Dear Birth Sense Friends,
It’s been a long time since I’ve written regularly for this blog. I’ve gone through a long period of discouragement and depression with the situations I have been forced into because of a job I need, and the things I see happening to pregnant and laboring women on a regular basis.
I started Birth Sense because I wanted to reach out to pregnant women with just plain common sense; so many of the things women accept without question just don’t make sense. I wanted to use my years of experience to help women avoid some of the pitfalls of modern obstetrics. But it got to the point I felt I was just “preaching to the choir” and not reaching any of the women I really want to help. On top of that, to go to work and find I’m assigned to an induction because she is a couple days past her due date is very discouraging. I always counsel moms about both the benefits and the risks of an induction, and most of the time they want to go ahead with it, either because they don’t believe they’ll end out with a c-section or they don’t care if they take the surgical route. So I have lost heart for a while. But I have gotten my second wind, and am preparing to embark on some new adventures, which I’ll share with you in the weeks to come. Meanwhile, I’d like to tell you a tale of true heroism (not) that occurred recently in an American hospital.
An obstetrician was called by a resident to see a patient who had gone into labor eight weeks prematurely, and whose water had broken. The resident reported that he had felt the baby’s hand when he checked the mother’s dilation. The obstetrician reports that he “rushed over to check the patient” , who was completely dilated, baby head down, with a hand along one side of the head. [Author's note: I have delivered numerous babies with this finding, which is called a 'compound hand', without difficulty. You can see some great photos of a baby being born with this presentation, as well as some good information about compound presentations here.] The obstetrician tried as hard as he could to push the baby’s hand back into the uterus, but was unable to do so [he could have caused serious damage to the arm by attempting this unnecessary maneuver].
The physician reports that he then “rushed” the patient to the operating room for a stat c/section, whereupon he discovered he could not reach his hand through the uterine incision and deep enough into the pelvis to bring the baby’s head out through the incision [this indicates that the baby was close to delivery, with the head far down in the pelvis]. He asked the surgical nurse to do a vaginal exam and push up on the baby’s head from below, but the physician still could not reach the baby’s head.
What he reports next nauseates me. He made a “T” incision on the uterus. This means that, in addition to the “bikini cut”, or pfannenstiel incision that was made on the uterus, he made an additional incision from the middle of the bikini cut straight up toward the top of the uterus. This type of incision significantly increases the risk of uterine rupture if vaginal birth is ever again attempted, and generally compels the pregnant woman to have c-sections ever after. The OB then delivered the baby feet first, like a breech baby. He noted that the baby’s hand and wrist were swollen and bruised, and I suspect this was due to the attempts he had made to push the hand back into the uterus. I have never observed a swollen, bruised hand or wrist in any of the babies I’ve delivered with a compound hand.
The OB relating this story in OBG Management’s Comments and Controversy remarked how glad he was to find that other OBs are using this approach, and that “it isn’t unthinkable”. I find it very sad that any OB would think it necessary to deliver a 32-week baby, who likely will not weigh over 4 pounds at the most, by cesarean section because there is a hand beside the head.
I propose that Spiritual Midwifery, by Ina May Gaskin, be mandatory reading for all obstetric residents. Ina May’s statistics are outstanding, and with a 2% c-section rate, doctors should be flocking to her to learn her skills. My daughter, who is currently 36 weeks pregnant, just read Ina May’s Birth Book. She commented that the number one thing she learned from the Birth Book was that babies will come out. Whether labor is fast or slow, easy or hard, complicated or trouble-free, if mom and midwife have patience, nearly all babies will be born vaginally and healthy.
If you are preparing for a hospital birth, read all you can about normal births. Develop a clear understanding that most babies will come out if not interfered with. Unless your baby’s heart rate is indicating fetal distress, there is time to consider the situation, weigh the options, and get a second opinion. It is quite likely that if the poor woman in this story had been given any time to consider her options, the baby would have fallen out on its own, eliminating the dilemma.
I completely understand your sentiments of working in this field. When I worked as a nurse, I got numerous calls to my manager about my strange practices(like, this nurse does not know how to help women push-I didn’t have them on their backs most of the time, imagine that). I am now doing doula work because I am able to have a little bit more autonomy, but I then give up the medical aspect of it. So I have to bite my tongue quite often as they explain the absolute necessity of checking the cervical dilation every hour or two. I have thought about going back to school to get my CNM, but I’m not sure I want to work in the current birthing environment. On the other hand, I know there are women I have helped, who have had better births because of me….I have to keep that in mind when I get discouraged. If we can help even just one birth to be safer and considerate, then perhaps it’s worth it.
