We received this email from a couple recently and are hoping to get some feedback for them from experienced birth professionals and parents out there. Please respond with your thoughts:

My wife and I just had a baby girl on May 11th. Her pregnancy went very well and the baby was healthy so we had no reason to beleive that the birthing would have any complications but still wanted it to happen in the hospital "just in case". At one point the babies heart rate was lost, the external monitor slipped, and "just in case" my wife was given a shot to stop her contractions. She had taken an epidural and some other pain relief but no one ever said that this would effect the likelihood of a cesarean being necessary. Soon after the babies heart rate was found we were told that everything was fine and that we should relax and get some rest while my wife dilated the last centimeter she had left and then she would start "laboring down". We were woken up about a half hour later and told that she needed an emergency c-section right now. My wife became very upset and continually said "no no no" but there was no discussion or explanation offered other than the baby was in distress and not tolerating the labor, which had been re-started with pitocin. We are both very upset about the way the birth was handled and the lack of communication. we also question the necessity of the c-section. We have requested the records from the hospital and are seeking some action, what, we don't know yet but if you could help please do.

Tags: c-section, cesareans, partum, post

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There does seem to be questions that you need answered and your medical notes should help.

I do not know where you live, but there are some amazing international organisations available to help you - one of the is called AIMS (Association for Improving Maternity Services).

Email them stating what happened and they should be able to offer you some sensible advice. Their email is helpline@aims.org.uk

Regards

Linda Hinchliffe
Mum of 9
Chair/Founder VBAC Information & Support
(Est. 1990)
i could only assume that if you were woken up and rushed off to the operating room at 9cms.. it was because it was a true emergency.. and the baby was not tolerating contractions. given the fact that you were given terbutaline to stop contractions during a bradycardic episode previously.. the heart rate may have been lost due to a slip in the external monitor, but on readjustment.. there must have been an issue, as it is not common or sensible practice to administer terbutaline for no reason.. or for the first episode. it must have been reoccurent. the epidural did not cause the c section.. it sounds like fetal distress did.. and although you were not hoping for a surgical birth.. sometimes it is necessary to save the baby..
i would talk to your doctor.. ask why it happened.. now that the emergency is over. i am sure he/she will be completely open to explaining it to you now that the emergency has been resolved. sometimes.. in the heat of it.. as medical professionals.. we need to just get the baby out.. and go in to details later.
i would also suggest talking to a counselor or a medical prof. about your own feelings about the birth.. it is hard when we have expectations.. and get caught up in something completely different..
it is true that there are uneccessary surgical births.. i fight constantly to prevent them.. but given the little info you gave, it sounds like this may have been necessary, my friend..
i hope you are able to get all of the details you need to resolve your feelings about the lack of control you went thru with your birthing process and enjoy your healthy baby and wife..
When we asked about the rush and why there was no time to tell us what was going on we were told that two scheduled c-sections had gone into labor early and that one was seizing in the emergency room. they had to get us in and out to make room for them. the terbutaline was administered at the first "drop in heart rate" . and as for the effects of epidurals on the liklihood of c-sections apparently there is a difference of opinion. as stated in this forum by a certified birth educator about 30% of women who get an epidural experience a drop in blood pressure, which my wife did, which is peculiarly close to the frequency of cesareans. if he World Health Organisation figures the rate of necessary cesareans at 10%-15% and the national average is around 38% then there is something going wrong in the medical world. our doctor , when asked about whether my wife's blood pressure drop had anything to do with the babys heart rate, simply replied "we just can't tell". It seems to me that things that are aparent to alot of people are conveniently explained away by doctors and health care professionals simply to make their job easier. granted it is an extremely dificult job. there were five other births the night my daughter was born. what is a once or twice or nine time occurrence for the life of the parents happens several times a shift for the health care worker. I am sure you know a lot of people in your area of work that are worn out and jaded. It was certainly evident in the attitudes and treatment my wife received from some of the nurses and doctors. the terbutaline, which was given without any consultation or consent, was given very casually. when my wife was told that it was to stop her labor the nurse also said, with a laugh, "don't worry we can get it started again". its frustrating, very frustrating. we are always told to get over it, to enjoy our baby, which we are, she's beautiful, but this equanimity we are so often encouraged to exercise is part of the problem. If so many c-sections are unnecessary and no one does or says anything about it it will just continue to happen. the advice to seek counseling is just the doctors shaking off their responsibility and letting someone else deal with the aftermath. whether this c-section was necessary or not we will never know, and our baby is healthy (her apgars were a 9and a10 ,not a sign of a baby in distress if you ask me, but I'm sure this will be used as justification for the doctors actions) and we are getting on with our lives but we will never forget what happened and are not willing to just let it go.

