Wednesday, December 06, 2006

Stink

I was called to the delivery room in case there was a problem with the baby, but before the baby even made it to me from the obstetrician we could hear her crying and breathing normally. She didn't need any resuscitation, just some drying off, but there was one thing wrong with her: she stunk to high heaven. In fact, the whole delivery room stunk.

Sometimes babies will stink because they are infected or just came from an infected uterus, but that wasn't the problem here. As I rapidly looked over this baby, I found the source of the smell: there, on her upper chest and neck, were feces, the mother's feces. Mother, as she was pushing her baby out, had also pushed some of her own feces out and they had gotten on the baby. The nurse and I wiped off the feces and threw out the dirty towel, giving some relief from the smell.

This may seem gross to some of you (and it is), but it's actually not that uncommon for mothers to have bowel movements while pushing during childbirth. In fact, mothers are often exhorted by the caregivers to "push like you're going to have a bowel movement," so it's hardly a surprise that they sometimes do. Usually it doesn't get on the baby, but it still manages to stink up the delivery room.

It's just one more thing that makes me feel sorry for moms during delivery. It's bad enough, dehumanizing enough, that they have to lay there with their feet up in stirrups and their bottom exposed to the few or several people in the room, but then to have those people witness you having a bowel movement seems just downright degrading. However, I think that many women don't realize it when they have a bowel movement during delivery, and even if they do, they might not care given everything else that is going on.

I don't think I could be an obstetrician. The sight of the blood and fluids I can take, but man, the smells and sounds would bring me down real fast.

37 Comments:

Anonymous RCM said...

"It's bad enough, dehumanizing enough, that they have to lay there with their feet up in stirrups and their bottom exposed to the few or several people in the room..."

As an English midwife, I have never understood this practise in the USA. I cannot imagine anything more awful than giving birth on my back, never mind having my feet in stirrups. We do not use them here.

I also notice an awful lot on US birth shows that the mother is on almost constant Oxygen/Entinox - do you know why?

Also - there seem to be a lot of people at each delivery - here it is unusual to have more than one medical person in the room.

Final question (I know you're not an OB) - why do US delivery rooms seem so loud? Lots of 'chin on your chest! push! push! push! -ing - do US OB's have midwifery training at all?

8:47 PM  
Blogger Old MD Girl said...

I think the stirrups part sounds more dehumanizing than the shitting yourself part. Something about displaying your goodies for the entire world to come and have a look at. Which they do. At least they don't shave the woman's pubic hair anymore. At least, so I hear.

9:00 PM  
Blogger Flea said...

A med school classmate of mine became an OB. During residency, we traded stories about the weirdest chief complaints we had ever heard.

His was "My p**** stinks so bad people won't sit next to me on the bus!".

His CC won. I too was grateful for having chosen peds.

best,

Flea

9:04 PM  
Blogger SuperStenoGirl said...

rcm has a good question: I've always wondered the same thing and I'm in Canada. Why do hospitals have women lay down with their feet up to give birth? It makes so much more sense to either be angled (which I believe is also done sometimes) or squatting where gravity at least even a little bit of it can help. The Ancient Egyptians used this, as well as Native Americans/American Indians.. and I'm sure many other cultures did as well.

So why are the women on their back while trying to push?

10:39 PM  
Blogger Kelly said...

Just to avoid the unnatural "laying on the back" position (amoungst MANY other unnecessary things), I have my babies at home. This is becoming more popular, but I think the Europeans and Canadians have the better methodology when it comes to hospital birth.

As far as the stink involved with giving birth---it IS quite annoying. It kinda makes getting an enema during the first stage a welcome idea!

Especially if you want a water birth ;)

11:30 PM  
Blogger Laura said...

i am glad that my ob was progressive nough to deliver my babies with me sitting in a birthing chair (most borning beds can be broken down into a chair which is wonderful for the moms...well, the last one he at first refused saying my b/p was too low and he feared i might pass out but i stubbornly refused to push until he relented and i sat up and pushed my baby out in one long, smooth push.
i would say from what i have seen the last couple years that the trend is back to lying flat with one's feet up in the stirrups. it must be due to the rise in epis and managed labors.
i just pretend like i didn't push anything out but my babies and placentas. it's a nice fantasy. ;) frankly, i really didn't care while i was in the moment.
i try not to notice when i attend deliveries too.

