Saturday, April 20, 2013

Birth Isn't Medical

My kids will be able to drive their own cars some day. My husband and I will do our best to teach them to drive safely and will also have them take a driver's ed class. In an effort to reiterate how important it is to be a defensive, safe driver, my husband and I will share some personal stories of losses we have experienced in our lives due to reckless driving, sadly because we have both experienced such losses of either dear friend or relative. Are the stories meant to scare our children? No. They may scare them, true. But they will be told in our efforts to be completely honest with them as to why we want them to drive safely and that it’s ok to tell a friend “slow down” or similar if they are driving with a friend who is driving recklessly.

If the odds are with them, they will never be involved in a fatal car accident.

Is driving a car anything like having a baby? No, not really. Not physically or emotionally. But they both have risks. Many factors in both cases can turn relatively small risks into very large risks.

I once read in a forum a simple sentence that spoke volumes to me. When I read it, it made complete sense to me and it has stuck with me ever since. It was this simple sentence: Birth isn't medical... until it is.

Birth isn't an illness. And I don't personally believe it is an accident waiting to happen. But that doesn't mean an accident can't happen. If the odds are with a low risk pregnant woman, she'll have an uneventful, safe labor and delivery. But low risk does not mean no risk. How can we predict when birth will become a medical event? Do we just trust that if someone takes good care of themselves during pregnancy, then all will be well? What about those who do everything "right" during pregnancy and labor but still end up in an emergency situation?

I wanted to share stories - real life stories - of events when birth became medical, and in some cases, when it became a down right emergency. It's in those moments - moment when being around professionals who know what to do and how to do it with many hands and minds to help - that it is very clear that birth isn't medical. Until it is.

I'm sharing them in an effort to spread awareness. Not to scare you. Information is power. Not just the good, happy information. All information. 

Thank you to all those who shared their stories with me!


Christine’s birth of her third daughter:
"Penelope was my third vaginal birth after a low-risk pregnancy. Labor and delivery was fine, no complications or issues. It wasn’t until after she was born that we learned there was a problem. We didn’t even notice it, actually. She looked fine to me. Our nurse just didn’t think she looked and sounded right so she thought giving her a little oxygen would help. Quickly, she realized she needed to call a team in for help – which happened within minutes, maybe seconds. Once they arrived they very quickly determined that Penelope was having trouble breathing and she needed to be placed immediately on a ventilator - giving her oxygen was not enough for her. They prepared to move her to a hospital that was better equipped to take care of her. Before transporting, the medical team determined she had a diaphragmatic hernia. Basically, there was a hole in her diaphragm, which restricted her lungs, making it very challenging for her to breathe without a ventilator until after her surgery. Diaphragmatic hernias can be much worse. Penelope was lucky in that her defect was small and she has thrived TREMENDOUSLY! I feel very grateful to have been under the care of such amazing nurses and doctors in a hospital, where they were able to immediately save her life and save her from suffering any neurological damage due to her inability to breathe on her own. She is now a happy, healthy toddler!"

Baby Penelope

Anj's birth of her first son:
"Short version is labor started at 40W6D, he flunked the initial cEFM (continuous electronic fetal monitoring), eventually his heart rate went high with low variability and he was born emergent c-section after apparently bleeding out in utero for suspected Vasa Previa. His APGARs were 1 and 8 which is damned impressive for a baby that was born almost completely flat.

The critical components were continuous electronic fetal monitoring, skilled team for resuscitation, NICU, Blood Bank for his transfusion soon after birth - and of course the operating room and OB. My attending was a CNM. She could make the calls, but obviously not perform the surgery."

Amber's experience as a doula at the birth of one of her clients:
“This birth was a VBA2C (vaginal birth after 2 cesarean sections) in a hospital. Picture perfect labor and then complete placental abruption. The mother was in the operating room under general anesthesia with baby born in under 4 minutes. OB said that the abruption had nothing to do with the VBAC.”

Sara's birth of her son:
"I woke up with SROM (spontaneous rupture of membranes; aka water broke) at 38 weeks and 3 days after a completely uncomplicated pregnancy. Contractions didn't really start until around noon; I arrived at the hospital around 3pm and was dilated to 9 cm. I had a completely unmedicated birth (not even a heplock), with intermittent monitoring. My son was born at 5:44pm after a delivery that my CNM described as "textbook." Then I delivered the placenta and began hemorrhaging. While my CNM began a manual examination of my uterus, the L&D nurses were giving me pitocin, cytotec, running an I.V., and paging the attending OB. Within 15 minutes, I was wheeled back to the operating room for repair of a cervical laceration. I managed to avoid a blood transfusion thanks to prompt care, and because the OB did an expert job on the repair, I did not have cervical incompetence during my next pregnancy. I am grateful for hospital birth and competent providers."

An anonymous OB:
“The thing that always scares the bejeepers out of me is someone whose labor is just moving along beautifully with a gorgeous monitor strip and suddenly the fetal heart rate tanks, and you just can't get it back up. It's the cord. It's pinched, thin, twisted, prolapsed, or whatever, and it comes seemingly from out of the blue.”

