Labor & Delivery

Skol v. Pierce: The Verdict

A few years ago, The Unnecessarean reported on a civil case, Skol v. Pierce, wherein the plaintiff alleged that the attending doctor (who was covering for the OB-GYN that had delivered her last four children) terrorized her and refused to give her an epidural or any other pain medications on account of the fact that he was angry at her for not calling his answering service before she came in. There was a spot about it on the local NBC News not long after the case was filed:

It looks like most of the sites that originally reported on the case never posted an update on the verdict, which was issued on March 1, 2012. The judgment was for Ms. Skol in the amount of $1,400,000.00, case “settled after trial for the [defendant]’s $1 million policy limit.” Some details and comments: Continue reading

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“Operating Room Services”

I went over my hospital bill. By far the largest charge on the bill is a $4,292 charge for “operating room services.” This confused me as I obviously did not have a c-section.

I asked my doctor about it at an appointment yesterday. He said that, when I got to pushing and my son was having decels into the 70s, and did not seem to be coming out (there had been one pop-off on the vacuum extractor), they had told the c-section team to get ready. Considering that my son was out 5-10 minutes later, pretty amazing that they charge so much for just a few minutes of c-section prep that was ultimately not needed.

Categories: Hot Doctor, Interventions, Labor & Delivery | Leave a comment

Posterior?!? WHAT?!?

I just received a copy of the hospital records for my induction, labor, and birth of Constantine. Turns out that the little brat did come out posterior. How come nobody told me this? Do they not realize that birthing a 9 lb 5 oz posterior baby vaginally makes for some serious bragging rights, and that this is the female equivalent of bragging about penis size?

I’ve modified all past posts to reflect this.

Anyways, here’s some interesting notes from my records:

  • They had thought he was in occiput anterior position with a “compound presentation” (hand, arm, or foot by his head). It wasn’t until after he was out that they realized he was “direct occiput posterior.”
  • The vacuum was applied when he was at a +5 station. I almost had that little troll out on my own. I’m betting I would have delivered with an intact perineum if he hadn’t been posterior or if I’d had more time to push, but they wanted to vacuum him out due to decelerations into the 70s.
  • It took three pulls and one pop-off to get him out with the vacuum.
  • My bishop’s score on the morning of induction was 3-4. The initial examination by my hot doctor found that I was dilated to 1.5, posterior (cervical position), firm, 50% effaced, and -3 station. His attending’s exam a few hours later bumped me up to a 2 and 60% effaced, but still a -3 station. A bishop’s score of less than 5 means that the induction is likely to fail, so I think I was right to fear going through with the induction.
  • One note says “will offer pudendal block.” Not sure why they decided against trying to talk me into that, but they never mentioned it. I would have declined.
  • The plan was definitely to start me on magnesium sulfate during the active phase of labor. Not sure why they decided against it (maybe because I blitzed from a 3 to a 7 in two hours and they realized things were moving fast enough that I wouldn’t need it?).
  • These records say “oligohydramnios” all over them. That just annoys me. I was a 6.3! That was normal. Low end of normal is still normal. Grrr.

I’m glad that I pulled a copy of these for my records. I’ll have to ask Sark some questions about my delivery next time I see him.

Categories: Interventions, Labor & Delivery | 2 Comments

Down with “natural” childbirth

As I’ve mulled over my birth recent experience, I think I’ve arrived at the conclusion that I dislike the expression “natural childbirth.” Here’s why.

I see natural childbirth blogs and Web sites with descriptions such as the following, from Natural Childbirth Stories: “Births the way nature intended. No pitocin. No epidural. Just the beauty (and intensity!) of the human body at work.” Hmm.

“Natural childbirth” is what I was shooting for when I started this journey, and I fought tooth and nail for it. In the end, I wound up with interventions which would not be considered “natural” by most NCB advocates, namely, Pitocin and the vacuum extraction. I think these interventions were medically indicated and absolutely necessary. Still, they probably disqualify me from the natural childbirth club.

But what is “natural childbirth” anyways? “Giving birth the way nature intended.” As someone with Rh-negative blood who pair-bonded with someone with Rh-positive blood, if I “gave birth the way nature intended,” I’d probably only be able to have one healthy pregnancy. Nature apparently intends for about 15% of women to have limited childbearing abilities. Modern-day obstetrical intervention has corrected that. Yet most NCB advocates would probably not discourage Rh-negative women from obtaining the recommended Rhogam injections, and would not say that your childbirth was no longer “natural” on that account.

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Categories: Interventions, Labor & Delivery | 2 Comments

A Better Birth — Part 5

Serge Constantine, called by his middle name or "Costa" for short

Serge Constantine, a few hours after he was born. Called by his middle name or “Costa” for short.

