April 2008


Danielle Elwood of ICAN of Connecticut recently began an outreach to the birth community of our fair state.  It seems that she contacted Governor Jodi Rell to request support officially acknowledging April as a Cesarean Awareness Month:

“The reason I am writing you today is about Cesarean Awareness Month which took place in April. As the founder and leader of ICAN of Connecticut, I took it upon myself to contact Governor Rell with a request to recognize April as Cesarean Awareness Month but I was met with closed doors. After being denied I called and spoke with someone on Governor Rell’s legal team who explained to me that the Governor cannot support such a controversial cause.”

Is it any wonder that our state’s Medical Examining Board enjoys the power it wields over midwives?  Gov. Rell we encourage you to learn more about the process of normal, natural childbirth and the history of misused and abused obstetrics.  We encourage you to talk to your peers in states where midwifery is welcomed as a safe option for low risk women.  Midwives reduce the unnecessary c-section rate and that shouldn’t be controversial.

Danielle also included a short list of states that recognize April as Cesarean Awareness Month:

Governor Charlie Crist (R) Florida
Governor Kathleen Sebelius
 (D) Kansas
Governor Mike Beebe
 (D) Arkansas
Governor Chet Culver (D)  Iowa
Governor Ernie Fletcher
 (R)  Kentucky

If you would like to contact Governor Rell you may do so at:

Governor M. Jodi Rell
Executive Office of the Governor
State Capitol
210 Capitol Avenue
Hartford  CT 06106

Toll Free: 800-406-1527
Governor.Rell@ct.gov 

 

You do so much to take care of yourself in pregnancy and you read about labor, try to take the most informative birth education series and choose the “right” careprovider and birth location for a healthy birth.  Most people don’t see this one coming.  We trust careproviders to first do no harm.  Harsh as it sounds, you can’t trust them all and even careproviders acknowledge some of their colleagues are doing things they would never do.

More importantly remember the best cesarean prevention is knowing your body is designed to give birth in its own time, in its own way.  If you are a first time mother it is especially important to know that birthing spontaneously and vaginally is the foundation for your next births.

 

“The two most power filled words – I can.”  – Anonymous

Every birth educator and doula needs to tell their clients this: Your careprovider must tell you if they plan to use Cytotec and must tell you about all of the risks involved before you consent to its use in your care.  You must remember that Cytotec also goes by “miso” or “misoprostol.”  Use all of these names in asking about this tiny little pill.

Throughout this blog you’ve read about the basis for informed consent as well as the disregard for informed consent when it comes to birth care.  You’ve also read about the dangers of Cytotec, how it’s used off label and it continues to be used in spite of the unpredictable rates of injury including death.  

While researching what progress we’ve made in raising awareness of the off label use of Cytotec I came across this lawsuit settlement from 2001 and now we are working to make others in the birth community aware of it as members of our Yahoo group spread the word:

$2 million 

Failure To Obtain Consent For Off-Label Use Of Cytotec 
Case name withheld
Plaintiff’s Counsel: Joseph J. Wadland and James L. Ackerman, Wadland & Ackerman, Boston and Andover 
The plaintiffs were a 38-year-old woman and her husband who were expecting their first child. At about 41 weeks of gestation, the decision was made by her primary Ob/Gyn to induce her labor. A dose of 25 micrograms of Cytotec, a drug that the FDA has approved for the prevention of gastric ulcers, but not for the induction of labor or cervical ripening, reportedly was given vaginally. The care providers did not obtain the mother’s informed consent for the use of Cytotec that was being administered for an “off-label” indication in a high-risk situation. A series of complications arose, including the deceleration of the fetal heart rate and the baby was delivered via Caesarian section. The baby was lifeless and resuscitation efforts were unsuccessful. The mother also required a hysterectomy as a result of off-label use of Cytotec. When the claim settled on Aug. 7, 2001, it was the first reported settlement or verdict in Massachusetts involving the drug Cytotec. 
This settlement was first reported in the Nov. 5, 2001 issue.”

If you are in an online group that shares birth information share this one.  Please.

Then continue to read our posts on understanding informed consent and the stories of Cytotec’s unpredictability

Own your birth.  Demand full disclosure of all care practices.  Spread the truth about birth: You can.

The only thing I was aware of for my first birth was that I didn’t want Misoprostol, per my reading. So, when I went in at 42 weeks and a few days for my induction (19, naive, unprepared) I told the doctor (not my normal one) that my doc and I had agreed to no misoprostol. He ‘reassured’ me that they hardly used that any more. In hindsight, I see he didn’t really give me a straight answer, so he also didn’t ‘really’ lie to me.

He administered the pill and left, saying my doctor was ‘on’ in 2 hours. When my doctor came in to see how I was doing and read my chart, he jumped through the ceiling, ANGRY.

