Scariest day of my life(graphic)

[arimama]

I attended a birth yesterday as a doula that made me never want to step foot near a birth let alone be a midwife.
The labor was looong, like 3 days. Babys heart rate was perfect through the whole thing so despite the long labor with the swollen cervix and a baby that just wasnt coming, the midwife decided not to transfer. With homeopathics the cervical swelling finally went down and she dilated fully.
When the baby was finally born he had:
nuchal cord x2,
Shoulder distocia,
Born in primary apnea, opened his eyes briefly after drying/rubbing/ being talked to, then went in terminal apnea, heart rate of zero, needed full rescusitation with chest compressions.

While the baby was being worked on by the two primary midwives, mom began pouring blood into the birth stool pan. Me and the student helped mom onto the bed and the student gave her a shot of pit. Mom was COVERED in blood, it was everywhere all over the room.

After the bleeding stopped the student was giving light traction(not yanking at all) and the cord separated from the freaking placenta. The primary midwife came over and manually removed it.

I was absolutly paralized with fear. I cant get the image of the lifeless blue baby on the floor and the bloody mom, and the terrified dad out of my mind. Its like a slow motion movie.
The midwives handled it and everyone is doing well. On one hand this was a perfect example for me of how even complicated births can be handled at home with skilled enough attendants. On the other hand it scared the sh*% out of me.

I would love to hear from experienced midwives/doulas how you moved passed your first scary births and kept going.

[holly6737]

I don't have any personal experience with that kind of birth, but I do want to give you a .


I would probably just remind myself about the statistical chance of each of those problems occurring, and then the chance of them occurring at the same time. Then I would tell myself that because birth is a natural process, we can't control for all of the variables and sometimes things like this are going to happen, however rare. Of course, I haven't been there, but that's what I imagine my thought process might be.

[Ackray]

I'm not a midwife but I've been in births like that. It's very scary. It's a really good learning experience though. You'll never forget, but you'll move on.

[mothercat]

arimama,
First off, hugs for you. Yes, that was a very scary situation for everyone involved. If you have had a chance to talk with the midwife she will probably tell you how scared she felt also. However, being scared is a lot different than being unable to help.
I think in the back of every good midwife's mind is just this scenario and she is always asking "What would I do if all of this happened at the same birth?" The competent midwives know it is a possibility and they take steps to be sure they have the skills, the equipment, and the assistants to keep everyone as safe as possible if it happens. It sounds as though that is exactly what happened.

Second, is dealing with your own feelings about what happened and what you felt as a reaction to it. You have just gotten a huge dose of groundlessness. Everything you believe about birth has just been taken from you in a huge and very dramatic way. As odd as it may seem, let yourself just dwell in that place for a while. If you look up "groundlessness" (try the luminous emptiness page), this feeling is not all a bad thing. This sense of doubt is really fundamental to Zen. Han Shan wrote

A little doubt,-- a little enlightenment. A big doubt,-- a big enlightenment. Refraining from doubt,-- one doesn't become enlightened.

Because of the emotional impact of what you saw, and now your doubts, there may also be a sense of grief-loss of those beliefs (not wanting to go anywhere near another birth). As with any loss, after the initial shock, you will need to make a choice. Will you let this overwhelm you and you give up helping women birth, or will you choose to get up each morning and believe that birth is still safe? Are you strong enough to make the choice you should?

While you dwell on all these things, be kind to yourself-exercise, journal, meditate, soak in a warm tub, listen to sweet music and connect with the things in your life that you love. Caring for yourself may lessen the impact of the PTSD that may yet come. My siggy leads to an MDC thread with several links to PTSD and birth trauma sites.

PM me if you would like to talk further. I am a home birth midwife and BTDTGTTS.

Linda

[channelofpeace]

I hope that you can come out on the other side of this with the knowledge that birth is still inherently safe.

I am sure that you have already thought of this, but because it was such a traumatic situation for even you, following up with the family so they can process it and bounce it off of you is especially critical in this instance. Be prepared for the possibility of them not being about to start processing it for a few months. I have found that especially in traumatic births, a followup call or email when the baby is about 6+ months old is important. It is like at first they are in survival mode, trying to care for a newborn and they might not be able to think/process the situation much until the baby is older and things have leveled off.

