Wednesday, March 14, 2007

The Twilight Zone

I've always been a firm believer that I am at the births that I am supposed to be at, and that every birth I am at teaches me an important lesson. Last night I began to question that belief. I have no idea what I am supposed to learn from the experience I was a part of.
A little over a week ago I got a call from the mother of a pregnant woman. She was looking for a doula for her (married) daughter T. I though it was a bit weird that she was the one calling but I agreed to meet them. Another odd thing was that this woman was looking for a doula at the very last minute. T's EDD was less than a week away. She mentioned that her daughter and son in law didn't have much money but really needed support. I agreed to discount my fee.
The next day I met the three of them. It was a very brief meeting but it seemed to be a good fit. I felt excited about working with them. We talked a little about payment I told them that since she was due within the next few days that they could pay me any time before or at the birth. I also didn't have them sign a contract since it was such short notice (looking back, BIG mistake).
As the week went on, I stared to feel off about the upcoming birth. I know "off" isn't a very descriptive word but I don't know how to explain the feeling or why it was there. I think my biggest concern was that I hadn't really developed a relationship with this mom. I really like to get to know my clients so I can adjust to what they may or not need during the birth. What I had learned about them was that they were hiring a doula because they wanted someone who knew the hospital "system" and who could help them gather information about the care they would be receiving.
Another concern that popped up in the week after I initially met with them is I found out they didn't really have a care provider. T was getting prenatal care at a clinic but the doctor providing her prenatal care doesn't do births. He recommends that his patients call the hospital and try to develop a relationship with doctors that have privileges there. I'm still not clear on how that is supposed to work but that's how it was explained to me. The clinic doctor told T to go to Hospital A because the doctors there know him and work with is patients on a regular basis. For a reason I don't understand, T and her husband decided to go to a completely different hospital. She had been unable to establish a relationship with any doctor but she was determined to birth at Hospital B.
T's husband called me around 2:30am Tuesday morning to tell me that he thought her water broke. He asked me what should she do and I said it was up to them. I asked what they felt like doing and he said they were going to hang out at home for a little bit and would call me when things changed. I said "that sounds like a good idea" and went back to sleep. When I woke up I started to feel real uneasy about that conversation. Did I inadvertently give medical advice? I didn't think so but I called them back to find out what was going on. This time I talked to T. I asked her how she was feeling and what she planned to do. She said she just woke up and felt fine and that she was gonna hang out a bit longer. I told her to keep me posted but I still had a nagging feeling about the whole situation. I decided (with the help of a couple of wise doula sisters) to call her back to make sure she knew that what she was doing was outside of what most medical doctors would be comfortable with. She said that she knew that they would want her to come in but she didn't feel that it was necessary yet. I was relieved that she had come to this conclusion on her own and not because of something I may have said to her hubby at 2:30 in the morning. She then told me that she had a scheduled doctors appointment in a couple of hours and asked if I thought she should keep it. I told her it would be a great idea to see her care provider so that he knew what was going on and he could verify that she had actually ruptured. She agreed and I sigh another breath of relief.
About 5 minutes before her scheduled appointment she called me to say that her doctors office told her not to come in and to go straight to the hospital. I agreed to meet them there.
As I was on my way, I got a call from my client's mother telling me that they had stopped at a restaurant for lunch.
I got to the hospital first and waited a few minutes for them to get there. I still had a uncomfortable feeling about the whole situation but I just couldn't put my finger on what it was. T, her husband, and both of their mothers showed up and the chaos began. As T was being given a hard time by registration because she had no doctor and no insurance, her mother pulled me aside to tell me that the husbands mother was not to be allowed in the room because T didn't want her there. Then T's husband pulled me aside and told me that T's mother must be stressing her out because T just told him to "shut up and stop talking".
