Yes, I Deliver

The circus nurse is now, officially, a (paid) labor and delivery nurse.
Goodbye academia, hello life.
Praise be.

Shift Work

Some of the best moments of the weekend:

Delivering a baby girl to a young mother - one of nine sisters and two brothers - with five sisters and one niece present. The youngest of the 9 sisters, aged 16, cut the cord.

A nurse, about to take a break tells her break-relief, "Don't let that Doc near my patient..." Sticking my head out of a delivery room about twenty minutes later I hear that very nurse singing sweetly and find her sitting side-by-side with that very surgeon while he strums away on his ukulele.

One nurse says to another, "You don't believe in God? Not at all?"
"No. Not at all." The first nurse hugs her tightly and then holds her by the shoulders at arms length and asks very seriously, "Then who do you think made Berkeley?"

Service with a Smile

This week a patient came in, via ambulance, to deliver at our hospital. She was 1cm dilated, (read: not much) huffing and puffing and crying out with every contraction. I met her, along with her Granny, in triage. As we prepared to walk to her room she, naked from the waist down, wrapped herself in a blanket, grabbed her enormous silver purse and said, "Let's get outta here."
Her granny looked a her and remarked, "You better not lose that blanket or you'll be showin' off the goods!"
She replied, "Well, I ain't worried about the goods! I'm worried about my eyeshadow. I ain't goin' nowhere without my eyeshadow. Not even to have a baby!" She turned to me, "I don't wear no make-up... 'cept eyeshadow." Which was true. She had on tons of dark grey and silver eyeshadow.
I just nodded and nodded as this conversation proceeded until we reached her room, at which point she turned to me again and said, "Okay, now I want a hamburger and french fries. I want it medium with pickles and no onions. And a glass of grape juice. And mustard."
Somewhat stunned, I chuckled, turned around, and walked slowly from the room. I was off for some grape juice - thinking that maybe childbirth makes women delusional (she seemed to be mistaking the hospital for McDonalds).... or just really, really hungry.

Congratulations, it's a....

Walking down the hallway on my second weekend as an OB nurse I hear another, significantly more seasoned nurse laughing so hard that she's holding her knees.

"And so," she says between breaths, "apparently these parents had decided to describe childbirth to their little guy, who was about three, in a very concrete way... they were very educated, you know? Anyway, when the dad bent down with the baby, this little guy peered inside the blanket and you should have seen his face wrinkle all up...he literally screamed: 'But you told me it was a puppy!' The parents were horrified but I couldn't help it... I laughed and laughed! I guess they learned their lesson.

It's like I say," she quipped, "you should always follow one simple rule: Never compare humans to food or animals. Someone always ends up disappointed."

Storklike

I work in labor and delivery now. Isn't that amazing? No, it's not a paid position. We're in the middle of a recession, so I'm told. But I am now actually a nurse and on the job every Saturday and Sunday. So far, I have been witness to a number of squinty little eyes blinking wildly at the new world. More on that soon, but I thought, for the time being, you might like to know.

WE CARE Solar

If you want to take a position on child birth, consider this. If you want to talk about injustice and what it means to work for women, imagine. If you want to take on a women's rights issue, this is it:

"Maternal mortality worldwide accounts for more than half a million deaths a year...that's the same as one woman dying every minute of every day, and that's an outrage. That should never be happening."
Laura E. Stachel MD, MPH, Founder of WE CARE Solar.

WE CARE Solar "reduces maternal mortality in developing regions by providing health workers with reliable lighting, blood bank refrigeration and mobile communication using solar electricity."

This organization needs, and deserves, your support.

Sudden Birth

So, this is a great video I wanted to keep around for posterity's sake. Labor and delivery instruction via the Berkeley Police Department and Alta Bates Medical Center, circa 1966.
If you decide to watch, just remember: "Keep calm. Keep calm. Keep calm..."

Walking the Cervix

So, have you heard of the posterior cervix that needed a walk...Alright, seriously.
Friday, Dr. M. had to do a pelvic exam on our L&D patient, 2 weeks post dates, to determine whether the cervidil was working to ripen her cervix. The problem? He couldn't find it.
So here we sit, mom with Dr. M's fingers inside, he, looking off in the distance, strangely, like he had been taken over by some alien mind control. After minute three, I'm beginning to feel uncomfortable and start burning holes in the side of his head with my gaze.
"So", says nurse J., also bedside, "feeling anything there Dr. M.?"
"Well, it's a 2... no a 3... maybe a 2," still hypnotized.
Nurse J. waits for maybe another 2 minutes, "So it's a 2/3??"
He withdraws. Talks nervously and red-faced about the amazing disappearing cervix.
The fact is, at this point, how accurate do we need to be?
And hasn't Dr. M. heard of walking the cervix, wherein when a cervix is remarkably far back (especially an issue for a first time mom) one can find the edge of cervix, placing one's finger inside and gently move it forward?
Seems better than mining for it.

