Question about my last birth that I attended - client lost it

Kalamazoo Doula · 12-18-2005, 11:14 PM

I attended a birth on Friday, and this was a mom that was having her third baby. But this was her first doula supported birth. Her second birth went really fast, so she originally wanted to hire me so I could check her cervix, so she would know when to go into the hospital, because she ended up waiting a little long, and she ended up delivering her secound 20 min. after getting to the hospital.
This is a mom that contacted me when she was 38 weeks! So I did a kind of crash coarse in doula support. She was okay with me NOT being comfortable with checking her cervix. I had told her that I was a new midwifery student and yes, this would be something that I would be doing as a midwife, or a midwife assistant, but not as a doula. She dropped that quick, even though I knew that is kind of dissapointed her.
I was called to the hospital Thursday night, b/c she was experiencing mild contractions all day, went to the DR office in the afternoon, but she was only 2cm, so she went home. She then thought that they picked up, and being worried about her past, she went to the hospital a few hours later. But her cervix was the same dialation, but maybe a little more thinned out. She was really emotional about being sent home, she just did not want to NOT make it, b/c this is what happend the last time, she was sent home, and then a few hours later, barely made it back to deliver. We ended up leaving the hospital and went to go get something to eat. Which was nice b/c I got to get to know her husband more. And we talked about how her last births went, she had told me that she has a big tolerance for pain, but when it comes time to push, she loses it. I thought, okay, not a big deal, I have dealt with moms that have not handled the pushing faze that well! No big deal! Right, wrong!
She called me up at 7:30 am and had told me that she had gotten a great night sleep, and the contractions had picked up in the last hour, so they were leaving right then. They had about a 40 minute dive, and I only have about a 8 minute drive, so I slowly got up and proceeded to get my oldest ready for school, and waited for my husband to come home from work, so I could go to the hospital. I left, and arrived at the hospital around 8:40. They were still in triage, and she was found to be 5 cm dialated and 100% effaced. She was given a HEP lock, b/c she was thinking of getting a epidural, which was already talked about prenataly with me. We moved to her room, and I set up some music and her husband went and got her bags from the car.
She was doing great with the contractions, she had a ritual of talking to herself, telling herself that she could do it and that she was okay. She had stated that she wanted an epidural. The nurse had told her that she had to have a whole bag of fluids to have the epi done, so she hooked her Hep lock up to a IV with saline. When the fluids where about 1/4 gone,she asked how long it would take to get done. Her nurse had told her it would probably take about 20 minutes to get the anestiologist there, and then it was about another 20 minute to get the epidural in. Two contractions later she really started to get aggitated, so the nurse asked her if she could go ahead and check her again, because the anest. wanted the cervix to be checked right before he placed the block. She got on the bed, and it was declared that she was 9cm and had a buldgy bag. I looked at her, and softley said that she was probably not going to get her epidural, and she was mixed about that.
Her doc then came in to discuss her options. He told her by the time the anest. got there, she would probably be already delivered already. He asked if he could go ahead and break her water to get the show on the road. He had said that she would probably start to feel to push right after he broke the water. This is where she started to lose it a bit. It really hit, when he broke her water, and then she started to push. She fought me and the nurse holding her legs, and screamed big time. She lost it! I was not sure what the hell to do, I kind of froze. I then was brought back by the fact I could hear the baby's heart tones going really slow. The nurse told the doc it was in the 80's, so we all told my client that she had to really push with the next contraction and get the baby out. She finaly took the back of her legs, and pushed her beautiful 7lbs. 7oz. baby girl out!

She amediatly stated that the pain was gone! And she was back! LOL Baby girl was doing great, they had taken her to get a really good suction b/c of some mec. being in the waters, but it was light. There is a funny story about this. My client had told the doctor that it was okay if he cut the cord if her husband did not want to do it. The doctor waited for the cord to slow down, I don't think it completly stopped pulsating, but still, I've seen it where it is done within seconds (personaly). The baby's nurse was by my client's side stimulating the baby while baby was on mommy's tummy. Before the husband could say anything about cutting the cord, the nurse started to take the baby! I was like, um, she is still attached! She almost pulled pretty hard on the cord, but figured it out fairly quickly! LOL

I think she was pretty imbarresed, she said that she has never done that! LOL

My question is: Have you gals ever dealt with a client that has lost it during pushing? If you have, do you have any suggestions on how to bring her back? Do you get more assertive? How? Help!
Sorry so long!
I was soooo glad that she delivered! I have another client due at the same time! Their due dates where only 4 days apart! Yes, I have a issue with burning the candles at both ends! I have never (knock on wood) had a problem with due dates so close, I did in fact have a issue with two clients delivering on the same day, but their due dates where a week apart! But this was NOT natural currcumstances.
Thanks for anything you can add!

