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The
Martha's Vineyard Times is a weekly publication.
April 14 - April 20, 2005 Edition
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Off
North Road
April
14, 2005
There
is no new Off North Road story this week.
The Miller family
April
7, 2005
By
Russell Hoxsie, M.D.
Part I
A group of women and I sat in my kitchen sometime in the fall of 1970
to discuss their hopes for a new approach to pregnancy, labor, and
delivery at the Martha's Vineyard Hospital. Those who have grown up
after the 1960s and 70s must have difficulty understanding the fire
and determination women had then for changes in the practice of hospital
obstetrics. I can remember walking through a typical labor room in
a large municipal hospital of that era. The area was like a stable
with five or more beds off to each side of a central aisle. Each cubicle
had a drapery to separate it from the next and, if properly drawn,
from the central aisle.
Founders
of the 1971 movement for childbirth education, (from left
to right) Lee Fierro, Russ Hoxsie, Peg Goodale, and Frances
Finnegan met recently to reminisce. Photo courtesy of Frances
Finnegan
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The
scene seems now out of the middle ages. Women in labor were heavily
medicated without many exceptions. The lucky woman might whistle through
with hardly the time to change clothes, let alone receive an injection
of narcotic or scopolamine. The latter was a breakthrough then in
American obstetrics. It seemed the perfect medication - memory was
abolished through delivery. The end of women's suffering was at hand.
However, that walk through the labor room was often horrendous, everyone
in advanced labor screaming their disorientation, in danger of catapulting
out of bed if not restrained. When a woman needed to be moved to delivery,
a great eruption of activity occurred: Hurry, I can see the
head, She's bulging, or Her water's broken.
Gurneys would fly through the curtains and head for the exit, privacy
a nuisance and patients left exposed. Not a pretty picture and this
filtered down to many women after their amnesia wore off and they
talked with nurses and some women who had been lucky enough to avoid
the same drugs. Everyone who was admitted routinely was shaved over
the birth outlet, most had enemas, which might be expelled during
delivery. Husbands, corralled in a fathers' waiting room well away
from the pandemonium of labor, waited and waited until a nurse appeared
to tell daddy the result of it all. Most of the men then paced outside
the large nursery windows waiting for a glimpse of their progeny in
the altogether as nurses got babies diapered, and swaddled.
No more surprises in the waiting room today, obstetrician
Pat Donegan told me when I talked with him recently about current
programs for delivery at our Vineyard hospital. No unexpected
twins at the last minute.
A month ago some of the 1970 group - Lee Fierro, Peg Goodale and Fran
Finnegan - sat with me in Lee's kitchen to reminisce about the old
days. These women were part of a group of Vineyarders exposed in the
1950s and 60s to Grantley Dick Reid's Natural Childbirth
and F. Lamaze's Childbirth without Fear. Lee had had five
children, one at home, without drugs after prenatal childbirth education.
It was a mish-mash, she says now. No one particular
system.
Peg had given birth under the Lamaze program and brought scads
of materials to the group. This material became the women's policy
manual. They formed Education for Childbirth. Gradually
other young pregnant women learned of the group and several of my
patients enlisted. Most of these early arrivals became teachers and
birthing coaches for the new movement. They taught two separate classes,
8 weeks and 6 weeks, in anatomy, physiology, and exercise. Lee told
the patients to train as if they were competing for the Olympics.
They alternated [on duty] in two groups, 8 weeks on and 8 weeks off.
Lee remembers, We came to Dr. Hoxsie's house and talked about
[our hopes and plans for] the whole subject of [childbirth, including]
going into the labor and delivery rooms. I remember [he] said, 'You're
going to have a fight with the doctors but go ahead; I'll support
you.' I remember several nurses were supportive. Dr. Rappaport was
the only doctor who came to one of our sessions to see
what was
going on.
He was very interested and asked a lot of questions.
I felt grateful he came
.
