Previously: Part 1: I maunder on about my experiences as a doula
Part 2: Statistics
The last birth I went to as a doula was for an aboriginal woman and her husband who had been referred by a friend of a friend. I met them, literally, outside the hospital’s door when they were going in for an induction. She was only 38 weeks pregnant, but was diabetic and her doctor was quite concerned that her baby would be enormous. “Huge, 10 pounds at least!” was the way it was quoted to me.
She was pretty chilled out about being induced early, because with her previous child, now an active three-year-old, she had been induced at 38 weeks as well. 10 hours later she was holding her vaginally birthed baby in her arms. Hard to argue with that record of success, and although I suggested that perhaps waiting at least another week would be a good idea, big baby or no, I could see that this idea was falling on deaf ears. I didn’t say much.
She went in for her induction in the evening and they gave her prostaglandin gel applied to her cervix. Her cervix was “unfavourable”, which is to say, nowhere near ready for giving birth, but the induction happened anyway. By 1 a.m. she was having frequent sensations and was throwing up – often a good sign of progress in birthing. This continued through the night. Her husband wouldn’t lie down and sleep for an hour to remain rested, so when morning came they was pretty exhausted, but they were both convinced that things must be going swimmingly and the birth would be soon.
The OB-of-the-day arrived and checked her and her cervix was as it was before, not dilated at all, not effaced, still posterior. Still, in other words, unfavourable. But still, her sensations were still frequent, and so the doctor started her on pitocin. The sensations became more uncomfortable and during one when she was moaning through the sensation a nurse poked her head in the door and said, “You look like you’re in pain. I’ll get you some demerol.” She came back and put it in the IV, I think. This, by the way, is an excellent example of the kind of “informed consent” that is often demonstrated in hospital births. She wasn’t asked whether she wanted it. She wasn’t even asked if she was in pain or suffering. She wasn’t presented it as an option with these pros and these cons. It was just given to her.
Once the pitocin was started, of course, external fetal monitoring was put on next. The contraction monitor worked consistently, but the baby, as babies pretty consistently do, kept moving around and the monitor would no longer be correctly placed so that the nurse would come in and fuss with the monitor, get the baby heart swooshing away on the speaker again and then bustle off, only to repeat the scene five or ten minutes later. She dozed with the demerol for quite a while, not even feeling her contractions any more and her husband and I dozed too in uncomfortable upright chairs against the wall.
The OB-of-the-day kept coming in and telling the nurse, who had already been upping the pitocin on schedule, to up it some more. At one point the nurse said, “We’re already at the limit that we’re supposed to use for an induction.”
The OB replied, “This is an augmentation, not an induction. Up it some more.” The nurse bit her tongue and did as she was told.
Every time she was checked her cervix was unchanged. Or no, a little changed. Effaced (thinned) to two fingers instead of three, still not dilated at all, but perhaps less posterior. This was considered to be progress.
Finally, after 24 hours from the first prostaglandin gel and about 2 hours before the OB-of-the-day was supposed to end her shift, the OB came and inspected the situation.
The baby was healthy as a horse, moving around, repeatedly bashing and kicking at the monitor, strong heart rate throughout, so they couldn’t use fetal distress as their reason for a c-section.
For some reason (because her cervix never dilated much most likely) they had never gotten around to rupturing her membranes, so they didn’t have that artificial timeline on their side, something to point to with assurance for why they needed to do a c-section.
Since she’d had a previous large baby vaginally it would be very difficult to argue cephalopelvic disproportion (where the pelvis is too small or narrow to allow the passage of the baby’s head).
And of course, they couldn’t just let her go home, say, “Oops, our mistake, your body wasn’t ready.” Not with that enormous ten pound baby inside.
Nope, they needed an ironclad irrefutable reason to cut this woman’s belly open. So they told her her baby was breech.
How big was that baby, do you think? 7 pounds, 3 ounces. And showing signs of prematurity. And sleepy, oh so sleepy, wouldn’t get on the boob and nurse, not for days and days and days. I lost track of them when she went home to her active three-year-old with her belly cut open.
It’s not like I did them any good. And while, as I say, I kind of suspect I just really wasn’t very good at this doula thing, I’m not sure that another doula could have improved things, prevented the outcome. I realized that as a doula I didn’t have any power to change the system. I might be able to occasionally help a woman emotionally or practically, but I would be witness to so much abuse. I stopped going to births as a doula.
Next: Part 4: The more things don’t change
Part 5: The system is broken. What next?