Sarah’s birth of her third child:
“I had a home birth for my third child. My labor was going along fine if not a little fast. While I was pushing, my midwife picked up on low heart tones. They were around 50-60 BPM. They weren't recovering after the contractions. The midwife did not hesitate to say that we needed to transfer immediately, for that I consider myself very lucky. It was a forty minute drive to the hospital. I was in the backseat of our van with my rear end in the air, fighting through the most intense contractions, praying that the baby would be alive when we arrived at the hospital. When we got there, the baby's HR had picked back up. I started pushing again, only to have the HR dip dangerously low again. I headed into the OR for a c-section. It turns out that he was positioned poorly and the umbilical cord was wrapped three times around his neck tightly, and very short. His shoulders were also huge and wide. I believe the nuchal cord saved us from a tragic shoulder dystocia. There was no way that he was going to come out vaginally. I have had people tell me that ‘nuchal cords are no big deal, they happen all the time, you just have to slip it off the head.’ That may be so in some cases, but not always and not in my case. I am eternally grateful for the hospital staff for safely delivering my son.”

Desiree’s birth of her first child:
“Normal pregnancy, delivered day before due date, 7.5 hour unmedicated labor (except one round of abx for GBS), had mobility, expectant third stage... then, horrible postpartum hemorrhage requiring two IV uterotonics and internal massage, and left my HGB at a 6.”

Becky’s birth of her second child:
“My first birth was an uncomplicated vaginal birth. For my second, I was the picture of low risk until my daughter's cord prolapsed - in the hospital. We had to change floors, but they got her out in four minutes - including travel time. Her APGARs were 7 and 9.

The scary part is I didn't believe I was in labor, I thought that I was having Braxton Hicks. My husband and mother forced me to go to the hospital. If I had been anywhere else- even the hallway- my story would be very different.”

Myrisa’s birth stories of her first two children:
“For my first baby, I was 30. Low risk pregnancy. On my due date, my water broke, and my mucus plug fell into the toilet. Long story short, took 48 hours for me to get to 10 cm and pushed for 3 hours. Baby was beautiful, 9 pounds 5 oz, 21 inches. Then after what seemed like an eternity, my placenta still would not come. Over an hour later it still wouldn't come. I started bleeding badly but I did not know, as I was so tired and groggy. The room filled with people and an anesthesiologist was there numbing me up from the waist down. I didn't know what was going on and I passed out. I had post partum hemorrhage because of a retained placenta with accreta and I nearly lost my uterus. They had to scrape the placenta off the wall of my uterus since it would not contract; the placenta came out in pieces. They almost gave me a blood transfusion but instead kept me a couple days extra just to watch me. It took me a good 2 months to recover completely and to not walk without a limp.

I viewed that as a bad birth experience, and I decided on a homebirth with the next baby. I found a CPM. No complications. Labor day came right on her due date. I tolerated the labor well; it only lasted 7 hours this time. But when it came to pushing, I was in the labor tub and I delivered her head, but I could not deliver her body. The midwife and her assistant hurriedly got me on all fours (Gaskin maneuver) and I pushed - nothing happened. They rushed me out of the tub and I had to walk to the bed with the baby's head dangling between my legs. They laid me on the bed and put my legs up (McRobert's maneuver). After a short while of her seemingly twisting the baby around, she finally popped out. No cries were heard. I was getting scared, and I couldn't see her because she was on the bed between my legs still and they were doing CPR on her. After what seemed to be a looong time, I finally heard her sputter, then cry. They put her on my chest. I was just so relieved to see her alive! She was 9 pounds 12 oz, 22.5 inches. I had no clue what happened, and was just really grateful my baby was ok. Turns out, as my midwife later told me, she had pretty bad shoulder dystocia and she came out with meconium. My baby luckily had no birth injury, and is a totally healthy 3 year old now.”

Karen’s birth of her son:
“I had an unmedicated birth in a hospital at 41 weeks. It was my second birth and the patterns of contractions were textbook perfect. I had a great doula. No cEFM just intermittent monitoring. There was meconium while I pushed. When he was born, his first APGAR was 5, but it came up to 9 for the second. My husband watched them work on him and told me later it scared him a little.

When my placenta came out, I noticed my doctor looking down at it with a worried look. I had retained placenta. And no epidural. My doctor had to use his hand to remove the rest of the placenta (thank goodness for my doula!). I knew it had to happen and was a risk of natural childbirth so I have never felt violated for that action. It was handled quickly and professionally and I left the hospital with a healthy baby.”

Another anonymous OB:
“I had one of my patients come into Labor and Delivery b/c she couldn’t remember the last time she felt her baby move. She was laughing and felt embarrassed and thought she was being over paranoid. We monitored her and performed an ultrasound. A perfectly healthy, low risk mom and perfectly healthy little baby… she was 39 weeks pregnant... Her baby had passed away.  It was a cord accident, it was pinched too tightly. It was heartbreaking. We sat and cried together….

