Wednesday, February 3, 2010

Bodie's Birth: An Example of How Our System Should Work

I am going to tell you the story of Bodie's birth because it is a good example of how I wish our system always worked. When I first spoke to Bodie's Mom she was looking for childbirth classes with someone who believed in natural childbirth and would be supportive of her choice to birth at home with a Licensed Midwife. We started the group classes at the end of October and I quickly learned what a sweet, intelligent woman she is.

Bodie's parents were seeing Edana Hall, L.M. for their prenatal care and planning a beautiful and peaceful birth at their home in Pismo Beach. Being a medical professional herself she was very clear on her reasons for wanting a homebirth. She explained, "Having worked in hospitals I can tell you they are a great place for sick people but if you aren't sick you don't want to go there. I'm not sick. I'm just pregnant."

As time passed I secretly began to hope I would be invited to their birth. I love going to homebirths. With all the hospital births I do, homebirths help me stay grounded to how women really birth. Even the "natural" births I help create at the hospital are not as empowering for the birthing women. I was sure this couple was preparing for a really special birth.

The first sign that everything might need to go a different direction was just over the horizon. Both her midwife and I had some concern about the baby's size and growth rate. We both had done the right thing and counseled the mom on her diet and she conscientiously made changes in her eating patterns. Her midwife also encouraged her to slow down at work and in life and focus on growing a healthy baby and Bodie's Mom did the right thing and followed her advice.

Eventually as the weeks passed and the baby's growth seemed to be slowing down in spite of the Mom's diligence her midwife did the right thing and sent her to Dr. Cedars, a local perinatologist, for testing. He discovered that the baby was in an alarmingly low birth weight percentile for the number of weeks gestation. Could her dates be wrong? No, Bodie's Mom was sure of her dates.

When the Midwife was told what the tests revealed she immediately did the right thing and told Bodie's Mom she was no longer a good "candidate" for a homebirth. Only healthy women with healthy babies should be giving birth at home. Bodie was no longer considered healthy. She gave the Mom the name of an O.B. for her to get in touch with right away.

Bodie's Mom chose to work with Dr. Yin. At her first appointment Dr. Yin did the right thing and explained to the parents about the need to monitor Bodie much more closely than another baby from now until he was born. Although understandably frightened they agreed that careful watching was necessary.

Putting aside her dreams of a homebirth was difficult even though she completely understood the gravity of the situation. Transitioning to the idea of a hospital birth was also scary. Her Midwife recommended she hire a Doula to guide her through this changing landscape and stand by her side. Bodie's Mom called me. I was invited to her birth but it wasn't going to be the birth I had been wishing for her.

Dr. Yin did the right thing when she advised Bodie's Mom to take it one week at a time. Perhaps things would turn around and the baby would do ok until closer to her due date. She might then be taken out of the high risk category. We hoped it would work out this way and Bodie could be born at French Hospital.

We worked together on things she could do safely and naturally at home to promote her body to move towards an inducible state. It began working and she began off and on to have mild contractions. But there came a day when through the appropriate use of technology it became clear it was riskier for Bodie to continue inside the womb than outside.

So Bodie's Parents did the right thing and checked into Sierra Vista Hospital where they have a Neonatal Intensive Care Unit at the level that Bodie might need. Mom was already having mild contractions. Her Doctor did the right thing by trying a different approach to the induction than simply hooking her up right away to pitocin. I worked with the parents and we did lots of walking the halls together.

At one point I stopped by the nurses' station to speak to their nurse. I explained I wanted her to know that once Bodie's Mom was in a more active labor I knew she was going to need to be monitored much more frequently than usual. The nurse was pleasantly surprised I felt that way. I expressed my concern about Bodie and my understanding that I knew he might not deal with the stress of real labor well.

Unfortunately that is exactly what happened. Shortly after starting into a more active labor pattern Bodie's heart rate was alarmingly up. This is a clear indication of stress. Our nurse hurried into the room and gave Mom oxygen, had her lie on her left side which is a position that is easier for the Mom to get oxygenated blood through to her baby, and called Dr. Yin. I explained what was going on to Bodie's parents and tried to began to prepare them for the emotional transition that their son might need to be born surgically. Lots of healthy babies have "funny" heart tones at times during labor and are born just fine vaginally but we all knew Bodie wasn't a healthy baby.

By the time the Doctor arrived the heart rate was back in the normal range. She wasn't alarmist and instead did the right thing by taking a let's wait and see approach. She stayed close by at the nurses' station where she could watch Bodie on the heart monitor. But it wasn't long before Bodie's heart rate began to climb again and it was clear how he needed to be born. I explained again to Bodie's Parents why this was now the safest option for their baby. Dr. Yin seemed surprised I was supportive of a cesarean.

What the medical staff didn't seem to realize is that an experienced Doula should know the difference between how healthy babies respond to labor and a compromised baby. A good Doula should champion staying the low tech natural path as long as the mom and baby are healthy. If mom or baby aren't healthy a Doula's role changes. She becomes a conduit for information about what is going on around the couple, since often the staff need to act quickly and don't have time to fill in all the details for the parents. The staff also doesn't have time to deal with the parents emotions but a good Doula meets that need as well. When plans change their is always fear mixed with grief that needs to be addressed. Life changes very quickly at that point.

So we all went to the O.R., Bodie's Mom first to be "prepped" while I waited behind with Bodie's Dad. This is a particularly difficult time for fathers. Very soon Bodie was out and it became clear there had been multiple issues contributing to Bodie's tiny size, none of which could have been prevented by anything his Mom could have done. There is nothing different that would have happened if she had chosen to see a Doctor for prenatal care or planned a birth in a hospital. Ultimately no matter what path she chose it would have lead her to that moment.

I am happy to report that beautiful Bodie has doubled in size in the few weeks since his birth. He is healthy and getting stronger everyday and so is his Mom.

This is how I wish our system always worked. This is how it is done in the Netherlands and they consistently have better outcomes than the U.S. All women are initially seen by Midwives. They assess them and determine if they need to plan a hospital birth with an O.B. or with a Midwife, or if they will be birthing at home with a Midwife. Each time prenatal care is given they are re-evaluating. Is she still a homebirth "candidate". If at anytime leading up to the birth or during the birth she is no longer a "candidate" they turn care over to the appropriate care provider. This care provider continues to work with the midwife and accords her the professional respect she deserves. After all she did the right thing.

Thank yous to Edana Hall, L.M., Dr. Cedars, Perinatalogist, and Dr. Elain Yin, O.B. for their quality care of Bodie and his Mother. I want to say an individual thank you to Dr. Yinn who took the time to get me re-connected with my mom down in the Recovery Room.

1 comment:

  1. I love this story. It's true, our system should work this way and I love that you're such an advocate for that. Please don't stop in your demand for change! Thank you!