Thursday, May 31, 2012

What licensure and regulation really means for people like me.

(This is my most recent birth story)

I had intentions before the birth of my son to write a post on the disadvantages of regulating birth. In fact I started a post more than once and just never finished it. I will say first that I am not against having a place for midwives to answer to if they give less than optimal care or if there is negligence. The issue I was most concerned about was that this would eventually leave many without alternative options. I really don't care what others feel about anything related to birth, just don't take my rights to choose away from me because as in the words of Bob Marley " My rights is my rights. Just like my life" No one should have the right to tell me who with and where I am allowed to give birth. If I make an informed and educated decision to VBA2C at home, it's my right and I am the one who lives with that choice no matter the outcome. What is already happening is women are losing the right to home-birth with a qualified provider. This means one third of the population of birthing women lose the right to an alternative option after many had already lost the right to VBAC in hospitals  due to bans on VBAC. We are forcing women to choose between an underground midwife (who will let them have the birth they want) or unassisted birth (which carries its own risks) and an unnecessary surgical birth which carries long term risk factors for both mother and future babies. How is this really making birth safer?

I had started this blog to prepare myself for the birth of my 6th baby which was intended to be a homebirth VBA2C with a certified nurse midwife. I had already used her before. In fact I used her for my last birth in October 2010. I knew after my first visit with her that the birth environment had changed and was hot and heavy with politics. In my state, certified professional midwives are trying to get legal which in turn has caused tons of microscopic views on the certified nurse midwives legally attending births at home. It was so hot that she told me that no one thought it was a good idea for her to attend my birth and that they were citing studies about uterine rupture being higher when there is less than two years between births. The only problem with that was this study they were citing was referring to the time between c-section and primary VBAC it was NOT talking about time between VBACs. It was irrelevant to my situation since my last c-section had been 7.5 years earlier and my last three births were VBA2Cs. The study that WAS relevant to me was that my personal rupture rate factor was lower this time than my primary VBA2C. Basically what it boiled down to is that I had to fight for my right to homebirth from the very beginning.

It didn't stop there it was almost every single visit there was a new consent tailored to me for me to sign. There was always something. I was the center of controversy over ONE birth where my baby died unrelated to the birth or the birth place. Everyone wants to focus on that ONE birth instead of looking at the bigger picture that I have had 2 more babies vaginally since my loss and neither were complicated births. It was becoming apparent that decisions were starting to be made based off of fear rather than facts. I was confident that all would be okay though and intended to advocate for our rights as women once my birth was finished.

The week before I was due I saw on a birth group on facebook that a different lady in my state had been dropped by her midwife two days before her due date and merely hours before labor started. She was lucky in that she already had back up care for a hospital birth. This news though sent chills through my spine because it had been one of my biggest fears, that I would lose my right to homebirth and be forced to go to the one place I wanted to avoid, the hospital. I had a prenatal appointment on May 16th and planned to ask what was happening because I knew that only a few CNMs were still attending VBAC homebirths and if this lady just got dropped what will that mean for me.

I got to my appointment and it was the first thing I asked about. It was true. All the CNMs were no longer attending VBAC homebirth. However because I had already had several VBA2Cs my midwife intended to keep me because I already had a proven pelvis and a proven scar. I was a little relieved but everything still felt "dark" I guess was the only way to describe it. I got my membranes swept and found that I was 3-4 cm dilated and 75% effaced. Within minutes of leaving her office I started having some strong contractions. I was anxious to hurry up and have this baby because I knew the political environment was getting really bad and I was tired of being a part of it. My world crashed in on me that night when my midwife called. I knew when I saw her number that it was bad news. My heart sank. Just as I suspected she told me that she would be unable to attend my birth and gave me a couple of options to consider. I was devastated. Everything I had prepared for and looked forward to was gone completely. I probably cried for a few hours over it. My dream of a peaceful homebirth was shattered. I was so upset. I didn't go to sleep until late. I knew labor was close I could feel it and now I have to hurry up and change all of my plans around and my whole mindset. I wasn't prepared for a hospital fight. I was prepared to avoid it. I was prepared for a homebirth. All of my affirmations were tailored for home not the hospital.