We got into triage and the nurses seemed like they didn't know what to do with her because she had no doctor, no insurance, and they didn't have her records. They finally figured out that T would be cared for by the on staff OB. He came in and immediately told her that because he doesn't know her, he couldn't guarantee her a healthy baby. Not that he's trying to scare her but because he knows nothing about her history, there could be all kinds of complications and her baby could have all kinds of health issues. What lovely things to say to a mom in labor!
I felt myself getting pissed off at this man which is probably the biggest mistake I made during this whole experience. He picked up her birth plan, which basically stated that they want a natural birth with minimal interventions, and told her that he would try to respect her wishes but he couldn't agree with many of the things on there. One example of what he didn't agree with was her request for dim lighting. He said he needed to be able to see what he's doing, which I understand to some extent, but him being able to see had nothing to do with her wish for dim lighting while laboring. At one point I asked him how much longer she would need to be on the monitor. I was hoping to be able to have her walk around to get things moving. He said she would need continuous fetal monitoring. Confused, especially considering that the standard is 20 minutes of monitoring an hour, I asked why. He said because babies can die in less than 5 minutes and if he were to let her get off the monitor for more than a few minutes, her baby could die and we wouldn't know it. The shock must have registered on my face so he then said "You and I have totally different beliefs about birth". He then went on to tell her that if she didn't progress a centimeter an hour that he would need to augment her labor.
Looking back, I probably should have kept my mouth shut but I just couldn't (besides, I had promised this family that I would ask questions for them if anything seemed out of the ordinary). I asked him how could we help labor progress if she wasn't allowed to get off of the monitor to move around. He then said that there is no evidence that proves that walking and moving around helps labor progress. I think a "wow" escaped from my lips and for the second or third time he said something about how different our beliefs about birth were. Even though this was true, it made me angry because I hadn't stated my beliefs I had simply asked him a couple of questions and this really wasn't about my beliefs, it was about what my client wanted for her birth. I told him "You don't know what I believe about birth".
Even as I'm writing this I am cringing at my reaction. My focus should have been my client, not arguing with the idiot doctor. In all his ranting about how dangerous birth was he also felt the need to say how he sees people try to have natural birth all the time and that he has to fix the mess that it causes. He said he's dealt with many transfers from midwives who just don't know what they are doing. He really seemed to have a big Hero/God complex.
A couple of hours went by and the OB checked her and she hadn't changed. He told her that he was going to start pitocin and she said no. This really bothered him. He said it had been at least 6 hours since her water broke and he'd let her go much longer than most doctors would allow. T's mother asked if mom and baby were fine and he did the whole "Yes, for now, but we don't know how long they will be". He kept talking about the risk of infection and that baby needed to be born 18 hours from the time her water broke.
T asked if they could wait an hour and he said "At what point are you going to listen to me? I know what I'm doing." I asked if we could compromise and try some other things first (which is what her birth plan requested). He looked at me and said "No, I don't compromise. I've delivered over 4000 babies, how many have you delivered?" My response was "I don't deliver babies" .
T and her husband asked for a few minutes to talk and think it over. I realized that the bad energy between the doctor and me was a problem so I went into the hall to talk to him. I told him that I felt that we had gotten off to a bad start and I explained that I wasn't there to argue with him, I was just trying to support the family and to help their wishes be respected. He said he could respect that but he may at some point decide that only the family would be allowed in the room because when I ask questions it undermines his authority. There was a huge part of me that wanted him to kick me out because I couldn't stand witnessing the disrespect he was showing this family.
T continued to refuse the Pit, OB continued to be an ass to her and I stopped asking questions. I tried to make myself invisible when he would come into the room. During all of this T's mom and husband started snipping at each other. T's mom told me that T really didn't want her husband there and T's husband told me that he wanted her mom to leave. It went as far as T's husband telling her she needed to get the hell out of the room and her saying "I'm not going anywhere". I swear it was the weirdest sh*t I've ever seen. I asked them to not do that in front of T and they both apologized. From then on they were nice to each other on the surface but you could feel the bad energy between them.
