Doula-ing, Part II
The second birth I attended was even more difficult to process than the first one. I don't often lose sleep due to emotional disturbances, but I did after this birth, which is saying a lot.
Kati was due the same week Michelle was. It was her first pregnancy. She came to me with her Colombian husband during a series of free prenatal classes I held for Birth Week, an annual event in Hungary. She was in her 37th week of pregnancy. She seemed so young to me, almost like a little wild animal, skittish and untamed. Her husband seemed young, too. I now know she is in her late twenties - not at all young to be having her first child. She explained that she and her husband recently tried to relocate to Spain, and lost a lot of money in the attempt, so they didn't have enough money to hire an obstetrician (which under Hungarian health care means that she will give birth with the obstetrician on duty at the hospital). They were considering hiring a nurse-midwife, which costs significantly less than hiring a doctor. I recommended a midwife that I know at the hospital she was going to give birth at (which is the hospital I gave birth in, and also the hospital where I now volunteer as a lactation consultant apprentice - I told you Hungary's a small country). She was even interested in having a home birth, but unfortunately, Nandu was going out of the country around her due date, and the only other midwife I know of requires everyone to do a week-long prep course before she takes on any clients, and there was no time for Kati to take this. So for various reasons, her only option was giving birth at the hospital with the obstetrician on duty, which can be good if you get a good doctor who does not feel compelled to "perform" for his or her fee and basically leaves a laboring woman alone to the care of the nurse-midwife on duty, or it can be bad if you happen to get an insensitive, brutish bitch, like Kati did.
However, I'm getting ahead of myself in telling this story. After discussing things with her husband, they decided to hire me instead of the midwife. To this day, I wonder (as no doubt does she) whether hiring a midwife would have made a difference to her birth.
She actually started having pretty painful Braxton-Hicks contractions more than a week before she had her baby. She was wonderful, though, didn't complain, didn't get impatient, didn't get discouraged, she waited more or less patiently to go into labor. She was about 8 days over her due date when I jokingly told her that at least she'll be able to brag to her grandkids that back in HER day, she was in labor for two weeks with her son!
The day her labor picked up was actually about 9 days past her calculated due date. She sent me an SMS early in the morning that her contractions were getting stronger. We talked on the phone, and she decided to stay at home, and we'd keep in touch by phone to discuss her progress, and to make a decision when I should go to her place or meet them at the hospital. In the end, she got through the entire day, and called me around 5-6 pm to go to her place. By the time I was in my car, her husband called me and said not to bother going up - they were coming down. In the background, I could hear Kati groan through a contraction, which made me happy because it's always a good sign when a laboring woman can no longer hold a conversation on the telephone. In my opinion, that's the best time to start heading to the hospital.
When they came down, I saw that Kati had snapped out of active labor a little bit, even though she moaned and squirmed through a few contractions in the car. She also complained of being nauseous and was clutching a plastic bag in her hand in case she needed to throw up. I made a mental note to keep both barf bags and plastic sheets in my car in the future - in case I ever give a laboring woman a ride to the hospital again. I guesstimated her to be around 4 cm based on these signs, and given her extended pre- and early labor, I prepared myself for a long labor.
We got to the hospital, I dropped them off at the entrance, explained to her what would happen once she checked in to the labor ward, and went to park the car. When I got back, she was still being examined. She was indeed 4 cm dilated, and she flashed me an amused grin as she told me the number. She seemed way too present for someone to be in active labor, so again I confirmed my mental impression that we would be in for a long labor. They put her on the CTG in a waiting room, and told us that all rooms were full, we'd have to wait to be transferred to a single room. Not good news... She was in the early parts of active labor, she would need privacy and quiet to turn inward and allow labor to progress. Being in a shared waiting room with nurses, doctors, other laboring women and their families walking in and out was not the best place to achieve this. Fortunately, shortly after she was done with her CTG, a room became available, so we moved in and started making ourselves comfortable. This was around 7:30 pm. Kati and I were both surprised when the midwife came in and said she wanted to examine her again in half an hour - afterall, it had only been half an hour since the previous manual exam. In the meanwhile, we lit a candle, I started hot water for her clary sage hot compresses, and started doing some back massage to ease her through contractions. She seemed to have trouble finding her place, she kept pacing and changing positions, not really allowing herself to sink into any kind of trance. Again, I figured it would be a slow labor under these conditions. Which is why I was extremely pleasantly surprised (as was she) when the nurse-midwife found her to be 6 cm dilated. Two centimeters in about an hour of restless pacing - that's amazing progress!
