Posted by My OB said WHAT?!?.
Jul
21
Posted by My OB said WHAT?!?.
“…If You Would Have Just Got The Epidural, This Wouldn’t Hurt.”
“Well, if you would have just got the epidural, this wouldn’t hurt.” -OB who inserted her hand inside the mother’s uterus immediately after birth when she suspected a postpartum hemorrhage.
There are 42 comments to this post.
umm…wow, I haven’t ever had an epi but I can’t imagine that being anything but painful.
Let’s try this again, doc. How about, “this is going to be uncomfortable. I’m going to try to make it not so bad but still, brace yourself”
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Susan Reply:
July 21st, 2010 at 6:23 am (Quote)
Exactly! I had to have an internal check 5 days after birth b/c of an infection, and the doctor was super nice and warned me about it and then was also very compassionate in recommending treatment and such. Obviously wasn’t an ideal situation, but he made sure to minimise any pain to me.
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Rebecca’s suggested wording gets it right. First we explain what we are going to do and why. Then we make any suggetions as to how to make it better. “Brace yourself.” “Take a deep breath” whatever.
But does this make anybody else wonder how much damage the doctor does to the woman’s insides when there is no epidural in place and no need to worry about pain? I remember reading about studies when they were trying to identify any possible small ruptures following successful VBAC by sticking their hands in and feeling around. There was concern expressed by the author that these doctors were actually causing ruptures with their poking around. There must be a rupture somewhere let me just test over here… And these were cases where no epidural was in place. Imagine how much their scientific curiosity would push them to keep poking if nobody was screaming at them to stop. Just a thought.
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This is not mine but it happened to a friend of mine. She refused to come in for an induction and ended up giving birth outside the hospital by mistake. There was no bleeding by the actual birth and normal bleeding with the placenta. The female doc did a internal check of her previous scar from a cesarean done 9 yeas prior with a VBAC in between. Ever though my friend refused consent and there was no indication of hemorrhage.
Apparently this is “routine”. To punish patients who don’t listen.
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CCindy Reply:
July 21st, 2010 at 8:59 am (Quote)
In this case I don’t believe it is to punish the patients who don’t listen in most cases. I really do believe it started off as a way to determine if VBAC was truly safe after decades of once a cesearan always a cesearan. It started off as a way to check and make sure everything was good. But it has probably become routine because the people doing it forgot why they were doing it. It has been proven safe you can drop the routine checking of the scar now.
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Sarah Dorrance-Minch Reply:
July 21st, 2010 at 4:03 pm (Quote)
Since the OB on call lied and said she suspected “haemorrhage,” using that as her justification, in this case I’m inclined to believe the worst. An honest bumbler would have said, “Since you’re a VBAC, I need to check your scar to see if your uterus is intact.”
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THe Deranged Housewife Reply:
July 21st, 2010 at 7:00 pm (Quote)
My midwife never did this when I had a VBAC. I always thought there was some speculation as to whether it was really a reliable way to tell or not.
And what difference does it make, after you’ve already had the baby? If you experience a rupture after the baby’s born, you’re going to know it for sure.
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Sarah Dorrance-Minch Reply:
July 22nd, 2010 at 1:12 pm (Quote)
It doesn’t make sense, which is why midwives aren’t known for doing it. Funny thing, that.
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Sheva Reply:
July 21st, 2010 at 9:18 pm (Quote)
If it was routine I think they would have done it by her 1st VBAC with the practice. But they didn’t, and they did do it here. With no warning, no explanation, no medical indication, and she refused to stop when mom said to. I’m sorry, but that reeks of abuse, not routine. (Oh, and doc yelled at the mom for not coming in that morning to be induced, and she didn’t let me into the ward, so mom had no one with her. I snuck in anyhow.)
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CCindy Reply:
July 22nd, 2010 at 5:27 am (Quote)
Ooouch, Yes in your friend’s case this was abusive. But the procedure itself could be a hold over in most cases that VBAC moms should be aware is not beneficial to them and should be discussed with the OB in advance in order to hopefully avoid. Also, this firned of your shoulc be climbing all over somebody about trying to induce her. Induction is a big NO-NO with VBAC! I understand that augmentation is now permitted although you have to watch that you don’t over do it on that too because it can CAUSE rupture.
