This story is about hospital routine, ignorance, fear and manipulation. But it is also about the violation of women's rights to personal liberty, informed consent and safe care.
Some days ago I was at a birth. A woman called me, she was probably just having Braxton Hicks contractions, but I would rather be prepared, just in case. We agreed to talk again as soon as it intensified. About twenty minutes later, she called and we met at the hospital. The woman was looking beautiful, quiet, relaxed, gently breathing through contractions and if she didn't have papers from a doctor stating that she was dilated to seven centimeters, I would not have believed she is about to go into labor.
We went to the delivery room and I asked her if she wants to have a moment in the tub. She said that this is exactly what she wanted. So she plunged into a warm bath and kept breathing calmly, beside that, she was completely silent. From time to time I listened to the baby's heart and nothing else. We had agreed with her husband that he will leave for the second period of the birth, he didn't want to be there for pushing. After a while, the woman asked what will happen next and I replied that amniotic fluid will leave and then the baby will be born. The fluid had not gone yet and the woman didn't need to push. She was resting in the bathtub. After a while, I suggested that she should squat in the bathtub for a bit (until then she had been on her side). The woman said yes, so I crouched down to support her; she had about two contractions in this position and then she said that it is very strong and that she'd rather lie down again, and so she did. Suddenly she screamed and I saw the crown of the baby's head told her that it's okay, that the baby will be born soon.
I stepped out the door and called for the second midwife to call the doctor and pediatric nurse. That was the deal. On the next contraction the baby floated into the tub. Peacefully and calmly. There was nobody. I helped the woman to take the baby into her arms. The baby was a little purple, so I gently helped it to breathe. By the time the doctor and nurse came, the baby was beautifully pink. I ask the woman to come out of the tub.
The woman and her baby looked happy and healthy, as did the husband when he arrived. But doctors were not satisfied. I was berated about the birth, that I even imagined to allow the birth into the water. I didn't give birth, the woman did, I helped her as best I could. She gave birth beautifully and smoothly, to a four kilograms child, and with only minor scratching to the mother and no harm to the child, which had an Apgar score (measuring the health of the newborn; 10 being the highest) of 10/10/10. The new mother was happy, her baby was healthy - what was the problem? The fact is that in this maternity hospital, women may give birth into the water only when there's a head physician present. But the head physician wasn't on duty and even if he was, he would have missed it, as it went surprisingly quickly.
I feel that I did a good job, no vaginal examination, no forced pushing, no unnatural positions, immediate contact with the baby, happy woman and healthy child, peace and quiet at the moment of birth... But in the eyes of colleagues and midwives I am a bad midwife. I didn't pull the woman out from the bath in time, and I didn't call for others, so they missed it. They told me that I will be in big trouble.
A few days after that birth, I was at the same maternity hospital again. A woman called me that she had lost her amniotic fluid. I asked what color it was and whether the baby is moving, and if she felt good. Everything was ok, so we agreed that she'd call me whenthe contractions came or if she needed anything else. She called about an hour later, saying that she was having contractions and they were quite often, and she wanted me to come. I'm went to see her. Halfway there, something tells me that I should call her, so I did, and she told me that it's very strong and frequent. I am telling her that it would be better to meet at the hospital.
The woman was fully dilated when she arrived. We went to the birthing room. She was on her side and after a while I advised her to move into the vertical position. The woman knelt and rested on her husband. I checked the baby's heart and everything was ok. After a few contractions, I saw that the baby was already progressing down through the birth canal. After the next few contractions, the head started to appear. I called the doctor and pediatric nurse. The doctor came and sat down next to me and said nothing. The woman didn't press too hard, the birth was progressing smoothly and in the next two contractions the head came. The woman was kneeling. The contraction passed and I waited for another one. I told the woman that the baby would be born now, that she could push.
The doctor started to get nervous and wanted me to pull out the baby. I knew that baby must finish its rotation, so I tried to buy some time by helping the woman to choose a better position, where it would be easiest for her. The doctor couldn't stand it, she couldn't wait for another contraction and forced me to pull the baby out in the middle of contractions. It was stupid. But it was so urgent to the doctor that I pull the head, I felt that otherwise she will push me away and do it herself. But the baby was not going, of course, because there was no contraction. The doctor was nervous and I tried to use more force, even though I did not want to, because I knew that it shouldn't be like that, the woman could be injured and it would be uncomfortable for the baby.
