Wednesday, September 9, 2009

Let me call my childbirth educator

I had a laboring woman recently, wanting natural childbirth. Things weren't going smoothly (the baby was OP) and we had been trying multiple positions, etc in an effort to get the baby to turn. At one point, the woman is crying and begging me for something for pain. The father is arguing with her about it. He doesn't want her to have anything. We manage to keep her going and don't give her anything (although I was ready to). Time passes. No progress. Baby is still OP. Mom is getting out of control. I talk to dad about the various options including continue with position changes in the hopes that baby will turn, try the peanut, Get IV pain medication, get an epidural and put her sidelying with the peanut. Possibly pitocin if necessary. He gets upset and tells me that epidurals and pitcoin are a joke...blah blah blah. I felt like I was being very reasonable but also honest about the options. He told me he had to make a phone call...he was gonna call his childbirth educator who they had spent 10 weeks with so "I think she knows about this stuff". The 'better than you' was left off the sentence but was definitely implied. I told him to that was fine and to let me know what they needed from me. I went out to the nurses station and declared that I was done. I told the nurse to let me know what they need and I will order it but that I wasn't going back in there otherwise.

It's one thing to decline an option I offer - no problem. But no need to be an a$$ about it. And I promise that I know just as much as your childbirth educator/massage therapist/mechanic whatever.

Well anyway, I went to the patient because she was wanting to her what her options were. I asked her to give me a little more time in the tub on her hands and knees in the hopes the baby would turn. She did that very reluctantly. Then we re-checked and she was an anterior lip and the baby was changing his position. I had her wait fifteen minutes on her hands and knees then was able to reduce the anterior lip and push. She pushed for about an hour to deliver her baby into our waiting hands (dad was helping catch) over an intact perineum.

So I have mixed emotions over this experience. It's a very fine line to walk between encouraging and supporting a women's desire to go natural and her requests for pain relief. Especially when things are not going 'normally'. I think we pushed her harder than we should have. But yet I am happy (and hope she was too) that she did it naturally. But I feel like I forced it on her but not allowing pain meds/epidural. I would have had she not made any change but by that time she was so close to being ready to push I couldn't see drugging her at that point or making her numb. I'm uncomfortable also because I did what I did out of some desire to keep the peace between her and her significant other. And that's maybe not the right motivation. I don't know....gotta ponder this one a bit more.

Oh, and I got an email from the nurse that was working with us last night. She's sweet as can be, a future midwife, and a doll to work with. Apparently she was planning to give a bath to the baby (which she would have not done had the parents told her they didn't want that done) and the father got upset and threw water all over her papers. Then when another nurse later came in to check on momma, he told her she was stupid three times to her face (not sure what the context was).


Beetus said...

The FOB in this situation was completely inappropriate on so many levels. It had to be awful to be in his crosshairs. He had an entire agenda before they even walked in the door. Everything you did, he viewed it from this warped lens.

I think you did all the right things here. You discussed options at the appropriate times. He reacted in an abusive way to you (and to the nurses later as well), yet you were still there for the pt, encouraging her and offering options. I don't think anything positive would have come from getting her out of tub for an epidural when she was an anterior lip. The change of position, the stress, the drama from the husband....none of it would have been worth it and the entire labor could have potentially dragged on, incl stalling at an anterior lip. Why risk all that. You did the right thing!

Ciarin said...

To be completely fair, the FOB had been doing wonderful labor support the enitre time. He was very hands on and supportive...up until that point. And he continued to be supportive as long as she didn't get anything for pain. He mentioned that she had said not to let her have anything when they had discussed this prior or labor. I think he was really trying to stick with her wishes. Just not in an appropriate way :p

Anonymous said...

What an outrage! I was furious by the 5th line of your post. Mom asks for something for the pain and he says NO?! No? The one who can leave at any time to go get a burger says No to her request for pain relief?

He sounds like abuser to me: angry and controlling. Poor mom and poor baby.

I am sorry you had to deal with that.


Sheridan said...

Wow. Well, I am glad that this mom had a vaginal birth. I am glad that they educated themselves. I am glad the FOB was supportive of his mom, but it sounds like he was a bit over the top.

I wonder how the mom feels now. Is she happy? Does he treat her this way?

There is a fine line and it seems like he crossed over.

Labor Nurse, CNM said...

I guess what strikes me about this is how the husband's behavior screams controlling and abusive. It was all about him and what he wanted, but what about the wife- I mean, she was the woman in labor!! I've recently had similar situations in which the partner appears very supportive and loving to his wife/girlfriend/baby momma yet when it really comes down to it it's all about his agenda and his control.

Ciarin said...

I think I forgot to mention'll love it....

At one point, he told her that if she took a shot of pain medicine, he would leave. If this had been my husband, I would have chucked the water pitcher at him and told him to get out!

Paula said...

Wow. With the comments I am reading, it gets thicker. What do yo uthink of the idea that this woman chose to have this man be with him? SHe asked him to "protect" her from her desire to have an epidural and pitocin. He was having a baby and sort of (perhaps in his minnd) failing, since she was suffering with the op position.

I feel awful being one of those people that folks sometimes call when they want info. It isn't an us against them thing, at least I try HARD not to make it that. You seem like a dream to work with. It's just an insecure Dad, in an environment new to them, who wants so much to do what they set out to do.

The last birth I had it was a real jerk doc and I am still sad. No at ALL like you.

This dad sounds like a real and true control issue guy. SOmeone who doesn't know who to trust. So sorry. Hope you can shake it off.

Back labors stink.

pinky said...

That sucks. Plain and simple.

pinky said...

I think the hospital needs to enact common decency act. That is where you are not allowed to raise your voice at other people or you will be fined. You are not allowed to throw things at people of their belongings. You are personally responsible to treat folks with common decency. And if you do not, you will either be removed or fined for each act.

As a nurse I am so sick of being treated by nasty people. This is one of the reasons nurses leave the profession. The fact that folks think it is ok to dump on them.

mitchsmom said...

Reminds me to be sure and tell family members ahead of time (before induction starts or in early labor) that I have to hear the patients' wishes from their own mouth...

It is frequently an issue on my unit for family members/friends to pressure a patient to get/not get pain relief and we always tell them - it's up to her, and what she asks for is what she gets.

That said, I DO understand the dilemma of having a plan to go natural then getting to that point that *everyone* gets to "just make it go away!!!" ... that some patients CAN get through with the right encouragement... but it is a very fine line... you just can't tell how they are going to feel about the decision in retrospect. If I have a pt thinking of changing their mind about what they want, I try to ask them to think for a few minutes more about it and then see if you still feel the same way, etc. etc. I've never done the "code word" thing before for when someone changes their mind and really means it (uses their code word), but I would if someone wanted to.

Ciarin said...

So I spoke with the patient today to follow-up with her as i was still worried that I had somehow crossed that fine line and contributed to birthrape or something. She was very appreciative and happy with her experience! Whew!