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This doctor is probably so used to numb women that she has never learned to treat women like they are actual people. She handles them roughly and when it causes damage it is attributed to the birth itself and not her.
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CCindy Reply:
July 22nd, 2010 at 5:40 am (Quote)
BINGO Number one problem Doctor NOT trained in natural childbirth. Number 2 problem) doctor forgot he was dealing with a human being.
And my first comment was supposed to say imagaine how much damage they do while fumbling around with a numb woman, and yes, I’m sure they just blame it on the birth. Because they have no idea how easy natural childbirth can be on the body. (NO I didn’t say it was easy to do, just easier to recover from than all the freaking complications from the interventions.)
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Sarah Dorrance-Minch had this to say,
Jul 21, 2010 @ 12:49 pm (Quote)
This is DEFINITELY a game of “Let’s Punish The Mother For Giving Birth Her Way Instead Of The Way WE Say Is Acceptable.”
As the OP mentioned above, the bleeding wasn’t shockingly bad. It was normal. No sign of haemorrhage to speak of.
Since I tend to be a bit of a bleeder, and I prefer to do everything my way if I can help it (obnoxious control freak that I am), I read up a little on ways to treat heavy postpartum bleeding and prevent shock.
Putting the baby on the breast and getting it to nurse, or failing that, using a breast pump to stimulate more oxytocin by stimulating milk letdown, is a relatively noninvasive method.
If the bleeding is a little more dramatic, there’s always better living through creative chemistry. Pitocin drips, methergine, ergot derivatives in general although ergot really isn’t preferred (but there are still ergot-based drugs, I’ve been on them for migraine control. Because LSD is synthesized from ergot, in theory it might do the trick, but realistically, no medical professional is crazy enough to try that.) I’m also including the “Hemhalt” tincture and other herbal remedies homebirthing midwives carry. Remember, just because plants are natural doesn’t mean they don’t “have chemicals.” Of course they have chemicals, as do we, and we wouldn’t use plants if we didn’t want their chemicals to interact with ours. 
Drugs used to treat shock from blood loss include epinephrine and (I kid you not) Sudafed (not pseudoephedrine, but phenylephrine or however you spell it – you know, “new formula” Sudafed as opposed to “classic” Sudafed. Either way, the dose is probably a lot higher than what you take for your sinuses.) Something that acts as a stimulant and a vasoconstrictor and acts fast. Obviously, getting the shocked patient into the “rescue position” and getting the patient hydrated are also important.
If bleeding is dramatic and the uterus seems boggy, the usual method (which is painful, but not as painful as an internal examination) is to firmly massage the uterus from the top, until it contracts. This is an external procedur. If the mother has pushed out her placenta and there is reason to suspect that there are retained fragments of the placenta in the uterus, a D&C will probably be performed – and it gets painful, so most of the time, pain meds are offered beforehand.
What the doctor above is doing is not standard procedure even in the case of a real haemorrhage. It is, in the context, purely punitive, right up there with the “husband stitch” after an episiotomy or bad tear, and not offering local anaesthesia for sewing up said tear or episiotomy. An internal manual examination of the uterus right after childbirth is excruciatingly painful, and the doctor would have known this.
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Emily Reply:
July 22nd, 2010 at 7:46 am (Quote)
actually, the algorithm for a postpartum hemorrhage goes something like this:
Pitocin
If uterus still boggy, external uterine massage and either more Pitocin or Methergine (we don’t use Hemabate much anymore)
If uterus still boggy, external uterine massage and 800-1000 mcg of Cytotec rectally
If uterus still boggy, bimanual uterine compression, which is what the doctor above is doing.
The most common cause of maternal mortality from childbirth is postpartum hemorrhage. That stat is worldwide. It doesn’t happen often here because we take the above measures to stop it. It’s hard to tell from the OP’s post what “immediately” was to her and what “immediately” was to the doctor. It’s possible that the doctor had run through the other steps of the algorithm already and still was not able to stop the bleeding. I completely agree that the doctor’s comment was horribly inappropriate.
