"I'm starting to feel some pressure, and it's kind of painful " Monica said as she laid there in bed. This perked up my ears-as a doula, those are the magic words. Pressure is wonderful. Pressure means things are happening. Pressure means the baby is coming. Another half an hour went by and the pain continued.
"Do you want me to get your nurse? Maybe we should push the button?" Monica's pain was getting worse and worse and wasn't subsiding with her epidural button.
"I've already pushed the button as many times as I can this hour" she said.
"And the pain is getting worse?"
"Yes, and I'm starting to feel my legs!"
I left and found her nurse and anesthesiologist. They came in and dosed her again, her third extra dose. They watched and waited. The pain didn't subside. Her Anesthesiologist explained that sometimes women just metabolize pain medication quickly and he'd given as much medication as he could. He apologized and left. Her previously helpful nurse shrugged and left too as Monica headed into more back-to-back pitocin-induced contractions.
I pushed on her knees and processed as quickly as I could. She had 2 internal monitors inside of her, a catheter, an epidural in her back, 4 IV lines in one arm and a blood pressure cuff in the other. She was literally tied up in the bed with no alternative positions to get into. A tub or shower was completely out of the question and getting her to her hands and knees seemed impossible as well. Knee pressure was helping but we were very quickly escalating into transition and I wasn't sure how that was going to go given the very limited circumstances.
Her nurse returned, hanging another IV fluid bag and adding it to her lines, not saying a word to us. She was joined by another nurse and they silently charted and left. I assumed it was another attempt at pain relief and said nothing as we were busy keeping Monica calm and working hard.
After another hour of difficult contractions her husband waved silently to get my attention. I looked and saw him mouth the words "Insulin" while nodding towards the machine. "Insulin?" I mouthed. "No, it can't be running..." I looked and it was. Her nurse had hung a bag of insulin.
When Monica had checked into the hospital, she explained to her nurse about her gestational diabetes and asked how they would be managing it while she was in labor. Her nurse explained that they would switch her back and forth between saline and sugar/saline while regularly checking her blood sugar levels to keep things even. Monica explained that she hadn't used insulin her entire pregnancy and it was very important to her that they avoid giving it to her unless it was absolutely necessary. Her nurse agreed and said she doubted that it would ever be necessary.
Yet here we were, looking at a bag of insulin dripping into her veins. As Aaron and I looked at each other, silently contemplating what we should do, Monica started pushing.
"I'm going to go grab your nurse, I'll be right back" I said. I found her nurse in the hall and asked about the insulin.
"Well, it was only a little bit, like the tiniest bit so I just didn't say anything" she explained.
"Um, well, I think you may want to mention it to at least her husband. I know it was something they were very specific about" I said. We got back to her room and her nurse gloved up and checked her.
"You have an anterior lip. Don't push and I'll come back and check on you in half an hour" and she left.
The next half an hour was rough. Monica panted her way through contractions doing everything she could not to push. About twenty minutes in she started pushing again and I ran to grab her nurse. This baby was coming. Her nurse went off to find her doctor and took another fifteen minutes to get back to the room. Her nurse checked her and yelped. She paged everyone and the room flooded with nurses.
Monica had found her happy place laying on her side. Her doctor arrived last and had just enough time to get gloves on as they rolled her on her back. She had previously injured her back delivering her first baby flat on her back and had requested not to deliver this way. I brought this up with him and he replied "Its fine. She's almost delivered anyway." She quickly delivered with only a few pushes and collapsed back, overwhelmed by the pain and agony of the entire thing.
I followed the baby to the warmer to take some pictures and began to realize that Monica was groaning and crying. I assumed it was her delivering her placenta and it took me a minute to realize this was beyond normal. I walked back over and grabbed her hand.
"Are you ok? What hurts?" I asked.
"What is he doing?? Why does that hurt?" she asked. I looked and realized her doctor was stitching her up. Without any pain medication. She was screaming as he tied the knots.
"What are you doing?! Her epidural wore off! Did you not give her local?" I asked, incredulously.
"I'm almost done" he replied. He proceeded to place 5 more stitches as I watched my friend writhe in pain because her genitals were being stitched up without any kind of pain relief. In a first world hospital. Where she will pay a hefty bill.
During all of this her nurse pulled the bag of insulin and tossed it in the garbage, never saying a word to Monica or her husband, leaving the room as another nurse took over Monica's care for postpartum.