Tara G. said:
i could only assume that if you were woken up and rushed off to the operating room at 9cms.. it was because it was a true emergency.. and the baby was not tolerating contractions. given the fact that you were given terbutaline to stop contractions during a bradycardic episode previously.. the heart rate may have been lost due to a slip in the external monitor, but on readjustment.. there must have been an issue, as it is not common or sensible practice to administer terbutaline for no reason.. or for the first episode. it must have been reoccurent. the epidural did not cause the c section.. it sounds like fetal distress did.. and although you were not hoping for a surgical birth.. sometimes it is necessary to save the baby..
i would talk to your doctor.. ask why it happened.. now that the emergency is over. i am sure he/she will be completely open to explaining it to you now that the emergency has been resolved. sometimes.. in the heat of it.. as medical professionals.. we need to just get the baby out.. and go in to details later.
i would also suggest talking to a counselor or a medical prof. about your own feelings about the birth.. it is hard when we have expectations.. and get caught up in something completely different..
it is true that there are uneccessary surgical births.. i fight constantly to prevent them.. but given the little info you gave, it sounds like this may have been necessary, my friend..
i hope you are able to get all of the details you need to resolve your feelings about the lack of control you went thru with your birthing process and enjoy your healthy baby and wife..
Derick,

I can completely understand your anger and disappointment in how things went during your daughter's birth. When I suggested your wife get support and look into ICAN (link posted in my last message), it was in no way to absolve providers of their responsibility. It is purely for her and it sounds like she needs to do some healing emotionally as well as physically.

As far as changing the system, there are many of us who are trying to do just that but it's hard to fight against such a powerful lobbying organization as ACOG. There is a grassroots initiative to try to get access to intervention rates for hospitals and specific birth providers available online. It's all about transparency in maternity care! This project is through the Coalition for Improving Maternity Services (CIMS). Everyone who has given birth in the last 3 years is encouraged to complete the survey and share their birth experience. The more we all speak out, the more things will come to light and hopefully necessary changes can be made. This also helps women who are now pregnant to make good choices about the provider and facility they choose for their birth. These are the 2 biggest factors in birth outcome (if the doc/hospital has a high rate of routine interventions and cesarean, mom's chances of experiencing these are greater even if she is low-risk with a healthy pregnancy and baby). I would highly encourage your wife to complete it and look at the results for providers and facilities where you live: www.thebirthsurvey.com

As far as saying, "the epidural did not cause the c section.. it sounds like fetal distress did.." that is analogous to saying, "the gunshot didn't kill the victim...it sounds like he bled to death..."

It is well documented that some of the disadvantages of epidural may include: drop in BP for mom, increased FHR irregularities, increased risk of fever, decreased mobility, longer 1st stage of labor, increased need for Pitocin, longer 2nd stage of labor, increased need for forceps or vacuum extraction, increased need for cesarean. It is also well known that Pitocin augmentation is associated with increased fetal distress, as is continuous EFM (electronic fetal monitoring) that accompanies such interventions, not uncommonly resulting in a cesarean birth.