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CCindy Reply:
July 22nd, 2010 at 9:15 am (Quote)
But it says suspected hemorrage. I would think if DOC had taken the time to run through the above algorithum that it would have been confirmed along the way somewhere. “Suspected” leaves doubt that DOC might be either making it up or paranoid and going through his/her own little ritual to prevent the occurance which he/she has seen before probably lost a patient and “will never let that happen again.”
BTW too much Pitocin can MAKE a uterus boggy. Beside you skipped put baby to breast. That should be number one!
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Sarah Dorrance-Minch Reply:
July 22nd, 2010 at 1:27 pm (Quote)
I think we may be looking at another difference between the midwifery model of care and the medical model of care. A homebirthing midwife isn’t going to automatically pull out a syringe or IV drip of Pitocin first thing, even if she works in a state where she has legal protection and is also allowed to carry such things with her. She’s going to try to get the uterus contracted by natural oxytocin (baby nursing, breast pump, etc) and herbs like blue cohosh alternating with black cohosh; if the gentler methods don’t work (and often they do, within half an hour or less, which is the time frame generally considered safe) then she’ll either pull out more aggressive modern synthetic medicines or transport the mother to the hospital for treatment, depending on whether she has things like Pitocin and methergine in her bag.
She certainly wouldn’t carry Cytotec. Ever.
Hospitals, on the other hand, treat shock a little more aggressively. If the bleeding is not only profuse but sudden, this can be a good thing, and a good indication for hospital transport right away rather than trying the gentler methods. If the bleeding is more of the slow, steady, worrisome seep variety, I can’t speak for anyone else, but if it were me bleeding, I’d want to try nursing my baby, eating some of my placenta if it were out, and taking Hemhalt tincture first.
And yes, too much Pit has been known to sometimes create boggy uteri.
Just for fun, I went through my husband’s old paramedic handbook last night (well, EMT, technically – he had EMT training when he went to police academy back in the late eighties. Yes, we’re that old.) Okay, mabe a wee bit of paranoia, because my Braxton-Hicks have reached the “OOF” phase and I’m waddling around in prodromal labour (and will probably continue to do so for the next week or two, knowing me, unless this labour is different) and since I bled like a stuck pig the last couple of times, I wanted to know how to treat shock just in case the baby beats the midwife by more than a few minutes or something. To wit: I have a Primatene inhaler for emergency use (it was cheaper than an epi-pen and didn’t require a prescription, and it’s much faster-acting than Bronchaid, which is epinephrine in pill form) and was curious to see if it would do any good or if it would be pointless. The information I got proved equivocal, but since epinephrine is a vasoconstrictor, it makes sense that it might stabilize me for a few minutes, although I’d need to warn the ER of what I’d just inhaled.
But I doubt I’d need it. The last time, I stopped bleeding when Kassandra started nursing. 
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Emily Reply:
July 22nd, 2010 at 2:05 pm (Quote)
Yep, too much Pitocin can make a uterus boggy. Absolutely.
A half hour is NOT a safe amount of time if a woman is pouring blood out of her vagina. I am talking about the above measures for an actual postpartum hemorrhage, not a slow trickle of blood, or a uterus that is boggy until you do some external massage and then it firms up nicely.
Midwives actually would, and do, carry Cytotec with them. It is extremely effective in stopping a postpartum hemorrhage. It is far different from using Cytotec on a pregnant uterus and Cytotec saves lives in other countries, as it doesn’t need to be refrigerated (like Methergine) or administered in a syringe (like Pitocin or Methergine).
I think we are talking about the management of 2 different types of bleeding here. For a slow trickle or a uterus that won’t stay completely firm, sure, latch the baby on and see what happens. For a woman who has no tone to her uterus and is literally hemorrhaging blood, the above algorithm can be effective at stopping the hemorrhage. Don’t know if you seen a woman bleeding like a faucet in front of you, but it’s rather scary.
If you stopped bleeding last time when your daughter latched, I probably would not term that a hemorrhage at all…sounds like nature worked just the way it was supposed to.
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Sarah Dorrance-Minch Reply:
July 22nd, 2010 at 3:40 pm (Quote)
My CPM does not carry Cytotec. Wouldn’t even touch the stuff. It’s one reason I hired her. I would never, EVER allow anyone who used Cytotec off-label anywhere near me.
