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 for 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'...

Allison's Birth: Braver than you believe, and stronger than you seem

As a doula and a Certified Professional Midwife’s apprentice I see all kinds of births and they are all special. But some of them are just extra special… Births that I know I’ll never forget.

Such was the case with Allison. Her birth happened recently, but I think I’ll remember it for the rest of my life.

When I met Allison at the midwife’s house for her first prenatal, her happy, easy-going ways immediately made me think that she would be a fun client to work with. Her bleached blonde hair, perfect tan, and French manicure made me wonder for just a second if she would find it difficult to just “let go” when labor happened. Would she be able to listen to her body, make the sounds that she needed to make, and assume the positions that she needed to when it came time to birth a baby? Would she be worrying about her makeup or simply focus inward and do what needed to be done? How would she do without any kind of pain medication at home?

She and her husband were totally confident that they could and would do this birth naturally just fine, and had no concerns. They didn't know anyone who had ever had a homebirth, but they were so excited about planning their birth. Her husband was a respiratory therapist and had worked in the medical field for years. Their midwife asked, “So why do you want to do a homebirth? After all, your insurance would even cover your birth in hospital, right?”

Rick and Allison looked at each other and smiled. “We’ve known for years that we would never have our baby in the hospital unless we had to! Rick has seen too much stuff there, and my mom is a labor and delivery nurse there and she’s always telling us stories. We would just rather stay home and have one on one care with someone who knows us as more than a patient number for their shift. We want somebody that knows US and what we want and what my health has been like….”

* * * *

When Allison was about a week overdue, I got a call: "Allison's in labor. Her water just broke, but she’s not really having any contractions right now.”

As I was driving to Allison’s house, her midwife called me to update me on the latest.

Allison had come to see her over the weekend because she wasn’t sure if she was in early labor or not with mild contractions.

”I learned some things about her pelvis that I wasn’t aware of before…” Joanne said, a hint of worry creeping into her voice. And then she said it: “I just don’t think her pelvis is big enough for any baby to fit through!”

I was a little shocked, because it had never come up as an issue at any of the prenatals with Joanne that I had been present for.

Joanne explained that she had not done any kind of vaginal exams early in pregnancy at Allison’s request. She had done Allison’s first vaginal exam when Allison and Rick had come over, wondering if she was dilating. And Allison had never seemed like the kind of person who would have a pelvic issue. She wasn’t petite and seemed to have a very average frame.

Joanne had NEVER worried about anyone else's pelvis during any of the births I had ever assisted her with. Sure, some women had to push longer and harder to get their babies out, but they usually always succeeded in birthing their babies vaginally. CPD had seemed basically non-existent in Joanne’s practice. Until today.

She thought that the inlet and mid-pelvis was adequate. With Allison, it was the outlet (nearest the perineum) that felt so tight during the vaginal exam.

We pulled up at Rick and Allison’s home and there she was - happy and walking around excitedly in early labor. Joanne did a check for dilation (2 cm.) and then said, "Can Mary check you, too? She needs some more practice."

Allison didn't mind, except that every time anyone inserted two fingers (ever so gently and slowly when she was comfortable) to check, she would totally screw up her face and clench her pillow and say, "Owwwww! My tailbone hurts SOOO bad!" That seemed kind of odd. Her midwife commented that her tailbone had been that sore the day before, too when she had done the first exam.

Then Joanne told Rick and Allison that we were going out to breakfast to give them a bit of quiet resting time to themselves in early labor. They liked that idea, and we left.

As soon as we drove away, Joanne turned to me and said, "Did you feel what I'm talking about with her pelvis?! I wanted you to feel that. That’s why I asked if you could check, too."

I exclaimed, "Did I ever! I'm thinking the exact same thing you are. HOW is a baby going to fit through THERE?!"

When I had checked Allison, it seemed as though the very outlet of her pelvis where the base of my fingers rested barely had room for more than three of my fingers. Joanne said that she estimated at the widest part, her pelvic outlet seemed to be not more than 6 cm (that's bone, plus think flesh, then try to get a space 10 cm wide and get a head through there!).