Blessings

[nashvillemidwife]

Originally Posted by arimama

I would love to hear from experienced midwives/doulas how you moved passed your first scary births and kept going.

Bad things are going to happen and if I do this long enough not all of them are going to have a happy ending. I figure someone's gotta do it, and I was called or "chosen" for it.

[Defenestrator]

I think that mothercat's post was a good one and had a lot of wisdom.

One of the things that helped me when I was a doula and apprentice midwife was to focus on my role. In the middle of all of the chaos, how could I help? I knew that as a doula or even a green apprentice that the midwives in the room didn't expect me to save the baby or stop the bleeding. What else could I do? In that situation (as a doula) I almost always turn my full attention to the mom and her role in the scene and her emotional process. If I am fully focused on her, then I can release the rest of it to the people elsewhere in the room. I really believe that mom's emotional process affects hemorrhage and so as a doula I would be making sure that she understood that the midwives were helping the baby and understood any directions or treatment being given to her. I would turn 100% of my focus toward getting her through the trauma of what was happening.

Shoulder dystocias and bleeding/retained placentas often occur together. So much so that I would make it part of my plan as a midwife to make sure that there was someone competent to handle the potential bleed available if at all possible. That said, I understand how scary it is as a midwife to have a baby in such trouble. It puts your heart right up in your throat.

Birth can be scary like this sometimes, but it is definitely possible to recover from the impact of a birth like this. Sometimes it takes a good long break or going to births again and again that remind us of what normal is. After my most traumatic birth as a new midwife, I took a 4 month break from all births (God helped me by making my schedule unusually light and I just didn't take on any new people) and then had lots of support around me when I did take on births again. The next birth I attended as a midwife afterwards was so easy, I swear the mama sneezed and the baby fell out. That birth was healing for me, but it was actually the next difficult birth that was more healing. At that birth I got to see how things could be really, really hard and how a lot of my skills could be needed and how things could still turn out ok.

One other thing -- you might find it somewhat healing to visit the mama and support her -- not only was she someone who had very intimate knowledge of the birth you attended, but I wouldn't be surprised if she were grateful for your presence. You might find some strength in appreciating the positive impact that you can make for birthing families.

[tlcdoula]

I am so sorry that you have gone through such a scary experience, but I can tell you first hand that the best thing is finding someone in real life to talk this through with. Whether it is another doula or a professional person you also need to process the birth.

A little over a year ago I almost quit being a doula due to some very difficult births that I encountered. The first one the mother almost died, and it was one of the scariest things I had ever gone through. It included them calling a CODE everyone in the hospital responding - there were probably literally 50 people in this small room spilling out into the hallway, and when I left that birth I said "never again." As luck would have it I was called to relieve another doula a few days later and actually told my boss I was not coming in and there was nothing she could do to make me come in (I worked in a hospital program at the time). My very wise boss insisted I come in and reminded me that she knew I would make the right decision. My feet were dragging, and I was so terrified to get right back in there, but honestly I was so glad that I did!!!

I won't lie - I was scared going back just a few days later. In fact the first mother was still in the hospital when I went to help this next mother. All turned out okay, and although it helped me to remember why I was doing this in the back of my mind I still had lots of processing to do.

Two months later I attended yet another birth where the baby almost died. Again I was very shaken, and kept saying "why is this happening to me." My very wise boss who is also a doula and has been one for a long time reminded me why I was doing this and talked me through some of the issues I had encountered. She reminded me of the huge difference I had made in the mother's eyes with me being there and helping her.

One year later I sent the mother of the baby who almost died her birth story (I always send them on the first birthday) and I got the most amazing letter and pictures from her. She thanked me for being there and for the difference I made for her and her family, and she also thanked me for the wonderful birth story that detailed some of the things she had forgotten but were so important to remember.