Peg said, No one had ever been allowed into the OR to watch
a C. section. When it finally happened it was a triumph for forward
motion. [ca 1972]
Fran began her story. I was pregnant that winter living in California
in various informal places. We were just a young couple and up till
that time it never occurred to me
[that I wouldn't just] some
day wake up with a baby. I'm a fruitcake you know
camping, hiking.
We moved to the Vineyard. [It] then was a great shock, rolled up the
sidewalks, nothing to do
awful. I saw a movie, 'River Run,' or
something like that, and heard mention of a childbirth book by Lamaze.
I went to the Bunch of Grapes and asked if they had it. The woman
in the store said that was strange; I was the second person to ask
for the same book that week. She gave me the woman's name and phone
number. Elizabeth and I began reading the book together, trading back
and forth
between Chappaquiddick and Chilmark.
On my first appointment with Dr. Hoxsie I said, 'Here's what
I want to do,' showing him the Lamaze book. 'I don't know how much
experience you've had with this before
no episiotomy, no shave,
husband present
. Dr. Hoxsie said he'd go along with it. I felt
great
. She described a later delivery. I have a
photo of Dr. Hoxsie holding my kid up by his ankles and slapping him
on the bottoms of his feet. I said I was going to get him on that
one. He's not going to get away with holding my baby upside down and
slapping him on the feet.
Lee added, We were pushing the envelope all the time.
The group's response was clearly stated. It was all grass roots. They
didn't want drugs or episiotomies unless they had to
. They wanted
the labor to go naturally. They made such a difference to the mothers
and the fathers, particularly during long labors; nurses changed shifts;
doctor was in and out. We always stayed no matter how long it
went. All the doctors went along
. It took time to be accepted
by the staff
. we were all women with children of our own who
were sitting in with a woman throughout her whole labor and delivery.
I can't help thinking the doctors and nurses were relieved and grateful.
I was a grateful doctor, I told the group. You took
over some responsibilities from me. I stopped worrying so much about
each patient. It was quite a change.
Lee interrupted, I didn't realize we relieved responsibility
from you, Russ.
That's right, I replied. You [thought you] were
all depending on me. Much laughter followed.
The long, lonely hours in the labor room with only one nurse and the
patient present were gone and my sense of attending a delivery
was engendered while the sense of delivering the baby
was modified, despite frequent lapses in language to the contrary.
Fran continued her first natural birth story. Pretty close to
dilating, I deliberately stayed home; the longer I stayed home the
less they could interfere with my labor. Michael was a nine-pound
baby born on Christmas. I didn't tear and went home the next day.
Everybody in the hospital came to see the woman who had given birth
without medicines or anesthetic - a freak. It was quiet, unrushed,
stayed overnight. And such a big baby. Elizabeth's was born next month
the same way.
I remember my mixed feelings attending this birth and wondered if
we had gone a step too far in changing the order of things. Coming
to the Island to practice obstetrics was an unsettling experience.
No longer with in-house support of a large hospital, the thought of
serious hemorrhage or ruptured uterus was unthinkable. With no blood
bank on-Island in the early days, I carried phone numbers of a dozen
new friends with Type O, Rh negative blood who agreed to come to the
hospital for emergency blood donation. Fortunately I never needed
them. A specialist's help was a couple of hours away. Emergency evacuation
off-Island was then in the pre-helicopter stage.
However, when Fran's wonderful baby, Michael, gushed forth with mother
panting and pushing under total control, father at her head and sharing
every labor contraction, I knew that we were onto something too long
delayed. Not a dry eye in the room survived and there were hugs all
around. Lee remembered our first conversation at my kitchen table
35 years ago. It went much like this today
. [It] seems
like a bookend.
Part II of this article will appear on April 21, illustrating some
of the highlights of obstetrical practice on Martha's Vineyard in
the new century culled from my conversation with Dr. Patrick Donegan
about his obstetrical practice at Martha's Vineyard Hospital.
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Martha's Vineyard Times 2005 - www.mvtimes.com
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