Saturday, March 28, 2009

Melons and Foufs



As a women in her mid thirties, I am now of an age where having children is starting to look unlikely. I have been married for ten years and have been completely settled and happy during that time but have just never had any urge to have a baby.

I sometimes think I must be wired up differently to other women because I have never been broody and have never once thought that I would like to have a baby.
I don't know why but do wander if it's because I saw too much at a young age!

I have always been fascinated with pregnant women (I do see the irony here) and took the first offer I had as a student nurse in 1993, to see a live birth. It was horrible. The women was in pure, unfettered agony and the husband was crying and shouting at the midwives. The midwife kept examining her to see how dilated she was, and every time she did, the women screamed to leave her the hell alone. When she dilated to 10cms, she needed an episiotomy (I had to sit down, the sound of crunching will never leave me) and then she couldn't push properly so they had to get this suction machine and pull the baby out. I thought it was all over but then the lady started haemorrhaging and the husband passed out, falling on top of me.

Fast forward fifteen years and I find myself as a final year medical student in a
birthing centre. I can see that things have changed. The medical room of the nineties has been replaced by a birthing room, which is a big lounge-like room with a bed, sofa and rocking chair in. There were no medical instruments to be seen (They were all tucked away in a friendly looking pine cabinet)

The midwives firmly told me that I was not here to "Deliver" a baby because in this environment, the women delivers her own baby. Midwives are scary people who don't like doctors very much (They hate medicalising birth) but are the kind of people that you definitely want around!

The next big difference I saw was that there are no longer repeated checks on how dilated the women is (They check every four hours, rather than hourly like I have seen) The midwives let the women's body tell her when it is time to start pushing, unlike the old days when the midwife would tell the women to start pushing because she was dilated to 10 cms. The emphasis is on non-intervention, i.e allowing things to happen naturally without medical interference.

Thinking about it, the birth in the 1990's and the one I saw last week were similar in that they were both first time young mums, having normal deliveries. The latest birth looked far less stressful because of the nicer environment but the one thing that doesn't seem to get any better is the bloody pain. These women are in AGONY!

We are living in the 2000's.... why are women still in so much pain when they give birth?

18 comments:

CV said...

although i'm only 22, i sort of feel the same way that you do.

while doing clinical hours, i shadowed a doctor delivering a baby .. worst experience of my life.

it was so horrible. i almost fainted.

that and just hearing the women scream from across the floor. it's enough to make me anxious and jittery.

Law Minx said...

I would never say NEVER with respect to kiddies, N2D - feelings of rampant broodiness can catch up with you at ANY time, even into your 50's!!

I am sad to see that your initial experience of birth was such an awful one; it does rather imprint on the psyche and is probably the reason why so few nurses go on to train as midwives - well, the birth COUPLED to the attitude of the midiwife, which can, at times be pretty appalling. Birthing centres have changed practice time out of mind, and MUCH for the better

Speaking as a former midwife who worked semi independantly out of a large London Teaching hospital for over 5 years, I would very much like to think that I am not a scary person, but our views of childbirth are essentially very different to that of the medical profession - which is where all the argument starts! For midwives, childbirth is the most normal and natural thing that a woman can do - crikey, she's been doing it since the dawn of TIME with very little fuss. Doctors, on the other hand argue that its the most DANGEROUS thing a woman can do - fraught with difficulty and any number of life threatening scenarios for herself and her unborn baby, and in consequence labour should be strictly managed and ended after 24 hours ( so called " active" management - YUK.) if delivery doesnt look likely.
Pain is undoubtedly the WORST part of any labour, but , I suppose if its of any comfort it is a STRANGE sort of pain, forgotten when that baby is put up into the new mums arms and dispatched completely to memory as that baby grows up. After all, if it wasn't FORGOTTEN who among us would go through it AGAIN, as many women are often wont to do?!
(PS: there is a plinth for a STATUE in the RCOG/RCM and a Nobel PRIZE to hand for the CLEVER person who invents a totally EFFECTIVE method of pain relief that lasts hours, wont KILL anyone, permits MOBILITY and has no lasting side effects - is that person you?!?)

Nurse To Doc said...

Hi Law Minx

Thanks for your excellent post - it sums up exactly what I saw during my 7 week block. There was at times open hostility between docs and midwives.