12:01 AM  
Anonymous Anonymous said...

SORRY for women giving birth? That's so strange to hear, I'm actually sorry for men NOT being pregnant and giving birth, and I've told my husband as much. But then again, I approached my pregnancy as making a person, and the discomforts were part of it, and when I was giving birth to my daughter, I approached it as doing a very special thing that I was made for, and I would enjoy it to the maximum. If I wanted to "chant" or make noise, I did. If I wanted to go around with no clothes on, I did. If I had a bowel movement, fine, the world could hang themselves if they didn't like it. (I just warned my husband of all the gross stuff that might happen, so he was prepared.) And I watched the video of my delivery to cheer myself up -I still do. The most beautiful thing, yells, blood and all. I'm looking forward to doing it again.

Anna -UK

5:11 AM  
Anonymous Anonymous said...

ahh,the ambiance! meconium,bacterial vaginitis,maternal feces,dirty feet,and last but not least,the all-pervading aroma of stale tobacco.makes you want to reach for the old oil of peppermint bottle.

6:29 AM  
Anonymous RCM said...

Supersteno girl - I think that in America birth is now highly medicalised & as such having a woman on her back to give birth is the 'norm'.

In England we encourage home births & all manner of positions in labour. Standing or squatting works very well, as does on all fours.

When I watch the US shows I end up hollering at the TV 'Get her on her feet!' or 'Don't let them do that to you - get out of those bloody stirrups!' So I tend not to watch too much.

I think I would be a US OB's worst nightmare!!

I also cringe at all the internal examinations they do. I would say that 30% of the births I attend have no VE - there is very little need for it in a 'normal' birth.

Generally, research shows that a women labours best when walking, sitting, bathing, relaxing (it is possible to relax xin labour) & being at home or in a nice room, with no shouting, no bright lights & no bossy Doctors!

7:48 AM  
Blogger stockingup99 said...

We don't have to lay there. Stand up for your birthing rights.

Here in the US doctors have bullied me with no-sense standard protocols which have been disproven.

They try to force you to fast for fifteen hours, followed by 50 grams of glucose, and threaten that your baby will be born to big for it's lungs if you don't. If you consent to that test which has a 30% false postive rating, then they put you on a diet to control the babies size. An 8 pound baby is considered large.

I fled from the doctors for my last birth, and birthed a healthy 9.5 pounder in a couple hours, without a hosptial. Most quacks around here wouldn't have even let me labor for fear of big babies.

The bigger, the easier. A full term baby has fat which squishes and cushions. It's the bony ones induced before their time that are a problem.

We must stop the cascade of interventions which cause so much trouble for our NeoHeroes.

10:33 AM  
Blogger Name:SuperStenoGirl said...

stockingupp99,
9.5 lbs is big - that's more than my dog weighs (oh, so I have a pillow princess but still).

Not having a medical professional around sounds nice SOMETIMES but in other cases it's really necessary. Take a friend of mine for example, her baby was only 7 lbs 11 ounces but her head was huge. It got stuck in the birth canal and the doctors eventually had to push her BACK in and take my friend for a cesarean. The baby was born with a ring around its head (and when my friend asked a nurse if it'd go away, the nurse replied "I don't know").

Other babies are breech, or other issues so delivering by yourself at home probably isnt always the wisest choice unless you have someone of the medical field there - a midwife is a good choice if you don't want a doctor.

And for the record - my friend's daughter was fat at birth. And fat afterbirth so much so that she had to lift the rolls of fat on her chin to bathe her properly. She looked like the Michellin(sp) man. My poor friend, she only weighed 103 lbs and the baby by 8 months weight close to 30.

rcm - thanks! I'm glad to know that somewhere else they're doing it that way. I've never had children but I've always wondered why they lay the woman down with her feet up it never made any sense to me. But yes, I can see what you mean by really medicalised.