My first child was born with a hand beside his head at 39
Weeks. 7#. That’s how he looked on ultrasound as well. I pushed 5 times.
As a CNM, I get exactly what you are saying. We could be twins. Remember the women that you have been able to provide the birth experience they want and deserve. One woman at a time, and they tell someone, and they tell someone, and so on. Good luck!
I’m also a Denise and a CNM and couldn’t agree more with your comments! Keep up the good work supporting women!
My VBAC baby was a compound presentation with her right hand up by her right eye… unsurprisingly she’s been a righty since birth… sucks her right index finger and twirls her hair with her left hand. She was 7# 11oz, 39w 1d. She’s 3 now.
That said, there was no reason for this OB to try to shove that baby back up into the uterus! This makes birth traumatic for both mom and baby. I am saddened and angered that this OB was so impatient that he couldn’t wait to see *if* this baby needed help instead of presuming an issue. I wonder about how experienced he was, how many births he’d attended. This sounds like a novice mistake.
As Denise said above – one woman at a time. Change is slow, but when we work together we can do it.
I wish I had listened. Oh, how I wish I had listened. I read Ina May. I read Henci. I ignored What to Expect. I met a midwife and picked her brain. I had a doula (two actually, one in training). But I still listened to that advanced maternal age bs and stayed with an OB practice instead of transferring. HUGE mistake. I labored well and long but ended up with a c-section due to an OB who cared less about my wanting a natural birth. I hemorrhaged a week later and nearly died due to neglect.
I know in my heart had I stayed home I would have had a natural birth. My story is one that could demonstrate the horrors of hospital birth to expecting moms. I hope they’ll listen but people don’t believe it can happen to them until it does. I’m the perfect example.
(You can google me for my story on Birth Connection. I’m also on Facebook)
How sad for the mom in this story. I had a 9#13 baby, compound presentation, and while the pushing was very long (4 hours, unmedicated) and the size/position blunted any urge to push, we made progress and the baby was born vaginally.
@Rachel – If you’re already doing doula work and the pay/schedule isn’t too restricting, it would be great if you could become a CNM doing homebirths. I’m a nurse myself with experience in labor and delivery and I’m pretty certain my home birth CNM was the key determinant in avoiding a Cesarean delivery. I hope that when I’m through with the small children stage of life I can follow in her footsteps.
I was born naturally at 39w, compound compound presentation (both hands by my right ear). I was small (5 Ibs 4oz) and it was a long second stage (4hrs unmedicated) with no urge to push, but a natural, vaginal delivery in the hospital with a CNM.
My fourth child was born with his hand wrapped in the cord beside his head. It must have been that way for some time, because for months he could not sleep unless his hand rested against his cheek. To repeat, he had not just his hand up against his face, but it was wrapped in his cord which went around his neck. He was full term, 39 weeks, and weighed 7 lbs 4 oz. We delivered him vaginally. I know he was stuck and unable to descend for a while, which is why I was paused at 3 cm, ruptured waters for 26 hr, and not going into labor besides fake contractions from pit, but once something in my hip popped out of place when I was given staydol, baby came down and delivered within 20 min, no further complications, good apgar scores. I couldn’t lift my leg on it’s own for more than 3 wks, but I didn’t have major surgery!
So I have a question: can a person with a vertical incision on their uterus from a C-section ever try a vaginal delivery? Where can I find the risks on that? My doctor did one when my 29 wk. baby had to be delivered because her head was up under my right ribs and he was trying to save her brain from injury. She had zero brain bleed, and I was told to expect some, so I guess it worked. I have had 5 children vaginally and I really don’t want another C-section, but I am concerned about the risk of rupture. Thanks.
It is harder to find a provider to support a mom with a vertical incision, but it can be done:
http://www.specialscars.org/
There is a also a Facebook support group: Special Scars Special Women
Thank you for pointing out this group.
This story sounds so eerily similar to one I heard a year ago, only the baby was fully transverse, and they were sure he would lose his arm. It was more than just bruising. Poor babies.
