The Politics of the Pelvic Exam: Practicing Applied Feminism

Sarah:

This is a great post about doing pelvic exams. I’m saving this for later and sharing the most important quote from the entire piece:

“A few months ago I was conducting a pelvic exam on a teenager, and it was her first exam. I absolutely love doing women’s first exams because studies show, unsurprisingly, that a woman’s first experience with a GYN health provider is likely to color her opinion of pelvics for the rest of her life, significantly impacting her follow-up and continued screening in the years to com.”

Originally posted on Sage Femme:

Pelvic exams are really hard for a lot of people.

That statement should be self -evident, but I have had enough pelvics, and certainly conducted enough with other providers to know that not every midwife or physician truly understands this. Not just pays lip service to it, but truly understands how traumatizing and re-traumatizing the pelvic exam can be. For those of you with limited exposure to pelvics, or those of you who don’t have a vagina, I’ll provide you with the basics of what we do:

1) The external exam. Examine the external genitalia, make not of any sores, irritations or cysts. 

2) The internal exam, conducted with either a plastic or a metal speculum. This is how we look at the vaginal walls, look at discharge, and look at the cervix and take any samples we might need to take (i.e.: pap smear, wet prep, or STD testing…

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Spring semester is here!

I am officially up and running in two new classes this semester. Human Sexuality and Anatomy and Physiology II, both of which are online, have started out smoothly. I’m not happy with my HS professor yet. She has been ignoring my emails and giving false directions in finding certain content. Hopefully she is just super busy and this is not what the rest of the semester will look like. I am used to having online professors who are very involved and responsive, which is exactly what they expect from us as students. We shall see….

In other news…my mom is doing great with chemo. It’s certainly not fun and sucking every ounce of energy out of her, but I am so glad to hear that she is still working when she’s able and generally doing alright.

Lastly, I got my first ever schlac mani the other day and I love it! I probably will never go without one now! lol

Happy Thursday all!

Shridam’s Birth Story

A note from Sarah:

I am so thankful for this community I have been welcomed into with open arms. The subject of birth is so close to every mother’s heart, no matter how her baby comes into the world. I have said a number of times that I want to share EVERY birth story that you’re willing to share. Some of those birth stories, don’t always have a happy ending. Regardless, your birth and your baby are important and your story is important. I am sharing a story below that is beautiful, loving, and heartbreaking. This is your official **Trigger Warning**. Please read with love and light for this mama. Thank you.

Sarah

******

Shridam Jasper Smith

10 lbs 15.4oz 23.5 inches

9.23.12 – 9.30.12

We wanted to have a homebirth with our first son but couldn’t afford it. He was a week late and we declined to go in for an induction that Friday but then nonstress testing said the amniotic fluid was low so we made an appointment to go in at 5am the next day to be induced. I went into labor Friday night and things were picking up steam when we got the hospital (My mom, husband, doula and myself). We labored pretty naturally for most of the day and didn’t get any pitocin until the evening. The back labor was pretty intense. Then after a totally refreshing nap compliments of Stadol, the nurses woke me up and I hopped into the stirrups to push for about 2.5 hours. I saw baby’s head in the mirror!  Dr.Koh came in and saw that the baby was OP so he got us all to prepare for a C-section. Dasaratha was 9 lbs 6 ounces, 21 inches and super awesome. Champion nurser.