1stimestar · 12-19-2005, 01:07 AM

I would let her know that with her next baby she should push on her hands and knees. I do tend to take the get in their face acttion any time they need to get back in focus. On the other hand, it IS ok if they "loose" it. It may just be what she needs to do to get the baby out.

tlcdoula · 12-19-2005, 08:27 AM

I totally agree with Georganne. Losing it might be her way of dealing with it because she said she did it with the other kids, and she still did accomplish the goal and it doesn't sound like it took that long to birth the baby. Did it take her long to push the baby out? You could also try the take charge routine, but again who knows. This might be something you could have talked with her prenatally about to see what she would want (if you are her doula next time

DL · 12-19-2005, 10:45 AM

You've gotten great advice. Georganne & Michelle have, very well, said what I was thinking to post!

Kalamazoo Doula · 12-19-2005, 12:16 PM

Thanks ladies! I'm gonna have to look up the Take Charge routine again, it has been awhile, and I really have not had to use it that offten.
This was my client's last and finale baby! This was know before, during and after the birth! LOL I'll have to remember the hands and knees again, if this ever happens again. I'll be calling her today to see how she and her family are doing, so I'll see what she has to say!
Thanks again!

heathenmamaof5 · 12-19-2005, 12:36 PM

Any time I hear of a mom "losing it" with pushing it makes me think of sexual abuse. I have read several articles on childhood sexual abuse affects on pg and nursing moms. It seems that the mom goes back to that place of something huge being forced on them. Think big penis, little tiny vagina. I know this is an uncomfortable subject, but with abuse rates being what they are, it is something we should be aware of. So one thing that could help is telling her that her baby is coming out. Over and over if nesesary. Don't ask ANY questions unless that info is offered prenatally. Remember that when we're in labor and giving birth we go into an altered state of mind. Regression could happen.

Jill

ps: my best freind did this with all her births. And yes she was abused at a couple diferent stages of life. As a child, teen and young adult.

Kalamazoo Doula · 12-19-2005, 03:15 PM

Jill, good point! I've been wanting Penny Simkin's book, When Survivors Give Birth, for quite some time!

Thanks

tlcdoula · 12-19-2005, 03:19 PM

Quote:

Originally Posted by heathenmamaof5

Any time I hear of a mom "losing it" with pushing it makes me think of sexual abuse. I have read several articles on childhood sexual abuse affects on pg and nursing moms. It seems that the mom goes back to that place of something huge being forced on them. Think big penis, little tiny vagina. I know this is an uncomfortable subject, but with abuse rates being what they are, it is something we should be aware of. So one thing that could help is telling her that her baby is coming out. Over and over if nesesary. Don't ask ANY questions unless that info is offered prenatally. Remember that when we're in labor and giving birth we go into an altered state of mind. Regression could happen.

Jill

ps: my best freind did this with all her births. And yes she was abused at a couple diferent stages of life. As a child, teen and young adult.

I totally agree and if you or anyone wants to read a great book on the subject pick up a copy of When Survivors Give Birth by Simkin and Klaus - very insightful book.

tlcdoula · 12-19-2005, 03:20 PM

Quote:

Originally Posted by Kalamazoo Doula

Jill, good point! I've been wanting Penny Simkin's book, When Survivors Give Birth, for quite some time!

Thanks

LOL - I should have read your post before replying

It is a very good book, but at times it has been hard for me to get through. I have been reading it very slowly for months now, and although it is filled with information it is also a huge eye opener.

heathenmamaof5 · 12-19-2005, 05:06 PM

My info came before this book. The book must be recent. I'll have to put it at the top of my to read list :]

Jill

Kim Trower · 12-19-2005, 10:57 PM

or take the training..when survivors give birth. It was great and I have already used the activities with 2 of my clients and it helped immensely!
Also, for moms that have fast pushing stages and are "losing" it...non directed pushing...just let mom choose position and push when she wants. It may be grunts here and there..but pushing long and hard is more likely to cause more panic. Also sidelying is a good position to just kind of slow things down a bit. And yes the take charge, look in my eyes, breathe with me, etc. works well. I had a client that was awesome in control during labor and pushing came she was very tense, saying "help me, help me, why won't someone help me" she was very very sensitive to touch on abdomen and genitals begging nurses to stop touching her that they were hurting her..and pushing was mostly screaming..but it only took a short time to push for both babies.