Friday, December 19, 2008

"That baby would never have fit"

At Better Birth, the story of a pelvis that seemed too small. The second I read this story I thought of a very different one.

Back when I worked in Denver, I was paged into a birth for a young woman having her first baby. She really wanted to have an unmedicated birth. She was a very sweet woman, and very petite. She and her family asked a lot of questions about whether she could squat for the delivery - they were really interested in alternatives. Unfortunately, she had a slow labor and her membranes were already ruptured. In the hospital, this is more or less a "don't pass go, don't collect $200" card straight to Pitocin. With the Pitocin, her already long and tiring labor become too difficult to manage without medication and she asked for an epidural. She was finally able to sleep and had several cervical checks from a pleasant new doctor, a somewhat older man re-doing his residency after moving from Italy. He looked skeptical after each one. "I just don't think this baby is going to fit," he said.

When she finally dilated to 10 and he said very lukewarmly that we could "give pushing a try". With his fingers still up by her cervix, he encouraged her to push with a contraction. Totally numbed by the epidural and unable to feel a natural pushing urge, we coached her to push during a contraction and she did her best. He shook his head. "It's not budging. We'll need to do a c-section." In my memory, he let her try only once, although he may have given her a couple contractions - it was very brief. She was so tired, and he was so firm that there was no way the baby could come out, but I still think back and wonder if there's something more I could have said or done to encourage waiting. To my memory, there was no fetal distress and no reason to proceed quickly to surgery, although I don't have the birth record I kept with me right now to confirm. But what I do remember is his absolute belief that the baby could not come out vaginally, and how it seemed self-fulfilling.

Now, I didn't feel what he felt. Maybe the head was really wedged oddly and he could tell there was no way to manipulate it and no way for it to fit through. But read above, again, for the story where care providers believed there was no way for the baby to fit and yet proceeded as if there was. Think about how things could have been different if the woman I worked with did not have Pitocin or the epidural, and could follow her instincts or be coached to help expand her pelvis. For the rest of her life she'll believe her pelvis is too small to give birth vaginally...unless of course she sees a video like this.

I have seen doctors tell women post-cesarean that the babies "never could have fit" even in situations where they couldn't really know that. The most recent one was especially strange - the woman had a c-section for a number of reasons including failure to progress (so she never got to push), she was not a small person, and the baby was not that big. And yet the OB told her "that baby would never have fit". One of the things they pointed to was the size of the head, but of course the head can mold during pushing and this baby's head was totally unmolded because of the surgery. Is this a doctor's idea of making women feel better about their c-sections? It's just totally strange.

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