Nikki Lee Health

Liz works as a doula, a professional labor assistant. She says, “I walk a fine line when I work in a hospital. I am there for the birth woman and her partner and family. And, I am always under scrutiny by the hospital staff. Sometimes I am welcomed by the nurses as they are so busy attending to charts and machines sthat it is impossible for them to be personal with all the women under their care. They are the foot soldiers, doing nothing without direct orders from their commanders, the doctors. I have noticed that any kind of comfort in the way of a hug or even a tender word is frowned upon.Occasionally there is a nurse that believes that birth is natural ,and is eager to help. However, if the labor is long, she will be replaced when the shift changes. When I am with a mother who gives birth with no medication or intervention, there is usually a large audience of staff who are in awe. Birth without drugs is far from the norm in the hospital.”

After Booth Maternity Hospital closed, the first casualty of the corporatization of medicine in Philadelphia,  I worked at Rolling Hill Hospital in maternity for 6 days,  resigning before I had finished my orientation because the care I was expected to give violated my integrity. On my first day of orientation, I was assigned to care for a woman who had been dealing with infertility. She had conceived, but unfortunately, it was a tubal pregnancy that became emergency surgery when her tube burst. She had had to have that shattered tube removed. I reached out to comfort her in her grief. I asked my preceptor what community groups were available for referral, so that this broken-hearted mother could receive support when she went home. My preceptor told me, “Now don’t do anything like that. If her doctor wants her to have anything like that, he will make the referral himself.”

I was assigned to labor and delivery for two orientation days.. There were four cesarean sections done in a row; none were emergencies. I became silenced, fumbling and numb with horror and rage. One vaginal delivery I attended was shocking because the doctor used his hands like forceps to pull the baby out of the screaming woman. The nurse immediately took the baby away, laid it on a warming table and used a long slender tube to probe down the baby’s nostrils and suck out what ever was there, including the baby’s air. I asked why the baby was being deeply suctioned as the baby had been in no distress. I was told off, brusquely, “Now this isn’t Booth. This is how we do things here.”

When I spent a day in the newborn nursery, there were 14 babies there. At Booth, when the nurses gave report to the next shift coming on, we would hold a baby in our lap, if there were any in the nursery, as they were usually with their mothers. When report was given at Rolling Hill, most of the babies in the nursery were crying. I could not listen to report because all I could hear was babies crying. I said something about it to my preceptor who said, “Oh, they are all right, they always do this” as she got up and shut the door to the nursery so that the sound was cut off.

When Roxanne when to midwifery school, she already had years of attending births behind her, having apprenticed with a British midwife. She became a nurse on the way to becoming a certified nurse-midwife, so that she could practice legally. She came to her hospital’s clinical obstetrical rotation with her eyes already open to how many unnecessary procedure are done and how much pain is caused to mothers and babies. She said, “We joked a lot in our family to get through the hard times. I would tell them, ‘I am off to the hospital again, to commit mayhem on women and babies.’ Many evenings, Roxanne would come home from nursing school and cry on the telephone to friends about what she did and saw. She said, “So much of the time I felt more like a perpetrator than a caregiver. In midwifery school, I was made to do three times as many episiotomies as the other students because they knew my philosophy about episiotomies. I would do them as carefully and thoughtfully as I could. I have a been a home-birth nurse midwife now for 20 years. In the 1,000+ births I have done, I have needed to do an episiotomy on 4 occasions. Each on of those women and I became especially boded because doing an episiotomy meant cutting into one of the most sensitive and intimate parts of their bodies.”

When Amy was a freshman in nursing college, nurses were standing up when a doctor entered the unit, and letting men in white coats get in the elevator first. Nurses called doctors “Doctor Last Name.” Doctors called nurses, “Amy.”

Dominique told her birth story at the childbirth class reunion. She had wanted an unmedicated birth. She described with amazement how nurses came into her labor room seven (7) times to ask if she was ready for her epidural. One nurse told her that the really good doctor at getting the epidural in easily was leaving the hospital soon, so she should really take advantage of his availability now. She said, “I figured that if they kept asking e, that I really needed it.” She surrendered her desire for an unmedicated birth and let them put the needle in her back.