We continued with the back massage, did some hot compresses on her belly, took a shower, and basically around 8:45, before she could even be examined for a third time, she started making pushing noises. This drew the nurse-midwife back in the room, confirmed that she was fully dilated, and left to call the doctor on duty.
Kati was still trying to find the best position. When the obstetrician on duty - a well-groomed, older woman with blond hair and a dainty gold necklace - came in, she happened to be on all fours on the bed. The obstetrician took one look at her, and the first, disapproving words out of her mouth were "This is how we're going to give birth?" And she left. Oh well, I figured, good riddance. Kati continued pushing on all fours, but she found this position less effective than being on her side with one foot raised - a very uncomfortable-looking position, but she clearly preferred it. The nurse-midwife noticed, too, that her pushing was less effective, and asked her if she wanted to get back on her side, which Kati did. This is when the obstetrician lady came back again, looked at Kati and told her to get on her back. She inserted two fingers into Kati's vagina and started stretching the perineum, which Kati clearly found painful and asked her to stop. The obstetrician phlegmatically said it wasn't her fingers that were hurting Kati, but rather the baby's head coming down. Kati clearly did not believe her. The obstetrician then said that Kati needs an episiotomy. Kati had signed the hospitals own release form and indicated that she does NOT consent to an episiotomy when we checked into the room. She also had a printed and signed birth plan and a signed power of attorney for her husband to make medical decisions for her should she be unfit. Of course, the doctor had no way of knowing this - she never bothered to find out. So the nurse-midwife quietly reminded her that Kati signed the hospital's own legal document, indicating that she does not consent to this procedure.
I should pause here to mention that the baby's heart beat had been fine through all this time. His head was not yet on the perineum, but was already in the birth canal, could be reached easily by inserted fingers, even though it was yet about an inch away from the perineum. Usually, even if a doctor favors an episitiotomy, they at least wait either to see if the baby's in distress or until the baby's head stretches the perineal tissues in such a way that the doctor deems likely to tear. This doctor did neither.
When the nurse-midwife informed her that Kati had not given her consent, in fact, signed her NON-consent to an episiotomy, the doctor's offhanded response was "I don't care, I'm the one who will have to sew her up. And a laboring woman is not competent to make legal decisions for two days following the birth anyway."
We were all just stunned. STUNNED. I could see even the nurse-midwife was, even though she quickly recovered, assumed an expressionless face and just continued about her duties, getting Kati ready for the episiotomy she did not consent to. I looked at Kati, too. I didn't know what to say, I had never even considered this possibility, this level of callousness and total disregard for her wishes.
So neither of us said anything. I guess we both felt nothing COULD be said after a statement like that. I was also acutely aware that as a doula, I could not, should not speak for the laboring woman. I also was aware that with a doctor like this, the very presence of a doula can be irritating, so I certainly did not want to make things worse for Kati by baiting this monster.
