פורום השבוע אינדקס אופנה יוגה גברים וצירים היום שאחרי הצילו צירים תזונה מאמרים חדשות ראשי
 
14/6/2004 23:52 Ilana Shemesh, natural midwife מאת:
Example of the importance of being assertive in birth
כותרת:
Wow-it's been a busy 10 days with 5 births. Lucky for me I had great sleep in between them all. Three were first births and two were third births. Some early, sone late, some on time. It all began with a first birth that was lovely, very straight forward, good and calm atmosphere with less than an hour pushing and no stitches. Only one was a real easy one, a third birth, daylight hours, from start to finish 3 hours, a waterbirth in the jacuzzi, and home 3 hours later. A boy after 2 girls so they were very happy. I birthed her other babies so it was nice and familiar like a friendly reunion. The other third birth was longer because the baby was posterior (looking face up to the stars), but easier than her other two births. It always takes her a long time from 8 cm. and the pushing took extra long since it was face up. The baby really moved around a lot in the ninth month. It was breech at 35 weeks, then head down at 37 weeks, then at 40 weeks PANIC as it was breech again. When she went to have it turned the next day, the little fellow got his act together and had turned head down during the night. We listened to wonderful spiritual music since she is recently Habad. I really got into it. Must be my orthodox roots. In between these births, were two first births. One was longish, but only came to me in the morning with 3 cm. and needed IV antibiotics as she is a GBS (Streptococus B) carrier. She continued to dilate nicely and enjoyed the jacuzzi and began to push there. Then her water broke and it was meconium so we continued to birth on dry land. The birth was fine, so was the placenta .Her perineum from the outside looked fine, no sign of any tears. Then when I checked inside and removed the big clot in the vagina, lots of blood began to pour out and I couldn't tell the extent of the internal tear, but I knew it was there. The uterus was contracted and the bleeding wasn't from there. I decided she needed to transfer to hospital for proper visualization and proper suturing that I couldn't do at home. I called the ambulance and notified the hospital that we were on the way. Her bleeding slowed down since the clot began to form again. When we got to the hospital we were greeted by a very nice midwife. I purposely don't want to mention the hospital, because I have had very good experiences in the past, and have come to the conclusion that it just depends on luck on who is there on duty at the time. Well, our luck was not with us and the doctor that came to examine was very arrogant and not flexable or willing to hear what we were saying. He insisted on an immediate infusion, which there was no need since she could drink and the blood loss was not excessive. Then he insisted on taking her to the operating room, giving general anesthesia, and doing a uterine revision. This is an invasive procedure where the whole hand enters the uterus to make sure that the cavity is empty of placenta. When I explained that there was not a problem with the placenta and it was whole and the uterus contracted, he said that since he didn't see it he couldn't trust my judgement. (afterall, I am only a lowly midwife with 22 years experience--so what do I know!!)We very politely requested that he first examine the vagina where I suspected the tear was, and if not satisfied to continue further. No way he would agree and said that since we came to his hospital for help we had to do it his way and follow the rules. These were strange rules to me! Then he proceded to very agressively and brutally push on her uterus to expell a clot. For him this was proof that the bleeding came from the uterus, but I knew that the clot came from the vagina where the tear was. The husband, who seemed during the labor to be a very polite and quiet English guy, in very quiet and polite and perfectly English accented English said, Well, no thank you, we are not interested in this line of treatment, do not touch my wife again, and we request another doctor immediately!!! I could have jumped for joy and kissed him! What guts--what balls! He left the room and another doctor was awoken to deal with the situation. Lucky for us, this nice young Russian had no ego and only wanted to do his job, and go to sleep. He asked me what the problem was, apologized for his poor English, and with no fanfare or theatrics, looked in her vagina. He said--yes, I see it, you were right, it's an unusual tear from side to side like a smile, in the bottom wall of the vagina, and that's were the bleeding is coming from. He proceeded to sew it up in about seven minutes, very gently and with local anesthesia. She went home that morning. Just imagine if this couple had given in to the first doctor. Her baby would have been seperated from her for a few hours. No breastfeeding. She would have been exposed to risks of general anesthesia and infection from the unnecessary uterine revision and would have suffered probably more blood loss. She definately would not have been able to leave so soon. I remember once taking a first birth to the hospital when the woman pushed for a long time with weak contractions and no progress. We also had a young and arrogant doctor who would not acknowledge me or my report and suggestions . He gave her pitocin which was what she needed,but then would only wait about 15 minutes. She made wonderful progress, but just as the head was nearly crowning, he insisted on a vacuum. I told the couple that in my opinion there is absolutely no indication for a vacuum and that she would birth in 10 minutes. The husband looked at me and said in desperation "What can I do, he is the doctor and he is in charge."I said, just refuse!! Well, I walked out because I couldn't witness this rape of a birth. and I told the doctor this. She had a huge episiotomy and a vacuum. Too bad that he could not be assertive and also trust me. That white coat can be so intimidating and people forget that they have rights too. The last birth was a first birth and a week overdue. At 40 weeks she was told that she has very little water and needs to be induced, so she signed herself out and monitored movements, which were plently. Still this caused her a lot of anxiety. (By the way, when the water broke at the end of the birth, there was enough water). She really had a hard time because her contractions were every three minutes and hard and she was only one cm. After four hours, there was only 2 cm. Four hours later, finally three cm. then I did acupuncture and she really responded well. All the back pain moved to her anus, which wasn't fun but more tolerable. Then the jacuzzi, and then she really began to dilate nicely and about 3 hours later was pushing. That took a long time as she didn't use the Epi-no (which shortens the pushing part) and we tried lots of positions. Finally she birthed, no stitches, and great apgar and squalking baby girl. Then the breathing was very rapid and she seemed to be having some difficulty so I ordered an ambulance in case it didn't get better or got worse and we would have to transfer. Meanwhile I warmed her well with a heating pad and she rested between Mom's breasts. Either she warmed up or got scared of going to hospital but her breathing became normal and she was nursing well. The ambulance was there for an hour, and I discharged it. About 12 hours after the birth they went to the hospital for the maanak lida and baby check. They had to wait from five to 11:30 at night for the gynecologist to check her (2 minutes) and all the paperwork, and then for the pediatrician to check the baby. When they arrived the baby had no fever. All this time she didn't nurse, and I guess the baby dehydrated somewhat, and at midnight it had a fever of 38.2. They wanted to admit the baby, but the parents refused to be separated from the baby. She gave a bottle of water and nursed and the fever went down, and the blood count came back normal. Still they wouldn't release the baby. So the parents insisted on signing the baby out, and they would be responsible to feed her often and check temperature. It took 3 hours of fighting and the pediatrician refused to document for them that she had checked the baby. They left with no hospital record of the events. Later that morning the hospital called the Tipat Halav and told them that they took home a sick baby, despite the fact that there was no fever or any other evidence of illness. They implied that they were irresponsible and perhaps negligent. This is a very scary situation when parents do not have rights of decision. I do believe that because they have long hair and did a homebirth they were assumed to be not responsible. I visited the couple today and all is well, I salute this couple for their assertiveness, and I think that the hospital should have been more flexable and accomodating. For example, if they had allowed the couple to stay with the baby and supervised the baby's hydration and fever, the couple would have stayed a day. Because they insisted on the separation, they refused. I really hope this long megilla of homebirth stories didn't tire you all out. The bottom line is this: PARENTS NEED TO BE ASSERTIVE AND EXERCISE THEIR RIGHTS FOR BIRTH AND PARENTING. WHITE COATS ARE PEOPLE JUST LIKE ALL OF US, SOME SMARTER THAN OTHERS, SOME WITH MEGA-EGO'S THAT GET IN THE WAY OF GOOD MEDICINE!! good night, Ilana Shemesh

