Sunday, October 21, 2007

Caution! Full Force Whining Ahead

This weekend has been less than ideal. I'm on call (which always puts a damper on the weekend), I'm nursing a second bout of mastitis due, I think, to Bean weaning some night feedings, even when I'm not getting called every couple of hours, I'm not sleeping well. My best sleep seems to be right around 6 am, which is unfortunate because that is when CindyLou has decided to wake up for the last 3 mornings and demand to be fed. The house is a wreck, I don't feel like cleaning, something in the fridge smells bad, I don't want to search it out, the bottles need labeling for the week, and I don't want to do it. I feel fat, but all I want to do is eat bad food like pizza, pasta, and Chinese. I need to organize baby photo albums, not just for Bean, but for CindyLou, too. I need to go shopping, but I don't want to leave the house. Florida State lost (again) to a team they should have beaten. I got a new consult this morning on a patient with an adnexal mass that looks like cancer. Oh, and Mr. Whoo is sleeping in today. (Now, this is partially my fault, since I told him to go ahead and keep sleeping when I took the kids downstairs at 6:30 this morning, but he is taking full advantage, let me tell you!) Bitch, bitch, nauseam.

I feel really short tempered and snappish, but I think it all stems from being bone tired. Yesterday I had to transfer a patient with PROM to the tertiary care center, and I got treated like some kind of second class resident by the accepting physician. Usually I can let these things roll off my back, but they really ticked me off. I got the business about whether or not I had personally examined the patient (I had), whether or not the appropriate antibiotics had been started (they had), and whether or not the patient was in active labor (she wasn't). I realize that I am a community physician, but I'm not stupid. I trained in a residency that was 90% management of high risk patients. I know that tertiary care centers get a lot of "dumps" on the weekends, but I have never shipped a patient that didn't warrant transfer. I don't know why I let that physician get to me that way, but I'm still silently fuming about it.

I also heard about a terrible call that the L&D nurses and pediatrician had to attend. Apparently a woman was being attended in a home birth by a lay doula, (no midwife, no back up physician, just a doula with no medical training) the baby was footling breech and had a cord prolapse...instead of immediately going to the hospital, she continued to labor the mother at home. The baby was dead when it was delivered. A beautiful, perfect term baby that didn't have to die. When the medical team arrived the doula was chanting and lighting incense around the house and the mother was hemorrhaging in the tub. It just makes me physically ill to think of it. Don't get me wrong, I respect the art of midwifery, and I think that having a doula can greatly enhance a mother's birth experience. In this case, the doula overstepped her bounds of expertise with deadly consequences. I wonder if she will be subject to the kind of lawsuits that obstetricians face daily. Sometimes, even in normal births, things go terribly wrong, and ignorance of when to forgo the desired birth "experience" and get to the hospital to save a baby or a mother is catastrophic. So sad for that family.

I'm dreading heading back into the hospital. The only patients in house are OtherDoc's patients, and it is always difficult to manage his patients because our styles are so very different. I tend to be overly cautious, and I write a lot in my progress notes. He tends to be a bit more relaxed, and often will not write notes at all. It can be really frustrating. Oh well, at least I have next weekend for which to look forward. Two whole blissful days off, just 5 short days away. I think I can hold out until then. Hope your collective weekends are going far better than mine! :)


Kristina said...

Sorry you are having a hard time lately.

I fully agree with you that this doula overstepped her bounds. You said she is a lay doula so I assume she is not certified (and actually there are some great doulas who are not certified) but wanted to point out that what she did was clearly outside of the Code of Ethics and Standards of Practice for a DONA-certified doula. I can't speak for the other certifying organizations but I suspect the same. I just wanted to point that out because so many people have wrong perceptions about what a doula's role is and there are many doulas out there that give the title a bad name, which makes it hard when we step into a hospital suite.

Mama to Monkeys said...

In regard to the baby who died due to a prolapsed said "that poor family" you suppose that maybe the family (I might be delusional, it's late) is willing to accept the consequences of their actions and decisions?

I know that after personally having learned the hard way any and all decisions you make, or decisions you choose not to make for that matter, fall into your own realm of responsibility. True, these decisions are not what you or I might choose, but we all make choices.

