Refusing Pitocin in Labor: Helen's Story
Just over two weeks ago, Helen was getting to know her newborn baby, Jesse, after spending the entire day getting to know what informed refusal is all about. Her story is heavily excerpted below and does not do Helen’s must-read blog posts justice.
Helen and her husband updated their Twitter status periodically throughout labor. A few of those tweets are interspersed in the story.
Helen’s water broke on her estimated due date. She went through her normal morning routine, regretting that this was her midwife’s day off. She called her doctor’s office when it opened and talked to the nurse.
I asked her about the OB on call–she was new to the practice, and not only had I not met her, I didn’t know anything about her. Scottie reassured me. I was still daunted, wishing hard that my midwife would somehow pick up on the psychic resonance of the numerologically auspicious date, but we slowly got everything together and headed to the hospital. Oddly, they had trouble confirming that my water had broken because I couldn’t seem to produce another gush for them. I was still 3 cm, and only 50 percent effaced. Part of me wishes that I had just turned round and gone home, because it didn’t take long for me to realize I’d just consigned myself to a medical labor and delivery, and I would have to fight tooth and nail to get the natural childbirth I wanted.
And the Pitocin-pushing begins!
It started around 11, when the L&D nurse assigned to me wanted to start an IV because the doctor had _already_ ordered Pitocin for me, as well as nothing by mouth other than ice chips. She had never met me, remember? I refused the IV and the Pitocin and said that the doctor would need to come in and explain to me why there was a medical indication for this intervention. The nurse seemed daunted, and at that point I knew she wouldn’t be an ally. She expressed concern about my tiny veins and the difficulty she would have starting an IV if there were an emergency. I insisted I needed to talk to the doctor first, and set about walking around the labor ward to try and get contractions going.
The doctor came in and checked me, and I was still 3 cm, now 70 percent effaced. She again said she’d like to start Pitocin, arguing that since my water had broken there was a chance the baby would go into distress and she’d like him to arrive “during the day while there were still plenty of people here.” I think my eyebrows shot off my face. I explained to her that I didn’t agree that Pitocin would get him here faster because sending me into hard labor too early might trigger what I call intervention cascade, in which Pitocin contractions are so hard and violent that even the most pain-tolerant mothers beg for relief, usually in the form of an epidural; then, once the epidural is in place, the mother is no longer able to work with the contractions, creating a stressful environment for mother and baby.
Pitocin-pushing… now with condescension and bonus threats!
She stared at me. “My priority is delivering a healthy baby,” she said, implying that my belief in intervention-free natural childbirth stood in the way of this. “My baby _is_ healthy,” I replied, gritting my teeth. She and the nurse combed through the print-out of the monitor, looking for evidence that the baby was in distress. “Look, the heart rate dropped here,” she said. “He turned away from the monitor,” I said. She was quiet. “Yes, you’re right, it’s only a partial reading, but if it drops again, I _will_ put you on Pitocin.”
Helen consented to the heplock, but held up her cup of melted ice chips while declining unnecessary IV fluid.
2:00 p.m.: Helen’s third Pitocin refusal
At 2 pm, I still was at 3 cm, but the baby had at least engaged and now was at -1 station, and my cervix was continuing to melt away. The doctor assured me that the dose of Pitocin she wanted to give me would be the smallest dose possible, and that really, all I needed was “a whiff” to get my labor going. She also admitted that she wasn’t accustomed to reactions like mine, that she was accustomed to a certain process. “Look,” I said, fighting the urge to remind her that I was her patient, not a process, “I’m not trying to be difficult. But a natural childbirth means a lot to me, and everything we do that disrupts that interferes with my ability to bring forth this child and bond with him.” That was my third refusal.
Helen was starting to fear that her not-yet-so-painful contractions were going to get her accused of failing to progress.
6:00 p.m.: The fourth Pitocin refusal
But by 6 pm–the next time the doctor came–I was only at 4 cm and 80 percent effaced, and the baby was still at -1. Again she wanted to Pit me; again I turned her down, insisting that if I could get to 5 cm, I’d be fine, and to “just give me a few more hours, please?” I was practically whimpering at this point.
7:00 p.m.: A hero arrives!
At 7, the nurse shift changed, and in walked my guardian angel, Lisa. The previous nurse introduced her as “our best natural childbirth nurse,” and Lisa took one look at me and the hopes I had delicately balanced on a cliff and said, “Well, the first thing we gotta do is get you out of that bed and onto the ball.” I got up, went to the bathroom, and when I came out, she had an exercise ball in her hands. “I talked to the doctor,” she said. “There will be no more talk of Pitocin. Now I want you to sit on this ball and every time you feel a contraction, start bouncing. We’ll get that baby down.”
Helen got down to business and at 7:45 p.m. when Dr. Pitocin-Pusher returned, the doctor was shocked.
I’d hit 5 cm/90, she could feel the baby’s head, and my contractions had doubled in strength.
Helen, with her husband’s support, got into the flow of her labor. She noted the difference between the process that the doctor said she was used to and her actual labor.
Contrast this with the epidural model where you can’t leave the bed and your partner has to tell you when the next contraction is happening when the needle rises on the monitor. We’d have been there all night and probably wound up having a c-section.
Helen had to hop up for another round of fetal monitoring and wrote, “I found I hated being in bed and got back on the ball as quickly as possible.”
…I was bouncing, and trying to breathe, and howling as I did so. It was an uncanny ululation as I allowed the baby down and felt myself opening, finally. I clumsily banged the call nurse button and told her what I’d just felt. “I need to push!” I said, I think with a scream. Keep in mind I’d just hit 5 cm. at 7:45.
She hurriedly got me into bed, hooked me up to the monitors, and checked me. “She’s at 8, and look at those contractions!” she hollered, galvanizing several other nurses into action and sending one off to get the doctor. I realized I was in transition and glanced at the monitor; the contractions were literally happening on top of one another, cresting like great waves pounding into one another before washing ashore in violent cascades. I think I finally understood what it meant to be in both agony and ecstasy at the same time, and stared down in bewilderment as they removed the bottom of the bed and Lisa began to manage my breathing using a counting technique that forced me to refocus my attention away from the wild banshee I was becoming as I continued to howl.
Helen began pushing and less than 20 minutes later, Jesse was lifted up onto her belly. Jesse was “9 lbs. 11 oz., 23″ long, with a 14″ head. 11/11/2009, 9:47 p.m. And absolutely beautiful.”
The doctor not only congratulated me but also–significantly–apologized to me. “You did say that if you could just get to 5…….”