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.