Processing a challenging birth

[saritabeth]

I am a birth doula and had a really challenging situation arise for me. Baby is fine in the end.

I don't want to get into the full story of their birth (to respect the privacy of the family), but I just want to talk about the effects it had on me.

the general background: long unmedicated labor in hospital with the use of pitocin.

When the baby was born the cord was wraped around his neck twice....he was very blue and very very limp at birth...practically no muscle tone. His inital apgars wer 0 and 7.
Babe was placed on mom's chest then immediately moved to the warmer where they tried to get the babe to breath better. He was gagging up a lot of foamy fluid and really sucking in hard to breath with dimpling between his rib cage.

it was seriously disturbing. I have never been at a birth where the babe had been so blue and so limp. I nearly fainted....no joke. The room started spinning and I thought I was going to literally vomit. I told dad to come around to where I was so he could be between mama and babe and I went to the other side of mom...sat on a stool next to her and just took some deep breaths. I managed to pull it all together but it was very upsetting to me to see the baby in distress. I managed to keep my emotions in check and do my job...but I really thought I was going to faint for a moment there.

The labor had been very very long and the parents did not seem to realize how serious the situation was. I am looking forward to following up with them and get their impressions from the birth. I really want to keep my own feelings seperate from their experience, as I think they experienced it very differently from me.

anyone else ever have a similar personal reaction to a birth?

[wwisdomskr]

I don't have any personal experience in this area...but, I just wanted to say that it sounds like you were very professional and did a great job caring for this family. I hope that you're able to find support in processing your experience.

[JunipersMom]

I would listen as they tell their impressions and then just agree. When working with birth, it is inevitable that problems or complications will arise. And because of your training and experience you knew that things were not right - those parents might not be aware of that.

[mwherbs]

so at 1 minute the apgar was O- and at 5 minutes 7

sounds like you did pretty well considering the situation- when you are an absolute bystander it can be very disturbing more disturbing than if you had an activity -- and a basically dead baby is very frighting and takes all of us aback -- sometimes it is only after that you think you have lost years of your life---- and like I said before you did really well---

but I wonder about the assignment of 0 at one minute- if the baby was gaging and sputtering-- and you say some tone-- were they doing chest compressions and bagging the baby the whole time after drying it off ? after looking at this scoring system would you say 0 was properly assigned?

here is the apgar scoring system
Activity (muscle tone)
0 — Limp; no movement
1 — Some flexion of arms and legs
2 — Active motion

Pulse (heart rate)
0 — No heart rate
1 — Fewer than 100 beats per minute
2 — At least 100 beats per minute

Grimace (reflex response)
0 — No response to airways being suctioned
1 — Grimace during suctioning
2 — Grimace and pull away, cough, or sneeze during suctioning

Appearance (color)
0 — The baby's whole body is completely bluish-gray or pale
1 — Good color in body with bluish hands or feet
2 — Good color all over

Respiration (breathing)
0 — Not breathing
1 — Weak cry; may sound like whimpering, slow or irregular breathing
2 — Good, strong cry; normal rate and effort of breathing

[mamallama]

When you say the labor was very, very long, I assume you were there for the long haul?

To me, that's one of the most challenging aspects of doula work--remaining effective under extreme sleep deprivation. In the case of a hospital birth with pitocin, I imagine that must have been grueling.

I don't need to hear the details to imagine you were exhausted, hungry, achy, and emotionally tapped dry. You helped a woman give achieve a vaginal birth in a hospital with pitocin and no pain relief. I bet it took everything you had.

It's no wonder you had a physical reaction when the baby was born in poor condition. I have felt the room spin twice before. Once was a scary case of sticky shoulders. The other time was a true bad outcome.

You didn't mention how you feel about the birth, though. Do you feel good about the support you gave? Is there anything you wish you had done differently?

[mamaverdi]

[Gray's Mommy]

Yeah, sometimes those babies just aren't what we expect. My best & worst birth was when the baby died 15 mintues before she was born. It was the hardest thing for me to keep myself together for my clients. I didn't have a physical reaction until I was in my truck driving home. I lost it & had to pull over several times to get myself home safely.

It took me over a year to process this birth & it still is in my thoughts.

[Reha]

I'm sorry it was so hard for you. I think it is very sad that if the baby was in need of resuscitation efforts, that they cut off the baby's lifeline of oxygen (umbilical cord) and took baby from mom.

