Wednesday, August 19, 2009

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?


  1. Okay, you really want discussion of this? I'll start.

    There is NO medication alone that will cease consciousness in a client outside of an operating room because ceasing consciousness in the mother poses extreme risks to the baby. I can not imagine in the far reaches of reality that they would give her something that caused her to lose consciousness outside of an OR. There *are* medications that can cause amnesia, but under those meds, mom could have given, even signed, consent. Scopolomine is the only medication I know of... sure there are others. We'd need to ask an L&D Nurse if there is any such thing. I have a few I can ask (and will).

    I find this story has MANY holes in it, but the original questioner asks valid questions about a doula's role in birth. You answered well in some ways, Anne, but I will add to it.

    A doula is hired for her expertise in an area the mother and father do not have. They are being hired to share her information and knowledge and has a right to expect to be trusted and heard. If a doula knew the baby's heart rate was dropping or the baby was in very real danger... if there were questions, they can always do a fetal scalp Ph to see how acidotic the baby is. If the baby TRULY is in danger, it behooves the doula to implore the woman to get help, even if she didn't want a cesarean. I am sure there must be some out there, but most mothers would do ANYTHING to save their child. Either they were crazily trying to convince the woman to have the cesarean or no one talked to her civily and explained the risks and benefits to her in a way she could understand. If I had a client who looked me in the eye and said she'd let the baby die before she has a cesarean, I would ask, "And you got pregnant why? Mothers sacrifice ANYTHING, even their bellies, flesh, muscles and BIRTH PLANS for their babies' health and life." If she insisted the baby die, I would think she was out of her mind and wouldn't give a whit how they got the baby out, even if they had to manipulate permission out of her. The woman needs psych help and sadly, there just isn't time to see a psychiatrist and get diagnosed and on medication before the baby died inside her.

    In birth, there are TWO patients/clients and unless you have stood bedside and watched a baby dying during labor and seen the amazing and wondrous work the L&D staff can do to save a baby, you can have any sort of indignation about a woman's rights to her body... blah blah blah. It is a LIFE there (and I am a very pro-choice midwife) and I would do ANYTHING to save either life; the mothers OR the babies. I would expect *any* care provider to do the same.

  2. Thank you so much for commenting in such detail, both here and on Facebook (there are a bunch of thought-provoking responses over there). I am genuinely relieved to hear multiple voices calling BS on this! I think what the story reveals, more than anything, is the attitude of the L&D nurse who told this story in the first place; as L describes it, her mom was "so smugly proud" to have participated in this - even if the details of this story are dramatically exaggerated or fabricated altogether.

    What a relief to get validation that this couldn't really be true, at least not in the way it was described by L's mother. I think it is still a very revealing tale, but more about the nurse's attitude than about something that actually took place in the way that she spun it. To wit, some more background on L's mom, from L herself:

    "The part that really horrifies me though is that it isn't even a moral dilemma for my mom. There's no question, not a single doubt in her mind that drugging an unwilling woman and sectioning her against her will is absolutely the right thing to do if she won't consent when the staff says she should.

    "But then, this is the same medical staff that shares a running joke my mother thinks is hilarious - often on the part of the patient's chart where you list serious risk factors, someone will jot 'birthing plan with a doula.' My mom has a certain measure of respect for a competent midwife, but none whatsoever for a doula, and she really believes that a 'birthing plan with a doula' is a serious risk factor that's going to lead in an unnecessarily painful, complicated birth."

    We've had other conversations about her mom - when told about my career plans and my doula blog, she remarked derisively that I "must have read 'The Silent Knife'," in a tone that made clear that this was why I was brainwashed into thinking there was any value to natural birth. (Because surely there is one book out there responsible for deluding gullible women into thinking that avoiding an unnecessary c-section might not be a bad idea.) Calling someone an "Earth Mother" is one of her favorite insults.

    Even if there are elements of truth involved in the story as L's mom told it - there is just no way to know what really happened. There are so many holes, as Barbara points out. And yes, I do think the biggest unknown is what led up to the distress in the first place, and this is the place where a doula could potentially have made a difference.

    So perhaps the moral of the story, factual or allegorical, is an advertisement for doula care on two levels: One, doulas may help prevent reaching such a state of crisis to begin with, and two, by hiring a doula, you are making a choice about who will be giving you continuous labor support - because taking your chances with relying on the L&D nurses for said support is a major crapshoot. There are absolutely fabulous ones, for sure - and, like anything else in life, some not-so-fabulous ones. You might get lucky and end up with a wonderful, supportive nurse, like Melissa of NursingBirth . . . or you might get L's mom.