11:22 AM  
Anonymous Crunchy Mom said...

And then doctors wonder why women want to birth outside of hospitals. I will never set foot in a hospital again unless I or someone I love is in grave danger. I live about five minutes from a hospital and less than a mile from our local ambulance dispatch, more than enough time to transfer to the hospital should a problem arise (and make no mistake: I would not hesitate to give birth in a hospital if I or the baby developed real complications).

1:00 PM  
Blogger stockingup99 said...

I didn't do it at home, or without a medical professional. I went to the midwife's office, which was around the corner from a great hospital.

She said seven minutes from picking up the phone to getting a C, they prep the room while we transport there. (in case)

I wouldn't recommend unassisted. Having a professional specializing in normal birth is important.

This time, I have a doctor who specializes in home births. I only switched because my employer said I need a doctor to qualify for maternity leave.

blank superstenogirl, you didn't mention whether she was on her back or not.

They lay women down, because it is easier for the doctor to view, and do things. Other positions have been shown to open the pelvis up to 30% more. Layinhg on your tailbone, puts it in the way and more open to damage.

1:11 PM  
Anonymous Anonymous said...

yup. that was one of my biggest fears approaching the birth of my child.
not the labor pains even though i was deadset on going unmedicated because i knew they would hurt, A LOT.
having a bowel movement was seriously my greatest concern. it may seem trivial but it was nonetheless huge to me.
thankfully i had 2 nice servings of castor oil to empty myself before the actual pushing.

-r-

1:20 PM  
Blogger SuperStenoGirl said...

Stockingup99, she was on her back. They tried to get her to sit up a bit but it was too late - baby was already firmly stuck.

1:28 PM  
Anonymous Another Mom said...

Yeah, the whole bottom's up approach to delivery in the US is pretty degrading. But poo is the least of it. I think the way everyone gathers around a fully dilated woman and chants "PUSH PUSH PUSH!" like they are gearing up for a big football game is just the rudest, most disrespectful thing. I occasionally watch that program called "A Birth Story" on a (US) cable network, and it seems like so many women spend the most vulnerable moment of their life getting yelled at rather than supported by their OB or nurse. How that actually assists the mom in getting baby out, I'm not sure.

Also, what *IS* the deal with OBs and nurses counting to ten during the push at the start of the contraction? It isn't step areobics ... seems to me that pushing longer or shorter than ten seconds would be just FINE.

2:50 PM  
Anonymous Anonymous said...

The things your parents never teach you about childbirth!

Anyone know of a gynocologist's blog where this discussion might be more appropriate?

4:26 PM  
Anonymous Anonymous said...

Er... obstatrician? (Never had kids yet.)

4:26 PM  
Blogger LeosMama said...

The dehumanizing is definitely the doing of the medical system in this country. Interventions and protocols are to keep the medical folks feeling like they're managing everything and keeping the mother/baby safe. But their fear really is dehumanizing and endangering.

6:09 PM  
Anonymous Anonymous said...

oh mah gawd,are we going to step back 100 yrs and have all the deaths we saw then? hope not.methinks a live baby and mama are more important in the long run than an "experience" not saying that some things need to change,yes they do,but home deliveries are opening up a BIG can of worms

6:20 PM  
Blogger neonataldoc said...

Wow, I don't know where to start replying. I agree with a lot of what rcm said. I don't like the yelling and crowds at so many deliveries, and have posted about that in the past (but I don't know how to put links in the comments section.) Anonymous 6:20, I agree that we can't go back to the bad old days. As far as opening a can of worms with home deliveries, I did that last spring.

7:50 PM  
Anonymous Amy said...

It's very simple. You want to discourage home births, you start treating women better when they go to the hospital to give birth.

8:23 PM  
Blogger Xquizitdazie said...

I don't know about other places but here they have birthing suites. They are quiet large rooms with a big bed, couch, chairs and T.V.s. They are actually pretty nice. Think hotel suites. You can have soft music on with low lighting as long as the labor is going well. It is quiet peaceful. I found out with my daughter that I could have her sitting up in a birthing chair. I also found out that as long as their are no complications this is ok as long as you tell your doctor your wishes. It would seem to me also, that one of the main reason so many women are forced to lay down during child birth is the opt to have an epidural.

