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Ronnie Falcao, LM MS, a homebirth midwife in Mountain View, CA

Attending Best Friend's Horror Birth - Coincidentally Face Presentation

It has taken me three weeks to process my best friend's birth enough to write about it. This is a very long account and I don't come up with many answers that may soothe many souls out there but I needed to write it and I am grateful for this accepting group that may be able to offer more insight. If nothing else, I know a lot of you will understand my emotions and not judge me too crazy.

The mom and I grew up together and have had our children close together. She was one week over due with her fifth when her husband left for a four day business trip, I still haven't forgiven him. She called me the evening he left to say she thought she was in labor. I went over and sat with her for a while. She was having a lot of back labor which she is very afraid of as she has a bad back. She has had back labor with two other pregnancies and delivered one baby posterior. I suggested she come over and sit in our hot tub for a while as this may turn off the labor or ease the back labor.

We loaded her kids up and drove the 10 minutes to my home. The water felt good to her but within a half hour I could tell her labor wasn't turning off so I called her midwife who is also my midwife. She labored in the water for a couple of hours and wanted to get out. She labored another five hours on the futon with great support from all of us. Her back pain was getting much worse and she wasn't progressing much in her dilation. When the midwife asked her what she wanted to do, she said she wanted to go to the hospital and get an epidural. My heart sank, I wanted her to get back in the water but I have tried really hard not to bring my wants to her birth so I didn't push it.

We decided on the preferred hospital, the one with the doctor most accepting of homebirth who has treated both of us for GYN issues and drove the 40 minutes there. This drive was really painful for her who was having terrific back labor and moaning with each contraction. I was driving and all I could do was remind her to keep her moans low and her throat open, she did great. In the van with us were her mom, her 17 year old adopted daughter and her 16 year old adopted sister. Both girls were in the back with their hands over their ears trying to block out the moans. Her mom was a nervous wreck. She's a lot like my mom, accepting of our decisions to home birth our babies but VERY nervous about the whole, risky situation and wishing we would come to our senses and go to the hospital like "normal" women :-)

The midwife met us at the hospital, she needed to drive her car as the hospital is close to her home and she wouldn't have any way back to my house to get her car. She had notified the hospital of our impending arrival and they were ready for us, or so they thought.

There were three nurses on duty in labor and delivery and two immediately came in to "help". Within five minutes they had destroyed all the comfort, support and love she had received in the preceding 7 hours of her labor. Before she could even get into bed they insisted on placing a stretchy gauze tube around her belly to hold the monitors in place. Her belly was quite large and instead of pulling the tube out and up they just pulled it up during a contraction which caused her to yelp with pain. After getting her in bed they checked her and told her she was 8-9, the midwife had last checked her at 7cm so the ride had given her some progress. The nurse suggested she roll far over on her left side as this would encourage final dilation and that it was too late for an epidural. They couldn't pick up the baby's heart rate in this position so they insisted on turning her over to her right side which she didn't like so we turned her back as soon as they were out of the room for a minute. When they came back in they insisted on rolling her back over. It would have been funny if I hadn't been so mad.

The less experienced nurse asked the midwife if she would do the delivery or it she should set up for an OB delivery. The midwife and I kind of grinned at each other and the midwife told her she was a lay midwife and the hospital administration would probably not like it if she delivered the baby.

The other nurse came in and took a quick OB history. All heck broke loose when they found out she had had a c-section with her third baby. They started scurrying around, setting up for a crash section, an IV, neonatal rescue, etc. I knew we were up against all the odds of a normal vaginal delivery at this point. During one of the moments the staff was out of the room, I told her she could refuse the IV if she wanted but she had to be the one to say "no" as they wouldn't listen to us. She is deathly afraid of needles and I knew this would really blow her concentration. When the nurse came in and took her arm to start the IV she told her she didn't want it, the nurse told her it was doctor's orders and proceeded to swab her arm, I stepped closer to her and told the nurse that her patient was refusing. She stopped then and told her she would have to sign a waiver. Of course she will sign the waiver, just leave her alone. I just knew I was going to get kicked out of this hospital by this time, I could feel my temper ready to explode. These people had no clue how to support a laboring woman, they only knew how to interfere.