Joanne told me that Allison's horribly sore pelvis seemed to confirm to her that her pelvis was, even though tiny, doing it's best to expand for labor.

As we drove on, Joanne sighed. "I don't think she's going to get this baby out no matter how long she pushes, but if she DOES, I think she's going to break her tailbone. This is probably one of those cases of true CPD, and I feel so bad for her because the reality of a C-section hasn't even crossed her mind."

I asked her what she had told Allison about her pelvis. She told me that she had only told her half the truth when she checked her the day before, saying, "You seem to have a marginal pelvis, and I think you are going to have to work harder than most people to get a baby out. But I think you can do it."

Joanne added, "I’m really not very sure about the thinking she can do it part, but we can only wait and see what happens when she starts pushing."

We went back to the house after breakfast, and Allison was munching on a granola bar and doing hula stuff with her hips and walking and swaying constantly. It looked like she had been to a belly dance class.

She did that all day long. She never stopped moving. She constantly paced, and swayed, and swiveled her hips and sat rocking on the birth ball. A couple of times, her midwife and I begged her to rest for five minutes, knowing she had a long, exhausting journey ahead once she started pushing.

Every time she got into a new position for a contraction, if it was more uncomfortable that way, she'd say, "Ooooh! This really hurts!"

We'd look at her and say, "Well, you can try something else... You don’t have to hurt yourself more!"

But throughout her entire labor her response every single time was, "No, this feels like it's opening me up and I want to bring it on! The more intense, the better! More, baby! Ooooh! Owie! This is powerful stuff!" She put herself in the most uncomfortable positions because she thought it would help her move things along. What could we say? We were impressed with her strength and determination. We just hoped that somehow she could and would birth this baby. She would be crushed if a c-section became necessary. But we kept our thoughts to ourselves.

As labor progressed through the afternoon, she became deeply focused between contractions (instead of watching a movie, talking, eating). Allison started to do all sorts of things that had her midwife and I exchanging some strange glances.
She looked like she was doing an instructional video for the The Labor Progress Handbook! We knew that she had never read any doula or labor progress books or seen these positions anywhere, so our mouths dropped open as she proceeded to do things like the double hip squeeze (pressing in on the top of the pelvis with a contraction, widening the outlet), the lunge and then she went into doing the lunge with one foot up on a chair and a huge, low, wide, squat with every contraction for hours. She'd hang on her husband and go lower and lower and wider and wider, saying, "Owwiee! This is wooorking!"

It would have been fun to try to keep up with charting her postions - she must have done at least twenty different ones, with no guidance from us! She would do something, and then say, "Is this okay? Should I do something else?"

We kept telling her that she looked like she was doing every position for opening the pelvis that we'd ever seen in a book and it looked like her body was telling her exactly what to do.

She'd smile and say, "Well, it hurts, but I want to do it. It just feels right." She was amazingly in touch with her body and so instinctual about everything she did!

By 5 pm that night, she was almost 10 cm, but because of the tight fit of baby's head and the pelvis, the anterior part of the cervix was getting "dragged down" with the head as the baby descended. The lip of the cervix that was in front of the head and under the pubic bone was starting to swell. The baby was descending, but stretching the anterior cervix along with it. It was such a tight fit in there that her midwife wasn’t even sure how to move the cervix back above the head. Finally, around 6 pm Joanne started trying to hold it back, from being shoved down any farther. She let Allison start pushing; trying to get the head past the cervix, hoping it would soon stay behind the head. But, because it was so tight in there, Joanne had an extremely difficult time holding it back. (Her fingers would get compressed between head and pubic bone, and baby started to mold around her fingers!)

Allison pushed and pushed and pushed (mostly on a birthing stool with her husband sitting behind her, encircling her with his arms and her gripping his knees.). At 8 pm, she finally got the head past the cervix.