Shri Kiss

  • Shridam was due September 16th. We didn’t want to have another C-section this go round and now we were in a position to afford midwives. We interviewed a few groups and went with the same midwives a couple people we knew had delivered with. We saw them for the regular checkup stuff, heart tones, measurements, weight ins etc and my seemingly endless list of questions about homebirth, pregnancy, transfer and nearly everything else under the sun.
  • For backup we saw some hospital midwives that work with M and R and take care of some of their transfers. I went to their clinic for all of the blood tests and ultrasounds. I had endless questions for them too. I was told by them and our homebirth midwives that we would transfer to that hospital in case of something like exhaustion or dehydration but that for an emergency emergency we would go to Heywood, the hospital 20 minutes from my house.
  • The pregnancy covered the best summer of my life, my husband, our toddler and everyone we knew was just so happy and excited that we would be getting a little baby boy. Stava and Dasaratha were able to accompany me to most of the prenatals this time which was really special. I was crazy healthy and felt great.
  • We went into labor Friday night but it stopped as soon as M got there. She left and told me to try to get as much rest as possible before things picked up again. I had light contractions until Saturday evening when things got hot and heavy and the two midwives came over again. We had my grandmother take Dasaratha to his Uncle and Aunties while we set to laboring. I see the hand of the Lord in that because we had considered having him babysat at our home but couldn’t think of anyone to watch him.

I labored leaning on Stava and moaning with him for awhile, at a certain point I was saying, “These contractions are stronger than me, I’m not handling them well,” and I decided to get into the tub. What GREAT relief! In my first labor I kept wanting to take a shower but we couldn’t get the monitor wet so I opted for Stadol instead. Anyways no back labor this time, baby was in perfect position very low, NOT ociput posterior (I was super afraid he would follow suit like his brother and religiously did my positioning exercises while pregnant). They checked his heart rate regularly the whole time and he was happy as a clam. We put on the birth CD my friend had burnt for us. The water made contractions so much more manageable, Stava was in there with me sometimes I would lean on him sometimes I grip the sides of the tub and stretch out.

Eventually I felt the urge to push and started to do that. I was a little insecure thinking I didn’t want to push if I had a lip of cervix so I hopped out of the tub and had my midwives gives me an internal exam (the First and only) I was 10 cm so I hopped back in the tub and began to push for all I was worth. Pushing was about 2hrs but isn’t seem very long at all, not like Dasa’s. No one was yelling at me; I pushed not on every contraction but when I got a “good pushing one” I would say, “This is it!” and grip the side of the tub stand up on my knees and holler and push. I reached down and felt baby’s soft head, it was awesome then I had Stava feel too. The midwives were checking his heart rate with the Doppler pretty frequently now (I appreciate that now but at the time it was sooo uncomfortable!) and it was right where it was supposed to be. I vaguely remembered being blood pressure cuffed throughout the birth but I didn’t pay that much mind. Sometime during the pushing I felt the water bag POP and the midwives rushed over to the birth tub with maglights to check the amnioty; it was clear.

At some point I felt like my pushing was becoming a little less effective and the midwives suggested I hop onto the birth stool. That REALLY directed the pushing energy, 2 or 3 pushes on that and I had his entire head out! I was done at that point, I asked if I still had to push because I had read birth storied where the midwives help ease the body out of the exhausted mother and though that sounded good I said, “Do I need to push anymore?” My midwife said yes, “You need to push with everything you have.” Then they said, “You need to get on hands and knees.”

*Sh*t* I had read enough birth stories to know that meant shoulder dyscotia. I got onto hands and knees and pushed hard, thinking they would be able to hook him and pull him out. They told Stava to call 911 and then had me get standing upright to push. Stava started to run downstairs but I hollered at him pointing to where the phone was on the dresser while I was pushing. Then I was lunging, standing, hands and knees, on my back with legs pulled all the way  back and super pubic pressure applied. We tried all these positions rapidly AGAIN and AGAIN. M and R were taking turns trying to hook the baby, and alternating putting the oxygen on his face and then on mine. I kept screaming, “I can’t push anymore,” because I was exhausted or “I’m still pushing!!!” because I WAS still pushing and felt no give from the baby. I screamed a lot and there was blood everywhere, all over me, saturating the floor. The two midwives kept taking turns trying to hook Shridam or break his arm and hook it, and they were putting oxygen alternately on me and then the baby. Stava said, “They had to tear you apart to get to the baby.” I didn’t know it at the time but Stava then left to flag the ambulances at the end of the drive. He feels like he didn’t do anything to help the situation but they may never have found our hidden drive on that dark and rainy night if he hadn’t gone out there. We just kept going in those positions. It was excruciatingly painful, I screamed and screamed and pushed and pushed.

