Vanita’s Preface: There is a well-known phenomena that new nurses and other professionals experience as their idealistic dreams of “helping people” are tempered by their less-than-perfect or possibly even disturbing experiences in the medical system. This transition is referred to as “reality shock”. The RN who wrote this story now is a “Doctor of Science”. She describes some of her ethical dilemmas with the use of interventions and deception in modern maternity care. After her experience at this very high-tech hospital, she continued to naturally assume that most of the routinely used modern gadgetry that women and their babies had been exposed to was helpful or even essential. Here is Kerry’s tale:
“How lucky am I?” That was my thought when I interviewed for my first job as a registered nurse and was hired into labor and delivery. For new graduates, getting a job in “L&D” was almost impossible. The unspoken rule was that you had to pay your dues first in another hospital ward, but a nursing shortage helped me get my dream position right away. I was young, naïve and had a lot to learn, about a lot of things.
I worked the evening shift in our local hospital in Southern California, the same hospital that I had trained as a student. We had 4 labor cubicles and 2 delivery rooms that resembled operating suites. Our patients were mostly the uninsured, poorer women of the county and undocumented migrants from Mexico. Our hospital was affiliated with a large university and our medical staff were primarily students, fully-qualified doctors (residents) in a 3-year obstetric program and 2 senior doctors who were available to come to L&D when needed.
I loved L&D. Mostly it was the happiest place in the hospital but occasionally the saddest. We were very busy and routinely overflowed our available rooms, ending up with patients giving birth at “scrub sink 1” or “hall 2”. As a teaching hospital, our patients often doubled as research participants. When our doctors were involved in research or a trial, our patients became the study group. Many times, the studies weren’t intrusive (e.g. collecting an extra urine sample) but occasionally it would involve something invasive like exploring the relationship between fetal scalp pH (the pH of the baby’s blood) and the fetal heart rate. To collect the blood sample, we needed to poke the unborn baby’s scalp as it descended through the birth canal. Most anxious laboring women eagerly signed a consent when it was presented that their baby “might be in trouble”. What wasn’t adequately explained was that the majority of “irregular” heart rate patterns were common and low-risk and mostly due to the head being squeezed as it descended the birth canal. Additionally, what wasn’t well described was the risk to the baby as we made numerous small holes in the protective skin of its head. Vanita’s note: (Fetal scalp blood sampling fell out of favor when it was realized it was just as effective to rub the unborn’s scalp and if the baby’s heart rate went up you knew the baby was okay).
I left this job after two years following an argument with one of the senior doctors. I complained when he supervised a 3rd year resident cutting an extensive episiotomy (deep vaginal incision) which I felt was not indicated. When I confronted him later, he said that the resident was graduating soon and that she hadn’t had an opportunity to sew up a deep episiotomy. He preferred that she cut and repair an unnecessary episiotomy with his help rather than deal with this situation by herself in the future. For the sake of training, I had also seen forceps used when babies and their pushing mothers were in no distress. These “opportunities for learning” didn’t happen only to mothers. I had seen healthy pink and crying babies have intubation tubes put down their wind pipes to teach the pediatric residents. Over the years I have thought about our vulnerable patients who were subjected to unnecessary interventions for the sake of the medical staff’s education. Most of these women freely consented, being led to believe that it was in their best interest while others were informed after the fact, creating the impression that it was an essential part of their care.
Vanita’s Note: Helping a baby breathe through a tube inserted into the windpipe or trachea is a useful skill not commonly needed with healthy newborns. Though can be very helpful it carries risks also.
It was hard to leave this job. I felt that I was abandoning my patients, but I wasn’t very welcome after I had spoken up. My story doesn’t end though and my nursing career has taken me around the world to places and experiences I will tell you about in future blogs.
Dr. Kerry Newlin, RN, Nurse-Practitioner, Doctorate Health Sciences
Kerry has had the great fortune of attending women during birth in the United States, Nicaragua, Kenya, Ethiopia, Liberia, and East Timor. She currently lives in Australia with her amazing Aussie husband. She spends her time tending her garden, remodeling her house and teaching the next generation of health care providers. She is the primary editor for Awakeningbirthnow.com.