2nd birth as a doula.. some insight?

  1. I just wanted to share my second birth experience as a new doula, I'm doubting whether I am strong enough for this..

    My client was scheduled for induction this morning (41.1 weeks) but called me at midnight to say they were at the hospital and just were getting admitted. She had a previous c-section (CPD) so this was a VBAC, she really wanted a natural childbirth.

    Basically she dialated so well, was at 10 cm at 4:30am without any pain meds. Pushed for 2 hours and the baby only was at spines/+1... the head doc came in and said "c-section". She cried so hard and I just couldn't help it either.. "so much work for nothing" she says.. I told her she is such a strong woman, it's an amazing thing what she did and that this isn't something she can help. I really do wish they had let her push in a squatting position, but the docs know. It's not that her pelvis was small but that a bone was funny and baby wouldn't get past it. (??)

    Anyways, she had an epidural to get ready for the section, and all the sudden babe's heartrate started dropping (whats the medical term for this? hyposomething?).. nurse started shaking and sternly told me to hit the nurse call button... baby heartrate at 60 now.. I just started crying inside. I felt like I was watching a baby die - we immediately turned her on her other side and no heart tones, I thought JESUS THIS IS RIDICULOUS!! I tried to stay strong for her. 9 people were soon in the room and baby's heartones came back up.. 130s.. everyone left. What the heck was that?! What an intense experience, I'm still shaking!!

    Her husband had left just after the epidural so he missed all that and thank goodness! But, she had her section and is feeling better than with her last section - and baby is doing well. He is soo cute. I was so amazed to see him and that he was alright.

    I tried to make the story as short as possible but oh my god, I am so drained. I got home about noon and slept til 7pm. And I want to be a L&D nurse!?!?! AM I CRAZY!?!
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  2. 13 Comments

  3. by   fergus51
    Some days are more difficult than others in L&D. I find for me, the most important thing to focus on in a case like this is the fact that you have a healthy baby and mother at the end.
  4. by   GailWHNP
    Give yourself a few more births. It often takes experience before one feels comfortable questioning decisions or acting as the woman's advocate. Ask questions, too. I absolutely love it when anyone wants to know what's going on! Then perhaps you would have found out Mom became hypotensive after receiving the epidural (common reaction) . . . Mom gets hypotensive, baby gets bradycardic. When you attend more births, you'll all see that nurses rush into the room when baby's heart rate is low and then leave when it gets back to normal. You'll get more comfortable and familiar, so don't quit, okay?
    Gail
  5. by   shay
    Ditto what Gail said. Epidurals cause a drop in blood pressure, which causes a sudden decrease in blood flow to the baby in utero. Blood flow to the placenta is how the baby gets oxygen, so a decrease in oxygen causes the baby's heart rate to drop in response. Turning mom on her side gets her off the superior vena cava, which is a major blood vessel that supplies blood to the uterus. Less compression of the vena cava increases (most of the time) blood flow to the uterus and the baby recovers as mom's bp recovers.

    When a baby drops it's hr, everyone rushes in, like Gail said, and gets 'ready' for a stat c-section. If the baby recovers, okay. We all breathe a sigh of relief and resume our business. It's not that they were being careless, that was just sorta the standard m.o. when you get fetal bradycardia.

    Yes, it's scary the first time it happens. I still get way stressed when we have to code a baby. It's normal. You get that huge adrenaline rush, then you 'crash' afterward. Please don't let this scare you away. You seem very dedicated. Hang in there....okay?
  6. by   Natalieboo
    Okay, I'm definately hanging in there! Thank you all sooo much for your replies, that's it bradycardia, that's what she kept yelling over the intercom thing. I kept trying to think back of the term.. and:

    Epidurals cause a drop in blood pressure, which causes a sudden decrease in blood flow to the baby in utero. Blood flow to the placenta is how the baby gets oxygen, so a decrease in oxygen causes the baby's heart rate to drop in response. Turning mom on her side gets her off the superior vena cava, which is a major blood vessel that supplies blood to the uterus. Less compression of the vena cava increases (most of the time) blood flow to the uterus and the baby recovers as mom's bp recovers.
    That sounds like exactly what happened. Looking back and replaying everything in my mind I really think that's what happened. The anesthesiologist came back in and talked to my client, saying she doesn't want to think she did that to her but it may have..

