So many questions..

SmilingBluEyes · Jun 20, 2005

You have your finger on the pulse of one of the biggest problems in many OB units today. Inconsistent training/teaching among staff regarding breastfeeding. I am so sorry all this happened to you. It sounds like a nightmare. It's a shame you were not visited by an LC (lactation consultant) and given straight and clear information about breastfeeding in the first days/weeks after birth.

True, a baby that big IS hungry. The way we do it where I am, is mom ALWAYS breastfeeds baby on demand, even if it's every hour or two. For babies over 4200 grams (9lb 2 oz) we have to monitor their blood sugars, as they tend to drop precipitously if not watched closely. AT NO TIME DO WE replace nursing with formula if we can possibly help it. We have mom nurse the baby first, for as long as baby will feed, then we supplement with a cup after feeding (if sugars are hovering between 40-45). If babies sugars stay above 45, we just allow breastfeeding on demand but no less than every 2-3 hours around the clock. Only in severe cases of hypoglycemia will we attempt to bottle feed or start an IV to elevate very low blood sugars.

I cannot speak on why the staff were not helpful in teaching you breastfeeding techniques. There is no acceptable "excuse" for this. I can imagine some "reasons", however. It would have a lot to do with adequate staffing (or not) in some cases. Some places staff poorly at night, and one nurse may have 5-6 couplets (that means 10-12 patients), or even more. So, if all moms are breastfeeding and just one or two have trouble, it may mean that nurse is spending hours just trying to help one breastfeeding couplet. If there are two or more having trouble, you can see how it gets to be a real problem.

It could also mean proper training of staff is severely lacking. Maybe the staff are not at all well-trained in helping nursing moms to get the basics down. That is a shame, but a fact in some places. I find hospitals that employ lactation consultants and have midwives on staff have better satisfaction rates for breastfeeding moms, as far as helping them on the "road to breastfeeding". Like I said, I am not excusing what happened to you, just explaining how it could happen.

Our LC calls each breastfeeding mom within 2 days of discharge to see how things are going. If the mom is having trouble Breastfeeding, she is invited in to visit the LC privately, to be observed nursing her baby, and have some 1 on 1 teaching done by the LC (who is VERY good). Follow up is so important. Each patient is also give her business card, lots of breastfeeding literature and the names of La Leche League chapters/leaders for the mom to get in touch for support and learning. Those first days are so critical yet so tough. The learning curve for mom and baby can be steep, even if baby is normal and healthy and delivery uncomplicated. I am so sorry you did not receive good support and consistent teaching for your nursing experience at the hospital.

I am also dismayed to read about your induction for labor being done without indication or informed consent on your part. I think that was unfair and stinks. Unfortunately, lots of doctors are inducing labor for many reasons, some of them due to plain convenience for them, but also, there is pressure from moms who are tired of being pregnant and "want it over with". You do not sound like one of them, however. I am sorry, I wish I could comment more about why they did this w/o your understanding or consent. It seems to me, you have had experiences that taught you what you want and do not want. This can empower you, really. I will explain how.....

There is a place I can direct you to go to discuss your negative breastfeeding and birthing experiences, anonymously if you choose. It's at http://www.ivillage.com. There, they have a negative birth experience board there where people "vent" about the things that went wrong that took joy from their birthing experiences. There is a lot of supportive and helpful commeraderie and help to be found there, if you choose.

Also, you may choose to send a letter to the hospital/unit manager discussing all the things you did here, expressing your dissatisfaction. You have every right to expect consistent, compassionate, timely and helpful nursing care and breastfeeding support. I am truly sorry you did not get these things in this experience.

Maybe next time will be different. You can have a say in it, by doing a birth plan that discusses how you want your birth experience to proceed (medical condition allowing) and the fact that NO nipples, pacifiers, etc be used for your breastfeeding baby. You can also outline your desire for help with nursing that first day or two---- telling them the first experience did not go well and you are set on breastfeeding your baby successfully. Ask them if there is an LC On staff and if so, ask to see him or her.

Also, if your health condition permits (you are low risk), see if you can get a midwife's care for the next pregnancy/delivery/post partum phase. Additionally, if you can afford, a doula is excellent help for labor and breastfeeding after birth. You would have a lot more "ammunition" in your "orificenal" just employing these two professionals, even in the same hospital. For info on doulas see: http://www.dona.org

I hope my post helps you a little bit. I am sorry I cannot satisfactorily answer for the less than stellar care you received. I just hope my suggestions empower you for the next experience, as well as help you decide what to do to help you work through the disappointments of this one. Good luck and best wishes.