During all of this I started having really bad back and stomach pain. If felt like the worst gas ever. So not only is there craziness around me but my body seems to be reacting to it.
Finally, the OB agreed to give them 30 minutes (they asked for an hour) to try some nipple stimulation to get her contractions going. We all left the room and let T and hubby have some time alone. Her contractions really picked up during that time but came to a complete stop as soon as the OB came back in. He checked her again and she had changed just a little bit. It wasn't enough for him so he again insisted on the pit. I tried to get her to explain why she had such strong objections to this option and all she could say was "I just don't want it".
OB was completely ticked off by this and told her that he wasn't going to treat her anymore. He called in another doctor. T's husband said that while he was in the hall he heard the doctor tell someone that T was stupid and shouldn't even be there.
At around 9 or 10 pm the new doctor came in and was so patient an kind. She listened to T's concerns and explained the concerns of the doctors in a way that wasn't rude or condescending. Finally, T agreed to the pitocin. By this point my stomach pain was almost unbearable. Since T wasn't in active labor and the pit was just getting started, I asked them if they would mind if I left for a couple of hours to rest and recharge. I told them I would come back as soon as they called me. They all agreed that since I was only 20 minutes away that they felt comfortable with that.
I left and the pain continued to get worse. By the time I got home it was so bad I was throwing up.
At 2:30am I hadn't heard from them so I called to see how things were going. T's mom said everything was pretty much the same and they would call when they needed me to come back.
I tried to get some sleep. At 7am I called again and I could hear T really working through the contractions. I asked them if they were ready for me to come back to the hospital and her husband said not yet. It was shift change and they would know more once the new nurses and doctors came on. He said that he wanted to make sure things were progressing before they had me come back up there.
I was starting to get the feeling that they didn't plan on having me come back and to be honest, I was so sick I really didn't want to go back. After I got off the phone with them my hubby called the doctor's office. They said I needed to be seen right away. I called T's husband back and told him that I needed to go to the doctor but I would be more than happy to send a backup when they were ready for the additional help. Her husband said not to worry about it, they were just fine.
I found out later (from T's mom) that he told them I had quit.
After my doctor's appointment I called to see how things had gone. Dad told me that they had the baby via c-section because mom never progressed past 5 cms and the baby never moved down.
I'm so sad for this mom. I still haven't had a chance to talk to her. I barely had a chance to during the whole time I was there. I wish I had been able to be there for her more. I wish I knew her better so I could have cared for her instead of dealing with the strange energy of the doctor, her mom and her husband. I hate that I allowed that OB to push my buttons and that I brought negativity to this woman's experience as well. I also hate how unprofessional I was about taking them on as clients. No contract, no payment. I'm assuming that they don't plan on paying me since I wound up not being there the whole time. Never mind the fact I lowered my fee by $250, I was with them for more than 10 hours, continued to check in with them, offered to come back (even though I probably couldn't have) and was told twice "not yet", as well as offered to send another doula in my place.
Maybe there are multiple lessons I am supposed to learn from this birth experience. Those lessons will come to me as I continue to process the whole thing.

By the way, I still have a couple of wonderful births to write about.


Leigh said...

Wow, what an awful experience indeed. My heart goes out to you - and to Mom - for having to be on the recieving end of all this negative energy.
Honestly, don't beat yourself up. I think you actually did the right thing, by going with your instincts (which you felt the whole time) an leaving to rest and recharge. It sounds like the situation just got worse and you knew it wasn't meshing and was honest in admitting there wasn't much you could do after that point. This is so tough, I know...but the lessons will reveal themselves. Your stregnth and abilities as a doula have not changed or been altered. You were put between a FEW rocks and a hard place! Sending my soul sista love to you,

Doulala said...

Thank you so much Leigh Leigh. I feel the love. :-)

marybeth said...

whoa. heavy. but i bet you are an even better you after that experience. life is on continual lesson.

love at ya.