Friday, February 09, 2007

Days five and six...sleep is for the weak

Pet mom wasn't the only woman at the birth center that evening. Our VBAC (Vaginal Birth After Caesarean) client was back. She was over her due date by a few days. VBAC clients are more sensitive than other moms, since they are at a higher risk for certain complications. She had already consulted with our doctor back up, had extra ultrasounds, a biophysical profile on the fetus, and a Non Stress Test (NST).

Even with all of these diagnostic tests at our disposal, and with studies showing success rates above 90% on trial for labor for VBAC attempts, many practitioners and hospitals do not allow women to choose to try for a VBAC. And, even with all of those diagnostic checks at our disposal at the birth center, we can't deliver a VBAC mom if she doesn't go into labor if the first place.

We had been trying to gently nudge VBAC Mom into labor using safe midwife tricks. She had been at the birth center on and off for days. We had her inserting evening primrose oil suppositories; we put her on the breast pump, and then had her pacing up and down the parking lot. Finally, she started having contractions. From early afternoon, all through the night, to the next morning we monitored her vital signs and the fetal heart tones. The midwives only did a few vaginal exams.

Unfortunately, she had still only dilated to three centimeters after almost a day of contractions. The same thing happened during her first labor. We gave her the option of trying to wait longer, or to go to the hospital. She chose to go the hospital. It seemed unlikely she would dilate any farther.

This is when things turned from bad to worse. Sometimes the doctor takes plenty of time to show up to the hospital when it is a non emergency caesarean. In the meantime, I stayed with the increasingly frustrated VBAC Mom and her partner. For five hours, we were left practically alone in the room. Our nurse apparently got called to assist an emergency caesarean section, but we were never told.

I tried to find a nurse when VBAC's Mom's fetal heart tones repeatedly dropped after contractions. I politely asked for a nurse at the desk, which was occupied by a lone receptionist. Apparently the pressure of being understaffed during a stressful time is enough to make certain nurses lose their cool. The only nurse on the whole floor pulled me aside and threatened to throw me out of the hospital for "antagonizing" her for asking her to check on VBAC mom. When I asked her a few minutes later if someone could please change the rapidly dwindling IV bag, she snarled from her paperwork "Can't you see I'm busy?" and never tried to call another nurse.

Luckily for us, our nurse who had disappeared for the emergency caesarean showed back up soon after, and showed amazing compassion and professionalism, unlike her stand in. I was shocked, considering how I usually had such wonderful experiences with the nurses at this hospital.

VBAC Mom had a hard time waiting for the doctor to show up. It is hard enough making it through contractions when you know they are dilating you to a goal. She knew hers weren't. She was very frustrated, and had a hard time dealing with the antagonistic nurses, and then the defensive director of the floor, who came down to the room twice. The director was trying to make up for the lack of attention and shoddy treatment from the nurse, but just came off as harassed and defensive. Or, she was coming to investigate my supposedly antagonistic behavior. She was sadly disappointed if that was her goal.

I returned twice after VBAC Mom had a successful surgically delivered beautiful baby boy. I have never seen a boy refuse to open his mouth like this kid! When VBAC Mom complained over the phone she was having latch on problems, I figured both she and the baby were just a little worn out from the prolonged labor and the surgery. But, when I showed up, this boy had his gums locked together like I have never seen. Even if he got frustrated and cried from our fussing and prodding, he wouldn't open his mouth.

"See?" said VBAC Mom. "My daughter latched on right away, no problem."

It was really hard to get her nipple in the little opening this boy would give us, since it seemed to flatten out when she cupped her breast to offer it to the baby. I asked the nurse on duty if they had any nipple shields. I got another defensive reaction. The nurse berated me, "Do those look like flat nipples to you?"

VBAC Mom, who had been trying to latch on for about a day by this point, tried again right in front of the nurse. Her nipple flattened out and the baby closed his mouth. VBAC Mom had already given him formula once. No one had suggested pumping to her. I was afraid of both of them giving up on the breastfeeding soon. The nurse looked for nipple shields, but couldn't find any. I went back to the birth center, and brought back nipple shields and a hand pump.

It took at least another half an hour of wrestling with this poor boy to get him to latch on, and then to get him to suck! Luckily, VBAC Mom was already producing lots of milk. We hand expressed some into the tip of the nipple shield, and got the baby to latch on to the shield on the tip of my finger. I tickled the roof of his mouth, and got him to suck. He got a taste of the milk, and something clicked.

"Breastfeeding is a learned behavior," I explained to VBAC Mom. "He is just not getting why we are trying to force him to suck this thing..."

We expressed more milk into the tip of the shield, and then got him to latch on to the shield over VBAC Mom's nipple. He latched, and he sucked contentedly.

"Is he on? Is he sucking?" I asked excitedly.

"I think so...ow! My uterus!" said VBAC mom.

I smiled. Afterbirth contractions are stimulated by effective sucking, and so is the feedback to the brain to encourage more hormones to produce more milk. He continued to suck for 20 minutes.

I told VBAC Mom to call me if she needed anything else. I made an effort to thank the nurse profusely for being supportive of breastfeeding, even though she seemed impatient and dismissive earlier. I told her I realized she didn't have the time to struggle with this kid to get him to latch on, and that I was ready to come back at a moment's notice to help. We need a good relationship with the nurses at this hospital so our transferred moms feel supported and we are welcome there.

VBAC Mom will still keep her postpartum visits at the birth center, and we will put her Polaroid up on the wall with the rest of our moms.

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