Fiona59 · Jun 20, 2005

I've worked post-partum care in a major CANADIAN city. We no longer had a lactation consultant due to funding cutbacks. Our units policy was to assist the mum with care and feeding of the infant per Mums wishes, so inconsistent care is best taken up with the unit manager.

It was common practices for each nurse on the floor (RN or LPN) to have five mums and however many infants under her care (I remember once having five mums and seven babies due to twins).

In my health region the new family was visited within 24 hours of going home by a home care nurse who was there to assist with breast feeding and provide any referrals required.

Best thing you could do it send a letter to the hospital and let them know how you feel about your stay, name the nurses who were great and name those who were less than adequate. As to why you had the labour you did you'll have to discuss that with the doctor involved. I had a bad experience with my first and all I got out of the hospital was "we did what we felt best for you and your infant". Kind of the white coats closing ranks. I later found out that the OB that did the delivery had a horrible reputation and basically was working his way across Canada and never stayed longer than two years at any hospital....

I'll bet that your care plan was signed off on all the education and assistance areas....

babyktchr, BSN, RN · Jun 21, 2005

Post date inductions are not uncommon....unfortunately...as well as inductions for the dreaded tired of pregnancy, my aunt will be in town THIS week...and the ever so popular "potential for postdates" induction. Seems you were induced for postdates. Did they try to ripen that closed tight cervix at all? That would've been the plan there. I would love it if more patients were educated and could say to their doc...I want to go home...especially if the baby is well and you are also. This "oh well, you failed your induction, lets just get the baby out" thing is really getting old where I work. Your baby, though was big, and I would worry that if you went another week it would've been too big for you to have lady partslly.

The other posts were right on with the breastfeeding.

kellyo, LPN · Jun 21, 2005

You have your finger on the pulse of one of the biggest problems in many OB units today. Inconsistent training/teaching among staff regarding breastfeeding. I am so sorry all this happened to you. It sounds like a nightmare. It's a shame you were not visited by an LC (lactation consultant) and given straight and clear information about breastfeeding in the first days/weeks after birth.
I'm doing clinicals at a local community hospital, and I am amazed at the lack of breastfeeding education. Classmates are in facilities that champion breastfeeding and I feel like I'm missing out on a lot. That's just a small part of my experience, but I won't bore all of you. Tomorrow's my last clinical day, and I've yet to see a lady partsl birth... If I don't see one, I want my tuition money back Hee Hee...

Cherry2 · Jun 21, 2005

""Did they try to ripen that closed tight cervix at all? ""

I was sent in for some monitoring on a wednesday- all was fine then, but was told they were inducing on saturday if nothing had happened. They didn't do anything but the cytotec (it was a little pill they put in lady partslly- I am almost certain that it was cytotec, but may be wrong there. As I said, I am not a nurse yet so I'm not positive) That was all that was done. The first was placed at 11am saturday morning. I was sent home and told to come back at 5pm so they could check me- or before if contractions started. I came back at five, was told I was at 2cm, They placed another. They put me on the monitors until ten, still nothing happened. They gave me a shot of something (the name escapes me now, but it was for pain, though to be honest I wasn't having a lot) I slept all night on the L&D ward and at 9am they placed another. That was all that was done. All that morning they kept putting me on the moniters and saying he wasn't moving around enough, so I did the usually laps around the hospital, they had me eat toast with jam, whatever they could think of to see if he would move more. But 2:30/3pm it was decided that he needed to come out and so he was born at 5:02.

My recovery was very easy and at the time, having a c-section wasn't a big deal b/c they led me to believe that it was and emergency. It wasn't until he was around 5 months that I started to research doing VBAC, and that brought up a lot of questions on the way things are done and why. I then started to question the TRUE reasons for mine. I was hoping that by asking here some of you may have opinions on this sort of thing and maybe be able to explain what was happening.

My doctor, whom I loved, was on shift the day my induction was scheduled but not the next day. That doctor was actually the one who delivered me 23 years before. Both doctors were so nice, I felt that they were really doing what needed to be done, but now am not so sure.

Anyway, thanks everyone for replying!

pebbles1977 · Jun 21, 2005

Well, I hate to speculate when I don't exactly know your situation, but from my experience on L&D, MDs get a bit frustrated when the start something and it's not working. Then again, the "baby's not moving as much" thing might be something to look into. Maybe they meant the heart rate was dropping? Either way, you have every right as a patient to get a copy of your medical records, and I would recommend that. It could set your mind at ease and also give you something to study and consider while you pursue your nursing career. Now, most institutions that I know require a few hoops to jump through to get the records, but you should have them. You should NOT even have to give them a reason why, just you want them. Look at the nurses' notes and see what was going on.

