Thursday, June 4, 2009

The Classic Old-School Doc Re-Appears

I am at one of the local hospitals pretty frequently, supporting doula clients in labor - often enough that I now have some favorite nurses and some of the L&D staff people remember me. That's usually a good thing.

I've also done exactly one birth each with quite a few different doctors. Fortunately, some I never see again. Other times, I wish we could trade back for the doc that attended the last birth.

As a side note, I have only ONCE in the last 4 years of attending hospital births, ended up at a birth where the attending physician was actually the laboring woman's own doctor. I used to kind of hope/assume that my client's doctor who had signed off on their birth plan and all would be there. I've stopped planning on that. It's always somebody else. Usually, somebody from that practice, but I find that doctors came come from the North and South Pole and still be in the same practice together! So, we're always in for a surprise when the doctor walks in the door (unless I've worked with him/her before... in that case, I may have an idea about what's coming!).

Not long ago, "Belinda" was due and planning a natural birth in the hospital. She had 2 little ones already, so part of our doula visits prenatally focused on who would take care of the kids and arranging transportation and all kinds of practical details. Besides her husband was in Iraq for most of the pregnancy, and arrived back just a few days before she went into labor.

As for the birth plan, her doctor had said that she was fine with everything on it.
She said that she doesn't do an episiotomy "unless it's necessary."
She said that she avoids C-sections whenever possible.
That she encourages natural birth for any of her patients who want to try it.
That she would allow her patient to move and walk and do whatever she wanted to during labor.
That she would allow her to shower during labor (since a birthing tub wasn't available).
The only thing the doc wasn't very agreeable with was delayed cord clamping. But my client decided to give on that one if she had to.

Then labor happened.

The couple had just been moved from triage into their room. Labor was progressing quickly. The nurse checked Belinda's cervix and cheerily announced, "You're a good, stretchy 7 centimeters! I better tell the doctor to come right in!" With that, she chucked her glove in the trash and hurried out. Belinda was concentrating hard on the next contraction. It looked like all she could do to keep from screwing up her face and crying out in pain.

Meanwhile, the nursing student was having trouble getting the I.V. inserted. So the phlebotomy tech came in to help. Eventually, the I.V. was in and running after the fifth try. Belinda grimaced as she gripped my hand and said, "This is the last stick, right?"

And then Mr. Old School Doctor walked in. He looked like a classic, right out of a book about an eccentric old man... And it began.

"How are you, Ms. Smith?" he asked, touching her shoulder briefly.

"I'm, uh, ok." She sighed, exhausted. "What do you need to do right now?"

"Well, we need to assess how quickly you're progressing. So, I'm going to check your cervix, and we can break your water..."

"No, I - uh, don't want my water broken. Not right now, anyway."

"Oh." he stopped and shrugged. "Well, then that's fine for now." He turned back to adjusting his glove.

Belinda spoke up quickly before the next contraction. "Then can I get up and walk around after you check me?"

"No, oh NO! No, dear. You're going to stay right in that bed. Catastrophic things can happen if you get up and move around in labor."

Belinda looked a bit shocked, but another contraction hit, and she sank back against her pillow and closed her eyes. A couple of minutes later, as she opened her eyes, and looked back at the doctor, she brought it up again. "But I've been planning to walk and be up in labor all along. My doctor said it would be just fine. We talked about it a lot. She said as long as the baby was fine, I could get into whatever position feels good while I'm having contractions."

I chimed in to try to help her. "Maybe," I appealed to the doctor, "She could stand by the side of the bed and lean over it, but not walk around...?"

He looked at me as though I was suggesting that we bring a real, live tiger into the room to help things along. I backed off and he repeated, "No, no, no.... "
Then turning to Belinda again, "Honey, I don't let people do that. The best place for you and your baby is right in that bed."

He sounded patronizing, kind of grandfatherly, and yet... I wasn't sure what to do next. The nurse had a sympathetic look on her face, but she was nodding with the doctor. I knew she knew there was no good reason fItalicor this. I had just done a birth with her several weeks earlier and that doctor had let the woman move anywhere she wanted during labor.

Belinda's husband looked uncomfortable. Clearly, he didn't like the conflict. "Uh, honey, maybe..." he trailed off as Belinda rode another contraction out.

Then she snapped her head around and said very calmly but firmly, "I want to be upright. I've read that it can help with labor. Can't I do something that will aid gravity to make the baby come down and out easier?"

"Ah... " he rubbed the white stubble on his chin. "We have ways to get babies out if you're worried about that. Have you ever heard of the McRoberts position?"

Another contraction hit, but he kept talking. Belinda stared, glazed over at Dr. Old School as he rattled on about the McRoberts position while she breathed and nodded and winced. I pressed on her back and wondered to myself what would come next.
He repeated, "Do you know what the McRoberts position is?"

Belinda gripped her husband's hand a little tighter. "No," she gulped, catching her breath.
"The McRoberts position opens up your pelvis as wide as possible for your baby to come through. Its when we lay you on your back and pull your knees back to your ears. So, let's do that. Okay? When it's time to push, we'll lay you on your back and your pelvis will open wider so this baby won't get stuck."

Belinda nodded and was swallowed up by the next contraction. Afterward, she tried one more time, "But can I get up now? Can I stand by the bed or something? These contractions are KILLING me! They are hurting so bad in my back here in bed."

The old doctor straightened up and adjusted his glasses. "No, dear, did you already forget what I just explained? We need you IN BED till you have this baby, okay? Terrible, terrible things can happen to babies sometimes when you get up. You wouldn't even want to know what. But they are catastrophic. Sometimes babies die. I'm just trying to keep your baby safe. And didn't you understand, the best position for this baby to come out in is when you lay back? Do you understand?"

