Hospital Drug Pushers
It’s not easy to get an unmedicated birth in the hospital. In many facilities, nurses are uncomfortable with the sounds a woman makes while giving birth. They urge women to accept epidural anesthetic, or at the least, IV pain medication to quiet them.
Gretchen (not her real name) planned a hospital birth with her second baby. She had had an epidural with her first birth, and felt that she’d been disconnected from the process because of it. She strongly wanted an unmedicated birth this time around. Because she was positive for Group B Strep, and wanted conventional treatment, Gretchen planned to go to the hospital as soon as she knew labor was starting, in hope that she would have time to get two doses of antibiotics before the baby was born. She called the birth center one morning to let me know labor was beginning and she was heading in to the hospital. “No need to come over yet,” she laughed. “It’s still early. . .I’ll call you when I need you.”
Three hours later, I received a call from the labor nurse. “Gretchen is about eight centimeters and feeling like she wants to push!” I hurried over to the hospital, wondering why Gretchen or the nurse hadn’t called me sooner. In the labor room, Gretchen was lying on the bed, panting with the contractions. She pushed a couple of times and had a beautiful baby girl over an intact perineum. It wasn’t until later that I found out what had happened in those three hours.
Gretchen had been sitting in the labor room for some time before a nurse came in. She explained she was in very early labor but had come to the hospital to get her antibiotics for Group B Strep. The nurse told her to put on a gown and someone would be with her shortly. The unit appeared to be very busy that day, and it was quite a while before another nurse came in to ask some questions and have papers signed. By this time, Gretchen was feeling some very strong contractions, and was pacing and breathing with them. The nurse told her that a 20-minute “admission” monitoring strip was required, and she must get on the bed in order to be monitored. Despite the fact that I, as the admitting midwife, had ordered only intermittent monitoring with a Doppler, the nurse strapped Gretchen to the monitor and had her lie on her back in bed.
Immediately, the contractions felt much more painful to Gretchen. She told the nurse she needed to get upright again, but the nurse told her she must remain in bed on her back for 20 minutes. The nurse then proceeded to urge Gretchen to have “just a tiny dose” of IV pain medication to “take the edge off”. Gretchen refused, explaining her desire for an unmedicated birth.
“Your birth will go a lot faster if you can relax with the contractions,” the nurse countered. “Just a little medication won’t hurt the baby and it will help you relax. You’re tensing up with the contractions!”
Again, Gretchen refused medication, and again, the nurse urged her to accept it. This went on for about fifteen minutes. Gretchen told me later that she finally reached a point where she thought, “Wow, if this experienced nurse thinks I’m doing so badly I need medication, I should probably trust her judgment and just take it.”
“I really didn’t want medication or even feel like I needed it,” Gretchen related later. “I just thought that since she kept urging it on me over and over, I must be doing a bad job of it.”
My standing admission orders included being called as soon as the patient was in active labor, or whenever the patient asked for me, whichever came first. If the nurse had called me when I requested, I would have been able to advocate for Gretchen, get her out of bed and off the continual monitor, and perhaps her experience would have been more satisfying. To top things off, the nurse had been “too busy” to give Gretchen her antibiotics before she gave birth, and so the pediatrician refused to discharge the baby before 48 hours “just in case the strep causes a problem”. Gretchen’s desire for early discharge after birth also went unsatisfied.
Heidi (not her real name) was planning a hospital VBAC. At the time, this hospital was allowing midwives to do VBACs, but had a policy that the OB physician covering call had to talk with the patient upon admission to determine whether she truly understood the risks she was taking by attempting a VBAC.
Heidi had probably had an unnecessary c-section with her first child. She’d showed up for her regular prenatal visit, reported a little light cramping, and was checked and found to be 9 centimeters dilated. After being rushed to the labor ward, Heidi’s contractions slowed. She was given oxytocin augmentation and instructed to start pushing as soon as she was fully dilated, even though she felt no urge to push. After pushing for a short while without progress, it was determined her baby was too large to fit through the pelvis, and a c-section was performed.
