Negotiating Choppy Waters
I recently attended a birth where the mom wanted to decline getting an IV access. This was not news to her doctor. She had told her doctor numerous times that she wanted to decline this procedure. My client was well informed and knew that evidence did not show this was an essential intervention for a healthy mom birthing. She had done her research and read the articles like this one in Evidence Based Birth. She had planned to keep well hydrated and felt it would restrict her.
When she arrived to the hospital she was well rested, hydrated and contracting regularly and moving along in her labor. She was put on the monitor for her twenty minute strip and within 40 minutes was told the baby looked great and she would be coming off the monitor. BUT when the nurse went to set up for placing the INT – IV access and the mom declined the nurse changed her tune and she was told she had to remain on the monitor until the doctor who was in a delivery would come in to talk to her.
So we waited another twenty minutes or more for the doctor to arrive. She sat on a stool and discussed the reasons for doing an INT. She mentioned that she once had a mom who needed a cesarean and did not have an IV and they almost had to use lidocaine on her belly to do the cut for the cesarean. THERE IS NO WAY that would have occurred. The vein in the bend of the arm is almost always accessible and can be done in an emergency. And this mom would have been put under general anesthesia before doing such a procedure.
Then the nurse decided to chime in. She said that if the mom who had desired to get in the tub wanted to stay in the tub as she once had agreed upon (Not funny how the nurse had to agree to allow this mom to get in the tub), she instead of staying in the tub for 50 minutes and out for 10 for a monitoring strip ( she said the one telemetry unit was in use and did not work well with the jets on in the tub) she would instead have to get out every 20 minutes for a 10 minute strip. She said without the INT she would be worried about the wellbeing of the baby. And she reminded us that it was about her license.
I knew this mom had just been told two LIES to try to manipulate her. Coercion has no place at a birth. Then the kicker- her doctor is going off call after saying she felt the mom could stay in the tub for the full 50 minutes of every hour. And the new doctor coming on is not happy that the mom does not have an INT. This is a doctor in a completely different practice- one she has never even had an opportunity to meet. Did you know that your practice may be one of the practices that shares call with another whole group or two or three of doctors? This doctor said they would not have accepted a patient who was not willing to allow an INT. So of course he wants her to get it. So now the nurse is still making the 20 minute rule stand.
The dad was fabulous! He said, “So wait. because my wife is declining the INT you are going to punish her?” I had to bow my head to hide the huge smile that spread across my face. This is not my battle to fight for them. I can remind them of what they desired and support them but my words should not enter into this negotiation. So this dad stepping up with such raw honesty was fabulous.
The mom and dad talked about having some time away from the manipulators and decided to get the INT. The freedom of being in the tub for longer lengths of time was more important in the end. What is sad about this story is this should never have happened. Having an INT IV access is not essential to a birth. If the mom had been dehydrated or wanted medication she could have gotten it early on. This was not this situation.
Sometimes you make a decision to use a provider or birth location you will find more choppy waters to negotiate than others. This couple was well prepared. They had had several discussions about what they desired in their birth. Their provider never said that they HAD TO HAVE an INT. She only asked them to keep considering it. The dad said he felt the doctor had been a push over or conflict avoider. I feel that she was a bait and switcher. She never told them what she knew she would inevitably make them do. The nurse who had lied and been manipulative all of a sudden found the telemetry unit and started to be kind after the INT was placed. She even told the mom she was lucky she was the one placing the INT since she never put it in the moms hand so she has more mobility and she used lidocaine so it was less painful. Gee- you mean the other nurses if she waited would not honor those same desires? Thanks!
I respect this couple for standing their ground- although I do think all of that adrenaline and lack of ability to relax and go to her laborland space interfered with her labor. I do think that when they repetitively asked her why she was declining and she repeated herself over and over, she was not being respected or heard. I do think that having to fight in your labor is counterproductive. I think they were worn down a bit but I feel in the end they chose their battles. But why do we have battles in labor to begin with?
When will informed decisions by a woman in labor be respected? Several times the word dead baby was used in the conversations about this procedure. When you use such phrases as sick or dead baby, it makes women fold. That was not true in this case because this couple recognized the lie. I hate that this couple had to even have any of these conversations taint their beautiful birth.
This couple negotiated the choppy waters of this hospital. They knew there would be some battles when they learned that this hospital had protocols that were not evidenced based and were more interventive. I am unsure if they knew that several practices shared call with their practice. Negotiating beforehand does no good at all in this case. Making a concession to get the INT for more freedom in the tub was one I would have made as well if I had been in this same situation. Having her husband as her protector and extra emphasis to her voice was priceless.
Understand the choices you make may mean you need to learn how to negotiate choppy waters in labor to get closer to the birth you desire. Ask your questions long before you get into the last months of your pregnancy.