I have people tell me all the time that I'm "insane", "dumb", or even "uneducated" because I have chosen a home birth for the birth of my next child after having a traumatic cesarean with my first. Now, granted, I will have a carefully chosen midwife in attendance, unlike this other women, but still that choice is mine, and mine alone to live with. And I take full responsibility for the outcome, just like I take full responsibility for the really crappy outcome of my first baby's entrance to the world.

Just like this woman chose to birth her baby without a midwife present.

frectis said...

That home birth sounds totally for real... wonder if the doula was Rumplestilskin? The art of midwifery has nothing to do with a doula idiot overstepping her bounds in laboring a woman at home. In other words, doulas are not midwives so please don't lump us competent midwives in with doulas who don't know WTF they are doing much less how to recognize a medical emergency as obvious as that. Thank you ;)

dr. whoo? said...

kristina~ Oh, I know. I'm not knocking doulas in general, but this story made me sick. I've had great pleasure to work with certified doulas within the hospital setting, and as I said before, I think they can greatly enhance the woman's experience. I just think this particular doula was some sort of crackpot, and the family that chose her suffered for it.

monkey's momma~ I feel for the family for their loss, and would feel that way for any family that lost a child, home, hospital or any other type of birth in between.

I am not name-calling women who choose homebirth in general here, just relaying a particular story that happened and upset me personally. For healthy, normal pregnancies, I think that (certified) midwives are perfect care providers, even more so than OBs because they can give extra time and attention. This doula was not a midwife, and had no training whatsoever, and yes, this family suffered the devastating consequences of choosing her.

My question lies in that when these sorts of things happen, why woulddn't the doula get sued within an inch of their life as an OB would in a similar situation? Because we are supposed to know better, but they are given a pass? Seems odd to me.

frectis~ Ack! I didn't mean to sound as though I was lumping certified midwives in with this untrained doula. You know, as I've stated prior, that I believe certified midwives are great providers for normal pregnancies, and that they would certainly recognize such a medical emergency. I was just venting my spleen at the story, not trying to stir the bee's nest.

I do resent your implication that the story is untrue. Why would I make something like that up? The pediatrician that went to the call and tried to resuscitate the baby was talking to the nurses about it when I was making rounds. He was devastated about it.

frectis said...

Sorry you resent my comment, but you wouldn't believe the things *I* hear as a midwife about the things we supposedly do-- or don't do. For example the hospital I took one of our patients to was shocked to learn I could assess fetal heart tones and start IV abx for prolonged ROM! I suppose they thought I'd be chanting and tossing pixie dust around ;) But if it's true, it's true.

frectis said...

Ps: Who would sue the doula? They don't have malpractice insurance to cover this sort of thing. Only postpartum doulas have liability insurance and that only covers them from liability for giving bad breast feeding advice, etc. I could see this doula being charged with practicing medicine without a license if she did anything remotely medical or at the very least practicing midwifery without a license (if licensing is available in the state you are in).

Totally sucks. That's for sure.

Anonymous said...

I have read about home birth and have even been encouraged to try it...but I couldn't do it without a midwife at least. Actually, I am not really interested in laboring and going through it all in my home with my kids. I am more comfortable in a birth center/hospital than at home. I get agitated with all the activity. It's actually quieter in the hospital believe it or not! However, I want less intervention than this last time. I was very unhappy with what was being forced on I am going to try to get my birth plan in order if I have any more, or plan a least request a friendly nurse!


Anonymous said...

First things first, Dr. Whoo I would shut down comments on this thread. You may get a lot of bile you just don't deserve.

Second, I understand how heartbroken and devestated the staff must be (Peds/L&D staff take justified pride in helping Moms and babies stay healthy).

Professional Doulas also take a great deal of pride in their own compassion and their ability to set appropriate boundaries governing their actions. The woman who attended the birth in this story showed callousness and disregard beyond my comprehension.

Anonymous said...