The baby's heart rate sounded wonderful throughout pushing, so she just kept going and going and going.

We weren't "directing" her pushing, just telling her what a great job she was doing, but she voluntarily did the "purple pushing" like people are often coached to do in the hospital for four and a half hours! I've never seen anyone do that at home without being "forced" to. I guess she knew what she needed! Joanne and I watched in amazement as she pushed and pushed and pushed. Her face was red and purple and the sweat poured off her. This beautiful lady was working harder than we had ever seen anyone work! In spite of dissolving into sobs between contractions at the sheer frustration and hardness of what she was doing, she never said, “I can’t do this!” She seemed to have an iron will to get her baby through her pelvis.

And her baby’s heart rate never showed any sign of stress. Who were we to say that she couldn’t do it?

At 10:00 pm, we started to see head. And at 10:30 pm, we had a little 6 ½ pound baby boy with a very tiny, very coned head and a woman who had just become a mother, absolutely beside herself that SHE DID IT!

So much for a woman with a literal 6 cm diameter pelvic opening!

She did it anyway!

So much for a woman who seemed impossibly tiny to birth a baby!

She did it anyway!

Less then three minutes after she finished those four and half grueling hours of pushing, she caught her breath, looked at her little boy and said, "You're so worth every bit of work I just did to get you here!"

I glanced over at Joanne and saw tears glistening in her eyes. I knew that she had to be just as proud as I was of this woman who had showed us that women are braver than they believe and stronger than they seem!

A Good Friday Birth!

On the morning of March 21^st, 2008, I started having consistent contractions and woke up around 3:30am. Not wanting to disturb my husband (in case this was the "real deal") yet unable to go back to sleep, I took a bath.

My husband came to find me and asked what I was doing. I calmly said that I was having some good contractions and wanted to see if they were regular. I relaxed in the tub and was fairly sure that these contractions were not going to fade like the Braxton Hicks ones I had been having for weeks. Once I was done in the bath I got back in my PJ’s and asked him to help me with some chores to prepare for the hustle and bustle of the wave of helpers that were soon to come.

As the contractions grew in intensity and came closer together I decided to rest on the floor of our family room. But as soon as I got on the floor my hubby panicked: "I’m calling the midwife... you are all over the place!!!" I chuckled after the contraction was over and said, "No I’m not, the floor is comfortable." He called the midwife and she said that she was on her way. He then called my sister in laws and the doula that was coming to help support us through the labor.

I decided to take a shower and attempt to relax. When I got out of the shower it was 7:10 am. Right then the midwife entered my bedroom. She was soon joined by my sister-in-laws and the doula. We had our team in place. My sister-in-law asked what I wanted to do. I firmly stated that I wanted to go for a walk and got dressed in some comfy clothes. We got my two sons dressed and got the Power Wheel out (compliments of Santa Claus), secured their helmets and off we went.

It was me and my two sisters-in-laws, the doula and my precious sons off on a mission to get this thing going. We left daddy behind with the midwife to get everything prepared for the delivery. The air was cold and felt good as my body progressed through labor and began working harder. It was comical to see my new sister-in-law chase my sons on the power wheel since normally it’s me toting my super sized belly while ensuring that they don’t run into anything and both remain on the Power Wheel.

We had made a complete lap around the neighborhood when we decided to grab coats for my sister-in-law and the doula. As I passed by the house, my sweet midwife she asked if she could listen to the baby to see how he was tolerating the labor. She checked on his heartbeat and it was perfect so off we went for round two. The boys decide to stay behind this time and have some breakfast, so my sister-in-law, my doula and I went on to finish the mission we had started.

After several tough contractions (breathing all the way) the contractions got to the point where I had to stop and lean on my sister-in-law for support. I decided to stick closer to home by this point and we took a few smaller laps. We approached the house and I decided that it was time to go inside and check on our progress. I had a series of two contractions on the porch and my doula gently applied pressure to my lower back to ease the pain in my back (you are heaven sent, Genny). We walked into the house and proceeded up the stairs to my bedroom. We had to stop on the way for another contraction on the stairs... again my doula applied pressure to my back. My son Ethan saw what the doula was doing and asked if he could help. I replied, “sure” as I was getting off the stair that I was leaning on for support and he gently rubbed my back (sweet moment between a laboring mom and her oldest son).