I noticed that you mentioned it was a long, long unmedicated birth with pitocin...I know that you mean mom didn't have any sort of pain medications, but having pitocin does qualify as being medicated. I don't mean to imply that IT was the reason baby was born like this, but I think it is still important to make this distinction. :

I too wonder about the 1 minute Apgar. It seems to me that many providers do not wait a full minute to assign the 1 minute score. : I just attended a birth where if I had assigned an Apgar score within seconds of birth, it would have been a 2 (and only for a heart rate of 108). Baby had no tone, bad color, no breathing, etc. But, I handed baby up to mom and mom carressed her, and spoke to her, and her 1 minute Apgar was 9.

I in no way mean to imply that this baby you saw would have been fine with just staying in mom's arms....it is very possible baby did need some outside help. But, what I mean to imply is that sometimes babies come out looking not so good to us, but the majority of time, they are fine. It can be concerning, though, seeing it for the first time (or even for the 100th time!).

I think that it is good to try to process your feelings about what you saw with your peers (like here on MDC). It is a very delicate situation to not impose our own feelings from a birth onto the mom and dad's point of view while still sharing with them our perspective.

[FancyD]

Not a birth professional, but I did have a very difficult birth, so here's my opinion FWIW. Somewhat similar circumstances, DS was blue, limp, had to bagged... We were totally in shock/denial. I guess I wish someone had been keeping a closer look on us, for at least 6 months after the birth. That was a difficult time, as it became more and more obvious that DS had some issues, but I was still in shock, essentially. Try to stay in contact, and listen to what mom is saying. Either there will no big issues, or (touch wood) she has an ally to help her out if she needs it.
HTH...

[Charmie981]

Originally Posted by Lennon

sometimes babies come out looking not so good to us, but the majority of time, they are fine. It can be concerning, though, seeing it for the first time (or even for the 100th time!).

I still remember the first blue and limp baby. My first thought was "OMG, he's going to die." It was TERRIBLE. My 4th birth as an apprentice, my 5th birth that wasn't my own, and only my 7th birth if you counted my own births. I was not equipped to judge a baby's condition based on appearance, but it didn't stop me from doing it. I was totally and completely freaked out.

What I have found in the many births since then is that some babies come out looking like sweet little newborns. Some come out looking like goopy aliens, and some come out looking like bruised newborn aliens. And mercifully only a few look like the're not alive yet. It's still disconcerting no matter how many times you've seen it, but most of the time the baby is fine at 5 minutes and even better than fine at 10 minutes.

Most of the parents of these babies are mildly concerned ("why's he blue" or "why isn't he crying") but leave the real worrying to us. At the last birth where I had a stargazer (3 and 8, but baby was very similar to what you're describing at birth...at 1 minute, there was respiratory effort, HR 116 and some muscle tone), the dad was ready to leave and get the older kids from school before I felt the baby was stabilized. I was screaming in my head "YOU CANNOT LEAVE YET," thinking he didn't realize the severity of the situation. In reality, he was concerned and that was his way of coping (finding something that needed to be done). He ended up staying, but said that while he was a little concerned, he felt like everything was under control the entire time. And I think that's the key: the parents chose their providers for just such a situaiton and the fact that the parents trusted the providers to care for the baby in that situation is a good thing.

[DoomaYula]

I attended a very challenging birth about 6 months ago, and I'm still processing it. (Baby and mom are fine now, but the labor and birth was very traumatic.)

Immediately after the birth I came home and wrote wrote wrote wrote wrote like five or six pages about it. Even though I'd been awake for like 30h and had barely eaten or drank any water, and I got home from the birth at like 4am, I still wanted to write about it. Even if I looked back later and it didn't make much sense, I still wanted to have my original thoughts.

After writing about it I talked about it to several midwives and doulas. I called my doula-certifying organization and talked to some people there about it. I talked and talked. I went into great detail. I talked to every birth professional who I knew on a personal level, and asked them if I could talk about it. Sometimes I wanted feedback on MY role, sometimes I just wanted to talk about it.

I can still talk about it for hours.

I'm definitely in a better space about it, but it's taken a long time. Birth can be difficult from a doula perspective -- we see a lot and can't "do" a lot and want to help the parents.

[saritabeth]

Okay, just a few things to respond to.

