First Person

There was nothing ‘normal’ about my normal delivery

The writer recounts her traumatic experience of labour and how her wishes were ignored by doctors.

The nine months of my pregnancy felt like a breeze – of course, barring the first trimester when your body is adjusting to a tiny human growing inside you. Read morning sickness, heart burn, severe anxiety, intense hormonal changes. I was extremely pleased with the fact that I could work till the very end of my term, I was physically fit (thank you yoga) and I could live my life as usual. In short, apart from a growing belly and severe tiredness towards the end, I did not face too many health problems.

It has been 5 months since I delivered my beautiful child and I am yet to fully recover from what can only be termed as a traumatic postnatal experience.

I clearly remember the night of December 15, 2016, the day before my daughter was born. My husband and I had finished dinner and were catching up on the day that went by. The first set of intense kicks started around 9.30pm. I dismissed them as normal since our visit to the doctor that morning confirmed that the baby is in no hurry to come yet. She was due in 10 days.

As the night progressed, the kicks started getting intense. Since I had trouble falling asleep, we continued chatting into the night. By 2.30 am our eyes were shutting and we were failing to comprehend what the other was saying.

That night I had a dream that my water broke in an elevator. I woke up in shock and realised that what I had dreamt had turned into my reality. At 3.45am, there I was, in a pool of clear amniotic fluid and my bed linen was soaking wet. I slowly got up and went to the washroom to check. As I sat on the pot, I felt an intense gush coming from me, with streaks of blood and mucous. I did not panic. I knew it was time to head to the hospital. I knew she was coming.

Once at the hospital, while I was being prepped for labour, I started practicing the breathing techniques I had learnt at my prenatal yoga class. As the contractions grew intense, I spread out my yoga mat and practiced the cat-camel pose. See, I desperately wanted a normal delivery. Throughout my pregnancy, I had read horror stories of women who had trouble recovering from a C-section. I had read about how hospitals in India force mothers to go through C-section to make money. I had read about women who never managed to lose their pregnancy weight following a C-section. I felt that a normal delivery was my only chance of having a happy postnatal experience. Little did I know that there is nothing “normal” about a vaginal delivery in India.

In labour and helpless

At 8 am, I was taken to the labour room. I had already dilated 3 cms and was in a lot of pain. By this time I had spent four hours at the hospital, being poked to draw blood for various tests and under the effect of enema. As the pains grew, I remember banging my hands against the iron bed. I remember kicking so hard, hoping that pain would dim what I was feeling throughout my body. But nothing helped. To make matters worse, the doctor soon administered a dose of Pitocin IV drip as my baby had apparently not descended into the birthing canal. Contractions grew intense within minutes. By now I had reached pain level 10. I screamed and screamed some more with little to no sympathy from the attending nurses. My husband was not allowed near me. He could only watch the “show” from a distance. His repeated requests to be allowed near me fell on deaf ears. He just wanted to hold my hand and tell me I would be ok.

In fact, he was asked to leave the room several times. All this happened as I lay there in pain, crying and feeling helpless.

By 9.30 am, my body started to give up. I could see my resolve of having an intervention free delivery shatter in front of my eyes. Thanks to that strong dose of Pitocin, my body was not allowed to labour naturally. Our spiral of interventions had begun. Unable to take the pain any longer, I requested for an epidural.

After a few minutes of feeling numb and painless, I found myself in pain again. This time I had dilated 8 cm. But the baby had still not descended. I was given another strong dose of Pitocin and had to take another epidural.

Finally at 11.15 am, my doctor announced that I could start pushing. But wait, how do I push or what do I push, when I cannot feel a thing waist down. I started pushing like throwing darts in the dark. At one point, my anesthetist – who would have easily weighed a 100 kgs  – sat on my stomach to apply fundal pressure. I kept pushing, with no clear instructions. Finally at 11.39 am, I heard a faint cry. I shut my eyes for a minute and my doctor announced that she would stitch me up. She had to use an episiotomy (a cut made at the opening of the vagina) to get my daughter out. I had clearly discussed not wanting an episiotomy during one of our prenatal visits. But I was told that it is standard procedure in India. I wish I had protested harder.

Since I had also requested skin-to-skin contact with my child, she was kept on my chest for exactly 30 seconds before taking her away to clean her. Even in the daze, I remember how the anesthetist thought it was appropriate to joke about my wishes.

Tough recovery

The deep cut (around 10 cm) resulted in a lot of blood loss and my hemoglobin dropped to 6 (from 12). I was given two bottles of hemoglobin and when that did not work, I was given a bottle of pure RBC blood. I spent four extra days in the hospital, being hooked to an IV, unable to hold my newborn or nurse her without pain. All the poking resulted in nerve damage on both my hands, to the point that I could not lift them because of throbbing pain for two weeks. Since then, numerous complications surfaced: thrombophlebitis, fissure, intense pain in the coccyx and perineum. But my daughter’s smiling face kept me sane through all of this. And of course, love and support of my family and friends.

Now my daughter is five months old. I have nursed her every day since she was born, even with two IV needles sticking out of me. I could not sit straight  –  even for five minutes at a stretch  –  for almost two months. But I continued breastfeeding because I would not have it any other way. I still have a lot of pain to deal with. But the most difficult has been the pain of not asserting my rights as a mother.

I have tried to be a good mother and caretaker to my baby. But I know I could have done much more, had my postnatal experience been as smooth as my pregnancy. It is unfortunate that mothers are not allowed to birth as they wish. It is unfortunate that birthing rights are a joke in India, even today.

This article was first published on Medium by India Birth Project, a series of crowdsourced birthing stories that highlight the highs and lows of giving birth.

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Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

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Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

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  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.