[As far as during labor,] I know two patients that have had Amniotic Fluid Embolisms. One happened during my residency and the other actually just happened a few months ago to a woman under the care of one of my partners. Both women and both babies amazingly survived. In the case of my partner, we had just had a drill days before it happened to cover this sort of scenario. It took a lot of hands to get the baby out and to work on the mother at the same time.”

Melissa’s birth of her first son:
After my first son was born, all seemed to be OK. It wasn’t until several hours later on after his birth the nurse noticed an issue when I was trying to nurse him. She thought he was turning a little blue so she calmly took him back to the nursery for the pediatrician on call to examine him. His oxygen saturations were not what they should have been so he was given oxygen. At this point I was so crazy exhausted that I was slipping in and out of sleep and I remember hearing him crying as they did various tests to him. Eventually my son was transferred from the small community hospital I had given birth in to one with a NICU. They did an echo several days later and diagnosed him as having a heart defect. After that he was transferred yet again to a hospital where he could get his heart surgeries. It was quite the introduction into motherhood let me tell you.”

Sarah’s birth and death of their first child:
“I delivered our first child, Kate, after receiving all of my prenatal care at an independent birth center. Though I had an uncomplicated pregnancy, as I passed 41 weeks I still hadn’t gone into labor.  I had a biophysical profile ultrasound, which I was told would indicate if my baby was doing well and if it was OK for me to continue my pregnancy.  The test result was an 8 out of the 8 total potential points in a biophysical ultrasound, but the test also indicated that my total amniotic fluid was below the acceptable level.  Our midwives told us that it was acceptable to continue waiting for my body to go into labor.

I went into labor a few days after I was 42 weeks pregnant and spent nine hours at the birth center in early labor. The midwives conducted intermittent monitoring of Kate’s heart rate and started hearing her heart beating irregularly. After an exam, they also noticed that my amniotic fluid was heavily stained with meconium. I was transferred from the birth center to a local hospital approximately 6 miles away.

After being monitored at the hospital, Kate’s and my vital signs started crashing, so I had an immediate, emergency C-section. In the operating room, I heard a nurse say that Kate’s heartbeat was in the 20’s (when normal is over 120). When Kate was delivered without a heartbeat, doctors resuscitated her, but it took over 10 minutes. In surgery, the doctors discovered that my uterus had ruptured, greatly complicating the procedure. I had never had any type of surgery on my uterus before and a uterine rupture on an unscarred uterus is very rare (possibly in the range of 1:20,000 births).  

When I’d recovered sufficiently from the anesthetic, we went to see Kate in the neonatal intensive care unit (NICU).  As advised by the doctors, we disconnected Kate from life support. There was nothing anybody could do for her. I held her while she died. Kate's official cause of death was asphyxia from aspirated meconium; it had gotten into the alveoli in her lungs and she could not transfer oxygen into her bloodstream. We don't know if she tried breathing when my uterus ruptured because it cut off her oxygen supply, or if my placenta had some time earlier stopped working, or even abrupted (separated from my uterus).

Even if you do everything perfectly and have no complications you cannot control whether you will have a uterine rupture, a placental abruption, a hemorrhage, or some other problem that prevents the flow of blood and oxygen to the baby.

When you are on the rare side of a statistic (such as the low chance of uterine rupture), the rarity becomes irrelevant, when the risk becomes reality.  If I’d been anywhere other than the hospital when my uterus ruptured, I, too, most likely would’ve died or would not have been able to have another child.

Though we can’t know for sure what role my being two-plus weeks overdue played in Kate’s death, the heavy meconium, which was present long enough to have stained her fingernails, indicated that she should’ve been delivered much earlier than when I went into labor.”


  1. I was 38w5d pregnant when my water broke. Our CNM came to our house and began monitoring my contractions about 12 hours later. About 18 hours after my water broke, our CNM noticed signs that things were not progressing normally and transferred me to the hospital.

    Upon admission, our son did not have a heartbeat but changing my position brought his heart rate back to normal. I was given an epi and allowed to sleep for a few hours. When I got to 10 cm his heart rate dropped and did not recover. We were rushed into the OR for an emergency c-section. Our son is now a happy, healthy 13 month old, but I shudder to think what would have happened 100 years ago.

  2. Thank you for sharing these stories. What you are doing is so, so important. Keep up the good work!

  3. I've never understood why people don't understand that babies "breathe" in utero. They breathe in amniotic fluid and whatever else might be covering their nose and mouth (meconium, birth pool water, etc). Just because a functional placenta supplies oxygen via the umbilical cord does NOT mean that baby can't or won't aspirate something that isn't supposed to be in their lungs. Come on people.

  4. Thanks for posting these stories. I am now pregnant with our second baby after an eventful birth with our first. We had a 35 week baby last year due to premature rupture of membranes. We didn't know he was breech until after they started to induce labor at the hospital because I wasn't progressing. I am really glad we decided to give birth at the hospital with the first and they caught the breech positioning before labor really progressed. Our son ended up needing to be rushed to the NICU after his c-section birth and needing a 6 day hospital stay. I was pro all natural child birth in my first pregnancy but after seeing how many unexpected things can occur in pregnancy and delivering I now how a birth plan of healthy mom and healthy baby with the second.


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