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.