The next morning I was up early because I couldn't sleep. I was sick over what the future held for me. I had a bad feeling about it and was really worried that this birth was not going to be anything like what I had envisioned. I called my midwife and was able to get some doula information from her. I knew I needed support because I understood that your surroundings and environment in birth can hinder or help you. This was such a crash test kind of moment because the doula and I had never had a single conversation about what I wanted, she had never met my husband, and I had to do a crash and burn birth plan on the fly. Nothing was organized. I talked to her on the phone for almost an hour and set an appointment for the following day for my husband to meet her and for all of us to go over the birth plan. I packed my hospital bag and sent her my birth plan via email for her to look over so we could edit it the next day as needed.

By this time it was probably close to 6 pm and my husband was cooking dinner. I had been having irregular contractions all day but around this time I began to feel really odd. I started getting kind of shaky so I took my blood sugar to see what it was. It was 79 which wasn't low enough to make me shaky but I figured I should eat something  since it was under 80. I got up and ate a couple of strawberries and some peanut butter. I sat back at my desk had a contraction and when it was finished I sat back in the chair.  I felt a gush of fluid but since the end of pregnancy is full of those moments and my water had never broken on it's own to begin labor I wasn't sure if that was it but figured I should go check. When I stood up I felt more fluid gush and it got my pants wet. I went to the bathroom pulled my pants down and sat on the toilet and the flood waters flowed. I thought it would never stop. There wasn't a question as to whether or not my water had broken. Crap..... I wasn't ready. I was NOT ready. I called my son and told him to get my husband. I told my husband my water just broke and that I needed some clean underwear, pants, and a pad and also to bring me my phone. I called the babysitter, my doula, and my midwife to get my records to take to the hospital. It looked like there was meconium in the water so this freaked me out. This is that first moment where I say I would have stayed home a lot longer if there had not been meconium present.

So here I am, in labor with little to no sleep and have yet to eat dinner but I don't have time to wait and eat because there is meconium and my contractions were already 3-5 minutes apart. My husband also was tired because he had been up early and worked all day.  Neither one of us were ready.

We arrive at the hospital, I am contracting every 3-5 minutes, water is gushing still. I get checked in triage they confirm there is light meconium staining, I am 5 cm dilated, 100% effaced baby is at 0 station and she is unable to push him out of my pelvis. So it's official I am having a baby. I was extremely nervous though because this was not what I had prepared for. I gave my birth plan to them which included things like I do not want to be pressured to augment because my labors are usually long but my body will do what is necessary to birth my baby. I wanted to be able to use the shower for pain management, wanted intermittent fetal monitoring and several other things. We got moved to a room and the work began.

At first I thought I was going to be ok. The OB on call was actually a midwife first and the nurse was great. The first 12 hours of labor I was left alone for the most part ( I got there right at shift change) There was one time when I was asked to be checked to make sure I wasn't close to birth because they had to go do a c-section. I think I was 6-7 cm at that time. Contractions were getting more intense and I was having a lot of pain in my left hip not to mention I was also really tired and out of energy since I had not eaten a good meal or gotten a lot of sleep prior to labor starting. This was one of those kind of labors where laying down or sitting was not an option for me. This took a lot of energy to stand up every 3-5 minutes and work through a contraction for a minute or more each time. I was also starting to feel a lot of pressure with my contractions and I guess I either sounded that way or the way my contractions appeared on the monitor seemed to indicated transition was occurring. The midwife/OB asked to check me because it sounded like I was bearing down. I agreed to let her check me and I was 8 cm. At this point I really wanted to use the water. Here is another "wish I could have" moment. Had I been at home this would have been the time I got into the birth tub which would have had several advantages such as helping to relax me, offering counter-pressure from the water, allowing me to be lighter on my feet so that while being upright during contractions I would not have had to exude as much strength to hold my own body weight. It would have been easier to move just all kinds of things. Unfortunately I didn't have this option. All I had was a shower and at that point I decided I wanted to use it. We got the ok about 12 hours after labor began to use the shower. I got in at about 6:30 am or so had about three or four contractions before they came back into the room asking me to get out. I was like are you serious???? I just got in here. I was told they wanted me on the fetal monitor for at least an hour before they would let me back in. Never-mind the fact that they had a hand held doppler they could have listened to the baby with coupled with the fact that they already had TWELVE hours of me on the fetal monitor. It was bullshit. I got out and it was way too much trouble to get in and out ( with the tube top thing for the monitors having to be taken off and put back on) so the option to use the shower was now out. ( I want to add a note here also that the clocks in the room were going crazy, like horror movie crazy, time would be at a stand still one minute and then the next they would be spinning out of control)