He didn’t tell me what was up at that time.

Labor went seamlessly.

Birth went quite well.

AFTER birth, I had quite a hemorrhage immediately afterward. Then, 4 nights after birth, I passed a few huge clots. Early EARLY a.m. leading into the 5th day, I woke from a sound sleep to what I ‘thought’ was my babe crying (she slept in a bassinet a few feet from my bed). I got out of bed and walked the two steps to her bassinet only to see she was still sound asleep. What I DID notice is that, in those two steps, blood began pouring from my body. I was having a late-postpartum hemorrhage (pph) and the only person who could help me slept like a rock and was 1 room away.

WARNING, THE REST IS QUITE DETAILED AND NOT FOR THE SQUEAMISH:

I hobbled quickly to the bathroom and sat on the toilet. When I heard the bleeding was not slowing, but increasing, I tried getting ‘low’ to get my blood pressure balanced and reduce gravity’s assistance with my bleeding. Crawling to the tub, I began yelling for my mom (who I was living with at the time). Once I pulled myself into the tub and laid down, I began beating on the wall that separated her bedroom from the bathroom. It felt like an eternity… it was probably a few minutes, but she finally came into the bathroom and found her tile and walls, bathroom and tub, painted in my crimson blood. Hand prints dotted the walls and counter tops while a steady line trailed from my room to the bathroom.

She didn’t wait for an explanation but called the hospital, told them she would not be waiting for an ambulance, but to prep the police because she would NOT stop for their lights. She bundled me up in the car on a towel and told me to hold my baby. Her reasoning, she later said, is she thought I was going to die and reckoned that holding my child would help me hold onto this world a little longer.

Off we sped.

I passed out a few times on the way.

Once we got there, they could not find a pulse because it was so weak, nor could they get bp. They had a horrible time getting an IV line in too.

They were asking me questions but I couldn’t hear them. All I saw was their lips move and this rushing water sound. I was answering them as best I could – later my mom would tell me I was yelling and swearing like a sailor – something I never do. They took me away, yelling over their shoulders that she could sign while I was IN surgery.

That’s the last I remember. Next thing I know, I wake up a few hours later in recovery – catheterized, I.V.ed, my then-boyfriend was there, and my stomach felt empty….

I had had placental retention – which caused massive hemorrhage and clots. I was somewhat ‘toxic’ as well and spent some time on antibiotics. My doc said that if I would not have woken up, I would have bled to death in my sleep. A few minutes longer, and I would not have survived my trip to the hospital.

While there in the hospital, he told me he considered it the fault of the misoprostol, aka CYTOTEC. He never used it, because my case made 2 life-threatening Cytotec inductions on his watch. The first, he administered the Cytotec and the mom almost died on his table. The second, me, he had specific orders for no Cytotec and the other doctor blatantly disregarded it and misled me.

My file says ‘iatrogenic complications due to the administration of Misoprostol for postdatism’ regarding my early pph. For my near-death hemorrhage, it states ‘late pph due to placental retention and subsequent septicemia’.

It affected my milk production. I dried up like the Mojave and had no idea (at that time) that I could reestablish milk production. So, at 5 days postpartum, my daughter went fully onto formula. I was devastated.

The saddest and most outrageous thing is that my file clearly ‘cuts out’ the TRUE cause for my placental retention and thus, my pph… the two are so clearly ‘divided’ that an untrained eye would never put the two and two together – thus, another example of the ills of Cytotec goes unreported.

My recovery took over 1 year. I had soreness and battled infection for 3 months postpartum. It took me another 4 months to be ‘ok’ having anything inserted into me (tampons, etc…) because of anxiety, and anemia was my ever present ‘friend’ while trying to regain my blood count and get my iron levels up. I have low bp anyways, so losing that much blood was no small stress on my body.

For more information on Cytotec, you can go to the Tatia Oden French Memorial Foundation website. Tatia Oden French was induced with Cytotec when she went past her due date. Both she and her baby died.

Women need to demand FULL and INFORMED consent/refusal. I was deliberately mislead and it almost cost me my life. It has cost many other women and their babies a higher price than I paid.

survivormoms_214_matte.gifImagine yourself in labor, and suddenly a very painful memory intrudes your mind and consumes your thoughts. Imagine how distracted you would become. Your contractions could slow down and stop. The physical intensity of labor might be overcome with the emotional pain of your past.

But it doesn’t have to happen this way. You can prepare yourself during pregnancy by reading When Survivors Give Birth by Penny Simkin and Phyllis Klaus and Survivor Moms by Mickey Sperlich and Julia Seng.

If you have been abused or even just suspect that abuse may have occurred, you are highly encouraged to discuss it with your entire birth team. This includes your doctor or midwife, birth partner, doula and childbirth educator.

