and existing guidelines, as well as solutions from other hospitals to improve care at BC Women’s Hospital. Guidelines and other strategies in all four target areas were implemented in the spring of 1997.

WHAT HAPPENED?

According to published results from the hospital:
After six periods, BC Women’s had admitted and delivered 1369 nulliparous women (first time mothers) with singleton, cephalic, term presentations. The Cesarean section
rate was reduced by 21% compared to the 12 periods prior to implementation. The number of epidurals initiated at 3 3 cms was 64% lower, continuous fetal monitoring was used 14% less, the induction rate had dropped 22% and admission at less than 3 cms cervical dilation had dropped 21%. All changes were statistically significant. Newborn outcomes were unchanged post implementation.”

WHAT’S HAPPENING TODAY (2009)?

It’s back to business as usual at this hospital. Women are induced, monitored, epidural’ed, and admitted early. The cesarean rate is 30% and the head of obstetrics is concerned but has no action plan. Why on earth would this be? I assert that it is because it is an “up at dawn” battle with the physicians to change their ways. The gossip that I hear from nurses is that the doctors did everything they could to undermine this project. For example, a doctor would examine his patient and state “She’s 8 cms dilated, get the anaesthetist.” Then, later, when the woman had her epidural, someone else would examine the same woman and find her to be only 6 cms. The doctor would smile and shrug his shoulders, “whoops”. The same thing happened around the issue of monitoring, induction and admitting. . . trickery to subvert the project and return to their old ways of doing things.

It’s a low tech, novel, innovative approach that had excellent results. I’d love to see it copied everywhere in North America but it’s a bit like dieting. . . everyone knows how to lose weight (eat less, exercise more) but only a few get into action. We DO know how to lower the cesarean rate, committed action is needed.

UPDATE: July 2017

A hospital in the USA brings their cesarean rate way down: http://www.stltoday.com/lifestyles/health-med-fit/health/st-mary-s-hospital-has-second-lowest-c-section-rate/article_38258dbb-a906-5e38-9c61-e321c16d6369.html

Marjorie Tew author of “Safer Childbirth?”

Posted on April 29, 2009 by Gloria

One of my heroes in the childbirth movement is Prof Marjorie Tew of Glasgow, Scotland. I’d love to meet her and give her a hug. She came to be a supporter of homebirth even though she gave birth in hospital herself and even though she was highly sceptical when her evidence showed homebirth to be safer than hospital. This is the kind of science that I love—when the scientist holds the opposite belief but can still trust her/his method enough to change beliefs. This book review of her 3rd Ed. of “Safer Childbirth” will give you an idea of what she has done for women.

Safer childbirth: a critical history of maternity care. Third edition.
Gavin Young
GP in rural Cumbria and member of the UK government’s Expert Maternity Group, which produced the report “Changing Childbirth”

Marjorie Tew. (442 pages, £15.95.) Free Association Books Ltd, 1998. ISBN 1-85343-426-4.

This book is exciting and makes humbling reading for doctors. Its relevance extends beyond maternity care. Marjorie Tew tells a tale of the abuse of professional power, the use of misinformation and the blindness and bigotry of those who should have known better. Even the very best, like Dugald Baird in Aberdeen, could lose their scientific footing in the headlong rush for doctors to take over and hospitalize childbirth: “if it is accepted that confinement in hospital is safer for certain types of patient, where the risks are high, it must also be safer for cases where the risks are less”.

The shift to hospital birth has been one of the great sociological changes in the industrialized world in the past 50 years. Yet this change took place with almost no evidence to support it. It ought to be a source of shame to those who promoted the shift through the 1950s, 60s and 70s that controlled trials were not considered necessary. Only a few brave voices cried in the wilderness, Archie Cochrane notably and Marjorie Tew.