According to her, I was not experiencing rapid bleeding, but I was bleeding heavily; and I remember from my second birth that I bled a little more than average as well. Since my daughter was eight weeks preterm and was whisked away from me before I could even reach out for her, nursing was not an option. I got a Pit drip. It did the job.
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CCindy Reply:
July 23rd, 2010 at 11:09 am (Quote)
I’m trying to stick to this situtaiton and the OP has not been identified even though similar situations have been described. But Emily do you really think it would says SUSPECTED HEMORRHAGE if the woman was bleeding like a faucet? You are doing what every other medical model practioner does and looking ahead and fearing the worst rather than dealing with the patient in front of you. You are the one who upped it from suspected to faucet. Ask yourself why you did that! There was no reason for this doctor to have his or her hand inside of this patient immediately after birth. There is no reason for you to be protecting or defend this doctor that yu don’t even know. I highly resent how quickly you are willing to say that the patient might not be remembering the passage of time correctly. I gaurentee you this mother will remember every detail of this birth until her dieing day and the doctor would have to look it up in her chart one week later.
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Sarah Dorrance-Minch Reply:
July 23rd, 2010 at 1:51 pm (Quote)
CCindy – I think it is this mentality you describe that makes health care providers, even the ones who pride themselves on being caring and “patient-centred” rather than convenience-obsessed, use drastic interventions so readily. (Patient?!? only if it’s a medical emergency, although I suppose a suspected emergency situation does count, if we’re going to remain on topic – thing is, in the hospital, EVERYONE is a patient, to the doctors, to the nurses, and to the CNMs with a medwife rather than a midwife outlook).
Always assume the worst. No birth is healthy until proven otherwise in retrospect.
Even in the instance of hospital transport, which might be for a nonemergency reason that simply is better off handled in a hospital rather than at home for whatever reason (let’s say I had opted to ask my midwife to take me to the ER to get my first degree tear stitched up, since three years ago she did not provide this service or carry viscous lidocaine like she does now). It MUST be assumed to be an emergency. It MUST!
And as long as we’re entertaining thoughts of emergency, why not allow the most drastic interventions known to be part of the bag of tricks, and pull them out at the slightest perceived threat?
Cytotec (the ulcer medication that turns cervixes to mush and stresses uteri to the breaking point, at least from what I’ve read in Dr Marsden Wagner’s writings, and I daresay I trust him more than I’d trust a staff nurse or typical OB these days)? Sure, no problem. In the words of one medwife, the only reason it has such a bad reputation is that it’s untested in clinical trial, and nobody wants to do a clinical trial because it’s cheap – $6 a pill – and the trial isn’t worth it, so why not just rely on anecdotal evidence?
Shoving your fist through the cervix to massage the womb from the inside? Why not use it as a procedure of first resort, rather than last? You never know, it MIGHT save a life! It’s heroic, drastic medicine. You shouldn’t ponce around with namby-pamby feel-good touchy-feely earthy-birthy hoohah like breast stimulation, black and blue cohosh tinctures and other herbs, or other old wives’ cures when there is a POSSIBLE THREATENED EMERGENCY at stake. And if it really is an emergency, sure, things like Pit drips and external uterine massage are tried and true, but they’re not the MOST drastic way to handle the situation, and what if the EMERGENCY SITUATION did not respond immediately to these effective yet less invasive measures? Somebody could DIE, and that means LAWSUIT.
Hmm. By that logic, all people who experience a deep cut while chopping up carrots should skip elevation and pressure points and direct pressure, and just got straight for the tourniquet. So what if that means amputating necrotized tissue? Meh. At least it saved a life!
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Emily Reply:
July 23rd, 2010 at 2:37 pm (Quote)
Well, if you are going to resent me for jumping to conclusions…please also resent Sarah, who I was responding to in the first place when she wrote, “If bleeding is dramatic and the uterus seems boggy, the usual method (which is painful, but not as painful as an internal examination) is to firmly massage the uterus from the top, until it contracts. This is an external procedur.” and “What the doctor above is doing is not standard procedure even in the case of a real haemorrhage.”
She is the one who brought up a “real” hemorrhage and I wanted to point out that, in fact, bimanual compression, is part of the algorithm for treating a real hemorrhage (what I would define as a woman pouring blood like a faucet).