Sometimes birth is hard and we can feel helpless and it is in those times we need to reach out to others and lean on them. I found discussing my fears and feelings with another birth professional (irl) to be the most helpful thing I could have ever done, especially when that other person is a very seasoned professional.

[mwherbs]

so it never gets old-- the stress and distress can be fresh every time it happens but what you can do is use the experience to figure out what you would do in the future and if you would do anything differently.sometimes it doesn't matter you may have done everything that could be done but stuff just happens... peer review can be helpful, research, processing with friends/coworkers who are supportive. How is the family doing?

if you have a huge gush of blood like that you do have placental detachment/or partial detachment so controlled cord traction at that point was in order-- very very often if there is a resuscitation you have a bleed--mom's focus altered, provider focus not on mom, none of the regular hormone triggers that help to clamp the uterus down-- luckily it isn't always the case but it happens ---- something that would have been on my mind with a long labor is that there is a possibility of hemorrhage so I probably would have mentioned to mom that I was going to have some pit drawn up in case we needed it

[arimama]

Ugh I just talked to the dad to set up a PP visit and he expressed to me that they just want to move on and just not think about what happened. They actually deleated the birth pics and are upset that I took them. I stopped taking them when things went downhill, obviously, but they didnt want any reminders of the birth at all.

How am I supposed to help them process if they dont want to? Heck how can I help them if I cant process it myself?

On top of it all I feel so terrible about taking pictures. They had told me that they didnt want birth pics, just pictures after the baby was born. But in the pushing stage the midwife told me to take pictures. I said they didnt want any birth pics, and she said "whatever, they can delete them if they want".
I should have just listened to my clients wishes.
This whole thing is such a crap storm.

[SublimeBirthGirl]

You can't make them process something. I would probably just let them know that you're there if they need to talk. I'd also apologize for taking pics when they'd asked you not to.

[tlcdoula]

Originally Posted by arimama

Ugh I just talked to the dad to set up a PP visit and he expressed to me that they just want to move on and just not think about what happened. They actually deleated the birth pics and are upset that I took them. I stopped taking them when things went downhill, obviously, but they didnt want any reminders of the birth at all.

How am I supposed to help them process if they dont want to? Heck how can I help them if I cant process it myself?

On top of it all I feel so terrible about taking pictures. They had told me that they didnt want birth pics, just pictures after the baby was born. But in the pushing stage the midwife told me to take pictures. I said they didnt want any birth pics, and she said "whatever, they can delete them if they want".
I should have just listened to my clients wishes.
This whole thing is such a crap storm.

I would simply give them some time!!! If this birth just happened everything is so fresh in their mind. Perhaps you could wait a few months or even for the baby's first birthday and send them a card and let them know you are there to talk if they want. Like I said the mama that almost lost her baby was so grateful at the one year mark to get her birth story detailing those little things that she forgot. Of course not everyone will want that, but this mother did.

As for the pictures I can understand them being upset. If I told my doula not to take certain types of photos and then she did I would be mad too. Even if the midwife told you to I wouldn't have because my clients told me not to!!! Of course, that is a lesson learned and you can't change it now other then perhaps telling them you are sorry for not listening to their wishes.

As for you - I seriously think you need to find a very seasoned doula in your area and maybe see if she will meet to help you process what happened. Do you have a mentor? In real life processing will do so much more for you then online.

[jenmidwife2b]

How do you move on? Remind yourself that this will be the most scary birth you may ever see. Truly. You may never witness anything of that magnitude happening again.

And bravo to the midwives for handling things so well and being not only equiped but trained to handle these emergencies. Birth happens, and sometimes it isn't the pretty serene thing that we want it to be, but it usually is wonderful and gorgeous.

As for the photos, don't sweat the small stuff. Mom and Dad deleted the photos, they don't want them, no problem. The midwives shouldn't have insisted that you take them. Mom and Dad need time before they can process the birth. Mom needs to heal physically and bond with her baby right now. Dad needs to bond also and focus on his new family. There will come a time when they want to process things, and when that time comes, be available, but listen to how they felt about it, not how you felt about it.