Mrs Tew was teaching statistics to medical students and whilst using the results of the 1970 Birth Surveys found that the conclusions reached by government (through its specialist advisers) were not supported by the evidence. Despite her unbiased stance and clear presentation of the evidence, British medical journals disgracefully refused to publish her paper until the Journal of the Royal College of General Practitioners finally did so in 1985.1

Tew presents a sad litany of errors which doctors inflicted on childbearing women including: enforced recumbency in labour, induction rates at over 50% and X-rays. “It has been frequently asked if there is any danger to the life of the child by the passage of X-rays through it; it can be said at once that there is none if the examination is carried out by a competent radiologist” (Radiologist, 1937). I would personally add electronic fetal monitoring to this list. It is not Tew but a paediatrician who wrote in 1987 “the recent history of perinatal medicine abounds with instances in which belated controlled trials eventually revealed that the apparent benefits of some widely acclaimed treatment had merely disguised the real extent of its tragic consequences”. Most of this stemmed from a belief that biomedicine would solve all the problems of childbirth, ignoring social and psychological factors. Tew has a lovely example from the Rhondda of 1936, where Ovaltine not obstetricians may have reduced maternal mortality.

We should be grateful for Marjorie Tew for her courage and determination in the face of sometimes vicious opposition. She is in the end I believe too critical of the benefits of specialist care. There may be more balanced views, but Tew’s account is lively and impassioned. Readers ought to buy a copy and pass it on to an obstetric colleague, but don’t expect any thanks.

Reference

1 Tew M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985; 35: 390–394

Added October 2013

Tew, M. Place of birth and perinatal mortality. J R Coll Gen Pract 1985; 35(277): 390-94
Using the raw perinatal mortality rates (PMRs) from a 1970 British national survey, the hospital PMR was 27.8 per 1000 births versus 5.4 per 1000 for homebirths/general practitioner units (GPUs). This was not because hospitals handled more high-risk births. When PMRs were standardized based on age, parity, hypertension/toxemia, prenatal risk prediction score, method of delivery, and birth weight, adjusted hospital PMRs for each category ranged from 22.7 per 1000 to 27.8 per 1000 while homebirth/GPU rates ranged from 5.4 per 1000 to 10.5 per 1000.
The 1970 survey assigned a prenatal risk score to predict the likelihood of problems during labor. When PMRs for hospital versus home/GPU for the same level of risk (very low, low, moderate, high, very high) are compared, the hospital PMR was lower only at the very highest risk level. All differences, except in the “very high risk” category, were significant. The PMR for high-risk births in home/GPUs (15.5/1000) was slightly lower than that for low-risk births in the hospital (17.9/1000). Moreover, the PMRs in home/GPUs for very low, low, and moderate risk births were all similar, but hospital PMRs increased twofold between categories, which suggests that hospital labor management actually intensified risks.
The percentage of infants born with breathing difficulties (9.3% versus 3.3%), the death rate associated with breathing difficulties (0.94% versus 0.19%), and the transfer rate to neonatal intensive care units for infants with breathing problems who survived six hours (62.0% versus 26.2%) were all higher in the hospital (all p<0.001), further evidence that hospital interventions do not avert poor outcomes. Although no national study has been undertaken since, smaller studies confirm that increasing use of hospital confinement is not the reason for the overall drop in PMR since 1970. In fact, those years when the proportional increase in hospital births was greatest were the years when the PMR declined least and vice versa. (End of quote) Preterm labour study by M. Tew (link to abstract) http://www.midwiferyjournal.com/article/S0266-6138%2805%2980228-1/abstract

Quote from the book, Safer Childbirth by Marjorie Tew:

“The degree of pain in childbirth perceived by a woman depends not only on the physical stimulus, but also on her emotional state and her cultural expectations.
Her perceived pain is less when she feels relaxed, unafraid and reassured by the continuous, comforting support of her birth attendant.
Not all doctors or midwives can inspire peaceful confidence and this is rarely the atmosphere in a large obstetric hospital where the obstetric practices themselves have the effect of intensifying physical pain.”

