True Story of A Good Advocate
Reba is one of the best advocates for health care that I’ve ever met. At age 41, Reba was delighted to be pregnant and savored the ‘growing’ experience. Yet people’s unsolicited advice and warnings bothered her.
At four and a half months, her neighbor said “You’re going to get an epidural, right?” Reba didn’t even know what an epidural was, so she ignored the question. At 7 ½ months, an ultrasound technician non-chalantly remarked, “Looks like your baby is pretty big. You might need a cesarean.” This remark was very upsetting. Why were people telling her this now? She wanted to experience labor and birth. When we met a few weeks later, she was still mulling over these remarks.
My advice was to simplify it to a few questions and work from there. This often helps when emotions and information become overwhelming or confusing. So I asked her the first question.
1. What’s working here? She was happily, healthfully pregnant and all was well.
2. What happens if we wait? She still had four weeks, at least, of pregnancy. No one had decided anything about cesarean, certainly not her.
3. What were her alternatives? First of all, a big baby is a healthy baby and an ultrasound is only an estimate. Secondly, she could discuss this with her midwife who would have a lot more insight into her pregnancy than the ultrasound technician.
Reviewing these questions gave her a structure to review her emotions. “Okay”, she said, “I can deal with this. I’ll get a second opinion.” That was the beginning of the firm and focused advocacy Reba continued to do throughout her labor.
Happily into her last month of pregnancy, her midwife was expressing concern about going beyond her due date. What’s working here? Reba asked. She and her baby were doing fine, there was nothing to indicate a problem, incipient or otherwise. Reba didn’t understand the rationale for a possible induction and so continued being pregnant.
Eight days past her due date, her waters broke though she wasn’t having any contractions. Nonetheless, it was a sign of labor and she was delighted. Yet, she was encouraged to be induced to get labor going.
What’s working here? Temperature, blood pressure, baby kicking…. all were okay. Her body was getting ready and it had only been a few hours.
What happens if we wait? The attending midwife and doctor reviewed statistics about rate of infection and subsequent harm. She confirmed that the rate of infection goes up with the number of internal exams. The doctor and midwife agreed. “Okay”, she said. “No more exams. I’ll take my temperature to make sure it’s okay and I’ll be healthy while I wait”. That was a well-reasoned, valid alternative.
In a few hours, labor did start. Mild, slow, though it was enough to say it was labor. For the next several hours, the question kept coming up about augmenting with pitocin to get things going. She repeatedly asked what’s working here, what happens if we wait (an hour, a day) and what were her alternatives? Going home to labor was one option, though it wasn’t chosen.
Reba labored for the whole day and night making slow progress. Not being on medication, she enjoyed the chocolate milkshakes that her partner brought to fortify her. In the morning, her partner took a shower and changed his clothes. Reba refreshed herself, changed into a pinstriped nightshirt and put on her glasses.
She looked very lawyerly sitting in a chair while the doctor promoted Pitocin augmentation. Reba, while pausing to have contractions, clearly expressed her dismay. “These continued suggestions undermine the work I am doing and contradict your stated respect for my choices.” Pause for contraction.
To her credit, the doctor apologized and she and Reba came to an agreement. They both understood the potential risks of a prolonged (vs. just long) labor and the potential risks of augmentation to ‘keep things moving”. They would not remind her about pitocin unless she asked or it was medically urgent.
Reba had another chocolate milkshake, told her partner to take a nap and continued to labor. We complemented her on her skills as a ‘labor lawyer’.
There was another shift change and another clothing change as she patiently, slowly progressed. Eventually, she was fully dilated and then ready to push. In the early evening, two days after the first signs of labor, their healthy, alert, good-sized baby boy was born. Happy Birth Day.
Afterwards, sitting in their bedroom with her while she nursed, we reviewed her experience. I asked her what was guiding her as she made her decisions.
“I just knew he was okay” Reba said. And he was. Her gut instincts, her heart and her intelligent advocacy guided her. In labor, it’s a lot more about gut instincts and heart, though it does help to have basic advocacy skills.
Who said women in labor don’t know what they want? From my experience, and Reba’s too, women know exactly what they want, and when they want it. We do best to listen.