Obviously pitocin is a medicated birth...But the distinction I was trying to make was that she had a pitocin birth without pain medication. sorry if that was unclear.

As far as the apgar scores are concerned....I think they were hasty with the apgar of 0. I really don't think He had been born a full minute when given an apgar of 0. But, that isn't my call to make.

My personal opinion....I would have like to have seen them leave the cord attached to baby while they were working on him...but again, not my call, not my area of expertise. I also would have like to have seen the staff encourage the parents to speak to the child....and to explain more of what was going on.

There are a lot of things I would love to write about this experience. That being said I don't feel there are many more details that I can give without feeling like I am telling someone else's story.

I do feel that I provided the kind of birth support that this woman was looking for.

I am feeling the tension between working in a broken system that doesn't really understand labor and contracting with women who want a natural experience within that system. I feel that I do a lot of good being a doula to women in a hospital setting, but I also feel frustrated by stupid policies and inherently wrong beliefs held by some staff.

I think that I will feel better about this birth experience after I have the postpartum visit and have time to listen to mom talk about her birth. How she feels about her birth is much more important to me than how I feel about it. It is so important to me that I not inject any negativity of my own into their story.

[DoomaYula]

When I said "write" I meant that I journaled. Confidentiality and all. I wouldn't encourage you to go into too many details on here.

Recently I saw a doc cut a cord while only the head was out on the perineum, and although that labor was LOVELY, seeing the doc do that was traumatic for me, as well as what the doc did postpartum.

[ldsapmom]

It is scary when something is going on with the baby, or the mother. I don't know if it is better or worse when the parents are aware or not?

One birth, baby was totally blue and unresponsive. The neonatal resus team was called. Mom was calling from bed, "Is he okay? IS HE OKAY?" And then it falls to me to tell them!??! What do I tell them? "S., he is okay, he just needs a little time." Dad was lost, wouldn't even walk over to the baby table. It was so scary. I felt like I was lying to her -- I didn't know what would happen -- but what else could I do? Tell her is was in distress, they were bagging him, and who knows -- he could die?

Luckily he was just a slow-starter. Remembering now, he had a tight nuchal cord that had to be clamped before he was fully born -- I HATE those, there is always so much more urgency involved afterwards.

Another time, mom had a complete pit induction, no pain meds, and sailed through swimmingly. While baby was on her chest and she and Dad were oogling, I see from my angle doc having a hard time with the placenta, and I see TOO MUCH BLOOD. Mom and dad are clueless. Doc is working. I watch as blood arcs out of her, seeing the concern on the doc's face, but mom and dad still have no idea. Doc says, "We need to take you back for a D&C NOW." They give the baby to Dad and whisk mom off.

They had no idea -- who was going to say, "Hey, you are losing a lot of blood -- you feel okay?"

That one turned out okay, too.

((((hugs as you process))))

[jengacnm]

You're doing a good job by coming here for support.

The first thing I thought was of course you had that reaction, you were probably sleep deprived. How about food? I'm not very good at feeding myself when I'm on long births. If your blood sugar was low, that didn't help.

Journaling, as suggested by Yumadoula, is a great tool. Read it again in five years to see how far you've come.

Massage or bodywork is great for bringing down your jangled nerves. I'd recommend getting it as a matter of routine, but definitely after something traumatic.

Finally, given the cicumstances, just accepting that you experienced a trauma and allowing yourself to work through it is the nature of our business. Long labors, depressed babies, and traumatizing experiences are part of what we signed up for when we chose this line of work. Fortunately, those experiences are the exception and not the rule. The next time this happens, be it next year or five years from now, you may find yourself able to explain to the parents what is happening as it is happening because you've seen it before.

Be gentle with yourself and keep up the great work you're doing!

Jennifer

[saritabeth]

Originally Posted by YumaDoula

When I said "write" I meant that I journaled. Confidentiality and all. I wouldn't encourage you to go into too many details on here.

Recently I saw a doc cut a cord while only the head was out on the perineum, and although that labor was LOVELY, seeing the doc do that was traumatic for me, as well as what the doc did postpartum.

Oh no, I got that. Journaling is a great suggestion.

Lots of good suggestions.

Yeah, the lesson learned here is to eat frequently. I think low blood sugar played a major role in the spins. I did get a few hours of sleep the first night ...but my support was over 30 hours in length. It was long, intense and exhausting for everyone.

It is so nice to remember that they aren't all that long!