Despite the many course-corrections during the birth of her third child, Amy Silva did not lose sight of her right to choose during each step of her birthing process. She tells Adriana how her decision to refuse a pointless COVID swab during labor changed protocol in her local hospital system.
How familiar are you with your local hospital’s COVID-19 protocols? Clue us in on what’s happening in your region on social media @birthfulpodcast!
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Related Birthful episodes:
- The Induction Process, with Toni Golen
- All about Inductions, with Dr. Gene Declercq
- Informed Consent, with Cristen Pascucci
- How to Stand Up for Your Birth Rights
- Pregnancy during a pandemic: The stress of COVID-19 on pregnant women and new mothers is showing, The Conversation
- External Cephalic Version (Version) for Breech Position, University of Michigan Medicine
- The Evidence on: Breech Version, Evidence Based Birth
- Sideways/Transverse, Spinning Babies
- Overdue Baby? How a Foley Bulb Induction Can Get Labor Going, Cleveland Clinic
- Birth Rights: A resource for everyday people to defend human rights during labor and birth, Birth Rights Bar Association and National Advocates for Pregnant Women
- Questions to Ask During COVID! Birthful
One thing you can do for you is make sure you understand the current COVID protocols for your place of birth– whether they are related to the number of people that can support you and if they can swap out with other people during labor or the rest of your hospital stay, or, if you need to have a COVID swab, whether it will be a rapid test or not, and how will the result impact your ability to be with your baby in case they are separated from you, like for example if they need to be taken to the neonatal intensive care unit (NICU), so that you can make an informed choice.
One thing you can do for the rest of us is share what you find! You can share it within your immediate community and parenting circles, and add it to the Birth Monopoly Hospital Policy Tracker. If you find that the policies are limiting your choices, you can search change.org to see if there’s an existing relevant petition that you can add your voice to… or start your own!
[Birth Stories] How This Doula Exercised Informed Consent Throughout a Long Birth
Amy Silva: So, I was super triggered and extremely upset, but at the same time, I was like so done being pregnant, and so done everything, she just… She wasn’t coming on her own and I knew that. It was intuition telling me like, “We’re not leaving the hospital today.”
Adriana Lozada: That’s Amy Silva recounting the moment she realized that her delivery would not be at home or in a birth pool with her older daughter as she had hoped for. Amy talks about how she powered through with a hospital birth, making informed decisions about how to dilate her cervix, when to break her water, and the induction of her birth, but then, when protocols changed and a doctor insisted she get a COVID test many hours after she was in the hospital, even though she was entering the pushing stage and the results would not be ready for three days, she exercised her right to informed refusal by saying no. Let’s get into her story and hear about how ultimately, she changed hospital protocols in her area to assert the rights of birthing people.
You’re listening to Birthful, here to inform your intuition.
Welcome, Amy. It is so great to have you here on the show. And why don’t you start out by telling us a little bit about yourself and how you identify?
Silva: My name is Amy. I go by she/her. I am married to my best friend, Kevin, and we have three beautiful kids together. I’m also a doula, and a yoga teacher, and a reproductive and mental health advocate.
Lozada: Fantastic. So, I know when you wrote in you said that you had to advocate, basically advocate the bejeezus out of this birth, and that’s what we’re gonna be talking about today. This is for your third birth that this happened.
Silva: Yes, so most recently, so December of 2020.
Lozada: So, briefly tell me, how were your first and second births?
Silva: My first one, in comparison to my other ones, was quick. Not really. It was 19 hours labor delivery. The second one, with my son, was 46 hours of labor and delivery, so long, long labors. Easy deliveries. They were both 30 minutes of pushing. That part was always fine, but the labor part itself, and I’m a bit of a baby, so I don’t deal with pain very well.
Lozada: I mean, but clearly you do, because you did 46 hours of start to finish, and we have to stress that probably the many first hours at the beginning was non-eventful, not that painful, like they ramp up. But you still did two days, you know?
Silva: Yeah. Yeah. Two days is a lot when you’re not sleeping.
Lozada: Yeah. So much. And then those were hospital births, correct?
Silva: They were both planned hospital births. Yes.
Lozada: So, for this third one, what were you looking to have?
Silva: So, with this third one, I was planning a home water birth with my midwives. So, with my first two, I’d always wanted a midwife, but I was never able to get one. This one, I was able to get a midwife. The day I found out I was pregnant, within an hour of finding out, I applied to all of the midwifery clinics, and I got a midwife, and I had an amazing team, so it was great.
Lozada: Awesome. So then, you were planning for a home birth, water birth, had your team of midwives, had done this a couple times before, and then how did it all start?
