Overcoming Obstacles... Actually Obliterating Them!

We have a client who was trapped by her insurance to not be able to seek the midwifery supported model of care and the water birth she had found was possible. She was working to try to make it happen when she went into labor two and a half weeks early. Then not only was she not getting the birth experience she had hoped for she ran into several other obstacles. But this story is not a bad one- indeed it is one about overcoming!


She started laboring around 10am in the morning and waited until she thought she was well into labor around midnight that night. It took her 2 and half hours in triage before they determined they were staying. This was the first obstacle of her labor. She knew when she found out she was only 2 to 3 centimeters dilated that it was too early to be at the hospital. She was in the midst of debating on going home when they examined her again after a couple of hours of walking. The exam revealed she was making progress so she stayed. What she was told was that she was 3 to 4 centimeters dilated now and also 70% effaced. I think if she had been told what was charted- and we found out later- that she was only 3 centimeters dilated and only 60% effaced, she may have gone home. But instead she is admitted.

The second obstacle was the doctor. She had been seeing a group of five doctors whom she had rotated through seeing over the last eight months. But instead she found out that they share call with another practice of six physicians she has never met or even had knowledge about this prior to tonight! So, she is about to meet a doctor whom she has had no contact with and has no idea what this physician's practice type is like!

She enters her labor room to be told that she indeed will not be allowed to not have the IV access she was hoping to avoid. She also will not be allowed to keep her yoga pants and tank top on but will be required to wear the hospital gown. She also will have a vaginal exam every two hours. These were not things that were part of her ideal birth at all! She agreed to the IV access after the doctor explained how important this element was but was not willing to agree to the other things- but did not tell the doctor at the time that those things were not going to be accepted.

The nurse came in later and the discussion regarding what she was going to wear was confirmed. She also told the nurse she wanted to be able to walk outside the room. This nurse was a new one and was taken a  bit about by the determinativeness of the mom's remarks.  She of course went to confirm walking outside the room was okay. Another obstacle hurdled! She did not ask the nurse, she told the nurse politely what she would be doing!

When the nurse arrived and said that she needed to be monitored, the mom asked for telemetry to be used. This nurse had no idea why that would be needed since she was only being required to be monitored every hour for 20 minutes. The mom said she was not getting back in the bed and being made to lay down again as she was initially. She said she was not moving from the rocking chair she was in. The nurse had no idea how to respond. She told her she would look for telemetry for the next monitoring but had to get this one done. So, although she did not agree- she did not fight it when we just slid her rocker with her in it toward the monitor. Another obstacle torn down!

When the nurse came to do another exam, the mom asked why. When she was told it was protocol- that was not a good enough reason and she declined. The nurse went to talk to the doctor who was off to do an emergency cesarean. The doctor said she would be in to talk to her. The nurse said it bought us at least another hour! When the doctor came in, abruptly turning on the lights in a dark candle (albiet electric) lit room, she said she needed to assess where the mom was in her labor. There was no watching the mom like a midwife would do. There was no reason given beyond that so the mom declined. The doctor figuratively threw up her hands and said the doctor coming on in 20 minutes would have to deal with this! She left just as abruptly as she had arrived! Wow, a huge obstacle detoured!

The next monitoring occurred while the mom was standing leaning over the bed. This is where she was when the nurse arrived. Her mom helped to hold it in place to get a good reading for the required twenty minutes. But no telemetry unit was brought! Then something magical happened. Our very green nurse had asked the charge nurse at shift change to assign the "natural birth friendly" nurse to this mom. When she arrived it was truly magical! She brought in the telemetry unit and got the new doctor coming on- again from the practice she had never met any doctors from- to agree to listening through a contraction and the minute after - only holding it in place- every thirty minutes. So instead of 20 minutes an hour we were looking at 4 minutes an hour!

The new doctor arrived. He entered the dark room and quietly met the mom. He discussed the reason he wanted to do an exam. He told her that if she was not changing, based on her ideal birth, he was going to suggest she go home! Now she had a real reason for an exam. His gentle exam showed she was indeed progressing and indicated she should stay. She had been 60% effaced with a posterior cervix and dilated to 3 centimeters. She was now 4 to 5 centimeters and 90% effaced with a midline cervix. She had made great progress! This doctor said nothing that was discouraging at all!

The idea of the bath, one that had been nixed by the first mom arose in a conversation I had with the new natural friendly mom. She said that there were rooms with jetted tubs but had never seen a mom be able to use them. When the first doctor had nixed the idea she said there were not properly equipped! Further inquiry meant they were not slip proof and did not have a thermometer. Also the water proof telemetry unit was lost. After some discussion on her parents going to get a mat and a thermometer and having the mom be willing to sit up or kneel to get the telemetry reading, the nurse went to find out if those obstacles were removed, could this mom move to one of those rooms! Wow, although this mom has done the early part of labor wonderfully without the need of water, the later stages of labor in a jetted tub will make a huge difference! This was a huge road block torn completely down!

She labored in the tub soon after.They managed to find a thermometer and use the doppler for monitoring the baby and her parents went to a local store for a bath mat! Give us what is required to make something work and we can do it! Later an exam was offered but declined. She did agree to another exam after getting out of the tub. She got out of the tub to walk.

The next exam came when she began to feel pushy. The doctor found an anterior lip and told her to not push. He also shared that he was on his way to the operating room to do an emergency cesarean. But this mom when she felt a strong urge decided to listen to her body!

She was on her hands and knees over the bed. The nurse told her she must turn over, but she declined. They grabbed another doctor who was on the floor to come and do the catch! He did not force her to turn over, and she gave birth to a little boy soon after! The funny thing about this is her practice of doctors, one of the doctors told her that at this hospital the only position to birth in was on her back with her legs pulled up to her ears! One more obstacle abolished! She also avoided an episiotomy that she suspected her practice may have found a reason to do.

I am so incredibly honored to have been with this woman in her labor. She was strong, spunky, opinionated but polite, unyielding in the face of opposition and full of determination! Her labor from the first contractions that were getting her attention to birth had been 36 hours long! She never wavered in her fortitude, never asked for medication and never complained about continuing her journey! She was unrelenting on having the birth she desired! I stand amazed by women like this!