I had the great displeasure of being in our state’s foremost ‘teaching hospital” last night, to help a friend of my daughter’s through the birth of her first child. Last weekend, CC was in the hospital for observation as an inpatient for 3 days due to high blood pressure, but was discharged on Sunday as there had been no protein in her urine, which would have indicated preeclampsia.
On Wednesday, she went to her regular scheduled prenatal appointment at the clinic where she has been regularly seen, but could not see one of the two physicians who know her and she feels most comfortable with, as they were not available. CC saw someone completely unfamiliar to her. This doctor, after hearing she was hospitalized over the weekend and observing her blood pressure was a bit high, decided that she should be immediately induced, almost 3 weeks before her due date. He sent her and her boyfriend right over to the L&D department.
It is quite normal to have what has been termed “white coat hypertension” which is a real and proven syndrome, and most doctors know that a patient who is totally unfamiliar with them and a bit nervous during an exam could be suffering from this. Yet, this doctor did not do the least harmful thing and suggest she continue checking her blood pressure at home, as she and her boyfriend were doing since Sunday, and, if it crossed limits set by her regular doctors, to come back to the hospital. Instead, he sent her for an induction.
At around midnight on Wednesday night/Thursday morning, CC was admitted to a labor and delivery suite (about the size of a large walk in closet), hooked up to a fetal heart monitor, a maternal uterine contraction monitor, a large bag of IV solution, and a blood pressure cuff. The first 12 hours, in an attempt to induce labor by having the cervix soften and elongate, a process which normally occurs when the baby signal’s it’s readiness to be born by secreting a hormone into the mother’s bloodstream through the placenta, they had been applying a prostaglandin gel by suppository, directly to the cervix, every four hours. Since it is 3 weeks before the actual due date and, a first baby, CC’s cervix is not ripened at all (a term used for how soft, thin and elongated the cervix becomes in the weeks prior to birth.)
I received a phone call from CC to please come and help her. She had been a foster child in the state’s foster care system since she was only 3 years old. My daughter had met her when they were both around 14 years old, at a special school for the mentally and behaviorally challenged and they immediately formed a friendship. I became friends with her foster mother and father, who loved CC, but were already in their mid seventies and felt it was not possible to adopt her as they had some of their previous foster kids.
CC’s natural mother was very much like her, developmentally delayed and of a low IQ, yet had conceived 5 children one after the other immediately out of high school and then had those children all taken from her by the state when the youngest was left in a bathtub and drowned.
CC ran away from her foster parent’s home last year, as they would not allow her boyfriend in the house, and had not been in touch much with any of us until last month, when she called to tell us she was having a baby with her boyfriend, another special needs kid who she’d gone to school with. She sounded scared and in need of a mother figure. She knew that I helped moms have their babies and she reached out to me.
I immediately sensed that my presence was not seen in a good light by the nurse or the doctor, when I arrived almost 24 hours after labor had been induced. Most especially, when I made suggestions to please allow her to get up and walk or squat at the edge of the bed in order to make her more comfortable and to hasten labor by using the natural force of gravity. I was immediately told that would not be allowed, no one in this hospital is allowed out of bed during labor, especially not someone who is being induced.
She was complaining to me that her back was hurting badly and that she wanted to get up and use the bathroom, but they were forcing her use a bedpan, which was uncomfortable for her and she hated it. Regardless, when I told the nurse she really wanted to get out of the bed to get to the toilet, the nurse brought the bedpan for her to use.
I rubbed her back for awhile after she’d relieved herself, and helped her get up into a sitting position on the bed, which helped her back a bit. The doctor subsequently came in and examined her, and proclaimed she “might be” at 1 cm. dilation. She screamed at him that he was really hurting her during the exam. He apologized, but did not stop whatever he was doing during the longest internal I’d ever sat through, until he was quite finished. Not much progress in 24 hours. She told the doctor she was starving, her back was killing her, and she wanted to get up to go to the bathroom. He told her he felt for her, he knew this was hard, but did not give her any indication that anything was going to change.
I followed him out into the hall, where each L & D nurse is stationed right outside each door at a little desk and chair, and where I saw most of the nurses sitting studying their paperwork and computer screens. I asked him if he was aware that the mother-to-be is intellectually limited, having the IQ of a 9 or 10 year old. He said he’d heard some “talk” about it. I asked him why she could not eat or drink very lightly since labor was not very far progressed at all, and why we could not get her up, allowing gravity to help open her cervix. He looked at me like I had three heads. It was not allowed, she was a high risk pregnancy due to her high blood pressure and the fact that she had been induced.
