Monday, February 29, 2016

UCSD Birth Center Experience **Updated**

**This post is a little bit graphic**


When I gave birth to Jordyn last year, we were still living in San Diego.

Photo from Wikipedia
We researched a lot of hospitals and selected the UCSD Medical Center in Hillcrest.  We chose this hospital because it is the only hospital with a birth center actually inside the hospital in San Diego.  The birth center is staffed and operated by nurse midwives.  We wanted care from midwives and use of a birth center because we had decided that we wanted as natural of a birth as possible.  As little medical intervention as possible, no pain medications, no continuous fetal monitoring and the ability to move around during labor.

Overall, our experience with the prenatal care was fine.  Nothing exceptional but not bad either.  Since there are so many midwives in the practice who all rotate being on call in the birth center, they recommend that you see a different midwife each appointment to meet as many as possible since you don't know who will be on call when you go in.    This was a little frustrating.  They definitely have some midwife to midwife communication problems.  We would have one lady tell us one thing, then on later tell us something else.  Everything was worked out in the end but it was some added stress that we could have done without for sure.

The morning of Wednesday September 3rd (2014) I had a weekly appointment (I was 39 weeks) and since I was already starting to have some random contractions, the midwife offered to sweep my membranes to see if that would get things moving.  That did the trick and by the next morning, I was in full blown labor.  After my water broke, we loaded up in the car and headed to the birth center.
And this is where things started to go wrong.

We checked in there and were assigned a wonderful nurse whose name escapes me.  She stayed with us most of the time and was just wonderful.  She was making suggestions, trying to do everything she could to get me as comfortable as possible.

Then the midwife Beth Tempe came in.

She seemed pleasant enough at first but the first thing out of her mouth was that they had some pain management options (i.e. meds).  During our prenatal care, we had sat down and written out our birth plan with one of the midwives and the first thing we put on it was that we were not interested in any medications and asked for the attending midwife to not even have that as an option.  This frustrated us a little because we felt like right off the bat she hadn't even bothered to read the birth plan at all but we tried to brush it off.

As time went on, she seemed to get more and more irritated with us.  Our doula (our Aunt Tracy) said after the fact that she got the impression that Beth was used to being in control and didn't like that we were so knowledgeable and in control ourselves.  We knew what we wanted and we were sticking to it as much as we could.  She made a few little snarky remarks that were not helpful at all.

For whatever reason, Jordyn decided to be stubborn and required me pushing for 2 1/2 hours to get her out.  (Ive already had a "discussion" with peanut that that is not going to fly this go round!)  While I was pushing, Beth started using her fingers to push me open.  Tracy noticed that she started doing this before Jordyn's head was even anywhere close to that point.  She was using two fingers on each hand and had levered herself up above me to push even harder.  I ended up with a nasty 3rd degree tear that required quite a few stitches after the fact.  I'm sure that I would have torn anyway but I do wonder if it would have been nearly that bad on its own.

So finally, Jordyn was born.  We watched the cord and waited to cut it until it had stopped pulsing.  Once it was cut, Beth started pulling on it.  Pulling to the point that her hands were shaking according to our friend/birth coach/photographer Erica who was watching.  Beau noticed that so much force was being applied that I was actually starting to slide down the bed as she pulled.  He calmly said that he felt that she was forcing it and asked her to stop.  Said we don't want it pulled (per the birth plan AGAIN).  She stopped and didn't say anything for about 30 seconds then started pulling again.  Beau again asked her to stop and she said "the cervix is closing, I don't have a choice" and pulled until the placenta came out.  This practice had preached informed consent from the get go.  About how every thing that would happen short of an emergency situation, would be explained and discussed by the midwife and nurses.  Not so much.  She didn't say a word before she pulled, while she was pulling or after it was delivered.

Once that thing was out, she was gone.

We have since learned 2 things about this.  One, it takes HOURS for the cervix to close after a birth.  The placenta is meant to come out on its own and the cervix is built to accommodate that.  Secondly, we learned that the average time in the US that a placenta is left to do its own thing before someone has to intervene is 30 minutes.  In Europe, it's often 1 hour.  She was pulling less than 5 minutes after Jordyn was born.  She didn't give my body the opportunity to handle it on its own.

Tracy started pressing on my belly as soon as Jordyn came out to try and stimulate contractions (very common doula practice) and Beth told her to stop it.  Again, not in control and didn't like it I think.
After the OBGYN on call came up to see if I needed stitches (duh!) they started to notice that I was still bleeding quite a bit.  I was given a shot of pitocin to see if that would help the bleeding stop but it didn't.  The nurse, a new one at this point, asked me to get into a wheelchair to go get my stitches and when I stood up, my vision went black around the edges and everyone said I went grey.  The nurse freaked out and they had me on a stretcher and downstairs to Labor & Delivery very quickly.

