Transport with a less than optimal outcome
Continuing the series on transport, I wanted to look at an example of a less-than-ideal situation. Mom and baby are healthy at the conclusion, so no need to worry there. Remember, my goal is to educate and empower, not to sugar-coat or to put the blinders on.
So, what does happen, when a family plans an out-of-hospital birth, but finds themselves transporting to a hospital for assistance? How are they received and does that change their options and opportunities?
Similar to my previous post, this involves a first-time couple who were very excited to meet their baby. In this example, the mother’s water spontaneously ruptured prior to labor. (Her water broke before she was having contractions.) We applied our current protocol and let her rest for a little bit before coming in to the birth center to see if contractions would start on their own. We discussed baby’s movements to be sure the baby was okay, and discussed some things she may want to try at home to get things going.
The time came to meet up at the birth center to assess and make a plan. Mom and baby were doing well and while contractions had begun, they were not quite where we wanted them in order to make effective cervical change. I remained with them throughout our attempts to get stronger, more regular and effective contractions going. Sometimes it would seem as though the uterus would respond and then with time not so much.
Looking at the overall picture, we discussed the situation and decided to go in to the hospital. At this point, we thought the uterus could use some Pitocin, and mom, if she decided to, could get an epidural to rest and relax as she continued her labor journey. We transported to the nearest hospital, not because it was an emergency, but because that is generally the right call when leaving a birth center and if specific back-up to a consulting physician isn’t available. (That was prior to the time of our current consulting physician and prior to the time of hospitalists, or OB/GYN doctors who are on premises to take any “walk-in” or transport patients.)
The mother had to go back alone for an individual separate triage time before being admitted. Once we were admitted, our nurse was noticeably open about her disapproval for the laboring couples desire for an out-of-hospital birth. It was really late at night (after hours) when we arrived, so the plan was to monitor and assess. The nurse was our only point of contact for a while and she communicated her assessments to the doctor. We were given time to rest and wait.
A couple hours passed and the nurse stated a favorable cervical check of 9cm! We were excited and ready to continue to labor the baby down while the entire team rested. Not so long afterwards, mind you it was only about 2 or 3 in the morning, the doctor came in to do a cervical check herself. One look at the parents (mom was short and dad was the size of a stereotypical linebacker) made the doctor call for an ultrasound. She began to palpate the mother’s abdomen and question me about the baby’s size. I assure her this is not a big baby.
All the same, she then does a cervical check and declares the mother is NOT 9cm, though she wouldn’t quantify her findings. She begins to talk of the complications of delivering a baby that is too big for a mother’s pelvis and works everybody up. The grandmother-to-be was in the room, the aunt-to-be was in the room and everyone was anxiously waiting to celebrate in the joy of the baby’s arrival. Now we have a doctor going against what previous internal assessments had been, by a nurse who was not new to nursing or to L&D, and was introducing this fear factor based on a snap judgment of the parents’ physical appearance.
They decided to proceed with a surgical birth (a cesarean) based on these factors alone. The ultrasound never came, but honestly, I don’t think it would have made a difference. Shortly after, they welcomed a 6lb 3oz baby girl at 40 weeks gestation with APGAR scores of 8 & 9 at the one-minute and five-minute intervals.
I did have a short moment with the couple and their family while the operating room was being prepped and I gave them time and understanding to discuss what was going on. I wanted to fight the snap assessment, but gave them non-biased causes, factors and things to consider from which to form their own opinion, but they were tired. They were tired, done and ready to meet their daughter. Without supportive and helpful information from the hospital workers or the encouragement to continue with their plan, they felt defeated and like they didn’t have a voice. Rather than dwell on the negative, they chose to put their efforts and energy into the birth and the long-anticipated meeting of their daughter.