The baby was born and I gave it to the mother. She sat down and leaned against the wall, welcoming her baby. The baby was a little purple and was not crying yet, but it moved and blinked. The umbilical cord was beating and I was calm, but the pediatric nurse was not calm and wanted me to cut the umbilical cord. I knew that it is most important for the baby at the moment to have a pulsating umbilical cord. Babies receive oxygen from the umbilical cord until they're able to breathe independently. But it looks like they don't know about that in the hospital! The doctor urged me to cut it. I turned to the mother and asked if she wanted the umbilical cord to be cut; baby was pink and started to whimper. The woman didn't want it done just then.
The doctor said that she would not discuss it and handed me a pair of scissors. I told the woman that the doctor insisted on cutting. I cut it as slowly as possible. The baby began to cry. The nurse wanted to take the baby away. I said that the woman does not want that, she has it in her birth plan. The doctor insisted. I said that the child is pink, and crying; it's okay and healthy. The nurse said that the baby was not pink and threatened to call the head physician if we did not allow her to take the baby. The parents told her to call the head physician. Meanwhile, the baby was completely fine.
The head physician turned on all the lights and wanted to take the baby away. The parents insisted they didn't want this and I supported them. The doctor said that he must see the baby on the table. I said that he could examine the baby on the woman, with the baby in her arms, and he told me that there are some rules and that he will examine the baby only on the table. The parents didn't want this but he told them that it's possible that the baby could stop breathing in five minutes and they will take it on their conscience. They said that the baby looks good, is breathing well, and he says that it is their responsibility if the baby dies, and that he would give them a reversal to sign. He left angrily. The child remained in the arms of its parents. After the head physician left, the baby was breastfed. It looked perfectly fine. Mom, dad and baby cuddled.
The first doctor called me to her office and yelled at me that I cannot do it this way, that it will be like they say, and that they have rules. The baby was Apgar 8/10/10, a healthy score for a newborn. I asked why she wanted to take the baby away when it was fine. I said that I think that on the contrary, the woman wants to be with baby especially for the baby. But the doctor said, "Come on." I told her that I am psychologist and I deal constantly with maternal suffering from separation trauma. She said that people today have nothing to do and they are trying to solve absurdities, that when she was born in '82, her mother was seeing her just every three hours for breastfeeding and she has no trauma. That we all survived it. I said that it's not about survival, but also about a good experience. She looked at me as if I was an idiot and said that if a woman wants to give birth at their hospital, she simply must obey their rules. I said that I understand why women want to give birth at home and she said that she doesn't care and said that if I want to work there, I would need to work in with them as a team, and that meant to do what they say. I said that I want to do what the pregnant women want and she said that I should stand with my feet on the ground and asked if I have ever seen resuscitation of the baby. She resuscitated a baby once and had never been so scared. I looked at her, I believed she was scared, and I believed that she was afraid on this day, but I was sure that it would be okay and it would be interesting for her to expand the horizon of what is still okay. She told me that I'm not there to expand anything. Blah blah blah.
She didn't care about my opinion. She was all about her responsibility for the child, I told her that it is the responsibility of the mother, she said that the mother does not know what she's talking after the birth... Blah blah. I left the doctor's office, but not before she told me that I will be in big trouble when the head physician of the hospital is informed of everything by the neonatal head physician. I went back to a happy family, they thanked me that I helped them so more.
I feel like crying. Maybe it was my last client in this maternity hospital. Maybe they will fire me, they have been talking about it for a long time. It is too much for them, first water birth and then even this, support of the mother in contact with her child. Ugh. I feel like a bad midwife. In my eyes, I am bad because I cannot do my job as I see it is safe and beneficial, that I have to go the way of compromise, and I am bad in the eyes of the doctors because the compromise from their point of view is not enough...I'm very angry. This is not healthy, this is not normal, this is not good for anyone. But what else can I do? When I keep trying to take care of women the way I think is right, they will fire me, and when I will not care about them the way I think is right, I will harm the women.
I feel like I would like to go only to home births, but it is also a challenge nowadays; moreover, it is not for every woman and where should those who cannot do so at home give birth?
Zuzana Candigliota, lawyer in League of Human Rights, published this article on her blog: http://candigliota.blog.respekt.ihned.cz/c1-62690570-pribeh-porodni-asistentky-nemocnice-mi-brani-poskytovat-zdravou-peci