This is the point where my birth plan along with my birth essentially went to hell.  When the 7 am shift came on their entire goal was to get me to consent to a c-section. One of the residents on the floor was the same one I met in triage during my last homebirth transfer. She was also one of the ones who kept pressuring me that time to consent to a c-section. I had asked that I not have a lot of cervical checks since my water was broken. I had just been checked so I found no reason for them to check me again yet they asked to anyway. I was then also told that I stall out at this dilation and that they recommend a c-section. This really pisses me off here because ACOG updated it's recommendation for VBA2C a couple years ago stating if the woman is a good candidate she should be given the option to have a trial of labor. How much better of a candidate can I get having already had 3 VBA2C births????? Again they are stuck on that ONE birth where I had a big baby that was 2 weeks late and uncontrolled gestational diabetes. Completely ignoring the fact that my other vba2cs were not only not 42 weekers but were also much smaller babies.

Anyway, I am starting to get extremely tired of holding my body weight up with every contraction and no other positioning was comfortable. At 9:45 am I made the decision to get an epidural because I knew that there was no way I could finish this birth as tired as I was and as hungry as I was. And the in and out of hospital staff in my room made it nearly impossible to eat anything other than light snacks ( I needed a freaking meal). Up until that point I was not connected to an IV line. I only had a heplock in place. I was connected to an IV line and within a few minutes I started having tectonic contractions. I had like 10 minutes worth of back to back contractions. I have no way of proving this but I am 1000% convinced that someone put a shot of pitocin in my IV. The only time I have EVER had those kinds of contractions was when synthetic oxytocin was put in my system. Because my body labors irregular pitocin makes it go spastic. I was asking what was happening and why was I not getting any breaks from the contractions. ( remember I am tired and have to stand through my contractions) This was completely off the wall and abnormal and came out of no where. It took over an hour for someone to come give me the epidural which I found to be an excessively long time. I finally get the epidural  at 11:00am and of course my contractions slow down and I try to sleep.I know how my body labors and I knew I needed rest so I was trying to get just that.

After an hour or so the resident comes in and again starts pressuring me about augmentation and c-section and says my contractions are not close enough and I refused both. She then kept coming in my room almost every hour saying the same thing. Then she comes and is trying to mess with the fetal monitor. When my epidural was put in place the tube top that holds the monitors in place was left up on my back. The resident went to pull it down and my doula told her it was stuck to my epidural glue and she said "that's ok" and then snatched it down. Within an hour or so all feeling came back in my body. The epidural was not working at all and I was in extreme pain laying in the bed ( remember I said these were the kind of contractions that made lying down or sitting extremely painful). At this point I want to mention that I got my medical records for this birth last week so I will note things marked on my chart from nurses and anesthesiologists.

At 3:52pm anesthesia was called to my room because the epidural was not working at all. My legs were not tingly at all. He comes in looks at the epidural line, puts some kind of medicine in ( benzocaine I think) and then adds more medicine into the epidural bag. He sits down and they force me to lay on my back ( can I just say I was dying from how painful this was) I am supposed to be waiting for the medicine to start working. I kept pleading with them asking when it was supposed to take affect. They said I had to wait 15 minutes.  I wasn't feeling much of a difference. He asked me if I could feel a difference in my legs. I said not really but my right leg felt more tingly than my left. I could still lift my legs though and was still having extreme amounts of pain in my left side. He stood up said he had proven the epidural was in place and that it was working and that his job there was done and he walked out. ( I want to mention here that in my records he stated that I said my leg was heavy and that was not what I said. I was visibly still lifting my legs in the air without a problem and verbally in pain from the contractions when he left the room. He never verified and never came back to make sure it was working. Also he notated on my records that the epidural HAD SLIPPED at least 1-2 cm)

At that point I am asked to lean to my left side for the medicine to go to that side. Only thing is it wasn't doing anything and was causing me an extreme amount of pain. At some point during this, the same resident came back in and told me that my contractions were too irregular and that if I didn't agree to let them augment my labor that I would be removed from labor and delivery. Said to me while I was in the middle of a contraction and clearly in labor.... She left the room and I asked my doula if she had really just threatened to remove me if I didn't comply??? My doula said that is what it sounded like. From this point on I constantly asked why the epidural wasn't working and asked the nurse several times to please tell them to replace it. The nurse I had at that time did not notate on my records anything during her shift so I am not sure if she ever called them or if they ever came to my room again while she was on shift. What I do know is that I requested it every time she came in the room.

