What would you make of my OB

[Myira]

I often wonder what to think about all I went through with DDs labor and birth and especially the OBs skill expertise and whether I am happy with it.

I must point out though that I now realize how unprepared I was for labor and wonder how a lot of what happened could have been different had I been more informed and mentally prepared.

I started having contractions on Tues 13th since 1 am, my due date was 18th and by 5:30 I could time them about 5 mins apart. Went to L&D and was told that its very early labor and sent home. Had cx the whole day and finally gave in & went to L&D and was only 1 cm dilated but they admitted me considering I was in bad shape. I have low pain tolerance and "asked" for an epi.Now I am not sure about the exact timeline but at some point I was given pitocin, my water was broken by the nurse and as when she did that she mentioned that there was meconium in there. She mentioned that the hospital pedi on-call would be called since DD would have meconium aspiration. At 6 my OB arrived, and right away told me that there were 2 options since DDs heartbeat was dropping, either he would use vacuum or go for c-section. Unprepared as I was, I blurted out c-section, but then changed my mind and went for vacuum-assisted.

Well DD came out 10-15 mins later and was suctioned from the mouth, but cried right away and her apgars were 8/9. She was whisked into special care but brought back to room in with me after 2-3 hours.

Well, she had bruising on her head where the vacuum was placed and OB had used hard vacuum as well, and that stressed me out to no end even more than when she was taken back to special care and started on IV antibiotics for elevated WBC count. She was thankfully sent home on the 3rd day as the blood count came to normal.

The hospital relaese docs mention subgaleal hematoma and googling for it brings out possibilities of scary outcomes. Breastfeeding suffered, she did not latch on for a week inspite of relentless efforts with the LCs at the hospital.

For all that stress about subgaleal hematoma, DD is now a happy healthy 20 month old.

Do you think anything could have been done differently by my provider? I love this doctor, he comes highly recommended and plan to go with him for my future 2nd. But I know at the back of mind I do not know whether I consider/ should consider him responsible in some way for DDs stressful birth?

[SnuggleBuggles]

Honestly? My lay-man, birth junkie take is this... It is a classic case of cascading interventions. You went in too early, for one. 3minutes apart is far more reasonable for a 1st timer. 3 minutes puts you more into active labor phase. Of course, there is a ton of variation so by going just with the numbers doesn't always work. I know you said you had a low pain tolerance and needed to go but, that is something that you could address in the future. It's not like I like pain but I found coping skills for labor (and a surprisingly higher threshold that I expected!!).

From the cascading interventions...you were there but not really in labor-labor. As a result they wanted to do something. (Read "Pushed" by Jennifer Block for more on this.) Hospitals need to use those beds and staffing and resources for something and sometimes they invent work to do. Pitocin to get things going so they aren't just hanging around waiting for labor to start. The pitocin contractions could be to blame for the meconium since it causes harder contractions for you and baby (people tend to just think of pitocin contx hurting more and forget about baby in the process). Some careproviders break the water "just because" or under the guise of speeding things up. Avoiding both of these interventions helps to have safer outcomes. Risks/ benefits need to be determined as there is a time and place for interventions.

It's good that your OB gave you 2 choices. Neither is risk free. With a c-section you face possible complications with future births and pregnancies. Would it have been better than the vacuum?? That is an issue that you need to trust your OB on. It would have been *great!* if she had taken the time to lay out the risks and benefits of the 2 so you could make an informed decision. Sadly, the burden of educating the mom about interventions and these things often falls to the mom. It's up to us to do the research and ask the questions before we go into labor. I wish that weren't the case. few practices devote enough time to patient education...or really even care if their patients are educated and informed. My midwife practice was an exception and it was wonderful.

In the future, a doula would be great. Any prep you can do ahead of time is a good thing too. Try not to dwell much on the past but think about things you can do for future births.

Sorry if that was more than you were hoping or not what you were hoping. (((hugs))) Glad your dd is fine now. :)

Beth

[Myira]

I completely can see how unprepared and dazed I was about my options and the whole labor and delivery process in general. All the interventions after I asked for the "epi"(too soon at that) were done by the hospital L&D staff and I am not exactly sure of my OB's views about them. That conversation, which should happen sometime during pregnancy never happened. The hospital childbirth class I took did nothing for me in terms of really understanding my options, enabling me to make decisions.

As you said, there is no point dwelling on the past, other than being better equipped for the future.

[swissair81]

1.You went in too early.
2.An epidural should not be given before 'active' labor- 4 or 5 centimeters.
3.Pitocin often (usually) stresses out the baby. It does not mimic normal contractions & it inhibits natural oxytocin.
4.If your Dr knew so early that there was mec in your water, they should have put in an IUPC (intrauterine pressure catheter) to dilute the mec in the fluid.
5.If a baby has an elevated WBC, they should have named the infection (because randomly giving antibiotics is pretty stupid). Do you know what it was? What was your GBS status?

End point: I don't know that your OB was responsible. There was a cascade stemming from you being admitted too early & taking an epidural too early. That said, next time I would find a more natural minded provider & maybe consider a doula to help you deal with the latent labor pain. You should definitely discuss your wishes ahead of time with your OB. A birth plan could also work, but remember your OB isn't in the hospital for most of your labor & s/he will give orders to your nurse without your input. Prior communication is key. Also hospital childbirth ed classes are given by a hospital employee & follow the line of the institutional policies. You should find an independent childbirth ed provider (but also make sure that you are okay with your chosen institution's policies in advance. They won't change them just because you ask them to.