I completely agree that there is no reason to do this immediately after a birth. I completely agree that women should be treated like individuals, like human beings, and based on their individual situation. I’m sorry that you feel I am being dismissive of the OP. I was trying to extrapolate from her situation, since that’s where the discussion seemed to be going, not dismiss what actually happened to her.
As far as Sarah’s post, Cytotec saves lives in 3rd world countries in terms of stopping postpartum hemorrhage. I’m sorry that you seem to not believe this. It’s use is contraindicated on a pregnant uterus (although I would say that the 25 mcg dose used for induction of labor is vastly different than the 800-1000 mcg used for a postpartum hemorrhage, but I have a feeling you will not agree with this), but there is no such contraindication for a nonpregnant uterus. There actually have been MANY clinical trials done on Cytotec, and the cost is much cheaper than $6/pill, another reason why it is so useful in 3rd world countries. I am by no means advocating its use for each and every pregnant woman or for that matter, each and every postpartum hemorrhage. However, I think that if it is needed, it’s extremely useful and can be life-saving.
I went through the entire algorithm to point out in the first place that, in general (aside from ridiculous docs, apparently), we don’t start with the most drastic measures. I’m not sure why you are twisting my words.
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CCindy Reply:
July 29th, 2010 at 1:00 pm (Quote)
You still skipped putting baby to breast in your algorithum. Wouldn’t it be nice if a medical professional reach for something natural rather than something out of a pill bottle?
You still dismissed the OP’s experience even if your intent was to deal with Sarah. She can go on sometimes!
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This happened to me with a 19+ week miscarriage. The placenta didn’t come right away and because the doc had to turn around from his drive home, he shoved his hand up my 18 year old insides and ripped it out. I swear he was right up to the elbow and I screamed at him “what are you doing?!?!?!?!” He was punishing me for miscarrying because he was almost home for the evening! WTF! He had a patient in crisis and left the hospital. Stupid @$$!
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Sarah Dorrance-Minch Reply:
July 21st, 2010 at 4:00 pm (Quote)
Holy crap. That could have CAUSED a haemorrhage.
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Alyson Miers Reply:
July 21st, 2010 at 4:18 pm (Quote)
That doctor should be tried for aggravated assault. He’s not a doctor, he’s a monster. I’m sorry you had to go through that.
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Well of course it hurt! That bonehead OB just fisted her to the hilt. Without anesthetics or little more than natural lube. That looked a lot like punishment to me.
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Sarah Dorrance-Minch Reply:
July 21st, 2010 at 3:59 pm (Quote)
Had that been the case, dear, s/he would have stopped before reaching the cervix. (I’m allowed to call him “dear.” That was my husband’s comment. )
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Lindsey Carr-Ruck had this to say,
Jul 21, 2010 @ 5:12 pm (Quote)
Well, Doc…I bet if your whole hand wasn’t just shoved into her hoohah…WAIT! A natural, unmedicated “birth” was her choice, not an unforeseen uterine attack. Explanation and perhaps an “I’m sorry, but this is going to be uncomfortable” would have helped. Maybe she would have been a bit more prepared for it.
BUT, prepped or not, the doc should have never put the blame on the momma when she experienced pain.
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I’m not pinking the link because while this SOUNDS like one of my submissions, the deal with me was that the nurse said this. I’d had a very pro-natural and supportive nurse until about 45 minutes before DS was born. A new nurse then came on duty, and while she was nice enough, you could tell she didn’t really understand why we were doing what we were doing (but to her credit, if we did ask for something, like the squat bar, she got it). After DS was born, and the placenta came out, so did a lot of blood. The nurse did really hard uterine massage, and that’s when she said, “If you’d had an epidural, this wouldn’t hurt so much.” I don’t think she meant to be cruel or unkind, more like “I wish you weren’t in pain and that you’d had an epidural so you wouldn’t be hurting now.” I let it go. I ended up having Methergine and Pitocin to stop the bleeding anyway. My only real fury with the nurse was she kept pushing Demerol saying, “With the overnight Pitocin, you might really be hurting.” Again, I just think it terrified her to have a patient in pain. I finally gave in–BIG MISTAKE. It made me loopy, queasy, and totally out of it–did nothing for the pain (which wasn’t that bad–plain old Tylenol probably would have been fine). DS had a really hard time getting a latch on, and I wonder if he ended up drinking Demerol milk. I felt terrible about it on a lot of levels…
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Sarah from Mindful Birth Options had this to say,
Jul 29, 2010 @ 10:25 am (Quote)
This is my quote. Sorry it took me so long to post I’ve had a busy week!