My son was born at 6:10 PM on Sunday evening. I had been in labor for just around 8 hours, and had only been on the 1-2 ml/hr Pitocin drip for the first 5 hours. Beyond that (and the attendant continuous fetal monitoring), the only intervention that was used was the vacuum extractor.

Constantine was placed on my chest immediately, snuggled up under my hospital gown skin-to-skin with a warm blanket placed over us, and he stopped crying almost instantly. He was very awake and alert. They waited for the cord to stop pulsing, then clamped it and asked my husband if he would like to cut it. My husband is rather squeamish about blood, so he kind of surprised me when he said yes and did the cutting. He came around to the side of my bed to look down on the two of us, and I noticed that he had tears in his eyes. As for Costa, I thought he looked like a little cherub, so chubby and with golden blonde hair. (The blonde hair really, really surprised me. My husband and all of his siblings have dark brown or black hair, and my natural hair color is medium golden brown. But all of my siblings were blonde as babies, so Costa seems to have gotten those genes or something.)

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Categories: Babies, Birth Plan, Doula, Gestational Complications, Labor & Delivery | 2 Comments

A Better Birth — Part 4

The shower was heaven. There was a chair in the shower, and I sat on this backwards with my legs straddling it, leaning on the back of the chair and letting the hot water roll over me. Having pressurized hot water sprayed on my back while I was contracting made it so much easier to work through my pain. I did feel my contractions slow down a bit now that I was off the Pitocin, but they did not stop or decrease in intensity. I immediately decided that if they wanted me to stay in the shower for only 10 minutes, they would have to come and tell me to get out themselves. I wasn’t going to time myself for them. I could still feel my baby moving while I was in the shower, so I felt pretty sure that he was okay.

I’m not sure how long I was in it, though I’m sure it was somewhat longer than 10 minutes, but I did get out when they came and told me it was time to get out. We tugged a new gown onto me and they said they wanted to check me again. I had one contraction while I was laying on my back being checked, and it was torture. My doctor announced (sounding a little surprised) that I was a 7 now. “Told you I was fast,” I said. He said there were two other things to discuss with me. One was that they had decided that it would not be necessary to put me on magnesium for my high blood pressure, so that was good news. The other was that they wanted to give me the option of breaking my water and putting an electrode on my baby’s head. They said this would “improve [my] mobility,” and I just thought, “say what??? How would an electrode coming out of my vagina improve my mobility?” I think they were really just tired of my monitors sliding around and falling off and wanted to keep my baby soundly monitored for the rest of the labor and delivery. I declined the AROM and the electrode just the same.

I noticed that they did not hook the Hep-lock back up to the IV cart (I’d already had two doses of GBS antibiotics by this point). I was off the Pitocin and on my own for good. My doula later said that this really surprised her, that she almost never sees deliveries where a patient is taken off of Pitocin once it’s been started. I think it goes to show that my team really was trying to respect my wishes for a natural birth, even though some interventions were needed.

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A Better Birth — Part 3

My doula arrived quickly, probably between 10:30 and 11:00 AM. I brought her up to speed on the Pitocin, the continuous fetal monitoring, and the conflict over eating. None of it surprised her. She said we would still move around the bed as much as possible and do all of the pain relief techniques we had discussed before, minus walking the halls of the labor ward and using the shower. My contractions had started not long after the Pitocin had started, and it wasn’t very long before they were only 2-3 minutes apart, though they still weren’t very hard. I could still talk and joke around them and sometimes through them. Over the course of that morning I watched an episode of Breaking Bad, most of a Korean film called The Good, the Bad, and the Weird, and maybe half of Happy Gilmore.

Meanwhile, my doctor had left for church, saying he would be back around noon. I was fine with this. We’d talked about religion enough for me to know that he was teaching senior high Sunday school that day and it was kind of important to him, and it was unlikely I’d deliver within 2 hours of being on a 1 ml Pitocin drip. I think he had also come in on his day off to deliver my baby, having not pushed me to induction the day before when he was scheduled to be there. Around 12:30 PM, my contractions were getting a little more intense and I said, “Where the hell is Sark? Tell him church is over, time to play doctor!” He came in around 1 PM to check my cervix, and he also brought me what I thought was a piece of Eucharist bread in a napkin. “I didn’t think you Greeks were supposed to give this to us heterodox Protestants,” I joked. (I later found out from my very high-strung Orthodox pal that it’s called the andidoron — Eucharist leftovers — and they’re allowed to share it with anyone. So that was a nice gesture on his part since I couldn’t go to church that day.)

