Abruptio Placenta, Part 2

After the doctor walked away from us in the L&D triage, we asked why my client needed a Foley catheter NOW. The intern explained we needed it because while the baby was doing fine now, we needed to be prepared to take emergency action. Hmmm, all right.
It was another 20 minutes before they got us into a regular room. Once there, the Foley was inserted by a nurse. The Ben Stein Blond doc came back in, told my client to open her legs, and without telling her she what she was going to do, proceeded to insert her hand into her vagina. I was at my client's head, consoling her, "talking her down" and praying with her. My client arched her back in discomfort and the doc scowled for her to be still, she was screwing the electrode into baby's head to have a more accurate heart rate. WTF? She in and out of there before either of us had a clue what she was doing.

The nice nurse started asking a load of questions, apologizing along the way for the absurdity of the questions and for the length of time it was taking. Everyone was confused because my client wasn't even admitted yet, which pissed me off because we stood in the ER receiving answering stupid questions for 10 minutes while my client bled and bled and they STILL didn't have her in their system. During all this intake crap, the baby's heart tones were going up. From his normal 140s to a high 162. Okay. That's okay.
Every time we heard the tone grow faster, my client would look at me with pie eyes, "Is that okay?" Yes, 162 is okay. Then it went from the low 160s to the high 160s. Then into the 170s. No one seemed to notice or mind.
I don't understand the heart tone range in the hospital. I had another client go in because she felt like she hadn't felt her near-term baby move in 24 hours, panicked, and went to L&D for an ultrasound. Baby was fine, but the heart tones were in the low 170s. Everyone was fine with that.
As a midwife, you learn 120-160 is the normal range. That is our learned comfort zone. Does anyone know why 170 is acceptable in the hospital?

At any rate, the baby's heart tones then started going into the low 180s. It would dip down to the 150s, and then spike to 178, 182, 184. It did this for a full 20 minutes. My client in the meantime was freaking out. Partially from the circumstances of just being there, about to have another section, being asking ridiculous questions again, about WHY she didn't seek prenatal care. AARGH!!!
My head was pressed against her. Calm down. We're crossing one bridge at a time. You and the baby need to be kept calm and safe. We're here together and no one is going to take your baby from you. (She kept talking about how they would take her baby to the nursery and never give it back.)
When my client calmed down, the baby's heart tones came down to a reassuring 150-ish.
The nice nurse doing the intake pointed out how my client's calm effected the baby's heart tones and she should try to do her best to stay calm. My client liked that and stayed relatively calm, despite still gushing blood onto the bed. The baby too, stayed in a normal range, until...

The intern busted in the room after 10 minutes of calm, a full half hour after the baby started going into the 180s and says quickly and full of panic to us and the nurse, "We need to get her into the OR right away! Why doesn't she have oxygen on?! She should be getting oxygen. Look at those heart tones!"
We all looked at the monitor plucking away at 148. Uh-huh.
The nurse told her that once the mom calmed down, the baby's heart tones came down and had stayed down.
"I don't care! Put her on oxygen! We need to get her into the OR!"

That's what we had been thinking too. By this time, we had been in the hospital for an hour. And the 20 page intake was still going on: Has anyone in your family ever had heart disease, cancer, hypertension, diabetes? Yes, who?
All grandparents.
Maternal or paternal? Great grandparents?
Meanwhile, we're changing the chux pad for the 4th time since we arrived in that room.

Another 15 minutes pass, and by this time the baby's heart tones have started to climb again. They've been in the low 180s for the last 10 minutes.
The Ben Stein Blond doc and the intern come in finally, along with the anesthesiologist and have my client sign the papers that release them from any fault while they're sticking needles into her spine and cutting open her belly, even though it has taken them forever to even get us into the OR.

We are wheeled down to the OR. My client wants me to come in with her. I'm given scrubs, booties, and a hair cap from a small, dinged-up metal locker with peeling paint and led to a bathroom to change. The bathroom is small, reeks of urine, and the door doesn't lock. I change as carefully as possible, without letting any of my clothes touch the filthy floor, then take my place in the chair in the hallway where they've told me to wait.

I wait and I wait. Next to me is some big clunking machine, with lots of tape holding it together. Next to the door of the OR is a huge piece of plywood with CAUTION tape all over it. It's a make-shift wall for whatever construction is going on. The floors are dusty with sawdust and grit.