I’ve attended other births in the past, including one of my own, which was considered high risk, and which I and the others had been induced with either prostaglandins, or just the simple breaking of the bag of waters, but we had all been allowed to walk, some of us pushing our IV poles, while we squatted, breathed through contractions, and did what a laboring mother naturally wants to do while laboring. I understand that using the prostaglandin comes with the risk of hypertonus, which is a condition where the uterus contracts much too strongly with little break between contractions, which must be closely monitored. But in previously attended births, it was enough to be on the monitors for the first 15 minutes of every hour and, if all was well, to be disconnected and allowed to do whatever felt comfortable until the next monitoring. But that is no longer allowed, I guess. At least not at the largest teaching hospital in our state.
I returned to her side and she was crying. I instructed her to roll onto her side, since it is a well established fact that lying flat on your back can compress the main artery supplying blood to the mother’s body as well as to the baby. Plus, it’s damn uncomfortable. I rubbed her back a bit more and told her how well she was doing.
The nurse came in a moment later, yelling at her that she must stay on her back as they could not read the monitor correctly or pick up the baby’ heartbeat if she moved at all. Since when? She then yelled at her that she wasn’t keeping her arm straight when the BP monitor was inflating, so they were not getting good BP readings. She then proceeded to tell her that she was going to insert a Foley catheter. I looked at this poor young girl and asked her if she understood what the nurse had just told her she was going to do. She shook her head no. I then politely asked the nurse to explain, in terms that her patient could understand, just what a Foley catheter was and why they were doing it. You would have thought I was the devil.
When CC yelled and cried while they were inserting the catheter and then again when they took yet more blood from her very small veins, the nurses hushed her and said things like “you will get your blood pressure up higher and that is dangerous, very, very dangerous” which, if you asked my opinion, is one of the reasons her blood pressure is high in the first place, being told constantly that her blood pressure is very dangerous, and not explaining things as a 10 year old could understand them, and making her lie still in a very uncomfortable bed, flat on her back at 9 months pregnant, and being scared to death. All those things can cause your blood pressure to skyrocket too.
This is different and difficult. In the past, I’ve always attended the births of babies born to couples who are of normal intelligence, and who the doctors and nurses listened to when they demanded their rights to the birth the wanted when they felt interventions were getting out of control. Or, who decided, on their own, to just do whatever they were being advised by the doctors. They were capable of making choices. But this is a mentally challenged young girl who is a product of the foster care system, a product of the special education system, and who just doesn’t know her rights and is not used to expressing them, anyway. When I encouraged her to say what she wanted, she was not listened to at all. I have no legals rights when it comes to her, as I do with my own daughter, who falls under my legal guardianship. CC falls under the care and oversight of our Department of Developmental Disabilities, who have done a fine job in allowing a mentally challenged young girl to become pregnant while living under the roof of her boyfriend. My hands are tied. I cannot use any of the tried and trusted methods of making labor easier and occupying her mind by undertaking any of the physical movement which soothes the laboring mother. This is the hardest labor I’ve ever attended because I feel as helpless as she is. But I can get up and walk, and I am not in pain, and I can reason. I am hurting for her.
The new modern labor and delivery system is so concerned with their monitoring equipment and their reams of paper proving that the anticipated C-section was necessary, so that they are not sued by the sharks in the law firms, that they have forgotten the human touch. All those nurses sitting out in that long hall outside these closet-like ‘labor suites’, not inside, comforting and caring for the PERSON in the bed and her partner, but fiddling with the monitors and the IV’s and the BP cuffs….it’s a travesty.
At 9am this morning, CC is at the same 1 cm she was at when I left early this morning so she could sleep (which thankfully, she did.) I will return to her when she is at 4-5 cm or when she cannot take it anymore and calls for me to come back. Perhaps because she is a state Medicaid patient they will allow her to labor longer and she may actually have a “natural birth” (?) due to concerns over the costs of C-section, which are not a concern for those with insurance. But I almost feel it would be kinder to her, to just skip this prolonged agonizing labor, which the modern hospital is making pure torture for her and her boyfriend, by not allowing her to nourish her body with light food or drink and by tying her to her bed with tubes and monitor leads and a catheter, than a normal natural delivery. And this is how they are ‘teaching’ these new OB-GYN’s to manage labor. Very distressing, to say the least.