9:27 AM  
Blogger LeosMama said...

Anon 6:20, nobody is advocating the bad old days when women and babies died so much. We can use modern science and evidence based medicine AND treat women and babies in a humane manner. Really.

6:35 PM  
Anonymous CJ said...

ND, to link in comments you type <a[put one space between the "a" and the next bit]href="http://www.linkURLhere.com">text to be highlighted here</a>

Your post on delivery room noise is here.

I started reading your blog when you posted about homebirth and I'm curious about your reaction, eight months later, to the debate. Do you still feel that it's terribly unwise to deliver at home? (assuming low-risk mother, qualified attendant, singleton vertex baby, plan to transfer if necessary and reasonable transport time) Does it still seem to you like it's thrill-seeking on the parents' part?

It was a big can of worms and I don't mean to re-open it, but I thought it was a fascinating conversation and you didn't post much about your reaction to it.

I wrote one of my statistics papers this semester on the research I read while following that thread. So here are my belated thanks for indirectly making a potentially dreary paper much more interesting. :-)

10:43 PM  
Blogger neonataldoc said...

Thanks, cj! Regarding my thoughts on home deliveries now: stay tuned, I'll write a post on them soon.

12:00 PM  
Blogger Highland Midwife said...

"that they have to lay there with their feet up in stirrups"

Horrifying. Positively Dark Ages.

If I were to try to dream up any position that is worse for giving birth than the lithotomy position, it would have to involve something unreal like chains and shackles holding a mother upside down under an airplane at 10,000 feet...

Doc, if I were you I would be having a serious talk with your OB Dept. They are at least 80 years behind in their thinking, and must have no clue what evidence-based medicine is. Midwives put women in that position when there is a serious complication that necessitates slowing or STOPPING labor!

And the use of Valsalva pushing? Proven to do plenty of harm and little or no good at all. What kind of moron adopts a technique so perfectly designed to de-oxygenate the baby, just because someone else thought it up and used it? Spontaneous open-glottis (natural) pushing is easier, faster, safer, and more effective. Read the research.

Speaking of research, I will be very curious to see what you have to say about homebirth now that the Johnson study has been published. You had stated before that midwives don't do research, so maybe you should take a look at a few articles. I have some posted on http://highlandmidwife.blogspot.com.

Careful though, we might convert you.

:-)
"Grandma"
Highland Midwife

3:04 PM  
Blogger neonataldoc said...

Highland midwife: When did I say that midwives didn't do research? A commenter may have said that, but I don't think I did.

7:51 PM  
Blogger Highland Midwife said...

Hmmm...Doc, you might be absolutely right on this one. I think it was that Dr. Amy T., who is always blasting any maternity care provider except OB's, and any birth site except hospitals, who made that comment about midwives. She tries to browbeat people with misquoted statistics, too, so more than likely the remark came from her. Her comment was here on your blog, though, under that home birth thread.

So I apologize profusely for thinking that was you!

:-)
Grandma

2:36 AM  
Anonymous frectis said...

Thanks, cj! Regarding my thoughts on home deliveries now: stay tuned, I'll write a post on them soon.

I'm a home birth midwife and would be interested to hear... however: do you really want to invite that debate beast to your site?!

4:53 PM  
Blogger karen said...

My dh is a pediatrician now, but he tells stories about his med school time that are pretty funny.
During his OB rotation he was in the delivery room with another med student. The mom was pushing hard and let out some very loud, very long stinkers. There was a pause in the action and the other med student said (rather loudly) "WHOA, who stepped on that duck?"
Yes, totally inappropriate, I know, and he got kicked out of the delivery room for the rest of his rotation!
But in hind sight it was pretty funny! :)
Wih my first delivery I was very afraid of pushing and having a BM. My pushing was very ineffective. As my OB was also ineffective, I switched to another for my ds. When I was pushing she told me I wasn't pushing well. I admitted I felt like I'd have a BM if I pushed any harder. She said (and I love her for this) "If you don't have a BM, I know you're not pushing well....now PUSH!" Two pushes later, ds was born! :)

9:42 PM  
Anonymous Beth W said...