After I admitted Heidi to the labor unit, the on-call OB arrived in the room. Heidi was almost fully dilated, having labored for some time at home before calling me. She was laboring silently, and had requested those around her to be silent as well. Heidi wanted to let her baby move down the birth canal without forceful pushing, unless she was unable to resist the pushing urge.
The OB began by reading her a list of the risk factors known to be associated with VBAC. Heidi remained silent, eyes closed, breathing through her contractions. The OB continued:
“I need to make sure you know that you are risking your baby’s life by choosing a VBAC. Your uterus could explode, and we could have to do a hysterectomy to save your life, or you could bleed so much that you could die. I also really need to urge you to have an epidural, just in case, so that if you do have a problem we can do surgery immediately. I’m not comfortable with you laboring like this without an epidural. And you need to be on the fetal monitor NOW!” his voice rose to near hysteria.
Heidi opened one eye, gave him a death stare, and said, “Would you please just go away? I’m trying to have a baby here.”
He refused to leave, remaining in the room despite my taking him aside and asking him to leave. He asked the nurse how far dilated Heidi was, and when she told the OB that Heidi was completely dilated, he began barking orders: “Now with the next contraction I want you to grab your knees, hold your breath, and push as HARD as you can to the count of 10!”
I don’t know how Heidi kept her composure, but she ignored the OB and continued to breathe her baby down the birth canal. The nurse and I both corralled the OB and urged him to leave the room, as we had the situation under control. Finally, reluctantly, he stepped out into the hallway. Heidi’s baby was born peacefully a few minutes later, without her ever really pushing.
Being urged to accept drugs is a common problem in many hospitals. In one hospital where I worked, the anesthesiologists decided that no one would get an epidural between the hours of 9 p.m. to 6 a.m. They would come into each labor room before going home for the night and give a speech something like this:
“Hi, I’m the anesthesiologist on call. I understand that you’re wanting a natural birth. I just wanted to let you know that I’m going home soon, and once I leave, I won’t be back until morning. You’re only 4 centimeters now; if you think these contractions are painful, you have no idea how much worse they’re going to get, and you won’t be able to get the epidural then. Are you sure you don’t’ want to reconsider?”
Not surprisingly, few women who were beginning to feel strong contractions could hold out for an unmedicated birth against these fear tactics.
In contrast, there are women who request pain medication and are denied it due to what seems to be an effort to “punish” them for non-compliant behavior. Iris (not her real name) had planned a home-birth and transferred to the hospital at 7 centimeters for pain relief. She had been in labor for about 36 hours, and was simply exhausted. Back labor and a baby in posterior position had caused her to reach the point she felt she was no longer coping with labor and needed some help. I was the labor nurse assigned to Iris, and was happy to be able to help a home-birther. While we were waiting for the anesthesiologist to arrive, I got her as comfortable as possible with heat packs to her back and lots of low back massage. When the OB and the anesthesiologist walked into the room, you could feel the hostility emanating from them before they ever said a word. The OB walked over to Iris’ side of the bed and started questioning her.
What made you think you wanted a home birth? Don’t you care if your baby dies? Why would you risk your life and your baby’s, too? Your water’s been broken over 24 hours now. You have put your baby at extreme risk! (Despite the fact that she’d had far less vaginal exams at home than she would have been subjected to in the hospital, which had certainly reduced her risk for infection).
Iris wearily looked at the OB and said, “Please, can’t we talk about this later? I just need the epidural now.” Tears streamed down her face as she tried to breathe through another painful contraction.
“You wanted a natural birth! Don’t think you can come in here crying for help now,” the OB spat the words out. “You can just do this without anything, as far as I’m concerned. Then see if you ever try a natural birth again!”
I was shocked at his words, and followed him out in the hallway to plead Iris’ case. Nothing I said or did made any difference—not speaking to the supervisor, or the chief of OB. Too often, supervisors and administrators protect each other’s interests rather than the patient’s interests.
Iris received pitocin to augment her labor, and was able to deliver vaginally, but it was a physically painful and emotionally traumatizing experience for her.