Giraffa is a nurse in a busy inner-city hospital. Many of the women she works with are disadvantaged. They are substance abusers, prostitutes, minorities and teens. Their babies aren’t planned. Giraffa has had her hip replaced twice since she started working and walks with a limp; she takes analgesic for hip pain eery day. Her hip makes the work more difficult for her, yet she often volunteers to cover extra shifts. She says, “I am here to bless the babies. Sometimes I am the only person in the room to welcome that baby. I whisper in the baby’s ear, ‘Hello Baby. Welcome to this world.'”

(This story is not from the birth world, yet reflects an attitude taught to students that will manifest when they care for mothers in labor. )In my second year of nursing college, my patient was an old, old lady with a diagnosis of dementia. She weighed about 80 pounds, had poor personal hygiene and unkempt white hair that stuck out from her head in every direction. My job was to bathe her. I was encouraged to pick her up, despite her fighting and screaming (she tried to bite me), put her in the tub and forcefully wash her. I earned a good grade because I had taken charge, she needed a bath and was considered incapable of cooperating by virtue of the diagnosis that was her label. I was rewarded for being mean. Why wasn’t I taught way to enlist this patient’s involvement in her own care without committing assault?)

Teresa is a childbirth educator at a small hospital. She tells the following story. “A medical resident came up to me in the hall one day and wanted to talk to me about childbirth education. .iI was happy to talk with him because the doctors usually aren’t that interested in what I do. Come to find out, he wants me to teach more about epidurals in my classes because he needs practice using forceps.”

I’ve seen women hurt  as part of obstetrical training. The pretty, 3rd year resident, 6-months pregnant, was the one picked out of 7 residents (all male)  to do the autopsy on a 5-month old fetus that he died in utero. Why was she on the one picked? Why didn’t the chief resident think about the well-being of the pregnant resident?

Dory was listening to a baby’s heart rate with a Doptone, an ultrasonic fetoscope. She was surprised to hear the sound of a cheering crowd inside the laboring woman’s belly. The Doptone was malfunctioning, [picking up a baseball broadcast from the radio.

A new nurse was working in labor and delivery. After the first few days, the other nurses started telling her, “You’re so much like Maggie. You’ll have to meet Maggie.”  She wondered what it was about this Maggie that everyone kept saying the same thing. When Maggie got back from vacation, she learned what the others had meant. “They told me, ‘You are always in the patient’s rooms,talking to them.’ Maggie and I were the only two nurses on staff who like patient care.”

Nina was 4’10” tall, having her second baby in the hospital. She had the external fetal monitor belt on, two intravenous lines, and an internal lead in her vagina, screwed into her baby’s scalp. Her baby was staying up in Nina’s pelvis. After hearing whispers about a possible cesarean section (“Big baby. . . . small woman”)  I asked her doctor if Nina could get out of bed to squat. The order was written. I helped Nina out of bed, held all those belts and lines, and supported Nina as she squatted on the floor and pushed out a 10 pound baby.. After all the cleaning up and charting was done, the doctor told everyone that I had saved Nina from a cesarean section. I was thrilled at the recognition, and basked in the glory of a doctor’s public praise. It wasn’t until much later that I realized no one had even thought about NIna’s achievement.

Liz, a doula, tells of working with a mother who wanted to birth naturally, without medication. She labored through the night and into the next day. “We went to the hospital; after several hours, the nurse began to ask her when (not if) but when she wanted her epidural. The mother stated she wanted to give birth with no medication. The nurse sat her down and told her that it did not matter how her  baby came into the world; what really mattered was the years ahead of her as a mother. She said that the pain wasn’t worth the trouble as she would get the same baby whether she suffered or not. I reminded this mother of all her hopes and dreams for her birth, but in the end, she was convinced, and had the epidural. Labor shut down and she ended up with a cesarean section.”