And Kati was still pushing, of course. The woman had her lie on her back, and directed her to push through the contractions. Kati tried arguing with her a few times, and she was just told not to talk, but to push in the most obnoxious manner possible. The baby's heart beat began to drop - he was clearly not doing well under this sort of directed pushing. (Babies often need to "come up for air" between contractions - and when mom is directed to push, baby is deprived of oxygen.) This gave the monster-woman more ammunition to interfere, I mean, afterall, now there was a baby in distress! So she kept telling Kati to push, kept feeling her belly and telling her not to stop because the contraction was still going on, and eventually, by literally sinking her elbow into Kati's belly to press the baby out. Kati yelled out for her to stop because it was hurting her, the woman ignored her. She performed the episiotomy and pushed the baby out.
It was 9:09 pm when Dani was born. Kati began pushing at 8:45, the doctor arrived on the scene around 9 pm, perhaps a few minutes prior. She diagnosed an "extended second stage" which was the official reason for the interventions she used.
Dani was blue when he was born, he needed oxygen. He was obviously worn and not well after his aggressive entry into the world.
To add insult to injury, the mean, obnoxious woman actually chided Kati for "clowning around" when her baby's life was in danger.
I will never forget the face of Kati's husband, who doesn't speak Hungarian and hadn't realized what was going on until he SAW what was going on, when he saw the doctor-woman with he huge surgical scissors about to cut into Kati's perineum. He looked at me like a wild beast, and yelled "No!" And all I could do was shake my head and keep on stroking Kati's hair as she pushed.
I was home by 11 pm, which nobody expected. I expected to be at the hospital all night... I couldn't sleep. When I tried, I kept replaying the entire awful scenario in my head, kept seeing Kati's face, kept seeing the scissors about to cut, kept seeing her husband's face with its utter horror.
My stomach is still in a tight knot thinking about it.
Kati knows she got screwed. Her labor, which promised to be so wonderously smooth, was totally diverted by this asshole of a doctor, performing unnecessary interventions, traumatizing her for life, and - in my non-professional opinion - endangering the baby's life.
Yes, Kati is a little wildcat, and she is issuing a complaint and will probably press charges, as much as charges can be pressed in this totally non-litigious country. I'm trying to help her in any way I can, including telling her what an awesome job she did, how great she was, etc. But none of that will ever erase the memory of being ignored, being cut against her will, and being disrespected and belittled during the birth of her first child.
Kati was due the same week Michelle was. It was her first pregnancy. She came to me with her Colombian husband during a series of free prenatal classes I held for Birth Week, an annual event in Hungary. She was in her 37th week of pregnancy. She seemed so young to me, almost like a little wild animal, skittish and untamed. Her husband seemed young, too. I now know she is in her late twenties - not at all young to be having her first child. She explained that she and her husband recently tried to relocate to Spain, and lost a lot of money in the attempt, so they didn't have enough money to hire an obstetrician (which under Hungarian health care means that she will give birth with the obstetrician on duty at the hospital). They were considering hiring a nurse-midwife, which costs significantly less than hiring a doctor. I recommended a midwife that I know at the hospital she was going to give birth at (which is the hospital I gave birth in, and also the hospital where I now volunteer as a lactation consultant apprentice - I told you Hungary's a small country). She was even interested in having a home birth, but unfortunately, Nandu was going out of the country around her due date, and the only other midwife I know of requires everyone to do a week-long prep course before she takes on any clients, and there was no time for Kati to take this. So for various reasons, her only option was giving birth at the hospital with the obstetrician on duty, which can be good if you get a good doctor who does not feel compelled to "perform" for his or her fee and basically leaves a laboring woman alone to the care of the nurse-midwife on duty, or it can be bad if you happen to get an insensitive, brutish bitch, like Kati did.
However, I'm getting ahead of myself in telling this story. After discussing things with her husband, they decided to hire me instead of the midwife. To this day, I wonder (as no doubt does she) whether hiring a midwife would have made a difference to her birth.
She actually started having pretty painful Braxton-Hicks contractions more than a week before she had her baby. She was wonderful, though, didn't complain, didn't get impatient, didn't get discouraged, she waited more or less patiently to go into labor. She was about 8 days over her due date when I jokingly told her that at least she'll be able to brag to her grandkids that back in HER day, she was in labor for two weeks with her son!
