A LONG but short Birth Story; Shared Decision Making

Shared Decision Making (SDM) implies “active listening”, always.
02/25/02,……. a LONG, yet short birth story:
This story is graciously shared with permission by Jessica & Alex Rodriguez, as each of their 3 births revealed key elements of “active listening”, which makes the Provider (midwives & physicians) better stewards of their care.
A) In 2015, Jessica & Alex had an uncomplicated pregnancy and spontaneous labor, of which they were reasonably prepared for; the birth  also involved Pitocin augmentation. As Jessica also had Thrombocytopenia (low platelet count, <100K), an epidural for pain control was not available. A healthy uncomplicated vaginal birth of their 8’7”  baby girl was the gift of life in starting their family.
Unfortunately 2 weeks later, Jessica was diagnosed with a DVT, in her left leg & treated effectively with anticoagulants (for 6 months), having no long term complications.
😎 In 2017,  a subsequent, pregnancy Jessica transfered her care to See Baby (Dr. 😎 and initially deferred anticoagulation because her intuition and research guided her to do so. This decision was initially supported as she  understood  the risk & benefit in NOT being treated (aka Shared Responsibility).
In my discussion with Jessica and her husband, I recommended additional testing to exclude Thrombophilia (a blood clotting disorder), which may place her at a higher risk for a recurrent DVT.  The test were (+) for both MTHFR (2 copies) & Factor V leiden; subsequently, Jessica agreed to begin the anticoagulation medication at ~ 20 weeks EGA, injectable Lovenox 40 mg/daily. The pregnancy continued uneventfully and she went on to have a beautiful Water 💦 Birth at 41 0/7 weeks EGA, birthing a 10 lbs. baby boy without complications and was graciously supported by her husband, Alex & Doula Mary Hanks.
C) In her current pregnancy (2019-20), Jessica initiated the Lovenox early, having an uneventful pregnancy until 35 3/7 weeks EGA. During a routine prenatal visit on 02/20/20, complaining of “feeling weird”, and  noting slightly elevated BP’s (140/90 mm Hg), Midwife Kim Holderfield, CNM evaluated &  “actively listened” to Ms. Rodriguez,  and we conferred about her care together. We (the pt. Jessica, Kim, & I) agreed to continue her evaluation in the hospital. Subsequently, a significant and isolated abnormal test result was the 24 hr urine collection with 5,790 mg of Protein (normal < 300 mg).   Other lab test were normal.
With further discussion regarding the diagnosis of Severe Pre-Eclampsia, and agreement with the recommendation to proceed to induction of labor,  Jessica made an emotionally healthy choice out of medical necessity (aka Guided Discovery).
Surrendering to a different path, the induction was long (> 24 hrs), involving extensive monitoring, Magnesium Sulfate (reducing risk of Eclampsia), Pitocin, artificially rupturing membranes (AROM), and for the 2nd time, indelible Doula support by Mary Hanks. Jessica had a precipitous birth  on 02/22/20, through a 7 cm dilated cervix of baby Mila Eden, 4’11”, healthy, and able to stay with her mother; Skin-2-Skin.
Amazingly, Mila’s precipitous birth (1 push), lacerated Jessica’s cervix (posteriorly). Her excessive hemorrhage, was treated urgently, warranting a trip to the O.R., placed under general anesthesia, and transfused 2 units of blood (PRBC’s).
Subsequently reunited with baby Mila Eden, and observed closely for 24 hrs, Jessica and Alex were able to witness 1st hand  (in  their last 2 pregnancies) the power & empowerment of SDM & Guided Discovery of which they expressed full confidence in their birth team, because  we were always “actively listening” to them.
And this empowerment resonates in Jessica’s own words: “I knew I can do hard things”, “that was tough”, “You listened” and “I trusted my team”.  Lastly “my 3 births were all different, yet all were amazing”.  And in Alex’s own words: “I knew she was strong”, and I had full confidence in the team”.
This is the essence of Shared Decision Making, Shared Responsibility & Guided Discovery.  Which seamlessly occurs in a powerfully supportive hospital setting like Atlanta Medical Center; Naturally a big “Thank You” goes out to the Staff & Nurses in creating this unique birthing environment.
Be well,

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