Passing information / educating patients?

This is my response to a nurse's blog post:

This is a very touchy subject for me, and I appreciate you blogging about it. I didn't write a birth plan for my daughter's birth. I had gestational diabetes, and I was being induced for PIH. I knew that what I wanted, an unmedicated birth, wasn't a possibility. I accepted that I was going to have an IV. I knew I was going to have the blood pressure monitor strapped around my arm and the fetal monitors around my belly. I knew that it would be nigh onto impossible to move around. With every complication, I knew that my choices were being reduced to the point that I was determined to go with the flow to get this baby out safely.

Where the lack of information / education / understanding about my birth came in was after my daughter was born. Everything fell apart 30 minutes after her birth. I was hemorrhaging, the placenta didn't detach, and my uterus began to flip inside out. I was in so much pain and my body was going haywire from blood loss and a plummeting blood pressure that I couldn't understand what was happening. I couldn't participate in the decision-making process. I didn't understand the explanations my doctor was trying to provide. I knew that they were taking me into surgery, but I didn't know why I was going there or what they were going to do.

The lack of information continued after I was out of recovery. I knew something wasn't right. I had 8 IV's, and I was still in the labor / delivery room. When I asked what was wrong, all they told me initially was that I'd had lost a lot of blood. While this was somewhat true, it wasn't the whole story. I was at the point where I didn’t have the energy to fight for answers, and in all reality, my brain wasn’t producing the right questions to ask. When the doctor came to do rounds, he told me that the placenta came out in 20 pieces, the uterus flipped inside out, and my blood pressure plummeted from 190 / 120 to 50 / 30. However, he did not tell me that he had done a D & C after his attempt to manually remove the placenta failed. He did not tell me that the placenta not detaching was called placenta accreta. He did not tell me that my uterus flipping inside out was called a uterine inversion. He didn’t tell me that I’d lost 50 percent of my blood. He didn’t tell me what was running through the 8 IV’s that were still in my hands. Did he give me an explanation? Yes. Was it complete? No. There was no discussion of the consequences of these actions. Could I have asked? Yes. Should I have asked? Yes. Was I capable of formulating the questions? Not at that time. The trauma had taken too much of a toll on my body, and while I recognized that I wasn’t getting the full story, I wasn’t in an emotional or physical position to fight the battle to find out what had happened. I just wanted to go home. I wanted to lick my wounds in private, and pretend that it had never happened.

It wasn’t until my 6 week postpartum checkup that I found out the clinical diagnosis. At that time, I only found out because I asked if a c-section would have been a better choice than the induction. The doctor definitely wasn’t the one to initiate the conversation. Even then, it wasn’t until I was interviewing a new OB to find out what the risks were of having more children before I found out that my old OB had done a D & C.

I don’t think that my experience was all that unusual from an educational / informational standpoint. I think sometimes that the bare minimum of information is presented to the patient. Just enough information is passed on to keep them from being a pest.

This is a pretty complicated topic. There are a lot of things that are required for women to be educated about birth.

1. They have to want to be educated.

2. The information has to be accessible.

I wanted to be educated. I wanted to know about normal, typical birth. I wasn't into researching complications just to worry myself about them. I wanted to know the basic physiological aspects of childbirth. How your cervix changes to allow the baby to be born. How to handle the pain without drugs. How to move to make it easier for the baby to descend. When complications arose, I did research the specifics of those complications. I knew that high blood pressure presented all kinds of problems. I knew what to watch for as far as signals that it was getting too high. I learned about watching out for pre-term labor symptoms.

The problem was that I didn't end up with a normal typical birth. I don't think there's a single childbirth class that really explains clearly all of the complications I ended up experiencing. I could have done Bradley, Lamaze, or Hypnobabies, but would they really have educated me about having my uterus turn inside out? They talk about complications they consider "preventable", but I don't know that mine really were. If under anesthesia, the placenta comes out in 20 pieces it's pretty darn stuck. It's not just a little bit attached. As for the inversion, is it possible that the attempted cord traction caused this? Yes, but I'll never know for sure if this was directly the fault of that procedure, or if it was simply something that happened spontaneously.

I think too many of these classes assume that everything will happen normally, in which case interventions aren't necessary. The problem is that things don't always happen normally. There are situations where interventions really are necessary. When these classes teach you, don't trust your doctor or midwife, aren't they doing a disservice to the women who truly are at risk? They teach you to obsess over the procedures instead of creating a relationship with your caregiver. When things to wrong, they leave you dangling. You're the screw up. You didn't follow their teachings. You never should have listened to the doctor. They're all out to get you. Their only goal is to get everyone out alive, and on and on and on...

Some childbirth books have sections on complications. Few of them give as much information as I ended searching out once I knew what had happened. Was the information accessible to me? Yes, if I searched medical journal articles and medical school powerpoint presentations. Does that mean the average mom needs to research birth at this level? I certainly hope not. It seems ridiculous to have every woman searching out the most rare pregnancy complications for absolutely no reason. There are enough concerns when you're pregnant without looking for trouble.

I also think that caregivers need to think about their role in educating women. I really think that they need to step up to the plate a little bit in making sure that their patients really understand what happened. Did my doctor's explanation meet that criteria? I didn't know how to look it up or research it, but I did have a pretty good grasp of the complications from a layman's perspective.

It just wasn't enough for me. I needed more.