I also second the idea of finding a seasoned doula (or midwife) and processing what happened at the birth. It will help you tremendously.

[mamallama]

I'm really sorry.

Last year I attended a hospital birth in the capacity of doula, and the baby did die. The mom hemorrhaged, the dad passed out...all around horrible situation.

The couple are long time, beloved friends of mine. It's been trying at best, especially as I have a son 2 months younger than their son would be.

You can't help them process. I know that's a bitter pill. The best you can do is to tend to yourself and remain available. In regards to self-care, Mothercat's post is excellent.

You can help them with the mundane things. Take them a meal. Do they have older kids? Take a small gift that will keep the older kids busy for a little while. A video? A non-messy craft project? Does mom need help with her sore perineum? Brew her an herbal sitz bath. This family needs some extra tlc--I'm sure you know how to provide that.

If you make yourself useful with the mundane things, they will feel more free to come to you when they do start to process. It could be 6 months or a year. It could be the next pregnancy. Honestly, it could be never.

Keep in touch. Send a Mother's Day card. Send a holiday card. Remember the baby's first birthday.

If and when they do want to talk, they'll most likely want you to just listen. Don't stress about having the answers. If there are answers, yours are probably not the same as theirs anyway.

Best wishes, arimama.

[doctorjen]

When you do have contact with the family, try hard to focus on their needs. One thing I find hard as a birth attendant when the birth has been hard on me, is remembering that the family's experience and their trauma is likely different from mine, and I don't want to add to their distress by telling them about my distress, if that makes sense. As someone else said, offer them the routine, mundane care things you would offer a post-partum family, mention that you are always ready to talk, even months down the road, and let them lead you.

I have a dear friend whose traumatic birth I attended over 3 years ago. Early on, it was painful for me to discuss it with her, because it had been so traumatic for me, and I felt the need to keep some of the ways it was hard for me to myself (for example, the physical sensations of doing CPR on her precious baby I will never be able to forget, or the seconds I wasted thinking something was wrong with my stethoscope when really baby had no heart beat.) When the mama herself was still in such fresh distress and her baby was fighting for his life, it was important that I support her, let her talk about it as she wanted to, and tried to help her have hope. I was able to process a lot of my own trauma with my labor nurses and also with our own pamamidwife who listened to me cry electronically for a while. Over the years, this friend/client and I have been able to talk in much more detail over time and process a lot together, and it's been helpful and healing for us both, but early on I think it was important for me not to dump any extra trauma on her.
Luckily, I also got to attend her next birth, which was gentle, lovely, and healing for both of us.

jenmidwife2b - keep in mind that this may not be the worst thing this doula ever witnesses. Hopefully it will be, but if you do birth work long enough something bad happens. It sounds like perhaps this all turned out well in the end - but tragedies do happen. I've been blessed to attend a lot of beautiful peaceful births, but every so often birth is unpredictable and wild and it's important to remember that and acknowledge it with some part of your brain.

[homewithtwinsmama]

At my last birth, my own second twin died. My midwife was with me (at the hosp due to extreme prematurity) and after my baby came home I didn't think I could ever feel safe around birth again. My midwife insisted I come assist her at a birth of twins just a couple months later (it just so happened to be someone literally in my neighborhood and a single mama who needed the support). I went and it was a beautiful healing birth for me and I jumped back in with a full heart and feeling safe again.

Another friend of mine on the CPM track had a baby die at a birth with her preceptors. Her preceptors forced her to come against her will to several births in quick succession because she was literally about to quit for good. Then she came down to our area and we had my midwife and another doula and I go through every detail of the birth with the three of us and we helped her process it (me helping with the helping mama grieve part). And now she is a full fledged CPM. Wiser and stronger for it. You will be too!

[homewithtwinsmama]

Originally Posted by arimama

Ugh I just talked to the dad to set up a PP visit and he expressed to me that they just want to move on and just not think about what happened. They actually deleated the birth pics and are upset that I took them. I stopped taking them when things went downhill, obviously, but they didnt want any reminders of the birth at all.

How am I supposed to help them process if they dont want to? Heck how can I help them if I cant process it myself?