    I was just REALLY tired and worn when I got home yesterday, but today I feel VERY ready for my next 3 clients!! Did I mention I am providing my doula services for FREE? But I am loving all the experience.. and with all of your help to help me process everything, I feel MUCH better about stuff. Thanks!!
  7. by   Dayray
    First let me commend you on becoming a doula. Often doctors and even nurse's get so busy they forget that this is (or should be) a very happy and exciting time for families. Doctors also frequently talk in jargon and if the nurse is too busy to explain everything patients often have no idea what is happening to them.

    I just started crying inside. I felt like I was watching a baby die
    You shouldn't feel bad for "crying inside" or begin afraid for your client and her baby. That's what makes a good Nurse/Doula. You should never lose touch with your feelings. I agree with the other post that said to give your self a few more births. With experience you will learn to temper your emotions with judgment and channel them in a way that will help your patient threw the scary/ sad parts. Even though you might feel sad (sometimes very sad) when things go wrong you will walk away begin glad you were there to help your client.

    [QUOTE]I really do wish they had let her push in a squatting position[/QUOTE

    Over time you will learn enough about delivery to know when to stand up to doctors and make them do what's best for your client. You'll also learn the right way to go about this and maintain a good relationship with them.

    Don't give up! You sound like your going to be a great Doula/ Nurse!!
    Last edit by Dayray on Jul 12, '02
  8. by   mark_LD_RN
    hang in there it gets better and you will get more confidence as it goes on. Don't feel bad for crying on the inside. i do it often, I even cry on the outside a lot it is not a sign of weakness but of caring. in this area caring is what it is all about.


    just a question for you? why wouldn't they let her try a squatting position. i get my patients in all kinds of positions, go with what ever works.
  9. by   shay
    Originally posted by mark_LD_RN
    just a question for you? why wouldn't they let her try a squatting position. i get my patients in all kinds of positions, go with what ever works.
    I'll bet it was either one of two things:

    1. Her legs were too numb from a whopper epidural and it was a physical impossibility for her to squat.

    2. The nurses and/or docs at that hospital ASSumed that a woman with an epidural couldn't/shouldn't squat to push, and refused to even let her try.

    Tiffany, I've let tons of my epidural patients squat if they wanted to.
  10. by   mark_LD_RN
    you are probably right. patient probably had epidural noodle leg syndrome,
    Last edit by mark_LD_RN on Jul 14, '02
  11. by   Natalieboo
    Oh no no.. she didn't have an epidural until AFTER the head doc came in and said "c-section". So they gave her an epidural to get ready for the section. BUT before saying "c-section" I just cannot come to terms as to why he didn't say let's change position or something. I mean, I asked the nurse twice if she thought a squat would help and she said no because "Jane" is a good pusher but that it's just not going to work out for her (???).

    I, as a doula, will NOT come between a patient and medical staff but it HURTS so bad to see that the nurse wouldn't even be willing to have her try a different position. I just assumed that because what the nurse said, that she really knew that her pubic bone or whatever bone it was, was truely in the way -- cause I mean she is doing the vag exam not me. I dunno, this is why I want to be a nurse! So I can do *more* to help patients..
  12. by   mark_LD_RN
    that is a shame, but a lot of times docs and nurses just aren't willing to try different things or just dont believe they work. I on the other hand will try any position that i can think of that might help, or any techniques that may help. there are lots of things to learn , i know a lot and there is an awfull lot more i need to learn.it is a continuous learning process and to be the best at what you do you need to seek out learning opportunities where ever and when ever you can.
  13. by   Natalieboo
    Mark, can I come work with you?? :chuckle
  14. by   shay
    Tiffany, sounds like the nurse was just unaccustomed to allowing pts to squat. I've seen nurses freaked out by stuff like the idea of intermittent (or NO) fetal monitoring, or laboring in the tub.


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