That homebirth won't leave my head. I am sorry for the family, and for the doula, really. I think she got in over her head, and thought she was helping somehow. She was naive to think that things don't sometimes go wrong. Unassisted home birth, or assisted without someone trained properly has risks that need to be well planned for (like being willing to call 911 or have a transport plan). I wouldn't advocate for unassisted/untrained assistant. Homebirth to me seems great if you like being home, but I personally think the stress of cleaning my home, and having my kids home while I such a small space is too much for me. I wasn't happy with my hospital birth in terms of how the nurse treated me, but was happy with the outcome of a healthy baby and healthy me. I was happy also with time I had alone with my newborn. In the past I was given more autonomy to deliver in the hospital room, this time my nurse made me stay in bed and on monitors. I begged to get up, begged for a shower. No such luck, and the OP position of my baby made delivery much worse than it would have been pain wise. I know next time (if there is one) I will ask for a nurse who is willing to catch a baby if OB is not in the room (this is the third non-doc baby) and will let me have more freedom if baby is looking fine. My baby had a decel, but I was told the baby looked good later on and was still not given freedom. Funny how devastated a woman can feel even when handed a healthy baby. I actually felt very violated and abused by my nurse who was only "doing her job." Weird. (by the way, some of it was her attitude...she really kept giving me the "I told you so" type comments and also she checked my cervix and kept her hand in there during contractions trying to push back my cervix to no avail. Only once I could get up and squat or on hands and knees did baby turn and then come out). Even with this, I would not stay home alone without someone who knows what they are doing. I just cannot take the chance.


Anonymous said...

Dr. Whoo,

You made yourself loud and clear in your post that you were critical of a particular situation, not midwifery, and not doulas in general! It could not have been any plainer. I think that the controversy over birth experience, home birth experience in particular is so emotionally loaded that some people have trouble hearing any criticism at all, regardless of the circumstance on the subject without getting a little defensive. I know I am guilty of feeling defensive when someone describes an especially dumb-ass comment or action by a nurse (I am one).

Monkey mommy, you had a traumatic birth experience, you did NOT NOT have a crappy outcome. There is a big difference. In our four children, I have had two traumatic births, and two truly crappy outcomes, and I swear with every breath I take, I will trade a birth experience for a living baby (PTSD and PPD and all) anytime, anyplace. Both of the above conditions are treatable. Grief is not.

Dr. Whoo, I know you don't want controversy on your blog, and my feelings won't be hurt if you don't publish this. But I'll say it anyway. And your decency to have feelings of sorrow for the bereaved parents, who surely did not truly understand what they were getting into, instead of judgment for their foolishness is admirable.


CNH said...

I'm going to go out on a limb here and state that the doula was not overstepping. Had she called 911 against the parent's wishes, she would have been overstepping.

Here's the thing, when women plan unassisted births (UCs), we know full well that the responsibility is ours. Good or bad, the outcome of the birth is in our, and only our, hands. And we don't want it any other way. So for a doula to be sued, or blamed, for something she just wasn't responsible for would be ethically wrong. You're right, she isn't trained to be a medical professional and was way out of her depth to pretend she was such. She wasn't in charge of that birth. No one but the birthing mother was calling the shots. If she misrepresented herself and the parents trusted her to know more than she did, then of course she should be held responsible. But I doubt that was the case.

I know this is a hard concept for an OB to grasp because you *are* taught that the outcome is in your hands only. Hell, even informed consent won't stand up in court to protect you! And I think that's a damn shame.

I chose to give birth at home without an attendant (and once before that with one) because I refuse to give my body, and my responsibility, over to someone else. Not even SOMEONE else, but SOMETHING else. An entity, namely your local friendly cost effective hospital, will be making the choices for me. No thanks. I refuse to be rupture, punctured, cut, strapped down, limited in nourishment, laughed at, called names, put on the clock, coached how and when to push, and basically treated as someone else's property all in the name of 'safety'. Been there, done that.

I choose instead to give birth in the peace and sanctity of my own home, where I and only I call the shots, and where my baby was welcomed into her father's own hands and never, ever separated from me for even a moment. Call it selfish, call it dangerous, call it irresponsible. Call it what you will. But I know from experience that having my child is more than manipulating a baby out of a uterus.

Birth is safe in the majority of cases. Constant interventions and a whole host of things that you probably already know and recognize make it less so, but it's still safe the majority of time.

I really do love your blog, I feel like I should say this. I am not aiming this little rant AT you necessarily. I am just frustrated by the blame game I see all around me.