After 15 minutes or so, I'm led into the OR. My client is there, strapped down to the narrow T-shaped table looking very pale and angry. The blue sheet is up high and resting on my client's chin. When she breathes in, it touches her nose. I push the blue guard away. My client complains about how silly it is to "protect" her from watching her baby being born, even through an incision. She wants to watch, but of course no one will let her. My client goes through various emotions quickly: from making small jokes, to crying, to digging her nails into her palms and growling in absolute anger.
The Ben Stein Blond doc is now chipper and happy, perhaps because she's now really in control. She's now asking my client in a sweet, high voice, "Are you okay, hon? You'll be seeing your baby soon!"
The doctor tells me through the sheet, that she thinks she sees a uterine rupture too. "That's what makes VBAC so dangerous."
I say, "Wow. She's had two previous VBACs. Do you really see a rupture?"
She says, "Umm, I don't know. I'll let you know in a minute."
(She never says anything more about there being a rupture... because there wasn't one at all, I'm sure.)
My client growls that she is not okay, she's losing blood and is being cut open. But no one comments to this.
I hear the OR nurses mumble under their masks about "the patient planning a home birth" and "how dangerous an abrupted placenta is".

At one point, my client moves her shoulders in discomfort, mashes up her face in pain and the anesthesiologist goes to add some more drugs to the mix. Another anesthesiologist tells him not to, "they're just pushing on her belly to get the baby out."
This prompts the BS Blond to tell me to stand up to see the baby being born. I stand and see his head is out. A fine color. Cord tight around his neck. He cries lustily before his body is even out. The intern is smashing her weight into my client's fundus to get his body out. Ack. Out comes the baby boy, who is still crying loud and clear and pinking up. They cut his cord immediately and tell me to sit down.
They take the baby down the hall. The baby nurse is sweet and gives us both a good feeling that she will do her best to nurture this boy until we get him back.

We wait for the long finishing-up. It's another 40 minutes or so before they get everything all closed up. My client is crying to see her baby. (They didn't even do the complementary Here He Is flash before swooping him down the hall.) We can still hear him crying now and then, and can tell he's just outside the door.

At the end of the surgery, when all the counting of instruments and rags have been completed (which is completely unnerving to me), the doctor calls me Andrea (which is NOT my name, but close). "Andrea, stand up. I want to show you this placenta and where it came away from the wall."
Hmm, I do want to see this. I love looking at placentas anyway.
Over the blue sheet I see a pink bed pan. In it is the placenta, large and healthy looking. In the doctor's hands, she's holding something else. I'm confused.
The doctor says, "Do you see this hole right here? That's what came away from the wall. Do you see how dangerous and big that is?"
The woman is holding a HUGE BLOOD CLOT IN HER HANDS!!! She's poking a hole through this blood clot with her gloved finger, telling me it's a PLACENTA!
Is she that stoned, or is she fucking with me like she would an intern?
I see her eyes follow my very puzzled eyes to the actual placenta in the pan and she says, "Well I think this is it. It's hard to be sure. Sit down now."

Lord have mercy on the hierarchies of the medical system! They are NUTS!

I couldn't tell my client any of this, because she was really writhing now. Feeling more and more sensation, panicking from having her arms strapped down and hearing her baby cry.

At any rate, the usual followed. She was put in recovery "for an hour alone to recover." We did get to see the baby and I got to hold him for her for about 7 minutes before they took him again. After an hour, they let one person at a time visit her. First her mom, then a family friend, then me. The mom and the friend had to go home to look after the other 6 kids who were with their great-grandma.
I said I'd stay.
The recovery room had no air conditioning. It must have been 84 degrees in there. There was a dusty fan blowing on my client. She was in a narrow, flimsy bed that looked like it came off the set of MASH. I have camping mattresses thicker than this "recovery" bed.
My client is sweating profusely and itching like mad from the numbing meds. She's thirsty and sick, throwing up into a bucket. The baby is with us, he's nursed and is sleeping. The heat of the room is terrible, it would make anyone nauseas. They tell us it's to keep the baby warm. We all know it's because this hospital is a dump and there are dirty fans parked all over the place.
They tell us she will only be in this room for 2 hours max.
My client looks white as a sheet. I ask a nurse about her post-op blood work. I want to know her hemoglobin. Trying to be snarky, the nurse wheeled around and said, "Do you know what it was BEFORE?" I went to my bag, pulled out her chart and her lab work from the U of M. I showed her her last CBC. "Her hemoglobin was low before, at 11.5, see? We working on getting that up all summer. But that's a pretty normal number for her."
The nurse seemed a bit shocked that despite my client not having any REAL prenatal care, I do have a whole chart and lab work on her.
"Oh. Well, those labs were done in early June. It's August now."
Whatever. Get your digs in. Women don't get routine CBCs in their last weeks of pregnancy in the medical system.
"I'd still like to know her hemoglobin if you have it," I say, smiling sweetly.

