The Mickey

We've been reading so many outrageous violations-in-birth stories these days: Catherine Skol's case, forced confinement, the parents who lost custody due (in part or completely is still up for debate, but still) to refusal of a c-section, sterilization without consent, and on it goes. Finding out about "pit to distress" was insane enough in & of itself. I was starting to think I'd heard it all - and then I was told a story a few weeks ago that I'm still completely gobsmacked by.

A friend of mine on a forum that I belong to - let's call her L - has a mother who is a very old-school Labor & Delivery nurse. She is quite devoted to the medical establishment's approach to childbirth. During a conversation on a birth-related thread, L sent me the following PM (posted here with her permission):

This woman showed up at the hospital to have her baby, and was adamant that she did not want a C-section. For whatever reason, the monitor eventually started to show fetal distress (mom didn't say whether it was pit or some other issue). The doctor recommended a C-section, the mother refused, the nurses begged, the mother refused. The doctor sent for a court order to force her to have the C-section, but the court order was taking too long, so finally the doctor slipped something into the woman's IV to knock her out and the did the C-section while she was unconscious. Yes, really.

I was completely shocked. My mother was one of the nurses who participated in this - for all I know, she was the one who administered the knock-out drug; it seems likely - and she maintains they did the right thing by intervening to save the baby's life. She said the woman didn't sue after she woke up, she was very grateful because she loved her baby, but I was so completely appalled; I said that was one of the most egregious examples of assault I could imagine but my mother (a very devout Catholic and pro-lifer) said the baby's right to live trumped the mother's right to refuse a C-section.

I have no idea how to process this and would be very interested in your thoughts. Is this common?! Do you think they did the right thing by saving the baby? Can you imagine making your peace with the natural progression of life and then waking up to find out you'd been drugged and sectioned against your will? Yowza.

It's hard to even know where to begin with this one, even after picking up my jaw off the floor.

One thing that's automatically frustrating about this is the fact that we have no way of verifying any of this, and simply have to take L's mother's word for it. The part where this is most maddening, of course, is the part where the patient was "grateful" for having been slipped a mickey in order to perform a surgery which she had specifically declined - numerous times.

We have to extrapolate so much here, but I don't think it's much of a stretch to say that a signed consent form for a c-section couldn't possibly exist. Even putting ethics aside, on what legal grounds does the hospital stand? Me, I would have not only sued but looked into criminal charges, depending on the details, of course.

L went further and asked:

As a doula, would you have counseled her to go ahead and have the C-section if the fetal distress was really that bad? Or if she understood that the baby might die and she was okay with that, would you have accepted that and told the hospital staff to fuck off and take care of her as the baby died?

There are just no easy answers here, especially without knowing what led up to this situation. I feel confident in saying that a doula's presence MAY have helped her avoid things getting to this point in the first place, depending on, say, whether certain interventions known to cause fetal distress (i.e. hyperstimulation of the uterus via Pitocin or worse, Cytotec, resulting in diminished oxygen supply for the fetus), but it's pure speculation.

L's questions bring up a potent and controversial point: It should be clarified what a doula can and cannot do in the delivery room - a matter that can be delicate when the mother is laboring in an environment that is hostile to her objectives, or even in settings that are more supportive of the mother's aims when things get complicated. What does “advocating for” her client in a hospital setting mean?

Here's my best understanding of it at this point: In addition to helping give literal physical support in the form of pain relief and effective positioning (using water, massage, breathing), a doula is there to empower the woman to stand up for herself, and to help keep the mother's birth plan on track as much as is reasonable according to the mom's own research and desires, knowing that things do sometimes have to change - helping the parents to recognize when intervention is truly in their best interest.

What doulas cannot do is run interference with hospital staff in any sort of direct way. This is not only beyond her scope of practice, it can risk getting her thrown out of the room altogether, which does the mother no favors at all. If I told the hospital staff to fuck off, even figuratively, well, that would be the end of my role in that woman's birth.

A doula CAN help avoid unwanted interventions by first helping the mother to ask for more time to think things over each time something not on the plan is suggested, and then taking that time to discuss whatever's been brought up, reminding the mom of the risks and benefits and how this step may affect the course of her labor. Or if an unwanted intervention is on the verge of being done and the mother isn't quite realizing what's happening, the doula can bring it to her attention so that she can decline it. Jennifer Block cites a clear-cut (no pun intended) example of this in "Pushed": a doctor poised scissors at a mother's perineum, though this was something the mother specifically wanted to avoid, and said, "I'm just going to help things along with a little cut here." The mother, being very off-in-laborland, nodded vaguely. The doula quickly pointed out, "She is about to perform an episiotomy. Is that okay with you?" And the mother sat up and shouted, "NO!"

So how to apply this to the situation L described? I have no clue. Certainly no firm answers, especially, again, without knowing the details. If Pitocin was the culprit, a doula presence could possibly have helped avoid it or kept it to a reasonable level, and could have made labor progress more effectvely. Once they slipped her the mickey? To answer her second question above, I could not have told the staff to fuck off, much as I would have liked to. It just would not be within my abilities, and like I said, would have most likely left her without my support at all. I don’t think there’s anything I could have done short of offering to serve as a witness in the trial (preferably criminal) that the care providers involved so richly deserve.

I have to wonder where the father was in this whole awful situation - and this illustrates another point about the specific kind of support doulas offer. Some dads have resisted the idea of a doula, insisting that they are all the support their wife needs. Many men can indeed be wonderful support, but many are quite out of their element in births, and can be easily intimidated by hospital scare tactics when those cards start getting played. This is where the doula can be of great aid to both parties. I'm digressing and starting to ramble, but I think it's relevant to this anecdote, wondering whether the father (if he was there at all, which, again, we just don't know) could have protected his wife.

Again I feel compelled to quote Navelgazing Midwife: "Women don't just need doulas anymore, they need bodyguards."

Experienced doulas, care providers, mothers, what do you think of this horrible scenario? Have you ever seen such a thing? Does it shock you? What, if anything, would you or could you have done?