“Safer Childbirth” by Marjorie Tew, p. 172

https://wisewomanwayofbirth.com/quote-for-thought/

When nurses speak up for women and babies

Posted on March 9, 2009 by Gloria

May 2007

I’m a labor and delivery RN, and have been one for 6 years. I can tell you the #1 reason why doctors (and yes, some nurses) will push patients to get an epidural — it’s much easier on us to do our jobs. What better way to manage multiple laboring patients, than by having them all comfortable with epidurals, and a pitocin drip to “manage” the labor.

UGH. I am sick of it. The unit I work at – and I have seen this at other units that have a lot of deliveries – is like a labor and delivery assembly line.

Pitocin – epidural – c/s if you don’t progress fast enough – off with you to postpartum – NEXT!

I’ve also noticed that many women that come to the hospital where I work do not go to child birth classes. Some have no clue what pregnancy, labor and delivery is all about, and just tell me right off the bat – they want their epidural. What can I do at that point? They don’t know me. I wasn’t at their prenatal appointments. I can do some very quick childbirth education, but usually by this point, they just do “whatever the doctor says to do”.

The women that come in with some education under their belt, are usually the midwife patients. They know in their mind how they would like their labor and delivery to go, and they come with coping techniques learned in class, or taught by their midwife. Even then, most women still will end up with an epidural, and chances are, many with epidurals will need pitocin to “speed up” their labor.

I am sick of the number of inductions that are done. Most for no real reason. The docs will come up with some far-fetched reason – suspected LGA (large for gestational age), suspected SGA (small for gestational age), prior macrosomic baby, advanced maternal age, maternal exhaustion, maternal request, history of shoulder dystocia (with normal growth on current baby), elevated multiple marker (blood test around 16 weeks), hmmmm…..the really good ones…..back pain (normal with pregnancy), hypothyroidism, tired of being pregnant (TOBP syndrome).

Doctors are inducing earlier and earlier too – even doing fetal lung maturity testing on 36-37 weekers. Those babies sometimes come out and need to be intubated and admitted to the NICU for being premature.

I could really go on and on.

Jennifer G. RN

From an OB Nurse about Hospital Birth“Countless complications in labor and delivery are caused by the medical interventions thrust upon women by their ‘caring’ doctors. Theseinterventions would always set off a series of further interventions (achain reaction of interventions) to try to ‘help’ mom and baby. Andironically, after it was all over, the doctors would look like saviors tothe parents!!! And the doctors caused all the problems in the first place!!!

“I’ve seen cord prolapse occur after artificial rupture of membranes. I’ve seen fetal heart tones descend rapidly immediately after the MD inserted an invasive monitor up inside the woman’s womb. Almost daily I would see fetal distress in response to synthetic oxytocin induced contractions.

“I am sorry to say that being a new nurse out of school it was very
difficult to speak out against these things- even though deep inside me my instincts were shouting out ‘NO!’ And sadder still- the truth was that most women walked though the hospital doors asking for exactly what they got—inductions, epidurals, forceps, vacuum-assisted deliveries and c-sections.

But they were never fully informed that the labor and birth choices they were making were so dangerous to their babies and to themselves.

At least, by the end of my three years there I had developed a way to work within’ the medical system to help moms’ have their voices heard and I was always a strong patient (woman’s!) advocate- but it is so hard to work within a system that is so corrupt in its view toward women and birth!

“My goal is to work as a midwife or doula in the future and to promote women’s choices and rights in childbearing. I apologize to all those women for whom I was their ‘nurse’ and for whom I assisted the obstetricians in the dehumanizing of what should have been their most sacred birth.”

-Mary Herrington, RN. (Mary gave birth to her second baby at home)

—

From a disillusioned obstetrical nurse

“Is it any wonder why women like me are leaving the nursing profession and why there is such a shortage when you have to work with abusive people as a bystander? My conscience won’t let me do it any longer.