[SnuggleBuggles]

WRT your OB's responsibility earlier in labor- they ok'ed the early epidural and they were likely the ones who gave the orders for the pitocin and AROM. Perhaps they just have standing orders? When did you get to see your OB in labor? I made a comment to my CNM that she was pushing meds on me, jus like an OB (I know, bad thing to say...I was deep into labor and she was on every nerve). She told me if she were the bad old OB I was envisioning then she would be chilling in the staff room calling orders in vs standing there discussing it with me.

Beth

[swissair81]

If a woman asks for an epidural, she will likely get it. Some providers will hold off, but not many. Some will discuss the fact that it is not smart so early, but... The AROM was to jumpstart the labor that stalled when they put in the epidural. Once there was meconium, they gave pitocin to make the baby be exposed to it for less time (and decrease the chances of mec aspiration).

[Myira]

Beth, I did not get to talk to or see my OB until the morning at 5:30 am and I was in the hospital the previous evening with epi and all interventions continuing throughout that night. the hospital resident OB was going to come over to break my water about 2 hours after the epi, but since he took longer the nurse broke my water. You think my OB was asked at every step of the way and it went ahead with his ok? I wonder...

swissair81, to your point about an IUPC (intrauterine pressure catheter) to dilute the mec in the fluid, they did do it, I just did not seem to know the technical term for it. I do not know the name for her infection and neither do the hospital release docs make any mention of it. I was always told that they are doing it as a precaution and keeping her in special care until the WBC count is normal to preempt an infection.

[swissair81]

I would seriously question them giving random antibiotics for an elevated white count. You could run into problems with drug resistance & usually they run a culture and sensitivity on a blood sample to see what antibiotic a particular infection would be most sensitive to.

Glad to hear about the IUPC though. I usually get a copy of both my & the baby's complete hospital records after delivery (and I tell my dr I will). They hide less that way & if they did hide something, I can call them on it.

To be sure, your doctor ordered everything. You are his patient, admitted to his service. All the orders come from him. He might ask the resident to sign them, but nothing happens without the okay of the attending physician. If they weren't able to reach him, the staff service would have been making decisions. I'm sure they would have told you.

[Myira]

swissair81, I forgot to mention I was GBS -ve, but was running a temperature when I was pushing during labor. I am not sure if something about the IV antibiotics for DD was hush hush, anyways, but atleast it wasn't and still isn't very clear to me.

Actually my OB is very natural birth-friendly as per many others who have delivered with him(although I know no one in IRL), so looks like it was failure on my part to get the dialog going about his opinions/policies/expectations.

[swissair81]

Re: the temp, how long had your membranes been ruptured by the time your baby was born?

Definitely have dialogue with your OB & any partners he works with & has a chance of showing up at your delivery.

[Myira]

It must have been atleast 5-6 hours prior to birth if not more that my water was broken before birth.

[SnuggleBuggles]

Actually my OB is very natural birth-friendly as per many others who have delivered with him(although I know no one in IRL), so looks like it was failure on my part to get the dialog going about his opinions/policies/expectations.

How could you really be expected to know you needed to talk about these things? I did but that's only because a friend gave me a copy of "The Birth Book" by Dr. Sears and that set me off in the right direction. Had I only read the crappy "What to Expect" book someone else gave me I never would have though to learn the things I did. Most moms that are pg are given to believe that the only thing they need to decide is if they want an epidural and what hospital. There isn't a ton of encouragement to do more than that...and sometimes people that do do more than that are looked at weird. :) I try to encourage anyone I can to write a birth plan simply b/c it is a great way to eve see the myriad of choices out there beyond drugs or no drugs.

I think the responsibility should fall to the Dr.. I wish every OB and CNM practice could be like what I experienced with 20 minute long appointments most of the time and some 40+ to do things like patient education (nutrition, birth choices...). It's a crappy set up we have going on nowadays.

Beth

[swissair81]

My Dr sits down and talks with me (like he doesn't have an office full of patients) everytime I have a visit (and by now I am there every 2 weeks). This hit home more than ever with my last appt. He was so backed up, he saw me an hour after my appt time. I would never have known that by looking at him. He came in & he made small talk. He spent time on the problems that concerned me. Awesome dude! (I never met him before I went into labor. He was the only partner of my doctor that I didn't get to see. The way he treated me, I could have been his best friend. I knew who I wanted to see when I found out I was pregnant again & it wasn't my former doctor.)

[Tanya]

I don't know about your OB. If you like him, stay with him. It's really important to like him/her. When I was in labor, the nurses didn't do anything without checking with my midwife. She would give advance approval on certain things like pain drugs. When my labor didn't kick in, she gave suggestions on what we could do (walking, nipple stimulation). When it still didn't kick in (my water had broken, so that's why I was at the hospital and stuck there), she let me know when the OB would be coming on call and what he'd want to do, so she gave me the options I had based on trying to have the baby before she left and he came or waiting, etc. When I asked for something besides ice chips, the nurse had to call the midwife for approval.

Anyway, I would strongly recommend you take a decent childbirth class. I think you need to be educated on various interventions and your options and you need to at least learn some type of coping method for the contractions. I have an extremely low pain tolerance. I'm an absolute WIMP. Ask my dh. However, just understanding labor and what my body was doing and knowing how to breathe and use various positions helped me get through two births. One was was back labor and the other one ended up with pitocin. I never had an epidural or any pain relief drugs and I hope to do it that way again with twins. I had a birth plan ahead of time and I really learned so much from my natural childbirth class.