labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, November 7, 2007

Are You Gonna Go My Way?

I was caring for a young girl who was laboring beautifully. She wouldn't describe it this way, with each contraction an exclamation of how fucking awful it was....and then she would continue on text messaging. She didn't want any pain medication, but kept talking about being numb. I was confused as to what she wanted, and talked to her about her options. But she wasn't having any of it.

After a couple hours of the fucking awful contractions and text messaging (oh, and sneaking in some glances at I Love New York 2 on VH1), she said she was ready for some medication. I called for the doctor, who said, "So we'll get you an epidural."

I said something about her asking for IV medication, but the doctor turned to this young girl and said, "Do you really want to be feeling this or do you want to be numb?"

"I want to be numb."

"An epidural, it is!" exclaimed the doctor.

And so the epidural goes in without a hitch. I suggest that maybe she could get a nap. She said she'd rather watch tv. Either was fine with me. She was happy.

But then the baby wasn't. The baby's heart rate took a nose dive. I told her to roll onto her other side as I opened up her IV fluids and put the oxygen on. She said she didn't want to. She was comfortable. I told she had to. Her mother came to my side and told her to do what I asked. And she began to complain. She would not move.

"Please, please roll onto your other side," her mother begged. I pushed the emergency light by this point and was expecting the barrage of people to come in.

And then I said something that got her to listen. "I don't care that you are comfortable. You need to get onto your other side now. Your baby's heart rate is down and moving onto your other side can help!" My tone was not nice. I felt like I was reprimanding her. Yet she listened.

After a few minutes the heart rate came back up. She looked scared behind her oxygen mask. I paused to catch her eye. "Listen," I said, "I want you to know I didn't intend to sound mean, but when the baby's heart rate goes down I need for you to help me."

This came to mind because I have been reading about birth trauma. I find myself reflecting on interactions I have had with the women I have cared for and wondering if I have made anyone feel scared or traumatized. I certainly don't think I am above it; I mean, I do work on a labor and delivery unit in a hospital... with a very medicalized approach to birth...I am part of a system that can take total control over every move. I learned labor and delivery nursing care under a medical model. I am sure that there were times I fell under the belief system of The Man. I try very hard to be the advocate for the woman I am caring for, but it is very hard to follow through with that in this environment. Hearing myself sound so authoritarian and bossy was a startling reminder of this.

This girl ended up with an emergent cesarean birth. The doctor said that no one could go in with her; hearing this pushed her into a pile of tears. I went to her side and said, "I will be with you the whole time." Once she was transferred to the OR and on the table with 6 people over her, prepping her, shouting out different things, I stood at her head. The anesthesiologist had the "gas" mask on her but big tears were streaming down her face. As the room spun in a controlled chaos, I put my hand over hers (strapped down, of course) and squeezed. For a fraction of a second I felt guilty for doing this as I watched the people who came in to help doing her abdominal prep or gowning the doctors. She hung on until the anesthesia kicked in. And I hoped that I did something to help her feel ok about what was happening.

Oh, and once she was awake in the recovery room she was text messaging again.


LeosMama said...

The medical model of care sets women up for this. They're not taught (from childhood, not just from the beginning of hospital-led birthing classes) about being in control themselves, about the pain being manageable and how to manage it, they're not taught about the things they can do to make labor flow better and things that will make it flow worse.

She wanted to be numb. She wanted to pretend life wasn't happening to her. She refused to acknowledge that any of her choices had consequences and so gave up all of her power. To people who also don't seem to realize that choices have consequences.

And she ended up tied to a table with strangers cutting her open to save her baby.

It's infuriating and it's not all her fault. Not at all.

As for your part in it, I can only guess, but I think a lot of birth trauma comes from women not being included in the decisions, not given information in a respectful manner, not being included in the decision-making. I can imagine that's difficult when the laboring woman is not educated enough about the situation to understand the information or to make safe choices. Or when she's not emotionally mature enough to make safe choices.

Betsy B. said...

What a frustrating situation to be in. Sometimes you have to be a bit mean to save a life.

Utahdoula said...

I think that just by being aware that your actions can have a profound effect on her and trying to be compassionate you make a difference.

Mother Jones RN said...

Wowser! Please submit this for the next CoS.


Anonymous said...

I think at that moment, she needed you to be firm. I recently had a birth with an OP baby, and the nurse wouldn't "let" me shower for comfort, nor even go to the bathroom (I had no IV, no meds). She bartered with me, if you let me check your cervix and it's not close to delivery, I'll let you shower. After putting me flat on my back, my baby had a heart decel. She turned me to my side, and baby still had a decels going. She stuck the IV into the heplock, and put O2 on my face. I sat up, because I was convinced that the heart was low because I was placed on my back to begin with. I sat up (and the nurse argued with me) the heart rate came up. After that, I complied but would argue a bit with the nurse. She had me on my back ever 20 minutes to check my cervix, she kept hands in to "move the last bit of lip out of the way." She had me pushing on my back, telling me it was the best position to get baby out. All the time I wanted to get up, not push until I was dilated, push squatting. Finally, the OB realized I had an OP baby and let me get up. I had the baby in the caul 10 minutes later. This nurse had spent half a day arguing with me, fighting me, and this time, I was right, I needed to be up. This was traumatic for me. However, if my baby's heart rate hadn't changed because I sat up, I would have complied and been greatful for her fighting for my baby's life. It's just that I think the interventions were causing suppine hypotention or other problems...and the OP baby needed me up and on hands/knees to move. She was doing what she was trained to do, and many times, it's the right thing. She just needed to let me know she was listening to me, and trusted me...and that she was there not just to scare me into complying. Hopefully, she'll be like you and will actually care what a woman feels when in labor. Then she can learn when to push, and when to let mom try it her own way.