Shri sans tubes

Eventually the ambulance and EMTs arrived. I thought we were going to go to the hospital, I was screaming things like, “Can we got to the hospital now? Get him OUT!!! but the EMTS and midwives told me I had to deliver the baby 1st. I hadn’t expected that. The EMTS were really awesome, they took over the oxygen and focused the midwives saying, “You can do this, you can get this baby out.” FINALLY he came out, with me in the hands and knees position, at 1:42am on Sunday, twenty minutes after his head had been born.

He looked so small, and even though he was all pink and peach, without a tinge of blue on him I could tell he was lifeless. He was so limp and floppy. Shridam’s wasn’t breathing and had no pulse. The EMTS began CPR and intubation immediately. I was sure that he was dead.

My own heart rate was at 200 and the EMTS were instructing me to focus take deep breaths, calm down.  The midwives gave me two shots of pitocin in the thigh and some Chinese herbs to stop bleeding.

We stayed in the room for like 15 minutes and then we each got loaded onto an ambulance. I nearly passed out as they took me down the stairs, because my oxygen mask had fallen off. Stava and all but two of the EMTS (we had first responders from like 5 towns) piled into Shridam’s ambulance and R and two EMTS went into mine. As I rolled past Shridam’s ambulance they told me he had a pulse. I couldn’t believe it, I was so relieved. It came twenty minutes after he was fully born and they started working on him.

From there we went to the ER at Heywood, Stava was sobbing on Shridam’s side of the room and my heart was stricken fearing for the worst. They did all kinds of things for him, that I’ll never know the whole of, they managed to get an IV in his belly button. They gave me three IV ports and pumped me full of blood, pitocin, morphine and two kinds of saline water. My placenta still hadn’t come out so two nurses massaged my stomach almost right down to the bed and Dr.R, come down from the maternity ward, reached in and grabbed it by hand, delivering the whole of it successfully. I had 3rd or 4th degree tears (I would here either from doctors in the next couple days) and Dr.R stitched me up into a, “patchwork quilt.” It hurt so much because apparently, like Novocain, litocaine is totally ineffective on me. R was in with me but they wouldn’t let M in and I was so out of it I didn’t really care.

A few hours later we both transferred to a bigger hospital with a level 3 NICU, and they cooled Shridam’s body for 3 days to try to keep brain damage as low as possible, but his brain was just completely gone, 40 minutes of oxygen deprivation was too much. He was 23.5inches 10 pounds 15.4 ounces when the weighed him. I finally got to hold him when he was 3 days old. He never cried and could only move his arms and face a little. The told us his EEG and MRI showed no brain activity and that he would not live for long. That Friday he managed to knock his arm into his ventilator tube, unpositioning it. We decided not put it back in and he breathed on his own until early Sunday morning when he gently died in my arms, one week old. There are many other stories and miracles that accompany his short week of life, but they are too numerous and hazily remembered to list here.

Shridam

I wrote the above only weeks after the loss of my birth and so have left it unchanged, because it’s as fresh as it is accurate. Some additional thoughts and reflections I have had since then and answers to common questions are below.

My first son was 9lb 4oz.

When originally telling me about how prenatal visits would go my midwives told me about the pee in a cup strips to test for urine. I would later show up and ask “Don’t I need to do that strip test.” And they would reply “If you want to.” Weight tracking was also optional, but I like to keep track of things so I did both each visit.

My midwives offered me a choice of taking the glucose soda and blood test at the hospital or doing a finger prick test with them. They didn’t push either as better, I opted to go with the finger prick test with them.

I did not have Gestational Diabetes during either of my other 3 pregnancies, and had no symptoms of it during Shridam’s pregnancy so I think his Macroscopic size may NOT have been caused by GD, but that’s not something I’ll ever know for sure.