He wanted to check my cervix, and it’d been over three hours since the last check, so I went ahead with it. I was only just past a 3. He said that was fine though, we were seeing cervical change so that was good. Inside I was a bit discouraged. 3 hours of contractions had only gotten me a lousy 1.5 cm? Then I reminded myself, Just get to a 4 like last time and see what your body does… We increased the Pitocin dosage to a 2 mL/hr drip just the same. It never got higher than that.

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Categories: Gestational Complications, Labor & Delivery | 1 Comment

A Better Birth — Part 2

I gowned up and let the nurse come in and strap me to the monitors. At some point, my doctor did a cervical check and said I was only about a 1.5 and 50% effaced, so the plan was still to start with a Cook’s catheter and then do Pitocin later on. I assumed that the monitors were just for another NST and that I’d be getting off of them later; shows what I knew. The nurse said something about starting my IV, and I asked her if I could do a Hep-lock in case the induction went well so that I could be off the IV later on. She said “no,” and I asked her to talk to my doctor about it. She came back and put something in my arm; I didn’t learn until later whether it was an IV or a Hep-lock.

Sometime later I was still being monitored and they had not started the induction yet, and I was getting hungry, so I began to eat some of the snacks in my labor bag. That’s where the trouble started. The nurse saw me snacking on a protein bar and a bag of trail mix and said, “Okay, but you can’t eat when labor starts.” I asked why and her answer amounted to “because I said so.” We argued about it until I finally blurted out, “Who’s going to stop me? Talk to my doctor about it, it was in my birth plan.” She left the room.

Around 9:45 AM, my doctor came back, accompanied by his attending and one of the other residents. “Did the nurse tell on me?” I asked. He kind of shifted uncomfortably, then said it was okay if I wanted to eat in early labor, but they didn’t recommend it and they really, really recommended that I not eat at all in active labor. I said I wasn’t making any promises. Then I said, “Non-stress test is over, can we get these monitors off me now?” And that’s where more trouble started.

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A Better Birth — Part 1

[Though this is part 1 of Constantine’s birth story, the story really begins with the discussion leading up to my induction.]

I spent the day before my induction trying to do all of the following:

  • Clean the apartment. It wasn’t in too bad of shape, but I wanted to come home to beds that were made, clothes that were folded and put away, a sink that was not full of dishes, etc.
  • Praying, meditating, and trying to relax. I called my pastor and she came over to my apartment along with one of the female interns from my church, and my pastor prayed for me and blessed me. I reflected on some passages in the Bible that I’d found inspiring (maybe more on those later). Much later, at 3 AM on Sunday morning, I woke up and read through all of the accounts of Gethsamane in the Synoptics. Never had I felt closer to Jesus’ admission, “My soul is overwhelmed with sorrow to the point of death.” Or to his prayer: “My Father, if it is possible, may this cup be taken from me. Yet not as I will, but as you will.” By that I mean that I really, really did not want to be induced, and was still holding out hope that maybe my labor would start on its own or my blood pressure and protein tests would return to normal and I would be allowed to wait a few more days. However, barring that, if induction was the recommendation I was going to accept it.
  • I called the people who were going to watch our daughter for us while we were in the hospital and told them that our daughter would be dropped off the next day at around 6 AM. We’d drop her off earlier on the off-chance that I did go into labor spontaneously that night, but otherwise Sunday morning was the limit. I double-checked my daughter’s overnight bag to make sure it was all ready for her.
  • I finished gathering everything I needed into the labor and delivery bag.
  • I kept a religious eye on Constantine’s kicks and movements and watched out for all of the signs of pre-eclampsia that my doctor had told me to watch out for. I knew that he felt like he was taking a bit of a risk letting me go home for one more day, and I didn’t want to let him down.
  • I did my share of bouncing on my exercise ball, and I even went ahead and tried sex with my husband that night (even though I don’t believe sex helps induce labor, I thought what the hell, we’re probably not having it again for six weeks at least).
  • I put my doula on notice that it was probable that I would accept the induction the next day.

I did have weak contractions 10-15 minutes apart for about 1.5 hours that night, falling asleep to them, but when I woke up at 3 AM the next day, they were gone. I was also beginning to lose small globs of mucus plug, though it was all white and yellow, no pink or red.

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The journey is complete

The URL for this blog contains the words “partus melior,” Latin for “better birth.” I gave the blog the English title of “Journey to a Better Birth.”

I’m happy to say that yesterday, that journey came to completion. My yellow bump turned blue as my son, Serge Constantine, was born at 6:10 PM, weighing in at 9 lbs 5 oz and measuring 22.5 inches long with a head circumference of 36 cm, after 8 hours of induced labor. I had a doula-assisted birth in the hospital and though it was not completely “natural,” it was better than my last birth in just about every way imaginable.

Complete birth story with pics of Constantine (called “Costa” for short) will follow soon.

Categories: Babies, Labor & Delivery, Personal | 1 Comment

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