[first baby, birth center turned hospital transfer, vaginal birth}
Healthy Mom, Healthy Baby
The experience of a laboring mother, father and a grandmother at Sarasota Memorial Hospital
“You have your birth plan, I have mine. When yours does not agree with mine, we will go with mine,” Dr. Abu declared. We were at SMH for a 36 week pre-term delivery. My husband had to fight passionately against unnecessary medical interventions including pitocin before and after delivery, a continuous IV, episiotomy, and immediate cord clamping. The tension in the delivery room was so high that it was a miracle my labor did not stop altogether. We sacrificed a peaceful, joyful delivery for my health and the health of baby Katherine. With the exception of delayed cord clamping, we got the birth experience we wanted. Unfortunately, we had to fight tooth and nail.
April 16th, 2012. 12:50 AM, 36 weeks gestation, my water broke. We knew before calling Birthways, the birthing center where we had planned to deliver our first child Katherine, that we were headed to Sarasota Memorial—Katherine was one week too eager to enter the world.
3:15 AM we were admitted to the hospital. Triage had confirmed Katherine was indeed on her way. Our midwife, now doula, Kaitlan waited outside as two nurses introduced consent forms and performed preliminary exams.
We wanted Kaitlan in the room as we waded through the decisions and paperwork. She had been through this process before, and as doula, would have been able to offer invaluable advice. We requested her presence three times. The fourth time, the nurses finally called her, but she never came. Labor and delivery turned her away, inconsiderate of the fact that she was our hired doula.
4:00 AM found me one centimeter dilated. By this point, I was overwhelmed with the sheer number of things vying for my attention—two nurses asking questions, the paperwork I was trying to read and the contractions just beginning to come. Kaitlan was still not present when Dr. Abu entered the room and we truly needed her input.
“You have your birth plan. I have mine. When your birth plan does not match mine, we will go with mine. You need a continuous IV, and because your labor is not strong enough, I am putting you on pitocin,” he commanded, leaving no room for discussion.
This was not the birth I wanted. I knew the effects of pitocin, and I knew that my situation did not yet merit such a drastic measure. My water had broken only three hours before, and my contractions had been increasing until the nurses and Dr. Abu entered the room. The stress of the current conversation was slowing labor. If time proved that my body was not acting as it should, I would have considered the drug as a means to prevent a C-section, but currently, it was an unnecessary measure whose consequences for baby and I far outweighed the benefits.
Neither did I want a continuous IV. If getting my labor going was a concern, I wanted to use natural methods, namely walking and nipple stimulation. A continuous IV would limit my movement and therefore limit my progression.
If dehydration was the doctor’s reasoning for the IV, the doctor did not take the time to ask about my liquid consumption. I had drunk more than a liter and a half since my water had broken, and I was continuing to drink.
“Give us four to six hours to get labor going. Then we can consider the pitocin,” my husband and I countered. We did not agree to the IV.
“I’ll give you two,” he responded brashly and then tried to motivate us with fear. “Your water broke at 36 weeks. There’s probably something wrong. You may have an infection.”
I broke into tears shortly after his departure, not because I was afraid there was something wrong with my body, but because the doctor was threatening to take what I had spent eight months preparing for with excellent nutrition, water intake and research. I wanted a natural delivery. I knew the pitfalls of the drugs and interventions the doctor was so adamantly pushing.
The nurse began to prepare the IV. “We didn’t agree to the IV,” my husband looked at me. I was willing to take it, but he knew how important my freedom of movement was. We asked the nurses for a few minutes alone. Kaitlan was still not present. Knowing her knowledge and experience would bring peace to the situation, he called her directly rather than ask the nurses, and then he left the room to find her.
Make peace Kaitlan did when she came into the room. “You could come to a compromise. Ask to be connected to the IV for twenty minutes to receive the antibiotic for Group B Strep. Then ask to be removed to allow movement.” The hep-lock we had requested would make this possible.
The nurses agreed to our suggestion and allowed us time to walk the halls. Walking and stimulating my nipples, labor progressed rapidly. Contractions came closer together and stronger. When the nurses asked us to return to the room for the IV, I was satisfied.
6:00 AM. By the agreed-upon time, I was in active labor. The contractions required my full attention, and I was more than moaning in pain. The nurse checked me. I was three and a half centimeters dilated. There was no more mention of pitocin until the baby was crowning.
I am grateful we fought against pitocin. Had I accepted it, my contractions would likely have been too strong to manage. I would have required other interventions.