The doctors who are abusive to women are also abusive to the people who save their asses time and again…nurses. There is much talk in nursing circles about the real reasons there is a serious shortage of nurses. While low salaries and long hours are contributors, so is the abuse nurses sometimes put up with. It is everywhere. I’ve gone toe to toe with these assholes over the years and had my hand slapped by my bosses and even quit
jobs because I’m not going to let them push me or any one else around.

However, that abuse is much different than when a woman is in a vulnerable state, cold and naked in an exam room or when she is laboring. Nevertheless, their behavior is still abusive.

“And I find a lot of the language surrounding birth to be downright
demeaning. For example, I was talking with a pregnant woman last week who was telling me the only problems she’s had with this pregnancy were recurrent bartholinitis (an infection of the Bartholin glands, which are just inside the vagina and provide lubrication during sexual arousal). I thought to myself, why the hell are they named after some doctor who discovered them. Why aren’t they called ‘vaginal lubricant glands’ or something like that? Arrogant, aren’t they?” -Karen

—

From an obstetrical nurse regarding elective inductions and cesareans

“Time & again, it’s the Mom who has requested an induction. I always tell them- when you got pregnant it was for nine months- not 8 1/2! Of course, we chuckle over the ‘disease’ of the week MD’s come up with for deciding to induce- PIH (pregnancy induced hypertension) and my personal favorite- ‘impending’ macrosomia (big baby). Fortunately, we do not use Cytotec, but
Cervidil. Still, inductions definitely lead to increased epidurals and
c-sections. Even more alarming, lately we have had a few ‘elective’
c-sections. I have heard inklings from a couple of MD’s that this ‘saves’ the vagina and prevents urethral trauma and stress incontinence later in life! I said to this doc (in the middle of a c-section, I might add) ‘I’d rather pee in my pants!’

“And would you believe that a female ob/gyn is giving seminars to docs touting this baloney? I don’t mean to get down on all MD’s- most of the ones I work with are wonderful, but some…..? So again, I stress that these women MUST educate themselves (and we RN’s must assist in educating them) on just what the consequences of their decisions could be. First and foremost WE MUST REMEMBER that we are their advocates! We have the knowledge- use
it!” -Jana

—

Flashbacks, and grim reality

“I am a nurse in the Special Care Nursery at the hospital where I had my c-section so I am confronted with flashbacks and bad feelings on a constant basis. It is awful!

“We were called to a ‘stat’ c-section the other night for ‘severe fetal
distress’ and the sOB’s started cutting this woman before the anesthesia was effective…and they did the old pull and tear maneuver while she could still feel it also. (It was in the same OR as I was in to have Alexandra.) I started sweating and got really anxious, scared, and thought I was going to throw-up and faint at the same time. But then I said, ‘OK PEOPLE YOU HAVE TO
STOP!! THIS MOM IS SCREAMING AT THE TOP OF HER LUNGS!!!’ They did stop and then gave her a general… but I felt terrorized all over again… and that poor mother!!”

“D”

Mama to Alexandra

_________________

Jan 6, 2008

In Response to a news item “ 2 N. J. Moms who died. . . hospital situation” Jan 6, 2008 8:06 am (PST) I am a registered nurse, and have no intention of ever working within a hospital setting again. It really is all about the business and not about the patient. The human life we are caring for. In NJ, where I reside, there is a nursing shortage. In addition to a nursing shortage, there are very poor unregulated nurse patient ratios, making quality care hard to provide when the nurse is spread thin. I don’t know what the mother baby ratio was at Underwood, but I do believe that with the appropriate monitoring, these cases if truly resulting in hemorrhage and a clot perhaps may have been prevented. But there are a lot of questions that need to be
asked. At what point in their stay did the episodes occur? Where was the clot? Was it a pulmonary embolism? Clot went to the lungs.
A myocardial infarction? Clot went to the heart. A stroke? Clot went to the brain. Was her PT/PTT time measured before or after the surgery?
Bleeding time. What were her platelets? Clotting component. These measure clotting predictability. Was she wearing compression boots on her legs and if so, for how long. This is to prevent clot formation, which is very often where clots form s/p surgeries due to venous stasis, and platelet formation at the incision site. How often was the nursing staff in the room? How often were her vitals measured? Did she complain of any DVT (deep vein thrombosis) pain? Leg pain, heat, swelling of the leg at the location of the clot? There is clot
busting medication available IV for emergency situations. But if no one was in her room for hours upon hours, no one would have seen the signs. I know from my 4 c/s that nurses don’t frequent the room as often as they should and they don’t respond quickly to your calls on the call bell. Was her vitals
monitored? If so, how often? what was her PT/PTT pre-operatively &
postoperatively? Was something nicked? Was it vaginally? Did they attempt
a blood transfusion? Did they attempt to stop the cause of the bleed?
There are so many unanswered questions here.