At about 5pm she requested to check me because she thought I was more dilated ( in retrospect I think she knew what was coming and was really was trying to help me hurry up and have the baby because she already knew I was in a hostile environment)  she stated I had blood in my urine and that it usually means the baby is lower down and putting more pressure on my urethra. For whatever reason she convinced me to agree. I already was starting to feel like this was getting ugly. She checked me and I was 9 cm with an anterior lip of cervix. I always have an anterior lip at this point in labor and usually just have to wait it out and wait for the urge to push. The baby will usually come down on their own and everything flows pretty fast after that. At this point though I had no urge to push nor did I have the energy. She asked if she could try pushing the lip out of the way so I could push but my contractions were 10 minutes apart ( in retrospect I think this was the transitional part of moving from transition to pushing where your body gives you a break to rest before pushing begins. ) This coached pushing really messed up my flow though. It took me out of the groove I had been in. Anyway I tried to push with her for the two hours she had left on her shift ( the fact that she stayed in my room that long also indicates to me she was well aware of the hostility happening regarding me) I was unable to get him past the lip. However due to me trying to push, now I do have the desire to push. Now it feels better to push than to not push. However I already know the consequences could mean that my cervix will start swelling unless I can labor down and get some rest. When the next shift came on I begged again for them to fix my epidural. They were contacted at 8:10 pm but no one came to my room they gave a verbal order to just add more medicine to the epidural bag. When I saw that is what they were doing I asked why and explained that it is not working I feel everything and I want a working epidural. I was told they had to do this first. I stated that they had already tried that and it isn't working and to please fix my epidural. At this point I am going back and forth between pushing to relieve some pain and fighting the urge to keep my cervix from swelling.

At 9:10 pm anesthesia came to my room ( a different one this time) and again had a syringe of benzocaine and medicine for the epidural bag. I asked why they wouldn't just give me a new epidural and the response I got was that they had to this first. I was in tears saying they had already done that and it didn't work and to please just give me a working epidural.  They refused and told me to wait 15 minutes to see if the medicine worked which it wasn't of course and never did work. 

I am literally all over the bed doing acrobats. Flipping over to my hands and knees, going on my sides. using the squat bar. All of that with a supposed working epidural...... Every time I see the nurse I ask for anesthesia to replace the epidural.

At 11 pm a doctor comes in and checks my cervix and states it is swelling and recommends I have a c-section. Claims my baby is having late decels when in reality they were variabilities not late decels. And it only happened less than 10 times. Either way his heart rate was always well within the red danger lines and was not in distress. I also had no fever or infection going on. So this was a bully move to attempt to get me to consent to a c-section. I told them no but that I wanted someone to give me a new epidural because I knew what I needed was rest and the ability to have more control over my urges to push since my cervix was swollen.

At 12:20 am May 19th yet another doctor has come to my room to "assess me" I asked this doctor to please contact anesthesia so that I can get a working epidural to finish my birth.

At 12:25 am anesthesia was called and again did not come to my room just gave a verbal order for more medicine in my epidural bag. I am getting really pissed off at this point because no one is listening to me when I am telling them it is not working. I have now been pushing /fight the urge to push for 7 hours. All I needed was some rest and to not push for a few hours. I knew the baby would come down on his own if they would just give me what I was asking for.

At 1:00am anesthesia is called again to come to my room only they don't get there until 1:30am and again they do not replace my epidural just kept putting more and more medicine in the line that was doing NOTHING for me. I am in tears feeling like I am in a torture chamber. Trying to understand why I am being refused pain management especially since I know it is possible to get a second one placed. I felt helpless and at the mercy of those doctors who consistently pressured me to consent to augmentation or a repeat c-section. I was so upset and I also had such a hard time finding my voice which was something I had never had trouble with in either of my past births.  It was like I was tongue tied.

At 4:30 am anesthesia is called to my room again. This is the 8th documented time they had been called to my room in 13 hours. EIGHT FUCKING TIMES and not a single time was I offered or given a new epidural. I begged again for a new epidural and again was denied and without any valid reason. Not only would they not replace it they never told me a valid medical reason as to why that was.