I'm glad everything turned out ok in the end, but you need some closure and answers. My gut says the FHR dropped, in order for them to call and emergent C/S, but who knows? Go find out.

Dayray, RN · Jun 23, 2005

I'll offer a possible explanation:

PLEASE PLEASE realize that this is only an educated guess and only using the information you have given.

First let me say that care varies widely from area to area, hospital to hospital and practitioner to practitioner. That being said it sounds to me that your doctors did what they thought was right for you.

Induction at 41 weeks is common. The reason for this is that placentas are made to work for 38 to 40 weeks. Your placenta feeds and breathes for your baby. It starts out with about twice the capacity necessary to feed and breath for your baby. Around 34-36 weeks it starts to get old and the capacity is lessened. At some point it no longer works well enough to give your baby all the nutrients they need. It is true that it may have been okay to let you stay pregnant longer but their is no way for your doctor to know exactly when your placenta will lose the capacity to adequately feed and breath for your baby. So the choice to induce your labor was a prudent one. Your doctor did this to stay on the safe side, sure you MIGHT have been okay to go longer but you might not have and they didn't want to take that chance with your baby. The fact that your labor didn't start doesn't necessarily mean that your baby wasn't ready. What starts labor isn't completely understood. Babies do have some part in starting labor but it is mostly your body that initiates it.

Your induction sounds fairly normal. I'm guessing that you delivered at a smaller hospital because the chooses made are consistent with that.

Someone had asked if they had tried to ripen your cervix. The cytotec you received was used to ripen your cervix. Ripening means, thinning and softening your cervix (getting it ready to dilate with contractions). In your case it did ripen your cervix and even helped you to dilate a bit. When you were 2 cm your cervix was ready for pitocin (it would have dilated with contractions caused by pitocin). They choose to give you medication to help you sleep rather then pitocin, I'm guessing this is because they didn't have the staff to adequately care for a patient on pitocin at night. At smaller hospitals it's better to run pitocin during the day because the doctors are closer if something goes wrong, there are more nurses and many don't have in house Anathesia at night so this was another safe decision.

In the mourning they put you on the monitor and were probably planning to give you pitocin to get you into labor. Because they let you walk I assume that your monitor tracing wasn't awful just not reassuring. They would have wanted your tracing to be reassuring before adding the extra stress of contractions on your baby. They must have not been to worried about your baby at that point or they wouldn't have let you walk. It sounds like they just weren't reassured enough to place extra stress on your baby by giving you pitocin.

After waiting a long time for your baby to become reactive and it not happening they were between a rock and a hard place. They couldn't safely give you pitocin and they couldn't send you home when your baby wasn't reactive. Here again your doctor choose to stay on the safe side, sure you may have been okay going home but they couldn't be sure. A non-reassuring tracing can mean that the baby isn't getting enough oxygen, it can also mean nothing but your doctor couldn't be sure. If they had sent you home with a non-reassuring strip this would have been grossly negligent.

At a larger facility you might have been given a test on pitocin to see if your baby would tolerate contraction but at a smaller facility if something had gone wrong during the test it could take too long to organize an emergency C- section. So it sounds to me that they made the only safe choose they had. That is to give you a C/S. They couldn't send you home, they couldn't give you pitocin so they had only one other chose.

There were allot of other things they could have done but none of them were as safe as what they did.

As for the breast-feeding, I very sorry that this went so badly for you. I think you have gotten some good explanation/information from other posters so ill just add one thought on this.

The recommendations on breastfeeding have radically changed over time. There was time when formula was favored over breast milk and a time when a combination was recommended. Current research is clearly supportive of breastfeeding over formula and that certainly seems most logical. Still many older nurses were taught that babies need formula and even though current research discounts this, they have spent years fretting over feeding schedules and cant see past the way they were taught. This is bad because they should change the way they do things but in their eyes they probably were trying to take good care of your baby.

I suggest that you ask your doctor about these things. Try to do it in as non-accusatory fashion as you can and give them the benefit of the doubt until you know all the facts. If you sound angry or as though you think they did wrong they might clam up for fear of being sued. If you just explain to them that you don't understand they should be willing to talk with you.

Lastly, As I tell my patients: It's okay to grieve over loss of the birth experience you wanted. Most little girls grow up dreaming of what it will be like to be a mother. None of them grow up dreaming of a C/S. Still even though C-sections aren't as fulfilling as a lady partsl birth (for those that want one) they are good things when used to improve the out come for moms and babies.

If you have other questions post them and please let me know if I was right about it being a smaller hospital.