I proceeded up the stairs to my bedroom... When I entered my room I was greeted by the smell of lavender and Sara McLachlan playing softly in the background. In that moment my fears were lifted and I felt a sense of peace come over me... this was the moment I had dreamt about and prepared for. This was a birth on my terms and I could see my dream unfolding around me. As I reached the foot of my bed I knelt to floor with a strong contraction. At the end of the contraction I stated that I was ready to get into the tub. I was amazed how everyone worked together to help me get my needs met. One person drew the bath as another helped me get into the wrap I wanted to wear through the delivery.

My midwife was making her final preparations. After a few more contractions in the tub, and a little screaming, I told the midwife that I was ready to know where we were at (I wanted to know how dilated I was). She checked me and stated that I was nearly complete (10 centimeters) and asked if I wanted to feel the baby’s head. I nearly shouted "no way... you are pulling my leg... you’re just being nice... how dilated am I, really?" She told me that the baby’s head was right there and asked if I wanted to feel it. I was in a state of shock when I actually felt my baby’s head and I began to sob tears of joy. I found a renewed sense of purpose and again focused on the task at hand.

A few contractions later my midwife checked the baby’s heartbeat: "whoosh, whoosh, whoosh, whoosh (Mason in utero)" My midwife stated, "130 perfect!!!"

Then a strange sound entered the room: "reear, reear, reear, reear." Once the contraction had passed I exclaimed, "that’s not my baby’s heartbeat… that’s a saw!?!?" We were having a new deck built and the project was being completed as I labored. Here was yet one more thing to serve as a reminder for myself and my family of the AMAZING experience of welcoming Mason into our home.

Throughout my pregnancy my midwife and I had discussed a plan to avoid tearing open along my previous episiotomy line. We had decided that the best course of action was to refrain from pushing and let my uterus push the baby out. I knew that this would be a hard thing for me to learn to do, but I was up for the challenge.

As the urge to push became greater and I struggled to breath through the intense contraction I heard the voice of my doula: "remember our pushing plan." This clued me in and helped me to remember what my wishes were and helped me refocus on the job at hand. (Thanks, Genny.) I could feel my uterus contracting and my body automatically pushing. I did my best to breathe through the contractions… and soon enough I heard my sister-in-law (now serving as the camera woman) exclaim, "he’s coming, he’s coming."

My midwife told me, "Slowly, slowly… we don’t want a large tear."

With one last contraction Mason joined us. It was 11:10am. He was welcomed into a room full of people that had worked together to make his entry into the world peaceful and full of love. I was in awe of him from the moment I saw him. He is BEAUTIFUL and has been a blessing from the moment he entered our home. Mason… I love you!!!

In the months proceeding his birth I had many doubts concerning my ability to deliver at home and when all was said and done, all I had to do was focus on the time that I had spent bonding with this little person growing in my womb and think of the sweet reward that was waiting for me at the end of the pain. It was through my own inner strength and through the love and support of a carefully selected team that I was able to make this dream a reality. To all of you that were a part of this journey I thank you for believing in me and providing me with the encouragement and support necessary to lay claim to my own personal victory!!! I will never forget this day…it certainly was a Good Friday!!!

- Linda D.
O’ Fallon, Missouri

Thank you, Linda, for sharing your birth story and photos. Your birth was beautiful, and I hope that it inspires other women that they, too can have a beautiful, peaceful birth like yours.

The saddest thing about Linda's birth is the fact that Linda's midwife could face up to seven years in prison for having attended her birth. Currently under Missouri law, midwives are committing a Class C felony every time that they attend a birth, which carries a penalty of up to seven years in prison.