The day her labor picked up was actually about 9 days past her calculated due date. She sent me an SMS early in the morning that her contractions were getting stronger. We talked on the phone, and she decided to stay at home, and we'd keep in touch by phone to discuss her progress, and to make a decision when I should go to her place or meet them at the hospital. In the end, she got through the entire day, and called me around 5-6 pm to go to her place. By the time I was in my car, her husband called me and said not to bother going up - they were coming down. In the background, I could hear Kati groan through a contraction, which made me happy because it's always a good sign when a laboring woman can no longer hold a conversation on the telephone. In my opinion, that's the best time to start heading to the hospital.
When they came down, I saw that Kati had snapped out of active labor a little bit, even though she moaned and squirmed through a few contractions in the car. She also complained of being nauseous and was clutching a plastic bag in her hand in case she needed to throw up. I made a mental note to keep both barf bags and plastic sheets in my car in the future - in case I ever give a laboring woman a ride to the hospital again. I guesstimated her to be around 4 cm based on these signs, and given her extended pre- and early labor, I prepared myself for a long labor.
We got to the hospital, I dropped them off at the entrance, explained to her what would happen once she checked in to the labor ward, and went to park the car. When I got back, she was still being examined. She was indeed 4 cm dilated, and she flashed me an amused grin as she told me the number. She seemed way too present for someone to be in active labor, so again I confirmed my mental impression that we would be in for a long labor. They put her on the CTG in a waiting room, and told us that all rooms were full, we'd have to wait to be transferred to a single room. Not good news... She was in the early parts of active labor, she would need privacy and quiet to turn inward and allow labor to progress. Being in a shared waiting room with nurses, doctors, other laboring women and their families walking in and out was not the best place to achieve this. Fortunately, shortly after she was done with her CTG, a room became available, so we moved in and started making ourselves comfortable. This was around 7:30 pm. Kati and I were both surprised when the midwife came in and said she wanted to examine her again in half an hour - afterall, it had only been half an hour since the previous manual exam. In the meanwhile, we lit a candle, I started hot water for her clary sage hot compresses, and started doing some back massage to ease her through contractions. She seemed to have trouble finding her place, she kept pacing and changing positions, not really allowing herself to sink into any kind of trance. Again, I figured it would be a slow labor under these conditions. Which is why I was extremely pleasantly surprised (as was she) when the nurse-midwife found her to be 6 cm dilated. Two centimeters in about an hour of restless pacing - that's amazing progress!
We continued with the back massage, did some hot compresses on her belly, took a shower, and basically around 8:45, before she could even be examined for a third time, she started making pushing noises. This drew the nurse-midwife back in the room, confirmed that she was fully dilated, and left to call the doctor on duty.
Kati was still trying to find the best position. When the obstetrician on duty - a well-groomed, older woman with blond hair and a dainty gold necklace - came in, she happened to be on all fours on the bed. The obstetrician took one look at her, and the first, disapproving words out of her mouth were "This is how we're going to give birth?" And she left. Oh well, I figured, good riddance. Kati continued pushing on all fours, but she found this position less effective than being on her side with one foot raised - a very uncomfortable-looking position, but she clearly preferred it. The nurse-midwife noticed, too, that her pushing was less effective, and asked her if she wanted to get back on her side, which Kati did. This is when the obstetrician lady came back again, looked at Kati and told her to get on her back. She inserted two fingers into Kati's vagina and started stretching the perineum, which Kati clearly found painful and asked her to stop. The obstetrician phlegmatically said it wasn't her fingers that were hurting Kati, but rather the baby's head coming down. Kati clearly did not believe her. The obstetrician then said that Kati needs an episiotomy. Kati had signed the hospitals own release form and indicated that she does NOT consent to an episiotomy when we checked into the room. She also had a printed and signed birth plan and a signed power of attorney for her husband to make medical decisions for her should she be unfit. Of course, the doctor had no way of knowing this - she never bothered to find out. So the nurse-midwife quietly reminded her that Kati signed the hospital's own legal document, indicating that she does not consent to this procedure.