Belinda meekly nodded her head and then looked away as she felt another contraction coming.

And so went the labor... the whole thing. I tried asking the doctor lots of questions about the how's and why's of what he was decreeing, but nothing made a difference. Every time he didn't want something done a certain way, he'd say in his most grandfatherly voice: "Catastrophic things can happen if you do ____ . Do you understand, honey?"

Belinda pushed her baby out in the McRoberts position, which the doctor insisted upon.
And really, everything went fine. Nothing catastrophic or even close to it happened. She didn't have a tear or skid mark or anything.

It wasn't that terrible of a birth. But, Belinda was frustrated at her helplessness to have any say in simple matters of labor. Frankly, I was, too. I thought the whole "not getting out of bed" thing was ridiculous.

I was honestly a little surprised to find a doctor around still practicing so "old school"... He suctioned really vigorously on the perineum for over a minute before he let the shoulders deliver... and the amniotic fluid was completely clear. And then he spent a full two minutes holding a pink, kicking, screaming baby upside down, wiping it's face again and again and again before he handed him off to his mother. I don't know what he was thinking.
I guess it was just protocol.

That's the kind of hospital births I see a lot. They're usually kind of okay, but some of the stuff you put up with is just... dumb and frustrating at times, and for some mothers, infuriating!

People like Belinda will probably have a homebirth the next time. But the hospital might get to keep her as a patient if all their doctors would just be a little more open minded to a very few things that can make a big difference in a mother's experience.

As for the catastrophic things that were likely to happen, I'm still a little confused. Beyond the possibility of a cord prolapse (which can happen at any time, in about any position), what did he think was going to happen if the mother stood beside her bed?!

Oh well. I just hope that I never run into him again at a birth. And should I ever need to have a baby of my own born at that hospital, I hope Dr. Old School won't be the one walking into my room.

But, then, again, it really wouldn't be the end of the world. If I really, really needed hospital care for me or my baby, I would put up with most of it. And I'd try to be grateful. But it would be hard to be impressed. I'm just sayin'...


Jill--Unnecesarean said...

"Do you understand, honey?"


natalie said...

'Catastrophic things can happen'!

This story would be laugh out loud funny from the sheer ridiculousness of it all...if it wasn't a true story.

Noah said...

If I were the laboring mom I probably would have just gotten up anyways. What's he actually going to do about it? That is so seriously rediculous!

Sheridan said...

Oh yeah, I was at a birth this week, with probably the same doctor. Totally condescending and it was so frustrating. The poor nurse I could tell she wanted to let mom do what she wanted, but she had to keep the doctor happy too.

Rebecca said...

I would have said "screw you" and gotten up anyway. And I don't say things like that to people...but I probably would have if I was in a similar situation. That guy makes me so mad!!!

Anonymous said...

along with the above comments.. a "give. me. my EFFIN BABY!" probably would have escaped my lips.

Lindsey said...

Yes, yes, I'm with Rebecca. "Screw you and get me a different doctor!" Until we as women start standing up for ourselves we are asking to be treated like this!

Katy said...

I, too, am mystified as to why that mother let the doctor treat her like this. Why didn't you just tell her she could do what she wanted?

Dou-la-la said...

Really unbelievable. The refusal to let her get out of bed is bad enough - what in the world was the rationale for holding the poor baby upside down for so long? Or, at ALL? Jeez, did he spank it, too?

I'm glad for your client that nothing injurious happened, but good LORD.

Joy said...

That is infuriating! I would've kicked him out of my room, no joke.

Joy said...

P.S. As others have stated, I would've gotten up out of bed without asking or getting his permission anyway.

flowers said...

This is very frustrating to me and I see it to. I go home thinking.....that woman has *no* idea how good her birth could have been. But of course you don't say that to a new mom, but when do we start telling woman that they are getting sucker punched by the docs? When do women stop letting this happen.

I'm feeling like the information that walking around as being completely safe, healthy and normal is quite available. Why didn't she just say screw you and get up and walk around. (well, I know why...power struggles, fear etc, but still)

I can't wait until more and more women start making their own decisions. Please let it happen soon.

Anonymous said...

Yes - I am a labor nurse RN and Doula and I am agreeing that she could have just said " I told you.I HAVE TO I just have to get up!" and then just do it ! Its okay for doulas to discuss this ahead of time -what to do and also to ask the nurse not to bring the doc in until crowning!

Anonymous said...

Yes - I am a labor nurse RN and Doula and I am agreeing that she could have just said " I told you.I HAVE TO I just have to get up!" and then just do it ! Its okay for doulas to discuss this ahead of time -what to do and also to ask the nurse not to bring the doc in until crowning!

Bobby said...

The happy ending to this story is really how far we have come. Babies who would have died in past years are alive and well with the progress that has been made in obstetrics. Thank you so much for your article. It really reaffirms how we are improving our medical technology for the better. Thanks again.

Jill--Unnecesarean said...

Bobby, did you read the post?

Ally said...

ARG! This is EXACTLY what happened to me. This guy was about two days away from retirement. And he wasn't grandfatherly about it either! When he insisted that I push without a contraction I asked if something was wrong with the baby. He said "no honey, but the baby's head is getting squeezed."

What do you even say to that?

Comadrona said...

A cautionary tale for doulas and other support people. In no way can you be be expected to advocate for the woman - the L and D staff don't want to hear you! (I'm a midwife and supportive of doulas but this is reality in most hospitals.) The woman, and especially her husband, should coached during the pregnancy to advocate for her and not to take any shit from such Drs. And afterwards I think it would have been appropriate to gather up some of the abundant evidence which supports upright, mobile birthing, and report this despot to the hospital for endangering the mother and baby's wellbeing with his non-evidence-based practice.