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Thursday
Nov262009

Refusing Pitocin in Labor: Helen's Story

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Just over two weeks ago, Helen was getting to know her newborn baby, Jesse, after spending the entire day getting to know what informed refusal is all about. Her story is heavily excerpted below and does not do Helen’s must-read blog posts justice.

Helen and her husband updated their Twitter status periodically throughout labor. A few of those tweets are interspersed in the story.

 

Part 1:

Helen’s water broke on her estimated due date. She went through her normal morning routine, regretting that this was her midwife’s day off. She called her doctor’s office when it opened and talked to the nurse.

I asked her about the OB on call–she was new to the practice, and not only had I not met her, I didn’t know anything about her. Scottie reassured me. I was still daunted, wishing hard that my midwife would somehow pick up on the psychic resonance of the numerologically auspicious date, but we slowly got everything together and headed to the hospital. Oddly, they had trouble confirming that my water had broken because I couldn’t seem to produce another gush for them. I was still 3 cm, and only 50 percent effaced. Part of me wishes that I had just turned round and gone home, because it didn’t take long for me to realize I’d just consigned myself to a medical labor and delivery, and I would have to fight tooth and nail to get the natural childbirth I wanted.

 

And the Pitocin-pushing begins!

 

11:00 a.m.:

It started around 11, when the L&D nurse assigned to me wanted to start an IV because the doctor had _already_ ordered Pitocin for me, as well as nothing by mouth other than ice chips. She had never met me, remember? I refused the IV and the Pitocin and said that the doctor would need to come in and explain to me why there was a medical indication for this intervention. The nurse seemed daunted, and at that point I knew she wouldn’t be an ally. She expressed concern about my tiny veins and the difficulty she would have starting an IV if there were an emergency. I insisted I needed to talk to the doctor first, and set about walking around the labor ward to try and get contractions going.

 

12:30 p.m.:

The doctor came in and checked me, and I was still 3 cm, now 70 percent effaced. She again said she’d like to start Pitocin, arguing that since my water had broken there was a chance the baby would go into distress and she’d like him to arrive “during the day while there were still plenty of people here.” I think my eyebrows shot off my face. I explained to her that I didn’t agree that Pitocin would get him here faster because sending me into hard labor too early might trigger what I call intervention cascade, in which Pitocin contractions are so hard and violent that even the most pain-tolerant mothers beg for relief, usually in the form of an epidural; then, once the epidural is in place, the mother is no longer able to work with the contractions, creating a stressful environment for mother and baby.

 

Pitocin-pushing… now with condescension and bonus threats!

She stared at me. “My priority is delivering a healthy baby,” she said, implying that my belief in intervention-free natural childbirth stood in the way of this. “My baby _is_ healthy,” I replied, gritting my teeth. She and the nurse combed through the print-out of the monitor, looking for evidence that the baby was in distress. “Look, the heart rate dropped here,” she said. “He turned away from the monitor,” I said. She was quiet. “Yes, you’re right, it’s only a partial reading, but if it drops again, I _will_ put you on Pitocin.”

 

 

Part 2:

Helen consented to the heplock, but held up her cup of melted ice chips while declining unnecessary IV fluid.

 

2:00 p.m.: Helen’s third Pitocin refusal

At 2 pm, I still was at 3 cm, but the baby had at least engaged and now was at -1 station, and my cervix was continuing to melt away. The doctor assured me that the dose of Pitocin she wanted to give me would be the smallest dose possible, and that really, all I needed was “a whiff” to get my labor going. She also admitted that she wasn’t accustomed to reactions like mine, that she was accustomed to a certain process. “Look,” I said, fighting the urge to remind her that I was her patient, not a process, “I’m not trying to be difficult. But a natural childbirth means a lot to me, and everything we do that disrupts that interferes with my ability to bring forth this child and bond with him.” That was my third refusal.

 

Helen was starting to fear that her not-yet-so-painful contractions were going to get her accused of failing to progress.

 

6:00 p.m.: The fourth Pitocin refusal

But by 6 pm–the next time the doctor came–I was only at 4 cm and 80 percent effaced, and the baby was still at -1. Again she wanted to Pit me; again I turned her down, insisting that if I could get to 5 cm, I’d be fine, and to “just give me a few more hours, please?” I was practically whimpering at this point.

 

7:00 p.m.: A hero arrives!

At 7, the nurse shift changed, and in walked my guardian angel, Lisa. The previous nurse introduced her as “our best natural childbirth nurse,” and Lisa took one look at me and the hopes I had delicately balanced on a cliff and said, “Well, the first thing we gotta do is get you out of that bed and onto the ball.” I got up, went to the bathroom, and when I came out, she had an exercise ball in her hands. “I talked to the doctor,” she said. “There will be no more talk of Pitocin. Now I want you to sit on this ball and every time you feel a contraction, start bouncing. We’ll get that baby down.”

 

Helen got down to business and at 7:45 p.m. when Dr. Pitocin-Pusher returned, the doctor was shocked.

I’d hit 5 cm/90, she could feel the baby’s head, and my contractions had doubled in strength.

 

Part 3:

 

8:00 p.m.