One particular time, a lady in the birthing centre had a lovely (can birth ever be lovely?) normal delivery but then had a retained placenta and was haemorraging.

They estimated 1000mls blood loss and still no sign of the placenta. They called the doctor who came and started laying into the midwives because they had not done any obs on the women. I don't know how I feel really - not sure what went wrong. In this case, the lady probably could have done with a b/p and pulse check but her bleeding was settling and the midwives seemed to me to be on top of things. I don't know but I certainly wouldn't have started having a go at the midwives in front of the already distressed patient.

What's even stanger is I have now moved to ENT and am missing the birthing stuff something rotten. Looking into ears just doesn't have the same effect!

Law Minx said...

PPH is one of those God -awful scenarios that one really cant plan for until it happens; of course we midwives undertake a risk assessment with regard to the possibilty of it's occurence, but life is strange and it never seems to happen to the people in whom we MOST expect it!

Did your woman have a physiological second stage, or was it a straight case of retained products, or a full bladder, or even a posterior tear?

It also depends on what one classes as a PPH; I always assumed that EVERY woman had some form of PPH regardless since typical blood loss varies between 350-500ml, equivalent to a unit unit and half, tops, of whole blood.

In any event it sounds like the Doc lost it a bit, I'm afraid; the midwives were correct in summoning assistance, but there was no need for him to lay into them either in front ofthe poor lady, or you. In fact, sad as I am to say it, he probably laid into them precisely BECAUSE medical students were present, and wanted to impress his All midwives are Flowery/hippie/unbalanced/unreliable and,unfortunately, all too typically OBSTETRIC view of childbirth, so is it small wonder there are often complete RUCTIONS between midwives and doctors?

For what its worth, I worked with some truly EXCELLENT OBGYNS, who knew when they were needed, the sense and sensitivity to know when they weren't, and sufficient trust and confidence in midiwives to know that those midwives would summon them the INSTANT ANY Labour became abnormal. Of COURSE we had our ding-dongs -some of which were quite spirited, though they were never truly NASTY- but thats to be expected in any good clinical relationship, dont you think?-

ENT eh? Im sure you must know THE JOKE then! If you don't it goes like this:

Obstetrician to ENT Doc:
" However do you manage to STAND it, looking down peoples THROATS all day?!?"

The Student Radiographer said...

What a fascinating read! Well done, and keep going!

As a mature radiography student, I'm finding it all extremely interesting.

I thought my workload was madness, but yours seems like extreme madness lol

Great stuff!

Anonymous said...

i don't understand what the big deal is in having an epidural.
you wouldn't have a tooth pulled out without anaesthetic, why is childbirth any different?

insightful mother said...

Law Minx, is it any wonder there is friction between the medics and midwives with comments like this

'In fact, sad as I am to say it, he probably laid into them precisely BECAUSE medical students were present, and wanted to impress'

Having worked in an obsgyne department, been present at numerous births and giving birth to a little boy myself, i think i have sufficient insight to suggest it has a lot more to do with the power struggle between the medics and midwives.

More often than not it is the inferiority complex of the midwives. I agree, there are of course some good midwives, but i don't see the midwives complaining when the doctor is summoned to an emergency, and the responsibility for the patient is deferred to the doctor.

May I suggest that those midwives who do not want to the doctor to come and 'impress' others, take on the responsibility of their action/inaction themselves and see how they conduct themselves in the face of urgency.

ps as for the comment regarding the pain of childbirth, 'After all, if it wasn't FORGOTTEN who among us would go through it AGAIN ' . Perhaps it has more to do with it being worthwhile as opposed to the well rehearsed 'myth' that the pain is forgotten. Such a load of tosh.

notjustmedical said...

Oh god, I bet if I was in your situation I would push my legs together and pray nothing ever happens like that to me!!

Just wanted to say, great blog, I've really enjoyed reading your posts!

Sarah said...

Hi there, I am so sorry to put this here but cant seem to find an email for you. I was just wondering do you think nursing/medical experience helped get your place at med school? Did u have to take the GAMSAT and UKCAT or just topped up ur qualifications with chem Alevel?
I want to go med but not sure if I should do nursing(do have a passion for it) then move to med as I come from a arts background.
Sorry to waffle and gooood luck with finals xx

Sarah said...

also sorryy did u find unis accepting? Im not totally sure who to look at, are u at bham or Leicester, and to be super nosey did u do all science Alevels or get a high grade in ur first degree? sorry but I wld love to get into medicine and well questions questions!
xx

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natashav said...