Over 85% of low-risk moms could give birth without medications or interventions. Once you start having interventions, there is a "domino effect" because pain meds and Pitocin require special precautions and further interventions to ensure the safety of mom and baby. As one intervention causes a side effect that requires further interventions, etc. there is a snowball effect and it increases the likelihood of instrumental or operative birth.

Respectfully,
~Amy
The sad truth is once you step into the hospital to give birth…you give up control.


Every year in the United States over one in three pregnant women have a cesarean section despite the consensus of the current medical literature that half of these operations were not needed. It is due to a phenomenon known as the cascade of interventions. It is widely the recognized that the use of pain medications; then an epidural with its requisite recumbent position in bed; then pitocin with its continuous contraction pattern; artificial rupture of membranes, etc. etc.; significantly increase the likelihood of requiring a cesarean. Also current medical research shows all of these interventions can have short-term and long-term effects on the physical and emotional health of mother and baby. Couples need to become informed about the potential side effects of these interventions on normal, physiological labor and birth. Each year in the United States over 4 million babies are born. Fewer than 5% of these births occur without medical interventions, despite the fact that overwhelming medical research shows women can give birth safely with minimal interventions as they do in the countries that have the lowest infant and maternal morality rates.

I suggest that you contact the International Cesarean Awareness Network www.ican-online.org. Then find a local chapter support group and then contact them to share your experiences and make changes in your community. You will never forget, but you can become empowered.
As a labor /delivery nurse I agree with Amy's assessment. A decreased blood pressure, limited repositioning of the laboring woman (with epidural anesthesia) and the use of pitocin can set the stage for decreased blood flow to the baby. Decreased blood flow leads to limited oxygen to the baby.
Pitocin induction along with epidural anesthesia require one to one nursing care. On a busy night nurses may be stretched to cover 2 and 3 patients.

Amy Meister-Stetson said:
Derick,

I can completely understand your anger and disappointment in how things went during your daughter's birth. When I suggested your wife get support and look into ICAN (link posted in my last message), it was in no way to absolve providers of their responsibility. It is purely for her and it sounds like she needs to do some healing emotionally as well as physically.

As far as changing the system, there are many of us who are trying to do just that but it's hard to fight against such a powerful lobbying organization as ACOG. There is a grassroots initiative to try to get access to intervention rates for hospitals and specific birth providers available online. It's all about transparency in maternity care! This project is through the Coalition for Improving Maternity Services (CIMS). Everyone who has given birth in the last 3 years is encouraged to complete the survey and share their birth experience. The more we all speak out, the more things will come to light and hopefully necessary changes can be made. This also helps women who are now pregnant to make good choices about the provider and facility they choose for their birth. These are the 2 biggest factors in birth outcome (if the doc/hospital has a high rate of routine interventions and cesarean, mom's chances of experiencing these are greater even if she is low-risk with a healthy pregnancy and baby). I would highly encourage your wife to complete it and look at the results for providers and facilities where you live: www.thebirthsurvey.com

As far as saying, "the epidural did not cause the c section.. it sounds like fetal distress did.." that is analogous to saying, "the gunshot didn't kill the victim...it sounds like he bled to death..."

It is well documented that some of the disadvantages of epidural may include: drop in BP for mom, increased FHR irregularities, increased risk of fever, decreased mobility, longer 1st stage of labor, increased need for Pitocin, longer 2nd stage of labor, increased need for forceps or vacuum extraction, increased need for cesarean. It is also well known that Pitocin augmentation is associated with increased fetal distress, as is continuous EFM (electronic fetal monitoring) that accompanies such interventions, not uncommonly resulting in a cesarean birth.

Over 85% of low-risk moms could give birth without medications or interventions. Once you start having interventions, there is a "domino effect" because pain meds and Pitocin require special precautions and further interventions to ensure the safety of mom and baby. As one intervention causes a side effect that requires further interventions, etc. there is a snowball effect and it increases the likelihood of instrumental or operative birth.

