19 August 2011

Midwifery Follow-Up :: Ewan's Hospital Birth

First of all, I wanted to thank you for reading and offering your feedback on my recent series on why we're opting for a midwifery model of care. I know there are a variety of strong opinions in just about anything concerning pregnancy and birth, but the feedback (even from those who prefer to receive care from an OB) was largely positive. I ended up learning some new things myself, and got to hear from those of you who have great things to say about the medical care you've received (or about the great midwives you had)!

I received one question that I thought about addressing in the course of the series, but (because I was concerned about length) didn't get a chance to write about. I was asked about how it was to have Ewan's birth in a hospital setting with an OB, so I wanted to take some time to answer that inquiry.

I have and will continue to sing the accolades of Dr. J, our OB in Washington State. We didn't find her ourselves, but was referred by our midwives when we learned about Ewan's heart. When I called to set our first consultation, the receptionist went on and on for about 15-20 minutes about how wonderful Dr. J was without me even asking her for her opinion. She was confident I would love her, and our first meeting with the good doctor proved our receptionist right.

We had a lot of questions for her, most of which she answered before we even had a chance to ask them. She said something like this: When I took this job, I understood that I'd be working incredibly long hours and getting called out of a sound sleep in the middle of the night. I trust a woman's body. If a woman was meant to have a baby in six hours, she'd have a baby in six hours. As for episiotomies, I just don't cut them. There are women who I swear would tear to high heaven who never did, and women who had their seventh babies who I thought would stretch nicely, but I ended up taking over an hour to stitch them up afterward. If you're going to tear, it's better to just let you tear. Now if we get to the point where something doesn't look right, nobody is going to freak out. I will let you know what's going on and we'll talk about it, and I'll let you make your decision.

We were sold. And her actions in subsequent visits (and in our birth with Ewan) bore out the truth of what she told us at the beginning. What's more, she was incredibly proactive. Before we even had our first consultation with her, she got in touch with the doctor in charge of the NICU at the hospital where I'd be delivering to make sure they were set up to handle a baby with Ewan's condition. She got in touch with them again four weeks prior to my due date to make sure they were set and ready to go, and again when she sent us over to the hospital from her office. Again, she was totally amazing and on top of it.

The overall hospital experience, however, left something to be desired. While I understand people are human and while I do not expect perfection at every turn, I also am savvy enough to know that there are certain standards to be observed when caring for someone in a medical capacity. Take a look for instance at this picture my husband snapped with his BlackBerry while the nurse was getting my IV ready.

Oh, modern medicine.

That's right. She's getting ready to put an IV in my arm, and is doing her prep work on a TRASH CAN. Even if the lid of that trash can had just been sanitized, is it really appropriate to stick a needle in someone's arm with materials that have been resting on top of a surface that says in big black letters WASTE ONLY?!

Fortunately, she was not our nurse for very long.

We had some great and incredibly caring nurses over the course of my labor, and nurses who (especially toward the end) kept asking me if I wanted any meds so I could be more comfortable. There are a whole host of reasons I won't get into here for rejecting medication, but one primary reason outweighed the rest: I didn't know how long Ewan would be with us, and I didn't want to be numb (literally or figuratively) to any of it.

When it came to post-partum care in the hospital, I had some fantastic nurses who were very patient and tender with me. Because of how quickly Ewan came out, I was one of those unfortunate ladies who tore to high heaven, as they say (north, south, east, and west) -- to the third degree. Ouch. They took amazing care of me. One nurse I was particularly thankful for since, when she was reviewing my chart to verify the course of post-partum medications, noted that I had a vaginal birth and not a c-section, so what was that drug (specifically for those recovering from c-section) doing listed on my regimen? I'm thankful she caught that error before I had something on board that I did not need.

And finally, there is something to be said for the NICU. I mentioned how our doctor was proactive in assuring that the NICU would be ready, not only with the right medications and supplies, but the staffing as well. When Ewan came, the doctor who was supposed to be in the NICU was nowhere to be found. The nurses attempted calling and paging him to no avail. And no one could find the medication to give Ewan that would ensure his PDA would remain open. When Ewan had to be intubated later that day, a nurse practitioner had to do it since the doctor was not there. When he was extubated a few days later at Children's, we learned the tube they used was too big for him and caused some lacerations and swelling to his windpipe.

Ewan at 1 day old. Poor little guy was pretty darn uncomfortable. (I can't look at this without crying.)

So, while we had some amazing people taking care of us, there were some areas of our care that were definitely lacking. I have no wish to disparage the hospital or any of the people who were taking care of us and as I said, I know people make mistakes. It happens. I'm incredibly fortunate to have gotten to have the birth experience I hoped for (even if the setting wasn't what I hoped for) and a supportive group of people around me. In our particular set of circumstances, most OBs wouldn't have given me the option of laboring and delivering naturally, but Dr. J did. My biggest regret is that Ewan was caused any pain as a result. But that's the truth of our experience.

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I also wanted to mention that following the completion of this series, I got an e-mail from a friend of mine who is currently pregnant and living with her family in Scotland. She told me that the system over there works much differently than the United States. Every pregnant woman is automatically assigned to a midwife and only sees an OB if it's absolutely necessary. The midwives will deliver at a local hospital if that's what the family wants (or if it's necessary), or at a birthing center or home if they prefer. There really isn't the same kind of stigma around midwifery, or about choosing a midwife "instead" of an OB.

It's become a topic of interest to me to learn how babies are born in different areas of the world, and I know I've learned a lot from looking beyond the US to learn about how it works in other countries. I guess I don't have a whole lot to add beyond that, but it gives me some food for thought in any case.

Thanks again for hanging in there with me, and thanks for all the feedback you've offered! It's been fun to discuss your experiences and hear your thoughts.

I hope you all have a great weekend!