We have spent several decades trying to change our law but year after year, the power and money of organized medicine has won in the State Legislature as groups like the Missouri State Medical Association have defeated the midwives bills every time.

Last year, one sentence was passed in a larger health insurance reform bill that would have made Certified Professional Midwives (CPMs) legal in the state of Missouri. However, organized physicians groups took the new provision of midwife law to court, alleging that it was unconstitutional and should not have been included in the larger bill. The physicians groups (with aid from the AMA and ACOG) have spent hundreds of thousands of dollars over the past year, trying to maintain Missouri's felony status for Certified Professional Midwives.

The physician's groups won a lower court ruling in August of 2007, saying that the Certified Professional Midwife provision was unconstitutional and unrelated to the health insurance bill that it was contained in. Consumer groups like Friends of Missouri Midwives
(www.friendsofMOmidwives.org) as well as individual pregnant couples appealed the ruling to the Missouri Supreme Court, where it was heard in early March 2008. We are waiting to hear the ruling of the Missouri Supreme Court, which will probably be issued by June of this year.

Linda's midwife was committing a felony under Missouri law
as she assisted with her home birth.
(Only her midwife's hands are pictured above to protect her identity.)

The groups and individuals in defense of midwives have also accumulated huge legal bills, as they have had to hire top lawyers to match the ones hired by the well funded Missouri State Medical Association, et al. So far, they have raised about one hundred thousand dollars for the court cost through bakes sales, fund raisers, and generous donations from all across the U.S. However, giving has recently stalled out and there is still about $40,000 more needed to finish paying off the court costs.

Would you consider contributing to this worthy cause? $5, $10, $50, or $200... Whatever you can give will go a long way towards paying off this debt to "Free the Midwives" of Missouri, so that more women can have a birth experience like Linda!

You can donate online or find information for donating by check at:

www.freethemidwives.org

Thank you!

Mary

Ten Centimeters. Push!

Last week I found myself in one of my favorite positions -- Leaning over a hospital bed, rubbing the back of a laboring mother.

Over all, the labor wasn't bad.

I went in with a positive attitude, hopeful of seeing a good birth. I liked the obstetrician - she was an extremely nice woman with a great personality, and seemed to genuinely be enjoying her job. She was very supportive of the mother's desire to have no epidural if possible. Although medical reasons made the obstetrician decide that induction of labor was appropriate, she respected the mother's wishes to keep the Pitocin drip at a minimum and not turn it up once she started contractions.

The mother had given birth in the same hospital twice previously and was well prepared for labor. Her husband was supportive and as helpful as possible.

As labor progressed and the Pitocin induced contractions became more and more unbearable and on top of each other, the nurses were awesome. They provided one-on-one care, basically having someone in the room with us constantly. They, along with the father and I, encouraged the mother to try all sorts of positions - standing, hands and knees, sitting on the birth ball, rocking, etc.

I was even more impressed when the nurses got into whatever positions they had to to continue to monitor the baby's heart rate. It seemed that whenever the mother was in an upright position, the electronic fetal monitor (EFM) just wasn't tracing the heartbeat very well. So, the nurse had to stand there for several hours continuously holding the doppler in place to maintain a tracing. There was absolutely no "I'm really busy. You'll just have to lay in bed so we can get a decent tracing" or any, "I'm sorry this isn't working. We're going to have to put in a fetal scalp electrode." (The obstetrician wanted constant monitoring because of an increased risk of fetal distress with the Pitocin induction.) Care was all focused around what the mother wanted and needed and what made her most comfortable.

I was also impressed with the information that they provided the parents with before taking any action. The mother got vaginal exams when she wanted them, not every two hours or according to any set protocol. The father and mother both didn't want her water broken early in labor. The hospital staff respected their decision and didn't do it till near the end, when the mother requested it.

As I massaged the mother's shoulders and gave the father suggestions for new ways he could support her and asked the nurses to better explain the progress to the couple, I found myself thinking, "This birth isn't bad. It's about as good as hospital birth gets."