Respectfully,
~Amy
Go ahead and contact an attorney to see what your optons are. At least you will get your medical records promtly. But, in order to sue anyone, you will have to prove damages. Sounds to me like you were run through the mill and chewed up. By the way, do you know why the statistics on "home birth" look so bad? Because they were not planned. I am really sorry for you. Amy is exactly right about the "domino effect."
Re: "don't worry we can get it started again".

Synthetic oxytocin is the drug most commonly associated with preventable adverse perinatal outcomes. Synthetic oxytocin-augmented/induced contractions are associated with uterine hyperstimulation, fetal distress, and hypoxia. The primary action of synthetic oxytocin is to cause all uterine fibers to contract at once, instead of in fundally dominant peristaltic waves from top to bottom. Synthetic oxytocin-augmented/induced contractions give the baby to little time to reoxygenate between contractions. which leads to a hypoxic baby that needs to be 'rescued'.

Synthetic oxytocin was recently added by the Institute for Safe Medication Practices to a small list of medications “bearing a heightened risk of harm,” which may “require special safeguards to reduce the risk of error.” A review of available clinical and pharmacologic data suggests that specific, evidence-based guidelines are available. These suggested guidelines focus on limited elective administration of oxytocin, consideration of strategies that have been shown to decrease the need for indicated oxytocin use, reliance on low-dose oxytocin regimens, adherence to specific semiquantitative definitions of adequate and inadequate labor, and an acceptance that once adequate uterine activity has been achieved, more time rather than more oxytocin is generally preferable. Am J Obstet Gynecol 2009;200:35.e1-35.e6

When will this approach be implemented?

Derick Kalt said:
When we asked about the rush and why there was no time to tell us what was going on we were told that two scheduled c-sections had gone into labor early and that one was seizing in the emergency room. they had to get us in and out to make room for them. the terbutaline was administered at the first "drop in heart rate" . and as for the effects of epidurals on the liklihood of c-sections apparently there is a difference of opinion. as stated in this forum by a certified birth educator about 30% of women who get an epidural experience a drop in blood pressure, which my wife did, which is peculiarly close to the frequency of cesareans. if he World Health Organisation figures the rate of necessary cesareans at 10%-15% and the national average is around 38% then there is something going wrong in the medical world. our doctor , when asked about whether my wife's blood pressure drop had anything to do with the babys heart rate, simply replied "we just can't tell". It seems to me that things that are aparent to alot of people are conveniently explained away by doctors and health care professionals simply to make their job easier. granted it is an extremely dificult job. there were five other births the night my daughter was born. what is a once or twice or nine time occurrence for the life of the parents happens several times a shift for the health care worker. I am sure you know a lot of people in your area of work that are worn out and jaded. It was certainly evident in the attitudes and treatment my wife received from some of the nurses and doctors. the terbutaline, which was given without any consultation or consent, was given very casually. when my wife was told that it was to stop her labor the nurse also said, with a laugh, "don't worry we can get it started again". its frustrating, very frustrating. we are always told to get over it, to enjoy our baby, which we are, she's beautiful, but this equanimity we are so often encouraged to exercise is part of the problem. If so many c-sections are unnecessary and no one does or says anything about it it will just continue to happen. the advice to seek counseling is just the doctors shaking off their responsibility and letting someone else deal with the aftermath. whether this c-section was necessary or not we will never know, and our baby is healthy (her apgars were a 9and a10 ,not a sign of a baby in distress if you ask me, but I'm sure this will be used as justification for the doctors actions) and we are getting on with our lives but we will never forget what happened and are not willing to just let it go.

