Full of Questions

My last two births did not go as the mommas had planned.  In fact, both ended in c-sections and I can safely say that was the furthest from both of their minds.  I have been mulling the situations over in my mind and I think by writing down my thoughts, I will get some peace and perhaps be able to “let it go.”

Momma number one was having her first baby and was overdue by one week on her estimated due date.  Her doctor told her if she hadn’t gone into labor by the Monday she was scheduled for an application of cervadil.  She tried many different things to hopefully get her labor “going.”  She tried  walking, nipple stimulation and two sessions of accupunture to hopefully “relax her into labor.”  All of this to no avail.  So she packed her bags and arrived at the hospital Monday morning.  Throughout the day we texted back and forth and I kept reminding her that her body knew what to do and baby would come when he was ready.  She agreed and kept a positive vibe.  Sometime in the late morning, her doctor checked her cervix and found it to be completely closed and not thinning at all.

She was disappointed but again I reminded her that she should try and rest and I thought the doctor would send her home and try again another day.  Maybe an hour later, she texted to say she was hooked up to the drip and they were trying the oxytocin to get things going.  She said she had a few contractions but nothing she couldn’t handle.  I told her if she needed me, I would come.  She said she didn’t think she needed me yet.  Everything was going well and baby’s heartrate was great.  Once again, I told her to let me know when she needed me.

The next thing I read on my phone was a text at 330 pm from her husband saying they had just done an emergency c-section because the baby’s heart rate had dropped dramatically.  He expressed that everyone was well.  I popped up later to see them and their new little bundle of joy but I was puzzled that the doctor had started oxytocin with a cervix that was completely closed and I remain puzzled to this day.  Even after a discussion with one of the head RNs from the hospital who found this situation to be odd, I still do not understand the passage of events.

Momma number 2 was having her second baby with the strong hopes of a VBAC.  Her water broke late one evening and we met at the hospital.  From the time she arrived, it was clear she was in labor and it was progressing well.  When we finally got into a labor and delivery room, the nurse checked and told the momma was dilated to 10 cm but she needed to push a little lip to the side.  She did this and encouraged the momma to push.  However, when she checked later she noticed something that wasn’t there prior and got the doctor to come and check.  He said the momma was only dilated to 8 cm and was somewhat swollen and that she needed to stop pushing.

Well, you can imagine how disappointed this momma was and what this did to her repose.  She started to get upset and felt as though she was losing control.  At this point she told me she might need an epidural.  She had put this in her birth preferences so we let the nurse know that she would like to do this.  The momma was quite tired as it was now early morning (around 5 a.m.) and her contractions were so close together, she was getting no rest.

This seems rather routine, don’t you think?  Momma gets epidural and things go along until baby is born.  Not this time!  Apparently there was a crisis with another momma and the anaesthetist was working to save her life.  While we were sympathetic to a very sick momma, the momma I was working with began to get frantic as she really wanted to push and knew she shouldn’t.  However, her contractions continued to pile up on one another.  She asked for laughing gas to help her wait, but as the wait went from minutes to three hours later, the pressure was on from the doctor on call for her to “just have the c-section” as the anaesthetist was not going to be available any time soon.  The momma refused as she told them, “I don’t want a section, I want an epidural!”  She was offered Fentanol and had several doses of this drug to help her manage these contractions.

Finally, three hours after she asked, a new anaesthetist was finally on shift and gave her the epidural she had been begging for.  The doctor returned and told the momma that she didn’t think there was any point, she would “let” the momma try to relax that cervical swelling down.  She let her rest for two hours but the swelling at this point was quite severe and would not subside.

At this point, the momma and her husband asked several questions and finally consented to a c-section.  She was exhausted and I think she just needed to see her baby.

My questions are these… In my (un-medical) opinion, it seems these two c-sections were avoidable and somewhat unnecessary.  I mean, in the moment, they were necessary as the babies needed to be born and were experiencing some distress, but really, were they really necessary???

Why would oxytocin be applied to a momma who’s cervix was completely closed? Check out this blog for information on a current “trend” called pit to distress. I hope this isn’t a new trend and if it is, what is the point?

Why would there only be one anaesthetist on at a time with no back up?  It would seem unusual for no back up plan to be in place in a large city hospital that must experience emergencies from time to time.

It was a lot for a new doula to take in and when you read all the data about doulas lowering the c-section rate, I wonder what else I could have done here? What are your thoughts?