  3. "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."

    It is hard to know if a doctor is crying wolf when you see 50, 60 and 70 percent cesarean rates, isn't it? Waning trust is one of the worst results of maintaining totally over-the-top cesarean rates.

    Do you mind asking what her what year this happened?

    Barb said: "In birth, there are TWO patients/clients and unless you have stood bedside and watched a baby dying during labor and seen the amazing and wondrous work the L&D staff can do to save a baby, you can have any sort of indignation about a woman's rights to her body... blah blah blah."

    And unless you've been through the blah, blah, blah and had doctors trying to bully you in to a cesarean without a shred of evidence to back it up, you start to think more about our rights to our bodily autonomy and decision making process. Know what I mean? I wouldn't be so quick to dismiss the blah, blah, blah as blah, blah, blah.

    Depends on your perspective.

  4. I gave birth vaginally on the table moments before a prescribed emergency C-section.My baby was 2 months premature. 4 days before she was born, I told hubby I was going to give birth very soon. 2 days later, I saw my OB/GYN and she said everything was fine. Of course, all this was unplanned, and there was no one to comfort my 2 year old than hubby and I didn't want them in there, so I labored without anyone for support (about 1 hour while the admitting nurse was trying to convince me it was too early for this to be real labor and the clueless resident was swabbing fetal fibrenectin (sp?) tests). The monitor showed fetal distress for about a minute when I almost blacked out. The dr came in at that time and found out my placenta was abrupting so I was going to go under for a C-section I heard. I asked "how long till the baby is out?" I don't remember the answer but I did what came instinctively, and was already pushing while being rushed down to the operating room with my gaping hubby's face a blur in the hallway. By the time they got me rolled onto the operating table, the baby was almost out and the dr realized this and told me to "give it all I have and push once more" (and I am impressed by her, of course) and out came my beautiful girl. Now she is a beautiful healthy 1-year-old.

    Reading this story, I am glad I didn't tell them anything about what I wanted and wasn't given a roofie to stop me from pushing or anything like that. During her NICU stay, the staff did screw up and their course of action triggered her food intolerances. The NICU staff continued to give my daughter Human Milk Fortifier inspite of us pointing out repeatedly that it was causing cow milk allergy symptoms in her until she started getting really bad diarrhoea and was on the point of dehydration. I now have zero trust in the compassion or competence of most of the medical community and would be inclined to have any future babies far away from them.

  5. just to clarify, I would have given anything to get my baby out quickly, (less placenta==less blood for my baby, I understand that without anyone explaining anything to me). I don't doubt that an emergency C-section was the right thing to prescribe at that point. But the reason why I even commented here is to point out that sometimes a mother's instinct and intuition are much better than the combined medical knowledge of many different experts and often the medical experts do not realize or respect that.

    I agree that no baby deserves to die insdie the mother because of the mother's philosophy of birth, and also believe that there are no healthy mothers who would make such a choice.

  6. Jill - yes, exactly. These c-section rates, combined with the true horror stories we've been reading lately, are precisely what made such an outrageous story seem, if extreme, like it could possibly, maybe, have happened.

    I'll see if I can find out what the year was - my impression was that this was recent, but it's just an impression.

    Allergy Mom, thanks for sharing your birth. Wow, what a compelling story. I like what you took away from that story regarding instinct and intuition. There was a story I just read today about how a mother's instincts saved a preemie that the hospital had given up on. I think you'll like it:

  7. When I read this story, and the comments, all I can think is the "blah blah blah" attitude toward Mother's rights is certainly the same attitude the cut-happy hospital staff had during my labor. I'm positive when they told my story to others that day, they didn't say "well, mom didn't want a cesarean, and can you believe it, she was right and we were wrong!" - No, I'm SURE they say "Mom didn't want a cesarean, the baby was DYING inside her, and her self-righteousness kept getting in the way of us trying to save that baby's life. What's that? Oh, no, she did get her VBAC and had a perfectly heathly baby, but she just got LUCKY."

    After what happened to me, I have ZERO faith in L&D nurses, or doctors, or anybody else who'd try to stand over me telling me there's no why I can birth a healthy baby without them raping me of my autonomy in the process.

    My baby was perfect. THEY didn't want to believe that. So I should sacrifice my uterine and mental health so they can feel better about their jobs? Nope. Not on my watch.