The midwife and I positioned ourselves on each side of her head and subtly refused to move when the nurses wanted to do something to her. About this time, 30 minutes after arrival, she needed to push. The midwife encouraged her to do what her body wanted. We said a lot of things to her but it was always out of earshot of the staff. She was doing great and was successfully pushing despite all the interference.

Then in walks the doctor. Not the doctor we had come for, not even one from his practice. This was the doctor with the highest section rate in his practice and his practice has the highest section rate in our whole state. I nearly died on the spot! I know I stood there with my mouth open for quite some time. I finally recovered and said hello to him. The midwife also introduced herself. The first words out of his mouth were directed at her, he nastily asked her just how many c-sections she does at home. I was speechless. He really has no clue. He wears his high section rate like a badge of honor and was chastising this wonderful midwife because she couldn't do them. I quickly retorted that she didn't need to do ANY sections at home and we like it that way. He totally ignored me and started giving orders to the nurses to break the bed down. As soon as the bottom half of the bed was gone he placed the stirrups, they were low stirrups but I was still aghast at how archaic this facility was. She objected to the stirrups but there was no other place to put her feet, the bed was gone. Her legs and abdomen were then covered in blue drapes with bars across her legs. Just before the doctor came in she had wanted to get into a hands and knees position, there was no way now, she was wrapped, tied and strapped.

I got the camera out and began filming over Dr. B's shoulder. Even with all the interference she was pushing this baby out, laying almost on her back with her legs up in the air. I was amazed at her strength. My next worry was whether Dr. B would cut her. He started pulling her perineum apart long before the head was ever crowning which made her shriek with pain. I wanted to hit him, instead I just got closer to his shoulder and started cheerleading right in his ear.

With very few pushes the head was crowning but it wasn't a head it was a face! The chin was out before the forehead. With a couple more pushes a big baby girl was born posterior and face presentation. I was amazed at my friend's strength and will power to deliver against all odds. Then it hit me that this is how most women in this hospital deliver and they never know any different. I was so angry.

We were all relieved that she didn't need any stitches. I know this was because she listened to the midwife's instructions and eased the head out despite no perineal support from dear Dr. B.

Then they took the baby and started torturing her. The nurse suctioned her deeply four times even though she got nothing out and the baby was breathing with no problems. She kept her on the warming table for 20 minutes of poking, prodding and suctioning. I wanted to take her and run. She was making the most soulful cry, it was almost talking. It still breaks my heart to remember it.

Finally, the staff left and she had her baby at her breast. I suggested she could leave now which she agreed to but her mom talked her into staying the rest of the night. She didn't get to leave in the morning though, because the baby was cold the first morning in the nursery. She kept her in her room after that and she was fine. Isn't it amazing what a great warmer a mom's chest makes? She left the next day and I finally was able to sleep. I felt like she had just escaped some evil dungeon.

I have spent the last three weeks running these events through my mind with a variety of "what ifs" and lots of questions. I think the thing that strikes me the hardest it that this facility, which I started my nursing career at, is still practicing obstetrics the same way they did 10 years ago. This is a medium sized hospital (350 beds) in the suburb of a large city. Why aren't women demanding better than this? I don't have an answer to that one and it's the question that bothers me the most.

I have also been bothered by how to process this birth. I have spent many nights unable to fall asleep because I was having conversations in my head with the staff or the doctor or the hospital administration, etc. When I asked the midwife how she handles it, her reply was to ask what we were supposed to learn from this situation and why that particular doctor came. She believes that whoever is at a birth is who is supposed to be there. I did learn that I can't recommend that hospital and I would never choose to go there myself. The midwife was more open about the doctor and felt he came in with a lot of curiosity. She also felt that he was impressed with her strength. I know the staff was, the nurses kept saying, they sure wouldn't do it without drugs and they couldn't believe anyone would. I also learned that these three nurses and one doctor have probably never seen a non-interfered-with birth. They are clueless about the power a good birth can give a woman. They believe birth to be a medical crisis that demands rescuing in order to provide a good outcome. We do not even speak the same language.

All is well now, baby is doing great and mom is also. This baby may be her last.