During my homebirth, my little girl had her hand stretched up over her head. I was 8-9 cm dilated and I wanted my water broken because we couldn’t get her to move farther down (I had gallons of fluid in there, or so it felt, and she just wanted to float up high.) My midwife reached in to check to see if we could break the water, but then she felt my daughter’s hand through the sack. She was able to feel every one of her little fingers. The look on her face was priceless – she thought it was the most amazing thing she’d ever felt! We decided to wait to break my water, and I was sent into the next room to do some pelvic tilts. That did the trick, and it got her hand out of the way just enough for her head to move up against the cervix, making it safer to break my water. After that, I took a nap, and woke up a few hours later ready to push out my big girl.
I bet most OBs would have either A.) broken my water anyway even though her hand was up over her head or B.) would have flipped out and cut me. My midwife just sat on her hands and let me do a few twists and turns to resolve the situation.
As a doula, attending births can make me so, so sad. After having a homebirth with my final baby, I just see how much more respectful women and babies CAN be treated when birth is seen as normal. The way these women are treated in these over-medicalized situations makes me feel like they’re being cheated and stressed for no good reason. Most moms I’m with don’t like it one bit, but many don’t even know they have any other options.
I’m glad you’re back. We need voices like yours. Thank you!
My daughter was in a long, slow, early labor for 6 days. She denied ctx to her “med-wife” and refused a vaginal exam at 40+1 weeks. She was told the next week, if still pregnant, they would discuss induction. She called me at work one night, “Something’s different; should I wake my partner?” I was having a slow night at work (L&D nurse) and they were about to send another nurse home, I asked to go home on low-census. Figured, if it wasn’t real, I’d give her hot chocolate, have her nap & send her home. She drove 60 miles, and arrived at my place 5 minutes before I got home. I filled up the birth tub – the plan was to labor as long as possible before heading to my hospital a mile away. She was rocking in the pool. She’d kneel over the side between ctx, and then go back into pigeon pose w/ right side forward during ctx. “Interesting I thought.” After 1/2 hour of this, I had all the candles lit & a cake in the oven, figured I’d check her dilation (she’s probably 4 or 5 I think), when suddenly her water broke, I reached down into the water and shook hands with my granddaughter! “I guess we’re not going anywhere. Push her out.” My daughter caught the baby herself after 3 pushes and only 2 hours of “active” labor. I realized that the rocking was instinctual – the baby needed more room on one side to accommodate her arm. Had my daughter’s medical staff known she was having ctx a week before or had she consented to a vaginal exam and been found to be partially dilated, she would have most likely ended up with and induction. Yet breaking the bag of water and/or pitocin would have wedged the baby in tighter and without the ease of movement provided by the tub to rock the baby out, I think she would have ended up with a CS. I’m so glad she trusted herself. By putting up with a week of very mild labor, she allowed her baby to gently descend and rotate and get into optimal position. I only wish more of my patients realized that “sick of being pregnant” is not a medically valid reason for an induction – and that most inductions are a request for trouble.
I too have seen so many unnecessary interventions in the hospital, some of which have caused major problems for mom and/or baby, and not even counting c-sections. I have become a nurse (finished my BSN last year) in hopes of continuing on to a CNM in the next couple of years. I still expect to see many moms who have hears only the horror stories and will demand an epidural the moment they walk into the hospital. I am determined, however, to stay there for the women whose experience I can enhance and whom I can advocate in demanding a natural healthy birth. I had 4 of mine at home and one more at the hospital after that and all 5 of those births were better than the 1st one that I had at a hospital without advocates and without being armed with all the knowledge I have since gathered. We need to educate each other, we need to keep talking to each other, we need to keep advocating for simplicity, integrity, respect and honesty in the birthing arena. Best wishes to all!!
I really would like to know- does this mother have any idea about the alternate ways this situation could have been dealt with before resorting to surgery, T incision and all? Did anyone say anything to the doctor, either at the time, or after the fact? Does the doctor even have any idea that there are other approaches? Did anyone report the doctor to the hospital or lisencing board? I hear stories like this all the time, and rarely does anyone say anything, the doctor goes on thinking they saved the day in the very dangerous birth, the parents think the same, and this continues to happen without recourse. yet the slightest adverse outcome with a midwife-attended birth and it’s all over the news, midwives are arrested, lisence revoked, prosecuted, lose their livlihood.
