Sunday Morning~Blizzards and Babies

February 15, 2015

What happens when you get a weekend blizzard in rural Maine with medical staff covering two different hospitals 25 miles apart? Tension, difficult decisions, and anxiety.

It was bound to happen. A woman’s water breaks when she is at her due date.  She is having contractions and lives a few blocks from our little community hospital.  A blizzard is raging and it is the middle of the night. This wouldn’t be an emergency necessarily, except that she has had a previous c-section. In our world this is a problem.

She has a very good chance of having a vaginal birth.  Her previous c-section was done in a big hospital in a different state where she wasn’t even given a chance to have labor. She doesn’t even understand why she had the surgery as it wasn’t fully explained to her. She told me she thought it was because she had asthma.

So our plan was to have a trial of labor.  Then the blizzard hit, there was another emergency in the other hospital, and the surgeon said we can’t wait for her to deliver, she needs to have a repeat c-section so he can leave.

I was sick. I asked how we would document this? That she would have an unnecessary surgery because we are short staffed? How can we use that for rationale? He agreed it was a difficult decision.  He said he would explain it to her.  The case in the other hospital was urgent as well and couldn’t be put off all day.  A few hours, yes, but not all day.

He made his way here through the blowing snow and presented the situation to this laboring woman and her husband.  He recommended that she agree to surgery since there would be no surgeon here if an emergency happened during labor. I held my breath, waiting for coercion-type language.  There was none.  He honestly explained it is very difficult in rural areas with so few surgeons and this was not optimal, but he felt it was the safest thing to do.  She looked at him between contractions and said clearly, “I don’t want surgery if I don’t need it. I refuse.”

He was stunned.  (Actually, so was I.) This had never happened before.

This scenario is something we’ve always dreaded but have not had to deal with––the need for him in both places. In their pre-delivery visit with the surgeon, women are told they will have to succumb to a repeat surgery if the surgeon is busy with other cases and can’t wait for labor to take it’s natural course. They understand this, but always hope it won’t be necessary.  Then today, with the worst possible driving conditions, here we are. And she refused. Awesome.  Her husband backed her up.  ”Nope, go do your other surgery, we’ll wait.”

So here we are, supporting her through a very normal labor with a very healthy fetus happily beating away.  She breathes through each contraction and dozes in between. She is confident that her body will do it’s job. She believes in this process and is grateful for the support. I am grateful for her strength and courage. Grateful that she is using common sense and not fear for this process.

The data tells us this is a safer option than the risks of surgery. Pregnancy puts women in a vulnerable position and often makes them consent to procedures they don’t need or want. As women’s health options in rural areas become more and more scarce, we have a looming public health crisis. Will it be called a crisis if only women are affected? Is it considered a hardship for poor women to have to travel hundreds of miles to get obstetrical care? In a state where winters are harsh and unpredictable? Where jobs are low-paying and many can’t afford gasoline? When they have no child care for other children and have to travel on dangerous roads?

I write as I wait to welcome this child. His life will be a factor in changing the resources for women and their babies. I’ll make sure of it.

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