Of course, the Pitocin made things miserable for the mother, and more than once she just burst into tears and cried, "I just can't do this anymore!" But every time she got to that point, we managed to re-focus her on dealing with this contraction and just getting through right now. Her obstetrician poked her head into the room at just such a moment, and very quietly, almost reverently watched her experiencing an intense contraction. "Wow," she whispered. "You just never see women willing to do this any more. I'm so impressed."

Ten centimeters came as the sun came up. The shift would be changing soon, but these nurses were excited that they would get to see the fruit of this labor before they left. The doctor was summoned. Mother got back into bed and was positioned in a semi-sitting position. The bed was broke down, and her legs were spread apart while the overhead lights were turned onto the site of action. The doctor gowned and gloved. Two nurses held one leg (since the stirrups were uncomfortable) and I held the other. Sterile drapes were placed everywhere, leaving only the vaginal opening exposed. The father, nervous and excited at the same time, held her hand, and reassured his exhausted, tearful wife that she was almost done. She was so tired, and kept saying, "I don't think I have the energy to push. I can't."

We all assured her over and over that she could and would get her baby out. The doctor leaned in close to her face and looked her in the eyes, "Just listen to me and do what I tell you. Just follow my instructions closely and you'll be just fine."

The mother nodded through her tears, and the father whispered, "Honey, you can do it. Just listen to the doctor."

"Okay, on the next contraction...." The doctor began to explain the process of letting the contraction build, then taking a deep breath and holding it while pushing as hard as possible while the nurses count to ten.

I sighed to myself. Purple pushing. Why do all doctors think that this is the only way to get a baby out? I knew they'd do this. Why do I even hope that this time will be different?

("Purple pushing" is the above described technique, termed such by many doulas and midwives because the mother has so little time to breathe and exerts herself so intensely that she often starts to turn purple and even burst the blood vessels in her eyes. It has been employed at nearly every hospital birth I've ever attended. It barrels a baby a baby out faster than any other method of pushing. A first time mother who might take an hour to push a baby out when allowed to do it at her own pace, will usually push a baby out in less the 20 minutes with this incredibly intense way of pushing. I personally think that purple pushing can be necessary and effective if a baby is in fetal distress and there is a good reason to get the baby out as quickly as possible. If there is not medically indicated reason, I think it just traumatizes the mother's body [tissues don't have much time to stretch and she's more likely to tear, etc.] more than necessary, not to mention that she thinks of pushing as one of the hardest, most exhausting things she's ever done.)

So, the pushing began. "Take a deep breath. Hold it! PUSH!! One.... two..... three..... four.... no, no, don't take a breath yet! Keep pushing down and out as hard as you can!... five.... six... that's a girl!... seven.... eight... nine... TEN! Good push! Now, quick, quick, another deep breath, and down and out! One.... two.... three.... "

(Mother falls back exhausted. "I can't! I have to catch my breath! I can't breathe! Just let me catch my breath!")

"No, honey. Not till this contraction is done." (Pulling her forward) "Take a deep breath right now, and hold it. Hold it while I count to ten... (more insistently) ONE! TWO! THREE! FOUR...."

Ten minutes have passed. We're seeing a baby's head. The doctor comments on all the hair. Mother is gasping for air between pushes and saying she needs to slow down. The Pitocin drip is still going, and the contractions are coming right on top of another.

"No, not till your baby's here. Keep going!"
The nurses get in her face to help her stay with the pushing a little longer. I want to tell her she can take a 10 second break, but that is obviously not the opinion of the doctor.

I tell myself that this is ridiculous, but determine to keep my mouth shut. I'm the doula, not the obstetrician. The doc keeps taking sideways glances at the monitor. The baby's heart rate shows no sign of compromise. It's plugging away with nice short and long term variability around 140, even during contractions with head compression. Wow! The doctor smiles, "Your baby is doing great! Let's hurry up and get him out!"