Once I got down there the OBGYN, who again was amazing, said that I has hemorrhaging and that I had a huge clot that was not allowing my uterus to contract and stop the bleeding.  Basically, what he had to do was stick his arm up to his elbow up my "who ha" (cervix was closing my butt) and pull out what ended up being a football sized clot.  Now mind you, I had no paid meds.  All they had time to do was give me was an IV and make sure I signed a consent form for a blood transfusion which a nurse told me I came very close to needing.  Let me just say, that hurt like nothing I had ever felt before.  Yes giving birth hurt don't get me wrong but this was something else completely.  Thankfully he knew exactly what he was doing and had it out in less than a minute.

I then got a small spinal block for the stitches and was finally able to relax.  Because of the blood loss, I was too weak to be able to get myself to the bathroom so I ended up having to have a catheter.  I hate anything like that.  I hate IVs, I hate needles, tubes, anything.  So that wasn't fun at all.  I also found myself in the position of having to completely rely on Beau and my mother to take care of Jordyn.  This bothered me.  I know that's what they were there to do but I felt like I should have at least be able to.  I wasn't able to pick her up, change her diaper, anything for almost 3 days.

We all feel that the hemorrhage was a direct result of the placenta being pulled so early.  The best we can figure is that she had a bad day, she she got fed up, wanted to be done with us but had to have the placenta delivered before she could sign off on the room.

We know perfectly well that we were not the only patients there.  I know she had other people to go check on but I feel like she put us in a bad and dangerous position simply because she wanted to leave.  I know situations like this come up often where the midwife is stuck with one patient but that is why they have back ups on call.

We were not sure how best to handle this so after a few weeks, I decided to contact the Patient Advocate program at the hospital.  I sent an online form in explaining what all had happened and the concerns we had and received an email from Adele Lynch a few days later on October 27, 2014.  In her email, she said that she would be forwarding my complaint off to the department head and I should hear something within 30 days.

I never got a response.  I emailed her back on December 24th, 2014 and again on February 14th, 2015.  Nothing.  I submitted a complaint with the California Hospital Review Board in April and I'm still waiting to hear back from them although they said it would take a long time.

I got frustrated again after finding out we were expecting again so I decided to find a generic email address for patient relations and I forwarded Adele's email to that address and said that I had not received a response and I wanted to know the status of my compliant.  And wouldn't you know it, that seemed to work.  She came right back (like within 2 days) and was just full of excuses about how she had forwarded all of my follow up emails onto the department head, and how sorry she was.  She did admit that she should have responded to me but whatever.  She assured me that I would hear back from someone within a week.  My guess is someone else saw my email and called her out on it but who knows.  I did get an email from Karen Perdion about a week later.  She is the midwife department head.  She again was full of excuses but said that she wanted to set up a time to speak with Beau and I on the phone.  We scheduled a time and spoke to her on the phone yesterday.

She asked us to tell her exactly what had happened and what our complaints were.  We laid everything out for her and expressed all of our concerns.  She was quite (taking notes) for the most part but she did seem a little surprised by what all we were telling her and said that what happened to us seemed a bit extreme.  She also said that that behavior seemed very out of character for Beth.  She said that she was going to have a conversation with her boss about it then one or possibly both of them would speak with Beth about it then get back to us on the issue.


**Update**

By the middle of Janurary, we not heard a word back from Karen so I sent a follow up email.  She replied back that Beth appreciated the feedback and would be more than happy to speak with us if we wanted...What?  I had no idea what she was talking about as we never expressed any interest in talking to Beth.

At this point, I had had enough.  This had been going on for almost 18 months, I was 21 weeks pregnant with baby #2 and I was just over it.  So I sent Karen a very frank email.  I said that I was frustrated that this had been dragging on this long, that I was irritated by the lack of interest from the hospital, that no we had nothing to say to Beth and we had been under the impression that she would be following up with us after her conversation with her supervisor as she stated on our phone call.  I also made it clear that we did not contact UCSD to provide feedback, that we were trying to lodge a complaint but we felt was being ignored over and over again.  I also said that while we never expected any kind of apology, we had hoped for the hospital to show at least a little concern about what had happened and show that something would be done to try to make sure what happened to us didn't happen to someone else.

She replied that she was not allowed to divulge any peer review process or any HR processes that may have occurred since our phone call.  She said her response to my follow up was the most legally correct thing but she should have written more.  (Although she then went into more detail about how there was infact a conversation with Beth and the supervisor and that the case was carefully reviewed any appropriate action was taken, which is all that I wanted in the first place.)

To be honest, I really wish she would have just said this in reply to my follow up email.  Her response to that email made us feel that she hadn't heard anything we said on the phone call and that nothing had been done at all.

She then went on to tell me all about how Beth has not had a complaint in 10 years (although I wonder how many people tried to and got ignored like we did initially...) and had one of the lowest hemorrhage rate in the practice.  Which somehow doesn't make me feel better but there you go.

At the end of the day, I've decided that it is just time to let this whole thing go.  I've spent almost 18 months dealing with this and I think at this point I've done all that I can do.  I'm ready to put this whole experience behind us and put our energy into everything else we have going on.  We have a crazy and exciting year ahead of us and we are both ready to just look forward instead of being stuck on this so this is the last update.


Thanks guys!!



Beth
http://clinicians.ucsd.edu/Clinicians/Details/11370


Karen
http://clinicians.ucsd.edu/clinicians/details/11639




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