As labor became more intense, time blurred. The nurse allowed me on a birth ball for a short time before requiring me to lie in bed, once again attached to the fetal monitor. I respected their desire to keep tabs on Katherine’s health, and the nurse said she would detach me after ten minutes.
Ten minutes never came. The monitors would not stay attached long enough to acquire ten full minutes of data. Except for bathroom breaks, I was attached to the monitor and confined to bed for the duration of labor. Thankfully, the nurses were gracious about allowing my movement within the bed.
9:00 AM. I had dilated quickly. Sitting on the toilet, I suddenly felt the urge to push. The nurse rushed me back to bed and confirmed what I already knew. I was at ten centimeters.
“Don’t push!” the nurse directed as she left the room.
‘Don’t push?’ I thought. ‘There’s no way!” I pushed anyway.
The nurse returned shortly and directed my pushing. Her counting was very helpful, and before long, to my surprise, the nurse called for the doctor. Katherine was close.
As Katherine was crowning, Dr. Abu held up the scissors to perform an episiotomy. “I’m going to cut her,” he announced without asking permission.
“You will not cut her,” my husband responded.
Dr. Abu was aggressive, “I’m going to cut her. I need to do it now.” The discussion turned into a full-on quarrel, and the atmosphere in the room was so intense that my mother could no longer stand. Gone was the hope of a peaceful delivery, overrun by the fight for a “Healthy Mom, Healthy Baby.” Incredibly, I was still able to focus, and the war raging around me did not affect my ability to deliver Katherine.
“Everyone be quiet,” I groaned, “ I need to push!”
The room quieted temporarily before the volume rose again. “Ask her,” my mother practically yelled.
All eyes turned to me, and between pushes, I made my wishes known. “No! Do not cut me. I’ve done my research.”
“This is not about research,” Dr. Abu negated my hours of study, “This is about what needs to be done.” He and my husband went at it again.
“I would rather tear than be cut,” I interrupted. I repeated myself to make sure I was heard, “I would rather tear than be cut!” I knew Abu heard me, but whether he would comply was another matter. My care was in someone else’s hands, and I was incapable of protecting myself. In the end, Dr. Abu did not perform the episiotomy.
Next came the dispute over cord clamping. The blood in an umbilical cord is the baby’s blood, and research shows that babies fare better when the cord is allowed to stop pulsating before it is clamped. My husband requested multiple times that Dr. Abu refrain from clamping until Katherine had received its blood. Abu refused and clamped the cord immediately, insisting he needed the cord blood to do tests because of her pre-term delivery. I cannot fathom that medical testing outweighs the overall health of my infant. We would have been pleased to have her blood drawn after her cord had finished pulsating. Instead, Abu disregarded our wishes.
I was very pleased that Dr. Abu placed Katherine directly on my chest after delivery. This was one of my greatest desires, and he made it happen.
After delivery, he once again tried to put me on pitocin. “She needs pitocin. Her platelet count is low. She may bleed out if we don’t.” My body, at that time, was showing no signs of hemorrhage. We understood the doctor’s concern, but stood firm against the force of his words. “Give us an hour. If I start bleeding, then administer the pitocin.”
I never hemorrhaged. My platelet count began to rise within 48 hours. The nurses in recovery were surprised at how high the other aspects of my blood count were compared to the norm they encountered in the hospital. Now, only a week after delivery, my bleeding has practically stopped. The pitocin was once again an unnecessary fear-based measure.
We did not need any of the medical interventions Dr. Abu so aggressively pushed. With natural means, labor progressed more than twice as fast as the average of over 20 hours for first-time Moms. Katherine was in my arms nine hours after my water broke. If I had accepted the pitocin, the contractions would have been too strong, and I would have required additional interventions. I did not need the continuous IV to ward off dehydration nor the pitocin to prevent hemorrhage.
Katherine required no interventions after birth except the suctioning of mucus from her airways. With a little coaching from our nurses in recovery, who were fantastic at what they did, we are breastfeeding eight times a day, and a week after delivery, she is only one ounce shy from her birth weight. Her pediatrician at her one week check-up declared her lungs, heart, weight and color excellent.
I am grateful that my husband fought for my health and the health of my baby. I am grateful for the natural childbirth we had as a result of his strength. We did not have pitocin. I was not connected to a continuous IV. I did not have an episiotomy.
“Healthy Mom, Healthy Baby.” Though Sarasota Memorial’s labor and delivery team touts this as their end, I would invite them to reconsider their means. A woman’s body knows how to give birth and in most cases, does it naturally.