The contraction ends. Mom falls back on her pillow and sobs and gasps for air. "Just... just let me rest for a minute..." I'm happy to see that the contraction is over and baby is wonderful. Surely they will let her rest till the next contraction hits. The father looks slightly concerned, torn between wanting to help his wife get what she says she needs, and wanting to follow the doctor's orders for the safety of the baby.

But, no, rest is not an option. The doctor wants to get this kid OUT! "You're almost crowning! You can't stop pushing now till your baby's head is out," she says firmly. The mother wearily sits forward, clutches her thighs again and pushes.

"No, harder, longer. Take a deep breath. Hold it while we count...." And again.... and again.

Finally a head emerges.

I breathe a sigh of relief. Finally the mother will get to inhale once without holding her breath for the count to ten.

I wait for the doctor to feel for cord around the neck. Instead she graps the baby's head firmly, locking her fingers under it's jaw line on both sides, braces her feet against the base of the hospital bed, and leans back, pulling for all she's worth. "PUSH!" she shouts at the dazed mother.

I watch with horror. The baby hasn't even rotated! How does she expect to pull the little guy out without allowing his shoulders to properly spiral through the pelvis?

The baby doesn't pop loose. Her eyes register panic. I see "lawsuit!" flashing through her mind. She yanks a little harder on the head. Still no baby. "Stuck baby!" the doctor half whispers severely to the nurses. The father has realized that the doctor is frightened and something is dead wrong. Tears squeeze out of his eyes.

"Supra-pubic pressure!" the doctor shouts in the direction of the nurse at her right shoulder. There are four nurses and a respiratory therapist standing by. Three of the nurses dive for the mother's stomach. (Supra-pubic pressure is usually applied with the palm of the hand, pressing down hard on the top of the pubic bone, trying to help the baby's shoulder "pop" out from underneath. It's a maneuver used for shoulder dystocia.)

One nurse lays the bed back flat with one swift maneuver. The other three pile onto the mother, leaning all of their weight into her stomach. She screams. "PUSH!" everyone yells together. "HARDER! HARDER! You've got to get this kid out!" The mother again grips her thighs, now having her knees almost to her ears and pushes with every ounce of strength she has left.
The doctor leans back and with all of her 200 pounds, pulls on the baby as if her life depended on it.

The baby pops out. It's been less then 15 seconds since the head emerged. The doctor quickly grabs a hold of the pink, squirming body of a crying baby and suctions and cuts the cord while uttering a sigh of relief. All that scare and an APGAR of 10. The nurses straighten up, slightly shaky. The parents can't stop crying and shaking. Their little boy is here, but his arrival was the worst minute of their life.

I stand there, still holding the mother's trembling leg and rubbing it and thinking...
About how this birth happened. About how it could have happened differently, if only some common sense had been used and everybody hadn't been in such a rush.

I replay every move over and over. It wasn't a shoulder dystocia. It was a little 6 lb. baby, being pushed out by a woman with a more than ample pelvis. If the baby would have been given another 30 seconds to rotate and line up the rest of his body, he would have slid out with the next push.

I shake my head, feeling sorry for the obstetrician who created her own emergency and is still shaking about the "close call" she had.

I feel most sorry for the mother and father who just went through some of the scariest moments of their life as they welcomed their baby.

The obstetrician tugs on the still pulsing cord, pulling out the placenta and throws it into a basin for pathology to inspect. She asks the nurse to turn the Pitocin up (to keep the mother from bleeding), and then inspects for tearing.

Seeing none, she looks pleased. It's been almost 5 minutes since the baby was born. He is wailing in his little warmer next to the bed. The mother is too exhausted to want to hold him right now, so the nurses are playing with him. The doctor pats her patient on the leg and says, "You look great! You'll be a little sore. Just use ice packs for a couple days. Congratulations! You have a beautiful baby!" She breezes out the door, to deliver the next patient.

I like her. She's a nice, caring woman. She's sweet and friendly. The nurses were great.

But now I know why I don't want a hospital birth. Sometimes I forget.
I'll remember this one for awhile.