Tuesday Feb 21, 2017
Out of Control: What I Learned From 36 Hours in Labor
As physicians, most have us have a few things in common. We like to help others, we frequently give of ourselves to a fault, and we like to be in control.
Control makes us comfortable. Walking into a hospital, an environment that fills most people with anxiety, puts us at ease. It is an environment we know, where things function in a way we expect, and where we find order. The workings of the body, the progression of disease, the expected lab and radiologic findings that correlate with the physiologic process -- these are things we know how to deal with.
From the time my husband and I found out that we were pregnant with twins, I knew that a large part of the control I enjoyed in my life was going out the window. This was not easy for me to accept, and as we all know, doctors do not make the best patients.
Holly Ray PhotographyHere I am with Maya Lynn and Merrick Eugene.
Our first daughter was born via C-section after a long induction because she was asynclitic. I had been hoping for a vaginal birth after cesarean (VBAC) with my next delivery, but I knew with twins this was less likely (something I was going to have little control over because the babies and my body would decide). I discussed it with my husband, who also is a physician. Although he thought I was crazy to want to try, he said he would support my decision as long as it was safe.
The next decision was finding a doctor. Our first daughter was born at our rural hospital, delivered by my family physician, who also is our partner and friend. But multiples involve higher risks for early delivery and complications, so my husband and I agreed that we wanted to deliver somewhere with a Level I neonatal ICU this time.
We decided we would deliver where we had trained. We also agreed on an amazing doctor who had taught us in residency. I called and asked if she would be willing to take me on as a patient and allow me to attempt VBAC.
These choices meant that our doctor and delivery facility would be three hours away, that we would have to travel for many appointments, and that more of my control was being taken away.
We were fortunate that the pregnancy was relatively uneventful, a whirlwind of appointments at our home facility, visits to our doctor in Wichita, a check-in with maternal-fetal medicine and multiple ultrasounds to check on the babies.
At around 32 weeks, I developed pregnancy-induced hypertension. This was one more thing that was not in my plan. I had to reduce my work schedule to half days and cut other activities to keep my blood pressure stable. This provoked a good deal of anxiety for me, and I felt pressure to see my patients before the babies arrived.
When I voiced this concern, my family physician, my husband and my obstetrician all said the same thing: You don't have a choice in this; let go of your need for control, because what is right for the babies is what's right for you.
On the day I went into labor at 35 weeks and five days, I said to my husband, "I can't be in labor. I have one more week of work, and it's packed."
First, he invited me to get back to him on how that was going to work out. Then he told me to stop being so stubborn and go to the hospital.
I wasn't convinced the labor was the real thing, still thinking that I had some control over this. (Of course, I know better. I deliver babies! I blame the hormones.)
I went to our local hospital, and my family physician checked me while I was hooked up to the monitor. The ruling? Regular contractions, and I was dilated to a 2-3. We headed for Wichita.
After what felt like the longest three-hour drive in history -- praying all the way that my water wouldn't break and stopping frequently for restroom breaks -- I tried to let go of my fear of what was to come. This experience was going to be the most out of control I had been in a long time. I took a deep breath, said a prayer for myself and my babies, and walked into the hospital.
I spent thousands of hours training at this hospital, but instead of entering a patient's room I was entering a room as a patient. I had to take off my clothes and put on a gown. I was hooked to monitors, rendering me stuck to a bed except for trips to the bathroom. I was dependent on my nurse to help me get unplugged and get up when needed. My medical history was taken by residents I had never met before, who changed shifts with my nurses every few hours.
Elevated blood pressure caused the cuff to go off every 15 minutes, waking me if I had been lucky enough to doze off. I had to ask to be taken off the monitor to labor while standing for a while, to be allowed to eat a snack, and to be checked when I felt something was happening. I had to wait for a physician to be called to get the answers, or for one to come to do my checks.
I labored for 36 hours with no control over the speed at which my body progressed, or over the variables showing up on the monitor of my babies' heartbeats, or over which baby was coming first.
When it was time to push, we went to the operating room to start the process. I had no control over the fact that I had to labor on an operating room table. I had nothing to drink because no food or drink is allowed in the operating room.
I had no control over the fact that Baby A was occiput posterior, so she took a lot longer to come; I also had no control over the fact that Baby A was supposed to have been Baby B.
What I did have was two successful VBACs and two beautiful, healthy babies.
I also had more bleeding than expected, leading to extra medications before I left the operating room. About 45 minutes after we got back to my room, I knew I was still bleeding more than expected, and I asked for the resident. I was apprehensive, and again I was reminded that I was not in control of what my body doing.
I had a manual exploration of the uterus done at bedside, and the resident realized I needed sutures. As he was about to start, I reminded him I no longer had an epidural and that some local anesthetic would be appreciated. Finally, a medical situation I had control over! He realized his error and got me numbed before starting the repair.
The next three days were a blur -- many heel sticks for the babies to check sugars and bilirubin, fundal checks and frequent blood pressure checks. I had no control over what time these were done, or when the nurses came into my room.
I felt better when I had a kind and interested nurse, and less so when the nurse was not so engaged. I felt calmer when a resident I recognized came to check in on me, and much more so when my OB or the family medicine doctor we had chosen to see our babies came.
I wasn't a physician throughout this process; I was a parent, a patient, and someone extremely dependent on the care of others. This experience taught me many things, but most importantly, it reminded me that we all like to feel in control -- no matter who we are and no matter what our profession. When you enter the hospital as a patient, you immediately relinquish much control. I waited for someone to help me to the bathroom, to bring my food or refill my water, to take my vitals or my babies' vitals, and to get my labs. When I was exhausted and finally dozing off, someone came to check something else, and I actually broke down and cried.
Being a patient has made me a better physician. I am more conscientious about giving my patients as much control as I can when they are in my office or in the hospital, and I encourage nursing staff to do the same. I make sure staff know they can call me with any patient question so my patients don't have to wait for an answer. We also need to understand that when patients break down and cry, sometimes all they need is a hug and a nap, which I can facilitate by asking staff to leave them alone for a few hours unless absolutely necessary.
We have implemented a two-hour rest period for all new moms and babies to allow them quiet time every day, something I wish had been done for me.
I am thankful for what I learned and for what I came away with, the best reasons ever for being out of control -- my beautiful babies Maya Lynn and Merrick Eugene, who came home to join their sister, Lyla Grace.
Beth Oller, M.D., practices full-scope family medicine in Stockton, Kan.
Posted at 04:22PM Feb 21, 2017 by Beth Oller, M.D.