תוכן ההודעה:


תגובות נוספות
15/6/2004  5:11 אילנה, מסכימה עם כל מילה שלך ומחזקת אותך ואת כל הזוגות היולדים לעמוד על זכויותיהם תמיד. מזל טוב! (ל"ת) - ענבל ל
15/6/2004  9:55 זה לא כל כך פשוט - איריס ל
15/6/2004  10:14 חה, הייתי אסטרטיבית עם המיילדת בלידה הראשונה - שרה
15/6/2004  14:10 Iris--knowledge is power - Ilana Shemesh, natural midwife
15/6/2004  15:34 אילנה, חיזקי ואמצי! וגם תודה קטנה בפנים: - חיים ואפרת
15/6/2004  17:30 OT חיים ואפרת - נשיקות גם לכם! (ל"ת) - annat
15/6/2004  20:58 אפרתוש!!!! מתה עלייך,מזל טוב!!!! ולאיריס - גילי אבישי
15/6/2004  20:59 אפרת!!! מזל טוב (וחיים)... - במבי
15/6/2004  22:5 אפרת? - כרמית_מ
15/6/2004  22:58 משהו משלי - חיים
16/6/2004  1:35 Efrat and Haim--I love you, and the concet was great! (ל"ת) - Ilana Shemesh, natural midwife
16/6/2004  9:18 חיים - אביב


   
 

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