There is so much improvement needed in hospitals in the area of pain management. Nurses and physicians should have mandatory education in non-pharmacological pain relief. If nurses hold negative attitudes toward women who want normal birth, they should be assigned to another area. More efforts should be made to give women balanced and factual information about pain relief well before labor. During labor, everyone should be working together to support the mother’s original plan for pain management. If situations arise that require a change in that plan, the supportive attitudes should continue. No one should be “punished” for refusing pain medication and later deciding they need it. Most of all, women—the recipients of this shabby care—need to speak up and speak out. If you had a bad experience, let the hospital administration know. Tell them you will take your birth elsewhere next time. Until women become vocal enough about the problems with hospital birth, and are willing to take their money where they can get the care they desire, nothing will change.
I can’t even articulate how FURIOUS I am at situations like this. Who do these people think they are? It completely and utterly appalls me that laboring woman are treated like this. I know you can’t give specifics about this situation. But if I could know, I would be writing a very strongly worded letter to the administration. I wish more women would speak up. We do not deserve to be treated like this. (especially when we are paying consumers)
This is just unbelievable! Each story I have read on your blog has made me feel like I just kicked in the stomach. I don’t doubt that these kinds of attitudes are out there, but I do want to say that not all doctors and nurses are like this. There are many nurses (myself included) who are passionate about supporting women in labor regardless of their choices. I agree totally that all LD nurses should recieve mandatory education on supporting women through unmedicated labor. The reality however is that it isn’t happening. So I make it my goal to role model good support, by being in the room with my patients and not at the desk watching the central monitor, by encouraging skin on skin, by taking new nurses under my wings and teaching them the skills they will need. Grassroots efforts to change the face of birth in our medicalized culture. One birth, one nurse, one mom, one baby at a time.
Your blog is great, keep it up. Looking forward to inspirational stories as well.
I do have lots of inspirational stories! I want to reiterate that I have not told these stories out of a desire to make physicians and hospitals look bad, but simply to try to clarify why I do not see an advantage to hospital birth in most cases. Women believe that because their physicians have a good bedside manner, they have the woman’s best interest at heart–and perhaps they do, but our opinions on what is best for a woman are often very divergent. Unless a physician or nurse is committed to the belief that each woman has the right to self-determination, to decide what happens to her body, you are on dangerous ground submitting yourself to their care.
This is so infuriating. As doula, I make sure that it is very clear to my clients: I am mostly needed when I am not there so call me when you go in so we can meet at the door!
I think one of the most frustrating things to me is admission into the hospital. Clients discuss what they want and do not want with their midwives, but the hospital has totally different protocols, like the continuous monitoring for 20 min. To have to fight or give in to something right upon admission is so so undermining the trust a client will have in what follows.
Women have to be so well prepared, it’s unreal.
Hospital admission is frustrating, because the experience is so dependent on whether you get a nurse who supports normal birth or one who dislikes it and is working at odds with you. As a midwife, I get frustrated with birth plans, because they are often very unrealistic in comparison with what I know the hospital will require. You can fight their protocols at every step, but this is not conducive to a peaceful labor environment, and it sets you up for negative experiences from staff who want to “punish” you for not cooperating with their program.
It’s stories like these that make me suspect a strong undercurrent of Misogyny in the medical field- from both men and women. As well as individual cases of megalomania….
Very well written blog – keep it up! As an Ob doctor and, I think, a patient advocate, I hurt for the abusive treatment these women received. I think some of my colleagues have forgetten the “care” part of health care…
I am grateful for OB physicians like yourself who are patient advocates. I have been fortunate to know several, and appreciate their skills when we’ve needed them. Thank you for your comments.
It’s painful to hear these kinds of stories. I lived through this with my first born. My nurse had such a distaste with my having natural childbirth. The doctors were frustrated with me for not having an epidural and told me i would wind up with a c-section because i kept humming through my contractions. My hubby ordered everyone out!! i had residents, nurses, doctors and people just walking in and out of the room. I felt so molested. Thank you for allowing me to share this.