On top of it all I feel so terrible about taking pictures. They had told me that they didnt want birth pics, just pictures after the baby was born. But in the pushing stage the midwife told me to take pictures. I said they didnt want any birth pics, and she said "whatever, they can delete them if they want".
I should have just listened to my clients wishes.
This whole thing is such a crap storm.

The midwife was right. One of my hugest regrets is that I have no decent pictures of my darling Leighanna. She is dead and I will never get those precious few hours back. The one picture I had of she and her twin together got lost by the NICU for 6 weeks (miraculously showed up in the Chaplains bible!!!!! PTL. I was so happy to have just that one picture for my surviving twin of the two of them together). Traumatized parents don't know what they want or will need to help get through the coming months. The midwives were smart. But, given what they said about not wanting pics, maybe you should have put the pictures away for a long time and asked the family later how they felt about it. Someday you may hear how much they regret not having kept them.

[MsBlack]

I have to disagree. despite your experience around photos. The mw was wrong to give the doula instructions superceding the instructions of the parents (who were in no position to argue at that time). This is why it is important for doula and mw to be in good comm, and to have clear boundaries concerning the role of each. They both have to understand that the PARENTS are in charge!

arimama--my heart goes out to you, this is so hard. I will reiterate 2 points already made here: one, your experience is different than the parents experience....you can offer your support in their processing, but if they refuse it now, maybe it will take some time, or maybe it will never happen but that is not about you in any way. It is only about their needs. And 2, you definitely need to seek your own healing, support for YOU in your grieving and healing from such a difficult birth. I am so familiar with that dread of ever going near to the birthing room again....and yet, any who would help women at birth must learn to cope with disaster even unto death. And it is only by feeling what you feel now, and gradually moving through that, that you will be able to embrace ALL of what birth is/can be, and become the most able to provide loving support.

My own sense of this for me was that I had to 'swallow' (not suppress, but fully take in) and eventually digest certain very fearsome, painful experiences ... and in doing so I became bigger, big enough to peacefully embody all of the potentials, and to serve birth all the better in it's many faces and phases. On one hand, I think my heart is more open, my emotional self even more engaged in this work than before. On the other hand, I think I will never again experience feelings so very sharp and difficult, having now come through certain things...I am more at peace now with the reality that with birth always comes the possibility of difficulty and death--that is just the way it is. Of course, continuing to move through, and attending more births despite my fears following difficulties, I also have been reminded that most often, birth is indeed joyful.

sending you healing thoughts and prayers!

[mwherbs]

you might be able to take some food by or stop by and offer to do some work/errands --

parents have their own grief and worries and you can listen and at times cry with them but I would not use them as a sounding board for my own distress

I think that the hardest thing to do at an emergency is to observe-- if you have something to do it lessens the fear in the moment, it will hit you afterward but not as much at the time. We had a resuscitation recently good heart tones- not a long labor at crowning we couldn't get a good count- this baby had not only the regular cord around the neck but a holster type wrap as well and I am sure the distress we were dealing with had to do with the arm and body pinching off the cord and the interplay with this particular baby's nervous system- we even did a blood sugar afterwards and it was fine -- but in the moment the heart beat was low low low, and the baby was floppy no breathing efforts- I rarely see this level of distress it is in that 1% now I have more often done, stimulation and puffs and babies respond quicker so although there is no guarantee I won't have another full on resuscitation any time soon it is unlikely, and with this one we did not have a hemorrhage so whew that was a relief - your post was timely for me --
now you have seen some of the hardest parts of our work, and it really doesn't feel good to be that close to death , yep it is really painful and scary and humbling and why we are there- yes we are there for the tricks we know to keep birth flowing and comfort the parents and most births that is all that is needed from us thank goodness so you can take heart in that , probably the more common things you will see again is hemorrhage, and shoulder dystocia, and this is why we end up discussing these topics passionately at times - take care

[cfiddlinmama]

arimama - I'm so sorry for the trauma all around. That sounds like such a scary experience. Thank you for sharing, everyone. This has been an extremely important and informative thread.