Wednesday, November 25, 2009

Reply turned post: Warning: this post contains the word "rectal"

Jill at the Unnecesarean recently wrote about out-of-bed birth and the Captain Morgan aspects of one of her births (you have to read it to fully appreciate). MidwifeNextDoor commented:

"Good for you! I am a CNM presently (reluctantly) working in the hospital. I've only done two out of bed births so far, but it freaks the nurses out! One nurse's chart notes on a patient went like this (the woman was pushing when she arrived at the labor ward):

"Patient REFUSES to give urine sample. She is standing by the side of the bed. I have repeatedly told her to get up on the bed, but she refuses. She stated, 'Women have been giving birth standing up for thousands of years and SO CAN I! And then she pushed the baby out. I did put gloves on before the baby was born."

This client of mine was a VBAC client, by the way! I didn't make it in time for the birth, obviously. I've done one bathroom birth, with mom on hands and knees, and one side of the bed birth with mom standing. There is so much fear surrounding anything different from the cockroach position (flat on your back, legs in the air) that it makes me stressed.

Would love to see more women refuse to get into bed."

This jogged a doula memory for me and I contributed my own comment/story. Since several people thought it was pretty funny I thought I'd repost it here:

"MidwifeNextDoor, your comment about the nurse's charting was so funny!! It reminded me of a birth one of my fellow doulas attended when we were in AmeriCorps together. There was a new CNM at the very by-the-book, public hospital we often attended births at, and she had trained in birth centers down in New Mexico. I can't imagine she's still there but at the time she was fighting to carve out a little sphere for normal birth, and we loved her for it.

One day she paged for one of our doula team to come in to a birth there because she knew the mom wanted to go unmedicated and felt like the nurse wasn't going to give her enough support. My teammate was on-call and told us the whole story later. I can't remember the exact details anymore, but it went something like this: When it came time to push, the unsupportive nurse really couldn't handle the hands-off approach. Mom began pushing standing up next to the bed and the nurse freaked out and said "She's pushing!" "Yes," the midwife said calmly, "she is." The nurse began to get huffy and started charting about the patient pushing STANDING UP. "What's her dilation?" the nurse asked. "Oh, she was almost fully dilated," the midwife said, "I'm sure she's complete now." The nurse went back to charting about how the midwife did not check but just SAID the patient was complete. The nurse at this point swings the computer around so her back is to this travesty. Whenever the midwife asks for a chux pad or anything else she needs, the nurse gets it for her and then goes back to charting with her back turned, so the midwife starts asking the doula to hand her things. As the baby descends, the midwife takes note of signs of progress and says "Could you please chart, 'positive rectal bulging'?" "WHAT?!" says the nurse. "POSITIVE RECTAL BULGING," the midwife says loudly, and she and the doula grin at each other. (Fortunately mom was Spanish-speaking and probably not paying any attention anyway so she wasn't privy to all this banter.) Shockingly, baby is born without any need for mother to get into bed, or for nurse to do much but stand with her back turned and chart ;-) "Positive rectal bulging" became a catchphrase around the office for a while.

Side note: after the baby was born, mom did get into bed to rest and cuddle with the baby, and the doula told the mom what a great job she did, how impressed she was, etc. She asked half-jokingly, "So, do you feel like you could do anything now?" and the mom looked up and very matter-of-factly said, "Oh, YES." "

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