My first child was born with his hand along side his head. It was a magical birth! Pushing was a little slow, but since he was my first, the pace could easily be attributed to that. I didn’t know until I read this, that a compound hand would ever be considered an obstetrical emergency. That first birth changed the course of my life – I wonder how much I would have missed out on if I had been in a hospital when I gave birth?
My daughter presented this way after I was induced because of “low fluid” with pitocin, and after my water was broken at 4 cm. my doc seemed completely overwhelmed by the situation,and I was rushed and prepped for surgery. I was devastated, doc assured me it was best for the baby…in my gut, I have always known that surgery could have been avoided. I did my homework and had my next baby at home with a midwife. However, the aftermath of csections are never properly explained. Moms are just expected to undergo surgery with no real way to know if they are making a sound decision. The emotional trauma is also not addressed and we are shuffled out with a newborn and some painkillers and told to have a nice life. I wish docs would view birth as more than just a matter of convenience.
Glad you’re back!
You are one of my favorite bloggers.
I was wondering if you’d had some sort of family emergency or something, so I’m relieved nothing awful happened, but sorry to read you are discouraged and sad..
It is easier for people like myself who are simply voices who occasionally rise up to ask people if they had considered differing information .. You’re actually immersed in it every day.. That has to be extremely hard..
I personally think this is a dark time in maternity care. I think that eventually it will be seen as such. I think you’re on the right side of history.
Oh and, I read that article and the comments on it. The worst one, I think, was the comment that said that this is evidence that they should abandon the practice of laboring down. Yuck. Yuck. Yuck. Yuck.
Welcome back! I have missed reading all the wonderful things you have to say about birth. I understand completely the feelings of discouragement, and I hope you find a way to regain the joy of helping one mom at a time!!
Weird… my daughter was born with both hands up by her head. For months she still would default to arm(s) over head when lying down. I have a bunch of photos of her in the Rosie the Riveter pose. My midwife (a CNM) mentioned it afterwards like it was no big deal, and I never thought anything of it until reading this. I don’t think I had a particularly difficult pushing phase, either. *scratches head*.
First, to echo what Mamaseoul said above – no, it’s not impossible to have a vaginal birth after a vertical incision but it can be nearly impossible to find a care provider that will let you try! The risk of rupture is higher than after a low transverse, but only 1.9%.
Second, as one of the founding members and Executive Director of Special Scars, I hear from stories like this all the time from the women.
It is horrifying to think of the damage that could be done to these babies. Please feel free to slip them our website. We have a Yahoo group and a Facebook group for support.
Thank you for all the work you do to try to protect women’s birthing space.
My daughter was 9lb 10oz, both hands up by her head, born easily with no tears. Silly, silly doctors. It’s a disgrace.
My #2 didn’t have a hand up, but he was occiput posterior. I had him in a hospital, but with an amazing, hands-off CNM. The pushing stage was long (3.5 hrs) but he came out no problem. The saddest part was the L&D nurse, such a sweet woman, said that she’d been at that hospital for 1.5 yrs and this was the first time she’d seen an OP baby delivered vaginally. The rest are rushed into surgery! The idea of what constitutes an obstetrical emergency keeps getting expanded and expanded and expanded. First breeches, and then twins, and now basically anything. I mean, I guess many OBs consider birth itself to be an obstetrical emergency. It makes me sad and really angry. (And the thought of an OB shoving a baby back up in the birth canal makes me want to throw up a little bit.)
Early on in my first pregnancy, I made the decision to leave the Ob practice I was using and go with a birthing center / midwife instead. It was the best decision I could have made. My first was born with his arm across his face, hand at his cheek. I never had the urge to push, just a vague sense that I needed to at some point. My midwife was kind and calm and the baby finally came out as they do.
I wonder what would have happened had I birthed in a hospital. More than likely, I would have been considered “stalled” and given pitocin and eventually, a c-section. It makes me incredibly sad that this sort of thing is considered “normal” by women who know no other way to give birth.
Did you send your comments to the OBG Management editors? The section is called Comment & Controversy. From reading the published comments, it seems most bypassed (implicitly accepting) the original reason for the ‘difficult delivery’, giving examples of maneuvers and strategies which had worked for them.