My horror story They medicated me and took my baby back to the nursery. They told me they
would bring him back at one am to breastfeed. They did not. I awoke at 6am
when they did my vitals, which was done by a tech, at the beginning of each
12 hour shift. Q 12 hour vitals are not enough to detect a potential
postoperative problem. They never brought my baby back. I asked for him,
and was told, soon. I called again at 7 and they were in the middle of a
shift change. I called again at 7:45 and was told the babies were being
seen by the docs and he would be brought to me after. 8:30 I called down
and was told that he was being seen by the doc. 9 am, the doc came into my
room, no baby. No nurse. It had not even been 24 hours since his c/s
birth. I was still medicated, still could not feel my legs, I was in
compression boots, still had the foley catheter, still had the IV. The doc
sat at the foot of my bed and proceeded to tell me that my baby had stopped
breathing, needed resuscitation. There were other details but all I could
here was my baby stopped breathing. He WAS fine when he was with me. He
left me there, by myself. I called down to the nurse, that I needed her
NOW. No one came for the 15 minutes that I was on the phone with my mother
and my husband telling them what had happened and to come down. I had to
call the nurses station again, this time, demanding that a nurse come and
release me from everything or I would do it myself.for God Sake my baby
nearly died. One came, and an hour later I was being wheeled down to see my
baby..nothing urgent to them. Not enough staff to meet the needs of the
patients. My son is wonderful, thank GOD, he is 16 mo old! But if I could
not get nursing support, and I was calling for it, who is to say that this
was not part of the problems in these Underwood cases? Tiffani

In response to: 2 NJ Moms who died after CS – cause of death?

Well, last I heard, “they” had investigated and found no liability on
the part of the hospital — which can be looked at 2 ways — sometimes
women die from “known” risks of surgery and there really isn’t anyone
“at fault” per se. Or, if you believe that you can always find fault
somewhere, then basically a deal was made with the families and no one
is talking about it. I’d heard that one death was due to hemorrhage
and one due to a clot. Being a surgeon, I could see both of those
things happening even if everything was done “right”, though the risk
of them could be increased if things weren’t done the best way
possible.

—
Gretchen (Veterinary surgeon)

__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
AND NOW, IN A DIFFERENT TONE, WE HEAR FROM NURSES WHO ARE ON THE OTHER SIDE.
This item made the rounds a while back after it was posted on Cafepress. It’s pretty horrifying but, somehow, it is good to have spoken out in words the attitude that I have seen on the faces of so many of the burned out obstetric nurses. The truth shall set you free but first it will upset you.

Gloria

Rules of the Labor and Delivery area1. Don’t ask me if my wheel can tell you if you got knocked up on the 15th or the 16th. That’s too damn close to have 2 different partners anyway… Just suffer for 8 more months, assuming the father is not the one it should be.

2. Bed rest does not include walking around Walmart, or running by the mall to pick up something.

3. Don’t come in the middle of the night because you’ve been throwing up for a week… and then ask me to get you something to eat.. 4. Breathing hard, and faking to your family like you’re having contractions, WON’T open up your cervix.5. Tears, and rolling around in the bed also will NOT open your cervix.