While they attempted to deliver his body they got out their 1 oxygen mask and passed it between me and Shridam. It was done so poorly because there were only TWO people there, they had to try to deliver and do oxygen and it just WASN”T ENOUGH. One of midwifes, M, was crying and in near hysterics, she kept kissing me and saying they loved me, they loved this baby. I appreciate that she was scared for us but I feel like her lost cool affected her ability to do her best on the delivery.

We never paid the 2nd half of what we owed them for their fee. Niether did they ever offer to refund us. Money just wasn’t brought up by either side.

They were there for me for anything I wanted to talk about. They brought me soup. They would likely have done more for me but it just made us ad and weird to see their faces so we declined.

On one follow up appointment they told me they had “talked to some of their peers” and played around with their soft birth doll and model pelvis to see what had happened. R said that his sticky shoulder was just “wackadoo” the worst she’s ever seen. A friend who’s training for homebirth midwifery, later told me that it HAD come up to be looked at by the ‘council of midwives’ or whatever but I never heard of it at the time. Nothing AT ALL like when you lose your baby in a hospital, and there are inquiries, there are reviews, there is an attempt to give the parents ANSWERS and some small piece of mind. No my midwives were back delivering babies the next week.

Unlike so many other homebirth loss moms my midwives weren’t negligent They didn’t lie to me. They did call 911. They just were not enough. Their skill wasn’t enough, their equipment wasn’t enough the sheer fact that there was two of them vs. a whole floor of maternity staff wasn’t enough and it turns out our “transfer plan” was way too little when emergency struck and even the heros at 911 were too little too late when we decided to birth at home.

I see so many people say to other moms, “You should have gotten experienced certified midwives, you needed complimentary care, they should have called 911 sooner, a good midwife will know complications when she sees it, Well your midwife should have been monitoring you and baby.” I HAD ALL THOSE THINGS. The *BEST* OOH Midwives are still NOT ENOUGH to save baby’s life in an emergency.

I am not “anti-home birth”.

This post has been quietly brewing in my mind for awhile now. It’s hard to define where exactly I stand on home birth but what I do know is that I am anti-bullying, anti-discrimination, anti-judgement, anti-disrespect…but I am NOT anti-home birth. Somehow the subject of birth and how one chooses to do so has become almost as delicate a subject as religion and politics. Oh wait…maybe that’s because those two things happen to fuel a lot of how and why someone chooses to birth. There is a terrifying birth story that is making waves and going viral all over the internet right now. You may have read it. Here is a link. The comments on the post itself as well as on a number of birth communities on Facebook have ranged from empathy, sorrow, love, and kindness to blame, distaste, and apathy. This is not a dead baby story. But it could have been.

Many of the more negative comments talk about how the writer is clearly anti-home birth and how “that’s just not fair” to happy home birthers. I get it. I had two beautiful hospital births and when people talk about how bad hospital births are I get a little defensive. Truth is it really doesn’t matter. We are humans with our own emotions and we get to own them whether someone else agrees or not. Maybe the writer is anti-home birth. She is sending a message that “hey, there are crappy home birth midwives out there. Be careful.” Maybe not everyone is hearing that but I am. But NO ONE has a right to say her feelings are not valid or that she should have picked a better midwife, etc….

I cannot emphasize the importance of education any more than I already do. This includes the client but more than anything includes the provider, or any professional one may hire for a service. Our country has a problem with how it manages home birth deliveries and the midwives and people that attend them. States vary on their regulations and standards of education. Many midwives are not bound legally by any form of liability insurance. More than anything, this just makes me sad. So I’m not anti-home birth….I am anti-lack of education, lack of experience…so many mistakes were made in that birth. It’s not the first time and sadly, that won’t be the last time either. An educated, proficient provider would have called 911 the moment she noticed the waters were stained with meconium. This is just one of the many problems with the birth and I am not going to keep breaking it down. Anyone can see from reading the story that there were many mistakes made.