Silva: So, I think I was about 36 weeks, and we attempted an ECV because the baby was transverse. So, we knew a couple months before that she was transverse. I’d had a 3D ultrasound and the technician there was like, “Oh, did you know the baby’s breech?” And I was like, “No. What breech position is she in?” And she wouldn’t tell me. So, I was like, “Okay, we’ll see what happens.” So, right away I was like Spinning Babies, let’s chiro, anything and everything we can to try and spin her now before she gets too big.
My midwives were like, “It’s okay. Don’t worry. A lot of babies are breech, and they flip themselves.” And I was like, “Yeah, that’s fine, and I know that.” But she never flipped, so-
Lozada: And you said she was transverse, and let’s clarify that, so by 36 weeks, you tried the ECV because she was transverse, meaning she wasn’t head down or head up. She was sideways.
Silva: Completely sideways. So, I went into the hospital. We went in one evening and they were going to attempt it, and they weren’t able to just because of the position that she was in, like her back was up against my stomach. Where her head was, they were like, “It’s not safe for us to move her.” So, we left quite defeated.
Lozada: And I also want to clarify what ECV is. It’s an external cephalic version, where they find baby’s head and bum from the outside and manually rotate into a head-down position.
Silva: Yeah, so the first time they didn’t really move her. They felt around and they were like, “You know, this isn’t gonna happen.” And then we went back about five days later and had a successful ECV. And by that time, I was 39 weeks, so I was like, “If we turn her today, let’s do a Foley catheter and try to induce labor, because I didn’t want her flipping back.
So, that was my choice to ask for that. It wasn’t even kind of presented to me as an option until I brought it up because my team knew that I really wanted as much of a natural birth as I could, and that did not happen.
Lozada: How dilated were you at that point to get a Foley in?
Silva: I was one centimeter.
Lozada: That’s all you need.
Lozada: So, they did the Foley. Did she also break your water?
Silva: She did not. So, they put the Foley in. I kept it in for 24 hours and then we took it out. My midwives came over to the house to check me and I was still only I think three centimeters at that point. So, they were like, “You know, let’s see what’s going on.” So, they did a physical check and the baby’s head was too high. They could not touch baby’s head. It was very bobbable is the term that they were using. So, not safe.
Lozada: Yeah. Yeah, and I’ve heard, over here we say like the head is floating, that they can actually… It’s not engaged, so if they touch it, they can push it up.
Silva: Yes. So, that’s how she was pretty much until she came out, so they’re like, “It’s not safe for us to break your water because there could be a cord prolapse if we were to do that.” And I was like, “Okay, I’m 39 weeks. It’s fine. We’ll see what happens over the course of the next little while.”
Lozada: You did the Foley and it got you to three centimeters, which is some good change, but were you having any contractions?
Silva: I was having contractions while the Foley was in. The second the Foley came out, it stopped. And during that 24 hours, I did everything. So, my doula was over, we were doing belly rubs, we were having a warm bath, we were… Literally anything and everything. Castor oil. I drank like an entire bottle of Castor oil and oh, it was awful, but I really just wanted to have my baby at home. So, after three days of just trying, I was like, “I’m tired. I’m exhausted. This isn’t working. Let’s just back off and just see if it happens naturally and we’ll come back to it in like a week.”
41 weeks comes, and we went up to the hospital just to check placement because I was still considered somewhat high risk at that point, just because the baby’s head was still floating, so every time they came to check, they would come every two days, her head was still floating. So, if my water was to break, I needed to call 911 still. So, we went to the hospital at 41 weeks just to check placement and just try to see if they could break my water, like see if it was a safe place to do it. It wasn’t, so I ended up asking for another Foley because I was like, “Let’s just try it again.” We were at 41 weeks. I was tired. Mentally, emotionally, just physically exhausted. Didn’t want to be pregnant anymore.
So, we were talking about inductions and I said, “You know, that’s fine because this doctor has said that she’ll induce me, she’ll break my water, she’ll let me go home.” The OB that we’d been consulted to was amazing. She was very open to my out of the box ideas, like I had said, “Can you break my water here and let me go home and labor and birth at home in my pool?” And she was like, “Yeah.” But we were there the Friday night and I said, “Can we just try the Foley again and hopefully not even have to come in Sunday for that induction?”
So, I’m gonna stress the reason why I’m saying I want an induction, I want an induction, because for about four weeks we were scheduled for a cesarean because she was transverse, so it was weeks of me thinking that I wasn’t even going to be able to have a vaginal birth, and that I was gonna have a cesarean, so the second that she moved and we did the ECV and she turned, that’s why I was like, “Let’s get things going now.” Because I didn’t want her to turn again.