Tara G. said:
i could only assume that if you were woken up and rushed off to the operating room at 9cms.. it was because it was a true emergency.. and the baby was not tolerating contractions. given the fact that you were given terbutaline to stop contractions during a bradycardic episode previously.. the heart rate may have been lost due to a slip in the external monitor, but on readjustment.. there must have been an issue, as it is not common or sensible practice to administer terbutaline for no reason.. or for the first episode. it must have been reoccurent. the epidural did not cause the c section.. it sounds like fetal distress did.. and although you were not hoping for a surgical birth.. sometimes it is necessary to save the baby..
i would talk to your doctor.. ask why it happened.. now that the emergency is over. i am sure he/she will be completely open to explaining it to you now that the emergency has been resolved. sometimes.. in the heat of it.. as medical professionals.. we need to just get the baby out.. and go in to details later.
i would also suggest talking to a counselor or a medical prof. about your own feelings about the birth.. it is hard when we have expectations.. and get caught up in something completely different..
it is true that there are uneccessary surgical births.. i fight constantly to prevent them.. but given the little info you gave, it sounds like this may have been necessary, my friend..
i hope you are able to get all of the details you need to resolve your feelings about the lack of control you went thru with your birthing process and enjoy your healthy baby and wife..
Derick,
As a certified labor doula, I am very sorry to hear of your wife's traumatic birth. Giving birth should be the best day of your life, and one that you can look back on with fondness. I am a 4 time C-section Mom, the first of which was an emergency. I understand that coming to terms with less than ideal circumstances can be difficult. My first suggestion is to try and find some positive aspects of your wife's labor and birth. This can be difficult, but for your wife's success with future labor and births, it is a very detrimental step. You both have the power to take this negative situation and make it into something beautiful!

I would suggest that for the next labor and birth, your wife should seek out support that will encourage her in the type of birth experience that she desires. As with most other situations, knowledge is power. Take this time to educate yourselves. Maybe find a great midwife that is familiar with working with women who desire a VBAC after having a traumatic experience. Get the support of a doula in your area, next time around, as they are statistically proven to decrease the use of epidurals and C-sections.

As I am sure you are doing, continue to build your wife up, telling her what an awesome woman she is for bringing your daughter into this world. Remind her that she did right things for her body as it was growing this little life, and that you won't let the last few hours taint your view of this 10 month process! And like I said earlier, EDUCATION is key!!!

Blessings to you, your wife and your new sweet princess!
Mandy in Denver
I feel for your wife. I had 2 c-sections and the first was not planned. I did not feel llike a mother after my son was born because he didn't come the right way. But i also took that anger and frustration and educated myself. I started looking into VBAC's and midwife's. My second son was delivered by a scheduled c-section. Because of not having a choice with my OB i gave in. He then spent 3 weeks in the nicu on a ventilator and had 6 different chest tubes. I then decided i would never put another baby through what my son went through. I decided with my 3rd baby i would go with a midwife and have her at home. It was amazing and it was so impowering to have the birth i wanted not one the hospital was going to tell me i had to have. i know it will take time to come to terms with what happened and you may never understand why or get your questions answered but remember your wife and baby are safe and healthy. You can make changes with the next baby if you decide to have more.
As a doula who has worked with my local hospital, as well as an emergency c-section, then VBAC mom, I feel your pain. Informed consent means just that. To give consent you must be informed. I have heard many Obs, CNM, and RNs give patients a true informed consent before ordering an epid., or pit. All of the statistics quoted in the previous responses are explained to the patient. Women do not get an epid. without knowing what can happen next because of it. I have also seen many babies who hop on and off monitors, and amazing CNM and RNs who stand with the monitors in hand while a mother labors in the shower, squatting, down on hands and knees, etc. just to keep the baby on.

With my emergency c-section I had a very hard time coming to terms with how my child was born, questioning my choices as to where I wanted to give birth. By getting answers, and finding out it was a true emergency, and that there was a lot going on medically that I was not in tune to, I have been able to come to terms with the fact that my daughter was born, but I did not give birth to her. I have to say though, having my son vaginally gave me back the power that I thought I had lost. A VBAC is an amazingly empowering event!
My wife and I are very grateful to all of you for the support, concern and information we have received. And thank you for sharing your stories. It has all been a great help getting us through this. We thank you.

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