Remember, all of your care providers have a responsibility to protect your privacy and rights. If they believe it to be in your best interest, they may also go out of their way to help you obtain appropriate services. Open communication is important and will certainly make a difference in your over-all pregnancy and birth experience.

If you are able to share specific details, those caring for you will be able to make better judgments and be more sensitive to your needs. There are some things that might trigger your memories of abuse. Some are obvious things such as being in bed during labor or breastfeeding after the birth. But other triggers, unique to your situation, might not be so easy to identify. This is where when-survivors.jpgcommunication between you and your caregivers can prove extremely beneficial.

Having vaginal exams are common during labor and at the end of pregnancy. But having them might put you in an extremely vulnerable position. If you let your medical team know about your history of abuse, they will be exceptionally sensitive to your particular situation and comfort level. You have the right to opt out of this particular intervention, and your choice should be respected.

Fortunately, there are many resources available today that help shed light and understanding on the problem of sexual abuse. Care providers typically maintain a list of resources that include local therapists or counselors that specialize in abuse. They may also have books, recommend websites, and provide educational materials.

get help

There are several options you can pursue in order to promote health and wellbeing. What may work for one mother, may not be the best method for another. Sometimes, you may need to experiment with several techniques before discovering which is the most helpful. A care provider should always be consulted prior to trying any form of therapy

This is the first in a multi-part series on pregnancy, birth and sexual abuse. This article is written for the pregnant woman with a history of abuse. Future articles will be written for those who work with pregnant women and will address ways to help a woman during pregnancy and birth.

About the author: Lasi Leavy has 15 years of working with at risk adolescents. She is an ALACE Birth Doula and Hypnobabies Childbirth Hypnosis Instructor.

Have you ever considered looking at your patient? Seriously, there’s a real person, a laboring woman behind each strip on your computer screen.

While walking the hospital halls recently with a client of mine who was in active labor, I caught snippets of the conversation between the charge nurse and my client’s certified nurse midwife.I knew exactly who they were talking about. They were looking at the computer screen containing my client’s EFM strips. The nurse said, I can see that the baby is doing fine, but I need to know what is happening during this time. When is she having contractions? Is she even having contractions? How do I know that she’s in a good labor pattern?

Dear Miss Labor Nurse, Please turn your head away from the computer screen and actually look at this person who is in your care for the night. If you look at her and listen to her, you’ll see that she is in labor and experiencing strong contractions. A cervical check not too long ago showed 6 centimeters dilated. Upon admittance at the hospital, she spent 30 minutes on both the uterine monitor and the external electronic fetal monitor. Perfect strips.

The midwife explained to the nurse that she was sitting with her patient and that she was having good strong contractions and that the baby was handling those contractions fine. The nurse just didn’t get it. She wanted to see proof on her computer screen and on the paper printouts.

She wanted a record of the contractions. A continual record of the contractions.

Only minutes earlier, we had all been in the room, my client sitting on a birth ball leaning over the bed. Her husband was doing counter pressure on her lower back during contractions while the midwife sat beside her, holding the doppler up to her contracting baby belly both during contractions and in between them for some “continuous fetal monitoring.”

Beautiful heart tones. Strong. Reactive. Variable. No decels.

The midwife didn’t bother putting the contraction monitor on my client because she knew it bothered her and everything was going ok, so there was no reason to. The LDR nurse walked in the room and wondered if the monitor were working, only to discover it had not been placed on her patient.

My client didn’t want it on. She asked what information it would provide. The LDR nurse said they could monitor her contractions. The LDR nurse said so you are refusing? My client asked her if she needed it. The LDR nurse said that they were watching the baby’s heart rate but they didn’t know when or if she was having contractions.

Then I said, your midwife is sitting right here next to you and SHE is monitoring the baby’s heart rate plus SHE knows exactly when you are having contractions because she is right here with you and she is watching your baby during the contractions and so far your baby is doing fine.

With that, my client said that she refused the uterine monitor. A new nurse stormed in a couple minutes later; the charge nurse who I spoke of earlier in this account. The nurse demanded, “Where is she?”

I said, you mean A? (the midwife).

“No the patient.” The nurse hadn’t even bothered to find out her name.

I said, “P is in the bathroom.” The nurse did a quick 180 and stormed out.

This was the first time I’ve doula’d at this hospital, and perhaps my last. There are other doulas who absolutely refuse to go there. I loved my client; I had been to her previous births at a different hospital and I didn’t even consider not going to the birth just because of the place of birth.

Labor nurses: every once in awhile you’re going to get a woman coming into your labor hall who doesn’t need continuous monitoring because she’s not using pitocin. She’s not having an epidural. When a woman doesn’t get those drugs, the rules can be different. It’s fine for a midwife to watch a woman in labor, using her eyes and ears and hands to help her patient. Labor progresses. Birth happens. Mommies and babies thrive without machines and paper printouts.