Cherry2 · Jun 23, 2005

Thank you fpr your post. Alot of what you said is what I had initially thought might have happened (although some I didn't realize might have been due to hospital size or staffing) As I said, at the time I didn't care what happened, I wanted him safe, and even now I still love the doctors and nurses I had. They were all great and that is why I have hesitated to ask about what happened. I am not angry about what happened- I just want to know why. With your explaination though, I am almost positive that is what went on.

I think part of my problem was that a few months after my son's birth I heard a lot about unnecessary c-sections, and inductions being a main cause etc, etc, and that made me forget what I had assumed all along and then figure something was done wrong, you know? But hearing you explain helps me relax. I still am hoping for a VBAC next time- and still doing what I can to learn about them, in the hopes that I will be allowed to have one though! Thanks again!

SmilingBluEyes · Jun 23, 2005

It's unfortunate but, in the USA, anyhow, it's becoming increasingly difficult to find hospitals that allow VBAC. (legal issues are always at the forefront here). In Canada, it may be very different. Find out where they(VBAC-supportive hospitals and staff) are in your area before you get pregnant. And then find a doctor who is very supportive of your choice to VBAC---you need them on your side. (just because a hospital allows VBAC does not mean a doctor is "for this" him or herself).

Also remember, informed consent is supposed to be just that, INFORMED. It seems to me you had a lot of questions on your mind during the whole process. Most women want desperately to do what is "best" for their babies and are fearful of asking "too many questions", thinking the doctor or nurse "must know best". You have every right to know what exactly is going on at every juncture and the rationale for every intervention. You should be asking those questions when they come up----it's your right.

The others said it well; inductions for labor beyond 40-41 weeks are very common and not unwarranted in many cases. Placental functioning often decreases rapidly after 40 weeks, and also, macrosomia (large baby) is common and risks arise for them, as well. But it seems your doctor did not really discuss the "whys" of the whole process very well---so the issue of informed consent (or lack of it) originally concerned me. I always ask my patients, "do you know what we are going to be doing today and why"? IF they don't, then we have a problem. And we DO discuss it before I start anything.

Did the information about breastfeeding help you at all? You brought up several issues, in your initial post, not just the issue of induction. A lot of good helpful advice was given you to help you sort through what happened and what to do "next time" to make the experience work better for you and your family.

You are not powerless. Educating yourself as you are doing is smart. So is being flexible. Make sure you know what hospitals allow VBAC and have Lactation consultants on staff. Go there. I bet your next experience will be a whole different thing.

Good luck.

Sleepy_Princess · Jun 25, 2005

I went through something similar two months ago. I had a "precautionary" induction at 37 weeks due to what was supposedly PIH. (I question this because my BPs were all below 140/90 and I never had protein in my urine.) I was put on bedrest for two days prior to the induction, but I wasn't given a chance to see if my body would respond to it. He didn't check my cervix to see if I was good candidate, and the baby's head was no where close to engaged. There was not a bed for me in the L&D unit the night before, so I couldn't have Cytotec... The whole thing seemed like a recipe for disaster.

Fast forward to the day of induction... We arrived at 7:30, and the nurse started the pit. The doc was supposed to be there at 8:00 to check me FOR THE FIRST TIME and rupture my membranes. He didn't show up until 10:30... When I was finally checked, my cervix was green and I was only a fingertip after two hours of pit. He came back a few hours later to check me again, and told me that he suspected my baby was very large and that I might need a C/S (this was the first time he had mentioned the size of my baby). When the anesthesiologist came in a few hours later, he asked me why I was being induced. After I told him, he made a little joke about needing to buy my doc a new blood pressure cuff. (My BP had been LOW all day, but my doc said it was because the bedrest was working. DUH!) I should have read the writing on the wall then!

Long story short, after 17 hours of pit., my uterus was saturated and no longer responding to it. I was 8cm and fully effaced when I was taken back for a C/S due to "failure to progress." :crying2: My "massive" baby turned out to be 6 lbs. 14oz. with a head measurement in the 10th percentile. She's 9 weeks old now in the care of a G.I. specialist because her digestive system was immature. She obviously needed those last few weeks... Needless to say, baby number two is going to be a VBAC with a midwife... (I would rather risk rupture than go through this again!) So, you're definitely not alone!

P.S. Let me stress that if this had been a serious situation, I would have happily gone through the induction and subsequent C/S without a single complaint. I understand the danger associated with pre-eclampsia, and I would never risk my child's life or my own. The doc chose to induce rather than try the bedrest, not because we were in any real danger, but because I was "far enough along and probably tired of being pregnant anyway." Sorry for the long rant.

JAHJF · Jun 25, 2005

I'm sorry the nurses weren't more helpful w/breastfeeding but as for your questions about your delivery you should be able to talk to your OB/GYN about your concerns about what happened and having trouble getting past it.

If not maybe a new MD is what you need.