Here from Grand Rounds, and rather amazed. In Poland, we have a big, heavily publicised push for "humane birthing", ie birthing suites at hospitals where a family member is allowed, the woman can choose any position, and the place looks home-like. This, like the presence of only a single nurse and doctor and letting the mother spend time with the baby before weighing etc, is slowly becoming a standard. I think that at this point, few hospitals would dream of telling a woman she has to lie on her back.

The catch? Everyone tells us the old practices were a Communist relic and no-one in the civilised world would ever do it.

Nice to see we seem to be ahead of the US of A in some ways ;)

11:39 AM  
Blogger Kenneth F. Trofatter, Jr., MD, PhD said...

I had no idea a little "Stink" could create such a furor! I happen to agree with many (but not all) of the comments and was going to leave my own, but it got so lengthy, I decided to post it to my "Fruit of the Womb" blog instead Poop is Part of Parturition If any of you are interested, please feel free to check it out.

3:20 PM  
Anonymous Kim said...

Ah, the Push and Poop scenario was part of the first delivery I ever saw...the one I promptly fainted at.

(I was 18 years old and never new you could stick those giant forceps where the sun don't shine.)

My Friend the Fleets was present during the first stage of my first labor. There was no poop factor as I happened to have a C-section after all.

Now, here we go to all the trouble of having a clean, dare I say sterile delivery rooms and mom goes and poops on the kid. So much for infection control... : D

4:07 PM  
Anonymous Anonymous said...

Weird. Atthe hospital I went to no one shouted push at me. Sometimes they'd count, because it helped me keep track of when to breathe, but no one was screaming. They'd offer me feedback on if my push was productive or not, and I welcomed that help.

I also labored on my back, my sides, and even my front. I had an epidural that made one of my legs numb, but everyone helped me roll over. I have to say, getting on your hands and knees when you can't feel one of your legs is a bit odd, but my husband's a strong guy. ;)

Sure, I wish I'd had fewer interventions, but I've now had two babies present transverse the exact same way. I have a feeling my pelvis is jsut shaped funny and makes them come out weird. I had to push for three hours with the first and an hour and a half with the second. I really was happy to have an epidural help me. ;) (Both times I also ended up with one leg numb and the other with only a small amount of pain relief, so I really have to think somethings wired a bit weird back there. Oh well.)

Anyway, don't be so quick to judge. Plenty of hospitals in the US aren't as they are portrayed on TV. :P

Oh, no stirrups, either, though honestly I would have liked something to push against. Instead, the nurses had to grab my feet and push against me. Somehow it helped make my pushes more productive. And honestly, in labor the last thing I'm thinking of is who is looking at my privates. All I wanted was to get the baby out. :D

(Though I was temporarily grossed out when I realized I did poop on the table with my second. But I figured oh well -- they see this all the time.)

Anyway, I'm pretty much against home births. There's just too many things that could happen, even when eveyrthing seems ot be going well. All I can think of is my brother's birth -- he was born not breathing, and my mom started to hemmorhage. I don't know if either one would have survived a home birth. Sur,e plenty are safe and fine, but I'd rather not have the avoidable risk, personally.

3:10 PM  
Anonymous Anonymous said...

Some people worship a devil who a reptile dinosour dragen hes the king of devils named Saten. Hes the oppisate of the one true Holy God. Saten best friend is a beast from the bottemless pit who has ten horns and seven heads, feet of a bear body of a leopard. Some Satenist maybe 561,000,000 are dead set on killing innocent babies when they get a chance to switch them with a clone. Someday they will have the beast mark on their right hand or forhead. Its 666 its a click where Christianity is hated. But Micheal and his angels will fight the devils and his Angels. The Canadian military, and Holland have a picture of Angel charoits. some day these 2 countries are going to go berzerk and kill millions of Americans maybe in 2058. Goddamit! I dont trust the Brittish people in Britian either.

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1:39 AM  

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