Lastly, I would like to address a comment that keeps getting thrown around by many people who are clearly “anti-hospital birth”….”Babies die in the hospital ALL THE TIME!”. You guys. This is NOT true. In fact, it is RARE for a baby to die in hospital and most of the cases in which one does not make it is due to some kind of fetal anomaly that could not have been prevented (like a cord accident or genetic issue).

Anyway, I had to get these feelings out. I had to express how sad I am that, 16 months later, this mama is experiencing so much birth trauma. I have no doubt that writing about it helps her. I had to share that, though I may have concerns about home birthing, I am not against it.

Behave in the comments. Remember to be respectful.

new year, now what?

I have to admit that I am not all puppies and rainbows about a new year right now. I feel like the last few months have been so taxing that I haven’t even had time to think about all the great things I know that 2015 will bring me. This month, even while off school for a few more weeks, will be busy. I am preparing to take the HESI A2 entrance exam. I am hoping to take that in a week or so. It’s a big deal because if you don’t get 75 or better you can only take it once a year and that means no nursing school. I am sure that won’t happen. I am doing the practice tests and have a study guide. I have strong and weak areas to work on.

I am also getting everything else together that I need to apply for nursing school. This includes transcripts, background check, and more. I have nothing but positive happy nervous energy surrounding this.

Last week I had my first mammogram. I am to have a mammo every year now, followed by an MRI 6 months after the mammo. This means I will now be screened every 6 months for breast cancer for the rest of my life. This is well worth it to hopefully prevent and/or catch anything that may appear super early. I have a small, pebble-sized lump that is being ultra-sounded next week. It is not concerning. I have had fibroadenomas (benign lump) before. Then again, so had my mom. We have fibrous breasts. Screening is critical. I did do the BRCA 1 and 2 screening and it came back negative. However, my lifetime risk is 25.4% of getting breast cancer, hence the screenings. This is the first time in my life I have ever been considered high risk for anything. What a trip.

And lastly, as per tradition, I ought to list a few goals I am happily looking forward to this year:

  • Getting into nursing school
  • Taking a human sexuality class- I never have and am sure it will be fun and interesting
  • Seeing my son start kindergarten
  • Get some home improvement projects done like painting and new fixtures (HA! In my dreams!!)
  • Pay off all medical debt
  • Pay off all cc debt
  • Take a family vacation
  • Read something (anything!) for fun
  • unplug more from social media and TV
  • Start a weekly family game night
  • See my mom complete treatment and be cancer free (really, the ONLY thing I could hope for)
  • START nursing school

See? Not too much to ask for. I will say that while goals are great, I have learned over the last few months that sometimes it is better to just take each day one at a time. I love looking forward to things, but sometimes life needs us to slow down and if I have learned anything from my mom having breast cancer and my best friend dying, it’s to slow down and love and enjoy the day we have right now, right this second. Happy New Years everyone.

prerecs are done!

Last week I received my final grades for Microbiology and A&P part 1…A in Micro and B in A&P!! Considering that the last half of the semester was quite hellish in my personal life, I am very happy. I am so grateful for online schooling! I could not have done any of this without the option. I was very nervous at first to attempt not one but two labs online again, considering that my first attempt didn’t work out well. This semester was actually great. I enjoyed both classes. I felt like it was the first time in all my prerec classes that I was able to apply what I was learning to real life. Next semester I will take A&P part 2 and Human Sexuality, both online again. I am grateful for a break right now. I am going to be studying for the HESI placement test during this break but I’m not hitting it too hard, not yet anyway. My brain feel so fried both from school and emotionally.

Last week, my childhood best friend passed away. It was so unexpected and tragic. My heart cannot take anymore loss or bad news. I work Christmas Day so we are celebrating on Christmas Eve, a day which I am really looking forward to celebrating with family…

Merry Christmas everyone. I’m hoping to post a “year in review” soon.