So, I understand inductions aren’t for everyone, and it’s not at all what I wanted, but at the same time I was weighing my options of if she flips back, I’m having a C-section and I have no choice, versus let’s try and induce labor and get this baby out before she has a chance to flip.
Lozada: So, did they put that second Foley in?
Silva: They did. With the first Foley, I was one centimeter dilated inside, three centimeters dilated outside, so there was still room for a Foley to work inside.
Lozada: And let’s clarify that again. All these different things, like we’re honing in really into your cervix right now. So, because the cervix is about an inch long when not effaced at all, it has basically an opening, a canal, and an opening, and this Foley bulb is two little balls with a tube in between or space in between or something, so one ball goes inside, and then the other one goes on the outside, and with fluid, they pump it so that the part in the middle manually or physically expands the cervix. And so, what you’re saying is the one that was outside, that part of your cervix was measuring three centimeters, but it was sort of coning into the inside. Okay, now I got it.
Lozada: So, then they did a second one.
Silva: We kept that one in for 12 hours and then it fell out, so they fall out if they reach what your cervix is going to do, basically. So, at that point, then I was three centimeters I think almost inside going into Sunday. I didn’t have contractions at all with the second Foley. Nothing. So, I kind of knew going into it chances are I was getting called in Sunday for an induction. When we had left the hospital Friday, we were told we were like 10th on the line, or like on the list of being called in, so we’re like, “Oh, we’re not gonna get called in anytime soon. Not really worried about it.”
Sunday morning comes. It’s like 8:30 in the morning and my midwife calls me and she’s like, “Oh, I just called up to the hospital and you’re the first person on the list to be called today.” And I was like, “Wait, what?” So, I’m in bed, sleeping, when I get this call, so I’m like, “We have to get the kids up. We have to get all of our stuff together.” So, it was just a big rush, and then an hour later I got the call from my midwife to come into the hospital. So, we got there just before 10:30. The plan was for me to go in, for her to check and see if it was okay and safe to break my water. If it was, she would break my water. If she couldn’t, she would see if the on-call doctor could break my water, and then we would go home, we would have my baby in the birth pool, and that was the plan that we all went into the hospital with Sunday morning expecting to happen.
So, we went in, and her head was still floating, and the doctor that was supposed to be on call… So, we had scheduled it for Sunday morning because the doctor that we’d been working with, that had been super understanding, and considerate, and amazing with my plans, was supposed to be working. When we went in, it was a completely different doctor who was like, “Absolutely not. I will not break your water. I will not allow you to go home. You are here now and you’re not leaving. You need to start Pitocin and then we’ll talk about breaking your water.” She didn’t even come into the room or speak to me herself.
So, I was super triggered and extremely upset, but at the same time, I was like so done being pregnant, and so done everything. She just… She wasn’t coming on her own and I knew that. It was intuition telling me like, “We’re not leaving the hospital today.”
Lozada: And so, what did you decide?
Silva: There were some tears. My husband and I chatted about it, and he said, “It’s up to you. What do you want to do?” And I said, “You know, I don’t want to do this anymore.” I asked the midwife, I was like, “What are the chances of me going home and this doctor that I want coming in later tonight, or tomorrow morning, and her calling me in and breaking my water and then letting me go home?” And she was like, “Honestly, at this point it’s probably not gonna happen.”
Lozada: And because holding onto that hope that somebody, anybody, would break your water and let you go home with the baby floating, the reason they haven’t been able to do it is because as baby’s floating, as the water breaks, that big gush of water comes out and since her head is not engaged kind of blocking the way, the umbilical cord can get flushed along with the water, meaning then creating an emergent situation where you have to run into the OR because it’s a cord prolapse.
Silva: Yes. And I had already done everything to avoid having a cesarean, so I definitely did not want an emergency cesarean, so that’s why I was weighing my pros and cons. We had this beautiful plan. Our daughter, who’s eight, was going to be in the birth pool. She wanted to catch the baby. She wanted to cut the umbilical cord. So, once we decided that we were staying, my husband had to call her and tell her that we weren’t coming home, and that was the most heartbreaking thing about the entire thing. But yeah, I’m gonna cry just thinking about it, like I cried, he cried, our midwife cried. It was such a hard conversation to listen to.
Lozada: So, tears have been shed, and you’re weighing everything, and you say, “Okay, this is what we’re doing. We’re staying in the hospital.” What’s the next step?