I should pause here to mention that the baby's heart beat had been fine through all this time. His head was not yet on the perineum, but was already in the birth canal, could be reached easily by inserted fingers, even though it was yet about an inch away from the perineum. Usually, even if a doctor favors an episitiotomy, they at least wait either to see if the baby's in distress or until the baby's head stretches the perineal tissues in such a way that the doctor deems likely to tear. This doctor did neither.
When the nurse-midwife informed her that Kati had not given her consent, in fact, signed her NON-consent to an episiotomy, the doctor's offhanded response was "I don't care, I'm the one who will have to sew her up. And a laboring woman is not competent to make legal decisions for two days following the birth anyway."
We were all just stunned. STUNNED. I could see even the nurse-midwife was, even though she quickly recovered, assumed an expressionless face and just continued about her duties, getting Kati ready for the episiotomy she did not consent to. I looked at Kati, too. I didn't know what to say, I had never even considered this possibility, this level of callousness and total disregard for her wishes.
So neither of us said anything. I guess we both felt nothing COULD be said after a statement like that. I was also acutely aware that as a doula, I could not, should not speak for the laboring woman. I also was aware that with a doctor like this, the very presence of a doula can be irritating, so I certainly did not want to make things worse for Kati by baiting this monster.
And Kati was still pushing, of course. The woman had her lie on her back, and directed her to push through the contractions. Kati tried arguing with her a few times, and she was just told not to talk, but to push in the most obnoxious manner possible. The baby's heart beat began to drop - he was clearly not doing well under this sort of directed pushing. (Babies often need to "come up for air" between contractions - and when mom is directed to push, baby is deprived of oxygen.) This gave the monster-woman more ammunition to interfere, I mean, afterall, now there was a baby in distress! So she kept telling Kati to push, kept feeling her belly and telling her not to stop because the contraction was still going on, and eventually, by literally sinking her elbow into Kati's belly to press the baby out. Kati yelled out for her to stop because it was hurting her, the woman ignored her. She performed the episiotomy and pushed the baby out.
It was 9:09 pm when Dani was born. Kati began pushing at 8:45, the doctor arrived on the scene around 9 pm, perhaps a few minutes prior. She diagnosed an "extended second stage" which was the official reason for the interventions she used.
Dani was blue when he was born, he needed oxygen. He was obviously worn and not well after his aggressive entry into the world.
To add insult to injury, the mean, obnoxious woman actually chided Kati for "clowning around" when her baby's life was in danger.
I will never forget the face of Kati's husband, who doesn't speak Hungarian and hadn't realized what was going on until he SAW what was going on, when he saw the doctor-woman with he huge surgical scissors about to cut into Kati's perineum. He looked at me like a wild beast, and yelled "No!" And all I could do was shake my head and keep on stroking Kati's hair as she pushed.
I was home by 11 pm, which nobody expected. I expected to be at the hospital all night... I couldn't sleep. When I tried, I kept replaying the entire awful scenario in my head, kept seeing Kati's face, kept seeing the scissors about to cut, kept seeing her husband's face with its utter horror.
My stomach is still in a tight knot thinking about it.
Kati knows she got screwed. Her labor, which promised to be so wonderously smooth, was totally diverted by this asshole of a doctor, performing unnecessary interventions, traumatizing her for life, and - in my non-professional opinion - endangering the baby's life.
Yes, Kati is a little wildcat, and she is issuing a complaint and will probably press charges, as much as charges can be pressed in this totally non-litigious country. I'm trying to help her in any way I can, including telling her what an awesome job she did, how great she was, etc. But none of that will ever erase the memory of being ignored, being cut against her will, and being disrespected and belittled during the birth of her first child.