Chamois Pants

An expectant mom called L&D this week wanting to know whether or not to come in for admission:

"I think my water has broken."
"What makes you think so?" asks the admitting nurse.
"There was wetness between my legs."
"How much."
"I don't know how much."
"Was it more or less than a teaspoon?"
"What kind of teaspoon?"
"A standard teaspoon."
"Well, all teaspoons are different."
"Um....what?"
"All teaspoons are different!"
"...O---kay. Were your pants wet?"
"Well, I was wearing these special pants."
"Special pants?"
"They're a special material. They're made of a kind of wicking material."
"A wicking material? So are you saying they were or were not wet?"
"I'm saying I don't know because the material wicks away moisture."
Another nurse turns to me an says: "Chamois pants?"

Making a Mother

The documentary The Business of Being Born (Rikki Lake & Abby Epstein) has been made available for viewing online. That's nice. What's not so nice is the message. I wanted to like this movie, I really did. But as my partner and I sat down to watch, it was pretty clear within the first two minutes that all of the positive popular press this movie has received has been seriously undeserved, and worse, uncritical. (A crucial exception is this Slate piece.) Not only did I not like this movie for its dubious historical, epidemiological and professional commentary on birth in the United States, I also didn't like that it was horribly elitist, classist and, yes, racist. This in all of the worst ways that information packaged for general consumption can be: coercively.

The underlying message of the film is that the right birth is a normal birth (the film’s term, not mine) and a normal birth is one that happens at home, unmedicated and without any intervention. There was absolutely no call to concern for women with no access to insurance or perinatal care, women with pre-existing conditions, women of advanced age or with high risk pregnancies, teen moms, et al. Basically, anyone that didn’t fit the bill of perfect health and fall into the category of upper-middle class American woman, was bound for the label of “bad mother”. That is shameful.

My partner referred to it as the NY/LA “boutique” image of the perfect childbirth. Of course, we all want women to have this intervention-free option. But for some of us, there may not be the luxury of an uncomplicated pregnancy and childbirth. And that can make us feel like we've lost control. It became pretty clear by Rikki's third hat change and overly dramatic forward-leaning, finger chapelling attentiveness, that this movie was primarily about women trying to either regain or maintain that control. Not until I was 1 hour and 9 minutes into the movie did I realize that it was not about control of one’s own childbirth experience, as the film lauds, but about control of other women and their experience. Sadly, 'expert' clinicians are also used to meet this end. At one point in the film, Dr. Michel Odent (the OB who also believes men should not be present at childbirth) makes the claim that when a woman gives birth by “caesarean section she does not release [the natural] flow of "love hormones" [oxitocin], so she is a different woman than if she had given birth naturally...and the first contact between mother and baby is different.” Here Odent compares women to monkeys who will reject their babies if delivered by c-section. Upon hearing this, I quite astonished myself and my poor partner, by bursting into tears.

Childbirth is a wonderful, moving, emotional, life-changing event for every woman; the amazing birth footage in this documentary attests to that. What is worrisome, however, is the shocking amount of misinformation the film conveys about childbirth, accompanied by a self-affirming (and often righteous) adamance about the importance of the “right” birth and becoming the “right” kind of mother. This is interspersed with an extreme lack of criticality in regard to the 'big picture' of various practices by those interviewed, including women, social scientists and health care providers. (I should say here that there was a striking absence of L&D nurses in this movie. Not one was interviewed!). Neither was there even a smattering of sympathy for women who have births that don’t go as planned. As a twenty-five year-old first time mom, I had a complicated pregnancy and The Kid was, in the end - thankfully - delivered safely to my arms by cesarean section. But I have known women who have had horrifically complicated pregnancies necessitating close monitoring of both mom and baby; mothers who have had perfectly normal pregnancies and lost their babies in what seemed to begin as an uncomplicated birth; husbands and children who have lost their wives and mothers because of unforeseen problems.

The empowerment of women is not as simple as demedicalizing childbirth. But it is as simple as avoiding shaming women into taking chances for fear of being a “bad mother.” Empowering women doesn't mean demanding we all make the same choices and become the same kinds of mothers; it means allowing us to empower ourselves to become the mothers we choose to be.

Two thank-yous: First, to the nurse midwife Cara Muhlhahn who in the movie describes her own difficult first childbirth, and of whom we get to see footage as she goes into the pain-induced dementia of despising everyone around her. It’s the best footage in the entire movie. And to all of the good docs and nurses out there who have blogged more accurate information about childbirth practices in the United States, inclusive - and even encouraging - of home birth.