At 5:00 am I had had enough. After 13 hours of begging for a new epidural, 13 hours of  trying to fight the urge to push and/or push I couldn't take the pain any longer. I was unable to cope. I had exhausted all measures. I had been running on an empty tank of gas for longer than 13 hours. There was no more reserve left at all. I had no support from my providers to VBA2C and because I was not at all prepared for a hospital birth neither me or my husband or our doula were really truly prepared for the hostile environment we walked into 36 hours earlier.  I finally called "uncle" and said I would have a c-section. I really did not want to augment because I know how pitocin affects me and I was more afraid of a uterine rupture and what that could mean than I was a repeat c-section. I had more of a chance of VBA3Cing in the future with a repeat c-section than I did if my uterus ruptured. So there it was. I had been tortured into submission. They had won.

This part really makes me angry. The anesthesiologist came in and said that since they "knew the epidural was iffy" that they were not going to use it for surgery. Instead they would be giving me a spinal. Are you fucking kidding me??? So you basically knew the whole damn time my epidural wasn't working??? She then takes it out and remarks "well that wasn't in very deep" only confirming what the FIRST FUCKING ANESTHESIOLOGIST notated that my epidural HAD SLIPPED. FUCKING ASSHOLES. 

My worst nightmare come true. I was worried this whole pregnancy that I would lose the right to homebirth with a competent provider. That I would be forced into the hospital to birth and that I would not be as fortunate to have a successful VBA2C as I was the last two times I went into the hospital.

The war against midwives and homebirth has morphed into a war against a woman's right to choose where and with whom she wants to give birth. This isn't right. Nothing about what happened to me was just or fair. Not only did I lose my right to homebirth, I now have increased risk factors not just for birth but for pregnancy if I were to choose to have another baby in the future. Is this what we call making birth safer? How so? 

Taking away options for women that want to VBAC isn't going to stop them from doing it. No one should have the right to tell me what I can or can't do with my reproductive organs. And attempting to regulate something like birth will ended up making women choose more unsafe options rather than safe ones because that will be all they have left. 

When I started this blog I had envisioned a peaceful and healing homebrith of my newest son. This blog has now taken a turn to fight for and advocate for women's rights. This was my LIFE that was affected. And I refuse to stand by and let this be something that happens to other women. Until crunchy moms and creamy moms can come together and realize that we can agree to disagree and still respect each others choices, we will continue to lose our rights and we will be blind to it because we are too busy fighting with each other to see what is really happening. We have to stand together and fight for the overall picture or we all will lose in the end.


  1. Constantly sending peace to you. You're moment of giving in sounds a lot like mine. Defeat. I am sorry you had to experience that. Hugs!

  2. I am so sorry. That is literally the birth experience from hell.

  3. I'm so sorry Michelle. I hope you give that hospital hell for that. It sounds like malpractice if they knew all that time the epidural wasn't working and still refused you pain meds just to get you to submit. It's not right. It's just not right. I hope your son was ok and that everything is going well now that you are home.

  4. I am so sorry. This was terrible for you. It is awful for the women of North Carolina. I hope the crazy situation is righted SOON

  5. I'm sorry you had to go through this Michelle :( I am baffled that people in states where ALL homebirths are legal are not only PUSHING for this kind of regulation, but claiming that it will make homebirth accessible for MORE women.

  6. Have you contacted an attorney? This is exactly what the law means by "pain and suffering". This wasn't just a failure on one persons part either, it was systemic and continuous, and I am sure you aren't the first to go through them using pain management to pressure women into surgery. You won't be the last either, unless something is done.

    What a nightmare.

    1. I have a family member working on that. I am not sure where it will go. I initially looked into what ICAN stated regarding this and it appears to be really difficult to pursue a case when mom and baby are healthy. They will say they did it to save my baby. And based on what I saw in the doctor progress notes they intentionally put things in my notes that DID NOT HAPPEN (like saying my epidural was fine) as well as made it sound like my baby was in distress. They labelled me a failure to progress 16 hours into labor and I have never had a labor shorter than 36 hours, in fact my last birth which was in the same hospital was a total of 52 hours long. They are excellent at covering their tracks to make it seems as if they were justified in their actions. I still consented under extreme duress. I would have never consented if they would have fixed my epidural. I knew all I needed was some rest, food, and peace. At that point I was so stressed out there was no way my body would finish laboring ( fight or flight).

  7. OH, I am so sorry. So sorry. I read this story with tears in my ears and my mouth dropped open more than once. A lot more. It is a terrible, horrible, awful state of things in this state. Yep, I'm here too. I was able to go to the new birth center for my most recent birth, but hope the situation will somehow resolve itself so I can have a home birth in the future. I'm fighting, too! My heart aches for you. You were treated despicably.