Helen, with her husband’s support, got into the flow of her labor. She noted the difference between the process that the doctor said she was used to and her actual labor.

Contrast this with the epidural model where you can’t leave the bed and your partner has to tell you when the next contraction is happening when the needle rises on the monitor. We’d have been there all night and probably wound up having a c-section.

 

8:30 p.m.

Helen had to hop up for another round of fetal monitoring and wrote, “I found I hated being in bed and got back on the ball as quickly as possible.”

 

9:00 p.m.

…I was bouncing, and trying to breathe, and howling as I did so. It was an uncanny ululation as I allowed the baby down and felt myself opening, finally. I clumsily banged the call nurse button and told her what I’d just felt. “I need to push!” I said, I think with a scream. Keep in mind I’d just hit 5 cm. at 7:45.

She hurriedly got me into bed, hooked me up to the monitors, and checked me. “She’s at 8, and look at those contractions!” she hollered, galvanizing several other nurses into action and sending one off to get the doctor. I realized I was in transition and glanced at the monitor; the contractions were literally happening on top of one another, cresting like great waves pounding into one another before washing ashore in violent cascades. I think I finally understood what it meant to be in both agony and ecstasy at the same time, and stared down in bewilderment as they removed the bottom of the bed and Lisa began to manage my breathing using a counting technique that forced me to refocus my attention away from the wild banshee I was becoming as I continued to howl.

 

9:30 p.m.

Helen began pushing and less than 20 minutes later, Jesse was lifted up onto her belly. Jesse was “9 lbs. 11 oz., 23″ long, with a 14″ head. 11/11/2009, 9:47 p.m. And absolutely beautiful.”

 

And…

The doctor not only congratulated me but also–significantly–apologized to me. “You did say that if you could just get to 5…….”

 

 

Congratulations, Helen. Thank you for letting me share your three part story.

 

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Reader Comments (10)

Yay Helen for sticking to her guns! Congratulations to her!

November 27, 2009 | Unregistered CommenterSusan

Wow. Just wow. Congratulations to Helen for... for everything. Wow.

November 27, 2009 | Unregistered CommenterRachel Z

Jill, thank you so much for sharing my story with your readers. Shortly before I wrote this, I saw another birth story posted at a prominent site in which the woman was routinely given Pitocin after her water broke--around the same time I would have been given it--and she wound up having a section in the wee hours of the following morning. It really hit me at that time how important it was to write my experience up. Thank you again for helping bring it to others. :)

November 27, 2009 | Unregistered CommenterHelen

That was such an awesome and inspiring story! I would love to share this story on my website as well! I hope that is okay with Helen! I wish so often that I had not given into pitocin when I had my second son, but the pressure was so great and the tactic they used at the time was infection from my water being broken and me being GBS positive. I was lucky that I was strong enough to withstand the pit-induced contractions and have no further interventions (this was in part due to my refusal to lay down and labor in bed despite the doctors orders that all patients on pit have to), but it could have gone another way. ;-) I think what also saved me is that I had a group of people supporting me. My mother was there, boyfriend, cousin and his wife, another cousin and a good friend. I had people at my shoulders and feet!

November 27, 2009 | Unregistered CommenterPatrice

Helen--Congrats on your new baby! The only advice I have is to stay home next time--it's lovely to labor with no pressure or fighting.

November 27, 2009 | Unregistered CommenterKristin

Patrice, feel free to share it--would love the link, too.

Kristin: I am familiar with home birth and you should have seen me procrastinating that morning. I wish I'd had the disposable income to afford a home birth, since my insurance wouldn't cover it (health care reform, hello?) :) It's likely that Jesse will be my last child, however, so I am finding other ways of helping others find the confidence to avoid unnecessary interventions. Writing my story is one of them. I had a lot of risk factors at play that caused me to take what I thought was a middle road--using a midwife in a hospital where I had a prior positive birth experience. But a lot has changed in the past 17 years since my first. Reading Jennifer Block's Pushed gave me a lot of insights into how things have changed since 1992. The most important things I did were educating myself and preparing to advocate for myself, and that really came in handy when I was making these refusals.

I just wish my midwife and I had done a better job coordinating what to do if she wasn't available, honestly. She is awesome.

November 27, 2009 | Unregistered CommenterHelen

Kudos to the second L&D nurse. There are many of us out here, advocating for our patients, skilled in labor support, against the resistance and abuse we get from coworkers like the first L&D nurse. There are many MDs like that one, sadly. She needs more patients who challenge her. The only thing that concerned me was the number of vaginal exams done with ROM. Also, yes, just staying home and not saying anything could be an option (oops I shouldn't say that.)

November 28, 2009 | Unregistered CommenterJust A Nurse

Thanks for your comment, Just A Nurse. Four and a half years later, I still beam with gratitude for that one nurse who was there and supported me (all of us, really) until she had to go home.

November 28, 2009 | Registered CommenterJill

Rock on, Helen!!! This is so great and inspiring-- thanks for posting it!

November 29, 2009 | Unregistered CommenterSabi

What a gorgeous birth story. I'm so glad Helen stuck to her guns and had the birth she wanted. :D

November 30, 2009 | Unregistered CommenterAnji
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