I was having my second child in a hospital. It was my second natural birth. My OB was in an emergency surgery and Id never met the OB on call. She was a little ticked off b/c I would not agree to have my membranes ruptured (this was about 5 in the evening hmmmmm). I had hid in the shower until I felt the baby’s head crowning. I hobbled to the bed and pushed twice and baby was born. Easy peasy birth.
Id asked for delayed cord clamping and my OB had been fine with this. The OB who caught baby however, said there was too much blood and she needed to “deliver the placenta” ASAP and ordered a shot of pitocin. I said I did not consent to the pitocin and she then shoved her entire hand inside of my uterus to “manually contract” my uterus. As I screamed in shock and pain and tried to pull away she said “well if you would have gotten the epidural this wouldnt hurt”. My doula later told me she yanked on the umbilical cord almost immediately after my daughter was born.
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Sarah from Mindful Birth Options Reply:
July 29th, 2010 at 10:40 am (Quote)
Oh and I just went back to read some of the comments.
For clarity- this was not a VBAC this was my second vaginal birth. I had no health problems or issues during my pregnancy.
This literally happened within Id say 2-3 minutes of birth. The baby was still on my stomach and the cord was being cut right before this happened. There was no explanation of what she was doing before or during, it wasnt until after I finally got her to remove her hand out of my body that she explained what she was doing. I was livid BTW informed consent in maternity care is one of hot button issues.
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Jane Reply:
July 29th, 2010 at 3:53 pm (Quote)
I’m so so sorry you were treated this way. I hope you followed up with your regular OB and the head of maternity at the hospital because her actions sound punitive.
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Sarah from Mindful Birth Options Reply:
July 29th, 2010 at 4:08 pm (Quote)
I really wish I would have been in the state of mind to do something about this situation. I did complain to my regular OB at my PP visit and she chuckled and said “yeah she doesnt have the best bedside manner” like it was a big joke.
I suffered from PPD for several months after the birth and I wasnt really in a fighting mood I suppose. Im really regretting it now. I know it is not my fault but inaction of patients is in part why things like this continue to be commonplace. My daughter is almost a year old now I dont know if it would do much good to complain now.
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Jane Reply:
July 29th, 2010 at 4:17 pm (Quote)
Actually, if she’s almost a year then you’re just about due for your annual physical, right?
Write a list of what happened in bullet points. Keep it as unemotional as possible, but document EVERYTHING you can that was done badly.
State explicitly to your OB (the regular one) that you suffered from PTSD and PPD due to the painful and punitive way in which you were treated. One of your bullet-points should be that the regular OB *acknowledged* that her partner OB “was known to treat patients in a physically abusive manner”.
Tell the OB you wanted her to see this because you’re going to be filing a complaint with the state licensing board and your insurance company.
The OB will get very upset, but you should still send a copy of this letter to the state licensing board, the hospital patient advocate/ombudsman, and the office manager of the practice.
Someone here used to advocate the Joint Commission as well. http://www.jointcommission.org/ Hospitals don’t like being on their bad side, apparently.
BTW, before the appointment, see if you can get a copy of your records because if the OB didn’t list “postpartum hemorrhage” then there WAS NOT “too much blood” and it wasn’t necessary to do what she did. That would be another bullet point for your letter.
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Sarah from Mindful Birth Options had this to say,
Jul 29, 2010 @ 1:38 pm (Quote)
Sorry I didnt “pink my link” this is my first time posting on here and I didnt realize what it was!
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Add Your Comment.
My OB said that to me, too, while stitching me up from a 2nd degree tear that I received because I did what they said to: pushed in lithotomy position. Guess what? I didn’t tear w/ my home waterbirths of babies #2 (same size as baby#1), #3 (1 lb bigger than baby#1), or #4 (2 lb bigger than baby#1).
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