I wish I could tell you this is just a fictional example of a story-that it's somehow over-exaggerated or untrue. It's not. As I've talked to more and more women I'm realizing that what happened to Monica is considered mild. Many women have episiotomies without permission, are threatened by their doctors with their lives or the lives of their babies and very often do not consent to what is being done to them.
What frustrates me even more is the response I often hear: "But is the baby ok? I mean, no one died, right?"
That's our standard-no one died? That is great, but in America, we're not even doing very well at keeping everyone alive. Our maternal death rates are the highest of all the developed countries and rising. In Monica's case everyone lived but she's a perfect example of how poorly the US is doing in terms of maternal morbidity. (Maternal morbidity includes physical and psychologic conditions that result from or are aggravated by pregnancy and have an adverse effect on a woman’s health).
Maternal morbidity rates are only rising and deeply affect women throughout their lives. Many women don't realize the rights they have to consent when it comes to childbirth. It's a delicate dance because OBs/Midwives are trying to deliver your baby safely and some interventions are necessary BUT not always, and not matter what, you should be consenting to what is happening to your body.
The right to informed consent is protected in most legal systems. Informed consent is generally both a right of every patient, and a legal duty owed by the healthcare provider toward the patient. A doctor has to provide patients with information relevant to their treatment, the risks and benefits of their healthcare alternatives, and to get the patient’s consent for any treatment or decisions about their care. Every patient has a legal right, grounded in their human and/or constitutional right to physical autonomy, to make the decisions about their healthcare, by granting or withholding their consent to any proposed intervention. People make decisions about their care based on many factors, including their personal life history and circumstances, which can be known only to themselves. (from human rights in childbirth)
In Monica's case, the insulin was probably necessary-but never mentioning it to her? That was completely un-necessary and honestly a little unnerving. Apparently if you check in to a hospital it gives them the right to dump whatever they want into your veins, without telling you. She could have easily delivered on her side-but for the doctors familiarity and comfort, was rolled to her back, risking further injury to her previous back injury. And the stitches? 100% UNNECESSARY to do without any pain relief. That was just painful torture that she will pay for. She left her birth feeling completely powerless, traumatized and overwhelmed by all that had happened to her. This is no way to send women into motherhood.
These things are not ok.
“Whether or not you have or want children,” says Cristen Pascucci, founder of Birth Monopoly and vice-president of Improving Birth, “please don’t ignore the reality it is still permissible, in 21st-century America, to tell a grown woman to shut up, lie back, and not question what’s done to her body.”
This isn't about Doctors vs. Midwives. I've seen homebirth midwives bully and coerce women as well. This isn't about home vs hospital-trauma happens at the hands of bad care providers in both settings. I'm not trying to paint a picture that doctors are out to get you. They're not. They usually want to help. But it's not ok for them to proceed without explanation, without consent, or with the thought that you shouldn't have a say in your care. You should always be consenting to what is happening to you, and even more important, AWARE of what is happening to you. I see trauma-free births happen in all settings, and I want that for every woman.
What is the solution?
It's time we speak up. It's time we realize what is and what isn't ok during childbirth. It's time for women to stop suffering in silence and believing that all of the trauma that happened to them was necessary to keep them or their baby alive. In my experience, most of the trauma is completely unnecessary and didn't save anyone! Just because someone went to med school does not make it ok for them to cut your genitals without your consent. If you removed the baby and the hospital setting from the situation, we would have fire and pitchforks ready to crucify the person that would do such a thing.
If you've been a victim of birth trauma, speak out. Contact your hospital and let them know what happened to you and why it was un-acceptable. Contact your care provider's office as well. Be sure to comment on their facebook pages and other social media. Rating a doctor poorly on facebook was once was the only way I got a response back. Warn other women about uncaring and hurtful doctors and midwives. We need to stop giving them our money and start giving them consequences for their actions. In Monica's case it would have been SO EASY for her nurse to mention she was giving her insulin while she administered it. It would have been just as easy for her doctor to leave her on her side to deliver as rolling her flat on her back. And the local anesthesia to numb her sat unused on his tray. Five extra minutes would have meant Monica wouldn't have needed to suffer through the feeling of having her genitals stitched up after delivering a baby. All unnecessary trauma.
I don't want to continue to see these easily fixable things happen. Please speak out. Share your stories. Fire care providers that haven't treated you well. It's up to us to fix this.
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