I wonder how possible it is to be an effective change agent from the inside – except that doing so involves questioning a peer’s professional judgement. This can be a significant impediment to changing the culture – could it be framed as ‘education’? Except the writer of the piece has been in practice 34 years! So perhaps some additional clinical fact has been left out which might provide more rationale for what is a challenging circumstance that several OB/GYNs (surgeons) have experienced.
The Ina May phenomenon is important to consider – yet just as the cultural elements supporting a rushed, perhaps ill-advised surgical birth when a vaginal solution was in the offing – so too it is important to realize the cultural elements in the births at the Farm support a patient, calm and (litigation-free) zone for encouraging long labors.
the challenge is how to move the dial in hospital settings where there is low tolerance and patience for labor.
Thank you so much for your attempt to enlighten mis-guided Mommas. We need all the information we can get. I had an amazing OB! She was the most skilled in that city in c-section deliveries, but she would not do it unless it was absolutely necessary! She was totally as natural as you can be with still having your baby in the hospital. (I even went without an IV both times, at my request.) I think what Mommas need to know most is that doctors do NOT, repeat, do NOT, know EVERYTHING. They mislead you to believe that it is their skilled knowledge that is leading them to do C-section, or other unnecessary procedures, when in reality it is (most of the time) by lack of knowledge, and out of fear of something going wrong, that they retreat to c-section. We were designed to give birth, and our bodies know exactly what to do. Yes sometimes, things go wrong in this world, but our bodies are amazing, and can easily cope and compensate for “malfunctions”. Like you said, time & patience. Surgery and medicine has it’s place, but it doesn’t need to be dished out like it was candy. Thank you so much for your educated, and caring information. It is very much appreciated!!
It’s great to have you back. I’ve kept checking your blog to see if there’s a new post. I love your writing and your rational, evidence-based approach, and though you may be preaching to the choir (to me), your voice needs to be heard. There’s a chance it can get out and make a change for the better.
This story is shocking, but the more we know, the better prepared we can be. Thank you for sharing it.
So glad you’re back! I have loved your blog. I know you may feel just like you’re preaching to the choir, but I know that I (and probably many others) have linked to you often in venues like my personal FB, my blog, etc. Hopefully these efforts from many women will start working to change the way women see birth- one mom at a time. We need your voice! Thank you for writing.
Ditto what last commenter said! Really glad you’re back, and I too have referenced your blog to friends and family members struggling over issues like vbac and where to birth. I think you make a much bigger impact than you know. Thank you!
I almost had to stop reading this account. Gasping along the way. My daughter was delivered with her hand on her face. My midwives didn’t even tell me what happened until after the delivery. It took me maybe ten minutes to push her out. I am so glad they knew what they were doing. I can’t believe this OB and his colleagues thought this was okay. I am sick about this.
I’m glad you are back. You will never know how you prepared me for my second (above) birth. My first birth was very traumatic, yet I had a midwife who advocated for me in the hospital setting and I was able to birth without a c-section. (I had vacuum assistance next to the OR table) With my second. I had an induction assisted by midwives. The pit was slow that I progressed on my own and transition came fast and my girl was here in less than an hour and a half. All Natural, with the exception of the pitocin…It was just what I wanted.
I love your blog and am glad you are feeling up to it again. While many women do not take an active approach in learning common ‘birth sense’ there are hundreds who seek for it.
I’m one of those.
Thank you.
I am a new RN and, while my passions and interests would normally point me in the direction of trying to find a job in the local L & D, I completely understand your comment about the depression and discouragement that stem from having to compromise in order to keep a job. I just discovered your blog, and it’s amazing. Thank you for doing this! I will be passing it along to doula clients.
So glad that you’re back!!
This post makes me so angry. My second baby (born in March) had his little hand up by his head the entire third trimester. Towards the end of the pregnancy my midwife wondered if that was why labor wasn’t starting, since I was a week overdue. (I learned later that a woman who was due the same day as me had her baby a few days before and the midwife had experienced her most difficult birth EVER- both hands were up at the baby’s face and his elbows were stuck on the pelvis during the birth of the head. Still, mom and baby made it just fine without even an episiotomy!) We tried “encouraging” my baby to move his hand, but it really didn’t work. He liked it there.
At 41 weeks he was born in the tub, nuchal hand and all. Labor was 2.5 hours and pushing was 10 minutes. I CAN”T FATHOM doing a c-section for a nuchal hand in a preemie?! If I was the mother I would want to sue for mismanagement.