6. Doing sit ups while in the bed to make the monitor “go up”…. also….. WILL NOT open your cervix.

7. Until your cervix is opening….. don’t plan on staying.

8. If you fight with your boyfriend and need a little TLC… go to his mother’s house, not the labor room.

9. If you are ther e with someone in labor, don’t try to read the strip and tell me what’s going on. You don’t know the difference between a fart and a contraction and you’ll likely just piss me off and delay your loved one getting pain medication or her epidural.

10. When I ask the patient a question, that’s who I want the answer from… OK? I don’t need her mother to tell me when she had sex last….

11. This day and time, if a patient is between the ages of 37 and 42… she has had approximatley 2-5 partners. If she is between the ages of 28-36, the average is 7. If she is in her early to mid twenties, then her age is how many partners she’s had… If she is a teenager, then “too numerous to count” applies. (and she has had, or currently has chlamydia or trich)

12. Open your damn legs. If you were a virgin, you wouldn’t be here.

13. Shave that shit. If we wanted a trip to the jungle… we’d go there.

14. Clean your ass before you come in. Unless you have the umbilical cord ha nging out, are in a serious accident, or are bleeding profusely, take time to wash it up a bit… it’s going to be on display.

15. You’d better be nice to your nurse. She, not the physician, decides when you get pain medication.. . There is such a thing as placebo. We can also make you wait the entire 2 hours… adding 45 minutes for our convenience. .. or we can give it to you 15 minutes early…. it’s all in your attitude.

16. The fewer visitors you have in with you… the better mood your nurse will be in.

17. Get rid of that one “know it all” visitor before it’s too late. She can ruin the entire experience for you by pissing me off.

18. If this is your 6th baby, either get the epidural before you come in, or don’t plan on one.

19. Don’t blame us when you’re baby can’t say it’s own name when it’s 5. Chances are, it was the cocaine you snorted in the parking lot, just before you were rushed in abrupting.

20. If your pulse is 50 when you come in… from all the downers you’ve been downing… chances are your baby will be several bricks shy of a full load. It’s your fault, not ours.

21. When I ask you if you smoke… you should include marijuana in that answer. Other things that should be included are, hashish, crack, meth, and any other illegal drug that you may have smoked. Nicotine is the least harmful of all the crap you could smoke…dummy.

22. Don’t bitch at us because your baby has to stay in the hospital until it’s 2 months old, weaning off of Methadone or Morphine. Regardless of what the bullshit clinic says to you…. Methadone is NOT healthy for babies.

23. If you call us and say you’re bleeding profusely, then I’d better see some blood when you come in. Do you know how many people we notify for shit like that!

24. Hard labor doesn’t just stop with 1 bag of IV fluids. We know a faker when we hydrate one.

25. If you’re an addict, we already have a preconceived notion about you, and we probably don’t like you. Nothing personal…. it’s just the way it is. You chose that life… now live it.

26. Regardless of the fact that your neighbor’s sister’s aunt had a baby at 30 weeks and it is perfect… that does NOT mean we’re going to let you have yours at 30 weeks.

27. Your neighbor’s sister’s aunts baby likely had to stay in the hospital for 6 weeks, and could possibly have problems that you’re not aware of… dumb dumb.

28. You’d better tell us if you’re on narcotics… trust me…… We’ll know soon enough, because our drug of choice is Stadol…. HA HA.

29. If you have track marks on your arm, “NO YOU CAN NOT GO OUT AND SMOKE” with your IV. What do you think we are, Stupid?

30. Don’t scream. We hate screamers. It get’s on our nerves and we just sit at the desk looking at each other and grinning and making faces. It’s not to your advantage.

31. If you don’t have custody of your 3 other kids, chances are you won’t go home with this one either. We ARE calling Social Servi ces. That’s our job.

32. If the baby’s dad is in jail, and he’s still your boyfriend, we automatically assume “birds of a feather flock together”.

Wise Woman Way of Birth

Gloria Lemay on natural birth, breastfeeding, and other womanly matters

Tag Archives: obstetrics