I am very sorry the birth you got a chance to see was an agonizing experience for both you and the mother you watched. The thing is that birth in the hospital is not a birth but a mockery of a majestic mystery of bringing a child into this world. It is a humiliating experience that no woman should have to go through. Normal birth is not like that at all. It is an elevating experience of high one cannot match in any other area of life.

Mary said...

Hi,

This is the assistant editor for Hospital.com which is a medical publication offering hospital news, information and reviews. We also cover a wide variety of medical topics, some of these articles being relevant to nursing schools and issues around their prospective students (scholarships, grants, etc). We are in the process of giving the nursing industry a dedicated section from our site and are currently seeking online resources which can be offered to our readers of this section. If possible I would like Hospital.com to be included within your blog roll, offering our information as a resource to your readers and essentially building a relationship between our sites. Please let me know if this addition can be made, Thanks!

Please email me back with your URL in subject line to take a step ahead and to avoid spam.

Thank you
Mary Miller,
may.hospital.com@gmail.com

LVN Schools said...

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CHRISTINA said...

I would like to ask what is the difference between being a nurse and a doctor. I've been researching but always get different answers. I believe since you've experienced both occupations yourself, asking you would be the best bet.

Nurse To Doc said...

Hello Christina

Thanks for your question asking me about the differences between a nurse and a doctor. I wrote a blog entry on this about a year ago called "Electricians and Plumbers"

Without going on too much of an essay I would have to say that the two professions are completely and utterley different. The electricians and plumbers tag still seems to me to be a great description:

1. Both work in the same environment but are totally separate professions.

2. They are both as valuable as each other but they do different things

3. Although they work in the same environment they could not do each others jobs. They might have an idea of what the other does and may be able to describe each other roles but each has their own separate role.

I had been a nurse for at least ten years when I started medicine and I absolutely thought that I would be half way there! This was stupid and bigheaded of me. Even at the end of my studies I still feel that nursing has hardly been any help to me. I can speak to people but then so could most women (or men) my age

Anyway - I am going write a blog post on this in the next week or so and would love to hear what you think

Best Wishes

Anna
xx

Law Minx said...

Insightful Mother,

A lateish reply on my part unfortunately, but I must respond to clarify a few points.

The power struggle argument you suggest is an old and well worn one. I do not deny that it exists, but it is my experience that both midwives and doctors work as a team to benefit the woman in their care. Yes ,there are rows, yes there are frequent differences of opinion, but these arise from each professions philosophy of childbirth. Obsetricians believe it is fraught with risk; midwives, that it is a normal and natural part of a woman's life. To work effectively together is to recognise this in one another and to respect it.

With respect to my comment, given the above, you mistake my use of the word 'impress'; I do not employ it in the sense of showing off, but rather of imbuing medical students with a sense that childbirth is dangerous.

No right minded midwife who values her practice would ever take umbridge when a doctor is summoned and takes the lead in an emergency. It is a part of the midwives remit to recognise abnormality and danger and defer management to the doctor, who is an expert in these matters. No midwife would complain about the presence of a doctor in this scenario - in fact she is grateful, and relieved.
You seem to suggest that problems in childbirth are entirely the fault of the midwife. This saddens me. You have evidently had problems with some of my colleagues,I have met such midwives; they can be pompous jobsworth and resentful; but you should not let this colour your perception of the profession as a whole. I could play the blame game and tell you of times when doctors have had to be begged to attend upon a parturient woman when the midwife feels something really very bad is wrong, but that would be a pointless exercise. The care of the labouring and pregnant woman is not a question of one upmanship but cooperation.

With regard to your views on pain and childbirth, they are your own. I respect that. but please dont dismiss my views as tosh by way of return. That simply diminishes your argument.

About Me

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I knew I wanted to study medicine from 5 minutes into my nurse training in 1992. This didn't go down too well with my peers but it has taken me eleven years to get my life in a place where I could apply to medical school, so I have paid my nursing dues! I was lucky enough to get two offers. I have been married for seven years to an ex footballer who is now a PE teacher. We have no plans for babies but I would love more King Charles Spaniels. I start medicine on September 20th 2006 and am absolutely petrified.