Two Childbirth Experiences, Two Wildly Different Outcomes

My letter of complaint to a clueless doctor

Photo by Alexander Grey on Unsplash

I became a midwife in order to help women with childhood sexual abuse and rape issues have a safe and sane childbirth experience.

My clients came from ABC Recovery Center in Indio, California, a residential drug and alcohol rehab. I put together the perinatal program there and provided many of the services that these ladies wanted and needed. Some went to doctors in the community and outcomes varied wildly. The following letter is one I wrote to an obstetrician in 2001. I wish I could say things have changed, but for far too many women and babies, they have not.

Dear Dr. A,

Two women in ABC’s perinatal program became friends and roommates. Both were pregnant with their first babies. Joey stopped using methamphetamines (meth) and came to ABC from jail when she was four weeks along. Alice had been clean from meth at ABC for 60 days before she became pregnant on a weekend pass by her boyfriend, a cross-country truck driver. Joey decided on midwifery care and home delivery for her pregnancy while Alice chose to have a hospital birth under your care.

Both stayed in treatment and kept every prenatal appointment and had every lab test and recommended procedure. Both women were 22 years old. Both are rape survivors, and both were abandoned by their mothers when they were 13 years old.

Joey went into labor ten days past her due date. She walked and squatted and got in and out of a birth pool for nine hours, then delivered her 7lb 3oz daughter in a supported squatting position using my birth chair.

Because Joey pushed a bit fast and hard, I had to put four stitches in her perineum. She was feeling great afterwards, nursed her baby without problems and was happily visiting with friends in her own room a few hours later.

Alice experienced no complications. She had a good diet with plenty of fresh food, and she walked two miles four times a week. Being with Joey during labor and birth had given her confidence but she wanted to have options for pain relief if needed and her boyfriend felt she would be safer in the hospital with a doctor watching over her.

You planned to induce labor at 40 weeks (normal human gestation runs 37 to 42 weeks and statistically first timers go ten days past their due date). Alice begged for a bit more time. You set a deadline of one more week, and claimed her due date was earlier, despite having a verified conception date (Baby’s father was a truck driver, remember? She was on her first weekend pass).

Kick counts were reassuring (baby was active) and I knew it was safe to wait, but you frightened Alice with your talk of dead babies. She fretted about the “risk” she was taking. What she needed was support for making informed decisions.

On the eve of her induction, Alice drank castor oil in an effort to stimulate labor. At 5 a.m. her water broke, and she went happily to the hospital with mild contractions. While confined to bed, her labor slowed. At 9 a.m. she was dilated two centimeters.

Your orders were to augment labor with intravenous Pitocin. To speed things up, you ordered the maximum allowable dose with the maximum allowable increases at the shortest allowable intervals. Within an hour Alice was experiencing intolerable pains lasting one minute that were two minutes apart. She begged for pain medication but was still only two centimeters. Told she could only receive anesthetic after she reached three centimeters, Alice bravely got out of bed with a nurse’s support.

She stood up, remembering Joey’s use of gravity in an upright position. Although she could only stand by the bed, that seemed to help. In another hour she had made it to three centimeters. An epidural anesthetic was administered, after which she was numb from the waist down and could not move her lower body.

Alice welcomed relief, but her baby continued experiencing contractions. In three more hours, complete dilation was achieved. Contrast this with an average first-time labor of 16 to 24 hours and you get an idea of how violent this induction was.

Little Burton was extracted from his mother’s body with the use of a suction device; again, by the maximum force allowable in the longest allowable pulls at the shortest allowable intervals. His head was bruised and swollen, his neck hyperextended. He would not stop shrieking and would barely breastfeed, probably because he had a terrible headache.

You cut a large episiotomy (incision) to widen Alice’s vagina. Remember the talks we had earlier about trauma-informed care (TIC)? Most of the women at the ABC Center are rape survivors.

She told me that as you sutured, her bare bottom was exposed and that you called a few nurses over to see what a great job you were doing, with no thought of the humiliation Alice felt at having her private parts on display.

The next day, Burton spiked a fever, not unusual in babies whose mothers were given epidurals. The hospital reacted by moving the baby to intensive care. Alice called me, sobbing. She could not feed her baby nor take him home.

Pumping her breasts while dealing with a very sore bottom, it took hours for Alice to produce a small amount of milk. She kept it cold and took it to the hospital partially frozen. The nurse took one look at the slushy consistency and poured it down the drain, claiming they could only accept breastmilk that was completely frozen. Alice was devastated. Burton was fed formula until she could produce more.

Despite negative cultures, you informed Alice that she had given her baby an infection. Could you please not blame the mother? Especially one who is no stranger to shame.

After a few days, Burton did come home. He continued to be inconsolable and was so nipple confused that breastfeeding never really got off the ground. Joey’s baby thrived contentedly, while Alice’s baby fussed continually.

Her stitches took a long time to heal. She went to your office before her six-week checkup, but you refused to examine her. Alice then presented to me with inflammation and swelling. The comfort measures I suggested were rest, homeopathic remedies and sitz baths with herbs.

When Alice became your patient, she was a happy, healthy young woman. She had every reason to expect a normal childbirth, but both she and her baby were traumatized. They had to deal with pain and separation when they should have been falling in love. I’m left feeling sick and sad, realizing that this is the standard of care in our community.

Sincerely,

Your midwife colleague, Mary

My clients at ABC participated in therapy and 12-step programs to help them face the issues that led to their chemical dependency. I respected and admired their efforts to make positive changes and become better parents. It hurt to see them sabotaged by thoughtless caregivers.

I wish Alice’s horror story was the last one I ever knew of. But since then some psychologists specializing in TIC are speaking out, and some hospital administrators, nurses and physicians are listening.

Research has shown how a history of trauma can impact a woman’s childbirth experience. The more people who learn and understand these issues, the closer we will come to having increased awareness in our mainstream healthcare.