Silva: So, 12:30, we started Pitocin, and I didn’t really feel any contractions until about 5:00, like they were very, very mild, like I was up walking, laughing, joking around. 5:00 hit and they started to get a little bit more steady. Again, we weren’t tracking them, because I didn’t want that in my head, being like, “Oh, they’re two minutes apart, or they’re lasting for a minute.” I just wanted to labor and that was it. So, you know, we got the yoga ball, we bounced, I had popsicles, so at 8:00 the resident came in to check me and that’s when I was five centimeters and that’s when they did a controlled rupture.
Lozada: So, a controlled rupture would be when they do just a tiny, tiny prick of just like a balloon prick into the amniotic fluid, and just let it slowly, so that baby can slowly come down and not have that gush of water and potential problems with the umbilical cord.
Silva: Yes. It wasn’t… I don’t want to say not controlled, but there was so much amniotic fluid, it splashed my feet and continued to leak for 15 minutes afterwards, like my midwife’s like, “I’ve never seen that much water.” So, we were like, “This makes total sense why she was never able to engage her head in my pelvis.” So, they break my water, and the doctors leave, because I’m in my midwife team and I just wanted to be left alone. We weren’t under OB care at this time. We were still under my midwives, so there was no need for anybody else to be there.
So, I ended up laboring until about 2:00 in the morning, and that’s when we maxed out on Pitocin. We got to the highest amount of Pitocin that my midwives are allowed to administer, and I went from… I’d gotten up to eight centimeters when they had checked me and then I slowly started going back down to five and that’s when we made the decision that I needed to transfer care to OB so that I could get more Pitocin. And at that time, when they take you off Pitocin, they take you right off, so they take you off and you have to start all over again.
So, I’d been in labor for X amount of hours, and then I decided, “If we’re doing this again,” I was in so much pain at this point that I was like, “I need some kind of pain medication.” And because of COVID and hospital policies, the only thing they will give you for pain management right now is an epidural. So, I couldn’t have morphine or anything else to just get me through just for a little bit. I needed to either have an epidural or not, so I chose to have an epidural.
Lozada: It tends to be very rare to see a cervix go back, shrink back in size, and once that happened, you decided to transfer care to the OB, so you get Pitocin again and get an epidural.
Silva: That happened. My midwife went home to sleep and the backup midwife that was there, she stayed, and I pretty much slept until about 10:00 in the morning. So, it was a new nurse that had come in, and with COVID, they had changed the hospital policy as of that Friday night to say that any admitted patients needed to have a COVID swab. So, I hadn’t had one when I went in on Sunday because I didn’t want one and my midwives didn’t even bring it up, because I had told them Friday when we were in that I wasn’t going to do that if it ended up me needing to be at the hospital.
So, with change of shift and change of OB, they started having those conversations. Not with me, but amongst themselves, that I hadn’t had a COVID swab and that I needed one. I could hear my nurse talking to the resident on the phone, explaining it to them, and the phone kept going on and off, and the resident came in probably about 11:00, 11:30. Same resident that I knew. And she was like, “Hey, Amy, so we need you to get the COVID swab.” And I was like, “No.” She was like, “What do you mean, no?” I was like, “I am not consenting to that. I don’t want it and it’s not necessary.” And the sheer panic in her eyes of me telling her no… Because she, I know she now has to go back to the consultant and say, “She’s refusing,” which is not an ideal place for her to be, but I’m the patient now, and it’s my choice, and it’s my body, and I said no, and I said, “I’m not gonna explain to you my reasoning because I don’t have to. My simple answer is no.”
So, at that point, the conversation went from me to the resident calling my midwife, to my midwife saying, “She said no. Sorry, she’s not doing it.” So, about 1:00, my midwife came into the hospital. She comes into the room, pulls a chair up in between me and the bed, and she says, “I just want you to know I’ve already put a call into the board of ethics.” And I was like, “Okay. What’s happening?” So, that’s when she tells me, “The OB is threatening to transfer your medical care back to midwives because you’re refusing the COVID swab.”
At this point, I was in transition, so my contractions are strong. They’re long. I’m just in this animalistic state already and I’m like, “They can’t do that. That’s not allowed. They can’t force me to do something that I don’t want to do.” I’m like in between crying and yelling, so when I get angry, I cry. So, I was just like, “That’s not fair. They can’t do this. The whole reason we switched from midwifery care was because I needed that OB care and now they’re gonna threaten to take that away from me. That’s not ethically right at all.”
Lozada: Because everybody has like these are your rights during childbirth. You have the right to informed consent and consent is not signing a form. It’s informed consent or refusal. You are presented with the information, and you have the right to say yes or no.
Silva: Absