When I think about my first birth, I am more likely to feel sad, angry, and regretful than to feel joyful and nostalgic. I had assumed that my care provider and I were teammates. But after this experience, I began to realize that doctors don’t always have a “team” mentality.
Right up front I will tell you the good news: by all conventional, external indicators, everything went fine. The end result was a healthy mama (me!) and a healthy baby (our first born son!).
But on the inside, I felt like I had been manipulated at a very vulnerable time in my pregnancy. And since I am also a Registered Nurse, I continue to fight guilt that I should have known better! As a result, I felt like I had been cheated out of something valuable.
Vague Expectations of Birth
Overall, my first pregnancy was picture perfect. My husband and I were blessed to get pregnant in our first month of trying. I was all belly, a beautiful pregnant Mama. I experienced the 24/7 nausea that many mamas experience during their first trimester, but I was still able to work full-time as a pediatric operating room nurse until about my 8th month. (I could have worked longer, but that’s a story for another day!) My only “complication” was recurrent vaginitis and yeast infections.
I had a vague idea that I should want a natural birth, but I was not as nearly “naturally minded” as I am today. Ok…I really wasn’t naturally minded at all 😉
I sort of thought that I didn’t want an epidural, but I couldn’t clearly express why not. I did not want an episiotomy (who would?!?!), and my understanding at the time was that episiotomies had fallen out of favor and were no longer the standard practice, anyway. When I asked my OB if he did episiotomies, he would only give me an ambiguous response that made me think he probably wouldn’t, but maybe there were rare situations where he would. At least, that was my interpretation that I wanted to believe at the time.
Choosing My OB
I chose my OB primarily because what you see is what you get: the OB who did my prenatal appointments would be the same OB who would be there for delivery. I was terrified of going to one of the huge OB practices where I couldn’t be sure which doctor would be on-call when I went into labor. Plus, his office was a convenient location, and he used the hospital closest to my house. Bonus: I rarely had to wait for my appointments.
Everything seemed fine with my doctor-patient relationship until 39 weeks (and 6 days). He checked Baby Boy’s heart rate, and did the standard vaginal exam. Then, before he left the room, he casually said, “I’ve taken the liberty of scheduling an induction for you on Monday.”
A scheduled induction was not on my (admittedly vague) wishlist for a natural birth. So I politely declined, inarticulately explaining how I really didn’t want an induction unless I was at least 42 weeks. At least, that’s what I remember saying. (I would have only been 40 weeks and 6 days by then.) From what I understood as a mommy-to-be and as a registered nurse, that was (and still is) the usual standard of care when everything’s going well.
He didn’t seem perturbed, but responded by telling me that if I didn’t want to schedule an induction then I would have to come in 3 times a week for a fetal non-stress test until delivery. I told him that was perfectly fine, I’d be happy to come in on the Monday, Wednesday, and Friday of the following week for check-ups.
My (Manipulated?) Fetal Non-Stress Test
The following Monday, the day that would have been my scheduled induction, my husband and I came in for the first fetal non-stress test. It was late morning, and I was starving…my parents were already in town awaiting the arrival of their first grandchild, and we were meeting them for lunch at a Chinese buffet after my appointment. I had purposely skipped my midmorning snack so that I would have more room to stuff my face at the buffet 😜
Unfortunately, the fetal non-stress test didn’t go as smoothly as I had expected.
If you’ve never had a fetal non-stress test, let me describe what it’s like. You lay on the exam table, and they place a monitor on the outside of your belly to record the baby’s heart rate and to help identify when the baby moves. (It’s pretty much the same monitor they use during labor, fyi.) I was given a button, and told to press it every time I felt Baby Boy move.
When babies move, their heart rate should increase a certain amount. If this happens at least twice in 20 minutes, then the test is called “reassuring”, and everything’s fine. However, if the baby’s heart rate doesn’t increase within the acceptable parameters, then it’s called “non-reassuring” results, and the doctor will want to investigate further.
Here’s the problem: Baby Boy wasn’t moving a whole lot at the moment, but he was hiccuping a ton. He had hiccuped A LOT throughout the whole pregnancy, so fetal hiccuping wasn’t anything unusual for me at this point. However, what I didn’t know was whether a hiccup counted as movement for the purposes of the fetal non-stress test.
So I asked my OB.
Me: “Should I press the button every time I feel him hiccup?”
OB: “Push the button whenever you feel the baby move.”
Me: “Yeah, but do hiccups count as movement?”
OB: “Just push the button when you feel the baby moving.”
I felt frustrated that he was being so vague when a simple “yes” or “no” could have sufficed. But I did the best I could, and interpreted his answer to mean that yes, I should press the button every time Baby Boy hiccuped. After all, a hiccup IS movement. Technically. I knew that it wasn’t enough movement to raise his heart rate enough to “pass” the test, though. A typical Baby Boy backflip would be the type of movement needed for that!
Plus, I was still starving and craving Chinese food.
I don’t remember how long the test took, but it pretty much ended this way:
OB: “Well, the results are non-reassuring so you need to go over to the hospital right now and we’ll get you induced.”
Me: “Umm…can I stop by a drive through and eat lunch on my way?”
OB: “No, you can’t eat anything in case we need to do an emergency C-section.”
Me: <breaks down into hysterical crying>
Luckily, my husband was with me at the appointment. He did his best to reassure me: the hysterical, extremely hungry, and severely disappointed pregnant woman, as we went to the car and drove straight to the hospital to be induced. I was 40 weeks and 6 days along.
At the Hospital for the “Emergency” Induction
I really don’t remember a whole lot of details about my labor in the hospital. Mostly bits and pieces, certain details that still stand out brightly after all these years.
The mother of a dear friend had volunteered to be my doula, and I was very glad to have her available…especially given the way my first labor and birth was turning out. Both my parents also came to the hospital to be with us during the induction and labor, although my Dad occasionally stepped out of the room to avoid seeing some of the more “intimate” parts of his daughter 😉
The Pitocin induction started around 1pm on the same day that the OB had originally wanted to induce me, only it was 6-7 hours later than he would have scheduled it for. I remember my doula inquiring of the nurses if it was a possibility to reduce the Pitocin once my body started regular contractions, but they pretty much said no, that wasn’t the way the hospital or the OB preferred to do things. I appreciated the fact that she asked for me!
Pitocin contractions are no joke. They are hard and fast, with no time in between for rest and recovery. I said it then, and I still say it after having had 4 more births…if there had been more time between the contractions, then I think I could have handled them better. But it was wave upon painful wave, with no breaks in between.
I tried laying down, standing up, swaying, bouncing on a birth ball. None of it really helped. I also ate a grape popsicle because I was still hungry and clear liquids were the only thing they would let me eat.
It did not fill up my belly like a Chinese buffet.
Breaking my Water
When the OB came in to check me, he decided that I was far enough along in labor to break my water. What an uncomfortable procedure. Having to lay on my back and endure the unrelenting Pitocin contractions, while he used what looked like a giant crochet hook to stick up my vagina and break my amniotic sac. Not fun.
Immediately after he broke my water, the contractions felt so much more intense. I had thought they were painful before, now they were magnitudes of order more difficult to get through. Wave upon wave, with no rest in between, and no end in sight.
I finally relented and asked for an epidural.
In hindsight, I wonder whether I could have endured without an epidural if I had been clearer on the reasons “why” I wanted as natural of a birth as possible. But I wasn’t. I only had a vague sense that a natural birth would be better for me, but without a firm, clear reason why.
For any of you that have gotten an epidural in the middle of labor, you know that it is no easy process. Having to hold still in a certain position, leaning forward in such a way that you have to “tuck” your hugely pregnant and contracting belly so that the anesthesiologist can reach where they need to reach…there is nothing fun about it.
After the epidural
Afterwards, labor was much easier. I had to lay in bed at this point, but the epidural was certainly effective! The only way I could tell I was even having a contraction was by watching the computer monitor that was tracking Baby Boy’s heart rate and my contractions. Everything seemed to be going perfectly fine with Baby Boy, despite the concerns of “non-reassuring fetal heart rate” raised in the non-stress test earlier that day.
At one point late into the night, I started noticing a dull but localized pain on the right side of my abdomen. I pushed the epidural button to trigger an extra dose of medication in the epidural, but it didn’t go away. The dull ache continued despite the epidural, and seemed to get a little worse with each contraction.
Time to push!
I pressed the call button to tell the nurse about the strange breakthrough pain. She answered matter-of-factly that it was probably time for me to push, and she would come in to check me in a moment. I remember thinking that it was kind of weird that my body was ready to push, but I couldn’t tell because of the epidural. I also remember wondering how “time to push” could cause breakthrough pain with my epidural, but still NOT cause the nurse and OB to hurry into the room so I could push.
Another time blur, but soon enough the OB was there and everything was set-up. My husband, my mom, and my doula were in the room supporting me. My Dad stepped out of the room (but I’m pretty sure I saw him peek in at least once to see his first grandchild being born!).
Apparently, I’m an efficient baby pusher. That assessment has been supported by my 4 following births, as each of my children arrived within about 30 minutes (or less) of pushing. I definitely feel lucky about that!
My memories of the pushing phase are a little disjointed and haphazard, possibly out of order. I remember my doula peeking over one of my legs and (I think) making a comment about seeing a “blooming rose of Texas”. I always assumed that she meant I had a hemorrhoid that was “blooming” with each push, but I don’t remember if I ever asked her and found out for sure.
The other short conversation I clearly remember during the pushing phase started with my OB. Near the end of a contraction, I heard him casually say to the nurse, “That doesn’t look like it’s going to fit, don’t you think?”
I seem to remember the nurse nodding her head diplomatically, but I don’t know if she ever actually answered.
I felt devastated. As soon as I stopped pushing for that contraction, I said aloud to no one in particular, “I know what that means.”
My poor husband had no clue, he hadn’t heard the OB’s comment. “What WHAT means?”, he asked. I didn’t feel like answering because I was so disappointed and frustrated. I knew I was about to get yet another birthing intervention I never wanted.
I saw my mom mentally rewind everything she had just heard, and she suddenly realized what was going on. She answered for me, “An episiotomy. She’s going to have an episiotomy.”
Baby Boy is Born!
Moments later, our precious firstborn baby boy was born: all 7 pounds 5.5 ounces of him. Daniel cut the cord (then put the non-sterile scissors down on the sterile table…but that might be a detail only a former Operating Room nurse would appreciate…).
Besides having a healthy baby and a healthy mommy, my only other consolation was that despite starting the induction early in the afternoon, I gave birth in the middle of the night…requiring the OB to be up in the middle of the night, too 😉
Don’t forget my placenta!!
The nurse part of me wanted to see my placenta. I don’t even remember delivering my placenta, probably because I couldn’t feel anything from the epidural. But I was aware enough that I didn’t want it to be trashed before I laid my eyes on it, and got a picture of it.
I had made sure to tell the OB, the nurse, and my family. It wasn’t due to any “crunchy” desire…it was purely my love for anatomy and physiology! After all, how often do you get to see a real placenta?
(Five times. If you’re me, the answer is exactly five times. So far 😆)
I’m pretty sure the nurse thought I was a bit of a weirdo, since I was so obsessed with seeing a placenta. Once I saw it and someone took a picture of it, I was satisfied.
What I would do differently (and how I think I was manipulated)
My doula was wonderful. After we were safely home, she came for a postpartum visit and helped me process my birth story. At the time, I could tell that she was trying to help me reframe what I viewed as a rather negative experience into more positive terms. I definitely appreciated that perspective!
But years afterward (9-1/2 years afterward, to be more exact), I still wonder about the care that I received…
Was the OB really concerned about Baby Boy’s heart rate during the non-stress test?
Or was I just that annoying and inconvenient patient that wouldn’t schedule the more convenient induction, so he forced my hand? Could I have done anything to encourage Baby Boy to wake up, or was there an alternative assessment that could have given different results? Would Baby Boy have been more active if I had eaten lunch before the non-stress test rather than waiting for a Chinese buffet craving? Was the OB intentionally being vague about whether I should push the button for hiccups, or was that the standard protocol?
What if I had declined to have my water broken?
What was the benefit of breaking my water, other than an attempt to speed up my drug-induced labor that wasn’t even taking that long? If I hadn’t had my water broken, would I have been able to endure the Pitocin contractions and not felt the need to get an epidural?
For the record, during my 3 natural births later on, my water never broke until the very end when I was ready to push. Having done it both ways, I can now say with certainty that laboring with an intact amniotic sac is less painful than laboring after the amniotic sac has been broken!
Did I really need an episiotomy?
The OB knew that I didn’t want one. I have since had successful births with little or no tearing, and I don’t think it’s simply because that area of my body is “enlarged”! If he had taken the time to listen to my body, rather than simply follow a standard procedure, would I have avoided stitches?
I don’t know, because back then I didn’t have the knowledge OR the confidence to “buck the system.” Even though I was an RN. Even though I (vaguely) wanted a natural birth.
What I would do different…
If the “me” of today was transplanted back then, I hope I would have had the courage to make different choices. But even so, I’m not sure if I would have had the strength to contradict the OB. When you’re nearing the end of your pregnancy, or you’re actually in labor, you feel so vulnerable and scared..at least I did. I can still remember that feeling distinctly, and I don’t like it.
But I hope that I would have questioned the non-stress test. Maybe asked to repeat it after I got a bite to eat and Baby Boy got a little more active, instead of automatically accepting his results. That could have potentially avoided the entire induction.
I hope that I would have declined to let him break my water. There was no medical need for it that was explained to me, only convenience. And clearly not my convenience.
I hope that I would have refused the episiotomy, even if I had to speak up during a contraction. Even if it meant that I might have a tear and need to be stitched up, I would rather have had to deal with that possibility than the definite consequence of being cut and stitched up.
Some Final Notes About My Medical Record
Writing this birth story was a LOT harder than I thought it would be. I am happy to talk about it with anybody (and I have, on many occasions), so I assumed that putting it into writing would be just as easy. However, thinking through all the details brought up a lot more emotions and questions than I expected.
For one thing, I realized that I really wanted to see my medical records and find out what he documented about some of these things. I’ve had this desire for years, but never made it a priority to make the phone call, fill out the paperwork, and pay the fee to get the records. So writing this finally spurred me on to do that!
(Side note: It’s a good thing I did it now! God’s timing is always perfect. The secretary told me that since my last appointment was seven years ago, my record was on the list to be shredded come January…just a few short months from now!)
The OB’s Notes About the Induction
Once I deciphered the typical MD chicken scratch handwriting, there’s a single line of notes written for my last prenatal appt for this pregnancy. He documents my vaginal exam (If you’re interested, I was 2cm dilated, 60% effaced, and -3 Vertex position, exactly the same as the previous week 😉). Then he adds:
“Offered an induction on 4/20/09 – Pt wants to think about”
To me, it feels like such an innocent little notation, especially when I reflect on everything that happened after it. (And considering what happened at the end of my second pregnancy under his care, it feels almost insulting…but I’ll work through that in my second birth story.)
But what he wrote is not what I remember. Where was the part where I declined the induction? And chose to do the non-stress test instead? Where is the part where he even offers that as an alternative?
The other page that I eagerly wanted to see was Baby Boy’s non-stress test. The OB’s notes were as follows:
Baseline heart rate is low with only one acceleration present. Does not meet criteria for reactivity-reassuring tracing. Recommended to patient induction of labor at hospital with monitoring of FHR pattern.
I struggle with this description. As an emotional Mommy AND a Registered Nurse who has studied this stuff, I feel like I’m still left with more questions than answers. What WAS his baseline heart rate during the test? Why doesn’t he mention how long the test took, or the fact that Baby Boy seemed to be sleeping, or that he had the hiccups, or…?
He claims there was only one acceleration, but in my memory I laid on that table for a looong time and there was only maybe 2-3 big movements at all because Baby Boy seemed to be sleeping…the rest of the movement was all hiccups. Was the OB trying to manipulate the variables, either intentionally or unintentionally, in favor of still getting me induced on his “induction day” at the hospital?
That’s the million dollar question for me, and one that I know will never be answered. Am I correct in ascribing dark motives to a manipulative OB concerned mostly with his own convenience? Or am I being unjustly hard on an OB who was genuinely interested in providing the best, safest care to me and Baby Boy?
Honestly folks, I’m sitting in Starbucks trying not to cry as I wrote that last paragraph.
…All’s Well That Ends Well?
In any case, the pregnancy that made me a Mommy has obviously shaped and molded me greatly into the person I am today. It started me down on a path towards taking personal responsibility for my health care, for one thing, although it took several more years to clearly see those results.
And, after all, Mama and (Not-So-Baby) Boy are still healthy and well over 9 years later. He’s a delight, and always curious about how things work (even curious enough to almost break the microwave once…doh!).