Scare tactics

Teresa's Birth

Teresa and her husband Jared really wanted to have a natural birth. They got pregnant in the spring of 2011 with twins. Teresa and Jared lost the twins and were not trying at all when they found themselves pregnant again the next month. From the very beginning Teresa was very proactive about her care and insisted that the doctor check her thyroid level. Her OB did and found that it was off. So, this time with the proper medication, her pregnancy stuck. However, this was not an easy pregnancy. Teresa had hyperemisis and could not hold any food down. She had an IV at home during her first trimester.

Once the throwing up started to slow down and Teresa was off the IV, she started looking into doulas knowing that she wanted a natural birth. I met Teresa and Jared very early on in her pregnancy. I really liked them right away, we really seemed to click. We did talk a lot about her concerns during our interview, but she still was looking into having a home birth. I recommended they take Bradley classes because Teresa and Jared really wanted to know all they could about natural birth and Jared really wanted to be a big support for her. Bradley seemed to be the best fit for them.

A few months later, I got a call from Teresa and Jared that they wanted to hire me as their doula. By this point, she was diagnosed with gestational diabetes. When we had our first prenatal visit, we talked a lot about nutrition. I wanted to make sure she was eating her protein to prevent pre-eclampsia and eating a proper diabetes diet. Teresa was very concerned about the insulin because after she would take it her baby would have long periods of no movement. She decided to take her care into her own hands because the doctor treated all patients the same and she managed her diabetes with diet and exercise.

At our next visit, Teresa told me she found out she had very low platelets. By this time, they knew she wasn't going to have a natural birth and had chosen a doctor. Their doctor seem to really respect their wishes and she really listened to Teresa's concerns. When the doctor told them Teresa had low platelets, she also told them that she would not be able to have an epidural and they would avoid a c-section as much as humanly possible. Teresa was very happy about her doctor's approach to this.

For the remainder of the pregnancy, the doctor payed close attention to her swelling, blood pressure and took labs to check liver enzymes. She also consulted with a high risk doctor. In taking all these precautions, Teresa's OB was confident that she hadn't developed pre-eclampsia. Teresa's biggest concern was the possibility of bleeding out.

At Teresa's 39 week appointment her blood pressure spiked, so her OB sent her into the hospital for some tests. Everything looked good and they sent her home. The following week at her 40 week appointment the same thing happened. It was Monday morning, this time when she went in for test she told her husband to go get some things done and to pick her up later. At this point they called me and told me what doctor was on call. I knew immediately Teresa was not going to leave that hospital without a baby. Dr. Cortez, yes, I will name her because if anyone goes to St. Jude, they must be completely aware of how this doctor treats patients so they can be prepared, anyway, Dr. Cortez was on that day and I knew from another doula that she uses scare tactics, she tells the mom if mom doesn't do what doctor says, how she says it, "baby can die." She tells the mom, "Your baby might be fine right now, but in an hour all that could change." She always uses the line, "If you were my sister..." Needless to say when Jared called me, I told him what was going to happen. Sure enough, Dr. Cortez said word for word what I said. She also went on to tell Teresa she was "Severe Eclamptic" and she could "seize and die if they didn't get her baby out fast." At this point, Teresa's blood pressure was normal and all the labs were coming back normal except for the platelets. Dr. Cortez also told Teresa, "There will be no acrobatics in labor because if you slip and fall and crack your head open, I am liable." She took Teresa's birth plan and scribbled her notes next to everything she wasn't going to let Teresa do and crossed out the rest. Dr. Cortez's plan was to induce labor by inserting a foly bulb, when it fell out she wanted to start a high dose of pitocin and "get her in pain, real pain because she needs to be in pain to get this baby out" and have the baby by midnight that night.

Teresa was in tears, feeling completely scared, angry and untrusting of anybody in the hospital. I encouraged her to call her doctor. Her doctor told her over the phone that she didn't think she was severe eclamptic, but she did have to wait for labs. Her doctor said if everything is fine, baby looks good and blood pressure is good, they do not need to rush labor. So, Teresa waited a few hours and decided to get prepidil on her cervix to try and soften it. When she was admitted to the hospital she wasn't even 1 cm. Once Dr. Cortez realized Teresa wasn't going with her plan, she refused to do anything. She said she wouldn't do anymore jell after the first dose because it won't work.

Teresa just waited till the next doctor came in. Tuesday morning when the next doctor, Dr. Buchannan came in, he really listened to Teresa and her concerns and gave her honest answers. He said she was NOT severe eclamptic and she could take the induction as slow as she wanted. Teresa chose more prepidil. Dr. Buchannan did 5 doses that day and through the night. None of it softened or dilated her. At this point Teresa was still very untrusting of the staff and doctors.

Wednesday, Teresa's doctor, Dr. Su was on call. Dr. Su also said Teresa wasn't sever eclamptic and she probably wasn't even pre-eclampsia. Her platelets were still a concern, but her blood pressure and liver enzymes were perfect also, the baby was doing wonderful. We are now at the third day and Teresa decides to do the foley bulb. Dr. Su inserted it and a few hours later it fell out like it was supposed to at 4 cm. Then Teresa decided to start the pitocin. They started at 1 ml and gradually went up to 12 ml. It was on this day that Teresa finally expressed to me that if she has a vaginal birth, she will get to meet her baby right away and if she bleeds out and dies, she will have at least gotten to meet her baby. But, if she had a c-section, she would have to be put under and if there were complications and she bleed out, she would never get to meet her baby.

Teresa never dilated again and her contractions never got a real consistent, strong pattern to them. At this point Teresa was getting worried about when Dr. Cortez was going to be on call again. She was told that Dr. Grey would be in the following day, Thursday.

Here we are at Thursday and Teresa still has not progressed. Thankfully her baby was doing beautiful the entire time. Dr. Grey comes in and has an honest talk with her, he tells her he will do what ever she wants and there is nothing to worry about unless things change with her or her baby. Teresa decided she wanted him to break her water. He did that around noon and 4 hours later she did not dilate and her baby did not move down. Teresa and Jared decided that in this situation, labor was not going to happen. She decided to go ahead and have a c-section.

They took her in for the c-section around 5 pm. There were some minor complications, her blood pressure spiked after and she took quite a while to come off the anesthetic. She was in recovery for hours, but Teresa and Jared had a beautiful 8 lb baby boy Thursday, February 9th, 2012.

In the end, Teresa had peace about her decision. It was a decision she made in her own time without being told what to do. She got to make that call when she was ready. There were no what if's after. She knew she tried everything possible to have a vaginal birth, in the end, she was happy to have the experience over and have her beautiful little boy nursing in her arms.