They ended up leaving us in that roasting recovery room for 4 1/2 hours. They did 3 heel pokes on "that huge baby" of 9# 6oz and they all came back fine for his glucose levels. They finally came back with some lab work numbers. Her hemoglobin was 8.5.
Wow. That's really low.
My client asked what we'd be doing at home for that. I told her I'd be sending someone to the store for liver, and feeding her every high iron thing I could.
The nurse perked up and said, "Oh, I can get you some food!"
She comes back with a tray of a high-sugar popsicle, a bowl of jello, and some ice chips. My client declines all of this.
Now tell me: how that will nourish a woman who has lost a ton of blood?
Madness, I tell you.

After asking many times, we finally get moved to a proper room. It's much cooler in there because the air conditioning seems to work somewhat. The room is old-fashioned. Stark white, two twin size beds, two TVs (that won't work unless you pay for them!). Nothing to read, nothing to look at on the walls. Once in the room and with a new IV (the old one went sub-cu, filling her arm with loads of fluids and making it grossly misshapen. She ended up with 4 IVs that all went sub-cu in 24 hours), my client cries for a bit. We hug and cry and try to process this crazy Hotel California hospital. I finally leave. She needs to sleep while the baby is conked out. I tell her to call if she needs anything that day, and to definitely call me the next morning.

**So this is all crazy, but it was a necessary surgery. The following is complete madness and infuriating.**

The next morning she is home by noon. She signed out AMA after a social worker came into her room in the early morning. The case worker wanted to know why she didn't seek prenatal care.
Again, my client had to tell her that it was her MIDWIFE who brought her to the hospital, who stayed with her during the surgery, and for 5 hours postpartum. All the staff had met me and questioned me. She has to reiterate over and over what "kind of prenatal care" a midwife gives.
From here, the social worker tells her that she knows she's an addict because her lab work came back positive for opiates, as did the baby's. And that mothers who are addicts don't get to take their babies home. And if that isn't enough, she can have her other children taken away too.
My client by this point is fuming mad. Demands to have her doctor called in.
The young intern comes in. My client tells her this woman is threatening to take her children away because of opiates in her lab work. Either they confused her labs with someone else or they are tampering with her records. My client demands to have her blood work taken again.
The intern asks to see the lab work the social worker is waving around, reads it, and then starts to apologize profusely.
Apparently, those labs were taken directly AFTER the cesarean. The opiates were from the SPINAL given to the mother.
The social worker shrinks, apologizes. Starts to explain how anyone could've made that mistake and that she wants to help my client get the proper assistance she needs for all her children.
My client tells her to get the fuck out of her room. Then she tells the intern to get the AMA waiver because she is leaving NOW.
The intern tells her last hemoglobin came back at 7.7 and her platelets were dangerously low. (However, the only "food" my client had received since surgery was chicken boullion!)
My client said she was leaving. And she did, with the scared intern pleading at her heels to stay.

Yesterday I visited my client and her baby at home. He's doing great. She's okay; sore and very pale still. I brought her a steak and liver pie, two jars of black bean soup, cream of wheat, a water melon and banana bread. EAT woman, EAT!

Despite my tone of anger while writing these posts, today I am sad about all of this. I really wish Michael Moore would've touched on the maternity system in SICKO.
I know Ricki Lake's documentary is out now, and Pregnant in America is coming too.

I have no problems taking a client to a hospital to receive care. Most woman are low-risk and can birth fine at home, but there are times when something else needs to happen, and I'm grateful we have the tools to help babies out safely. While we have a healthy baby and a marginally healthy mother, we're all scarred and frustrated from the lack-of-care we encountered in that strange little hospital.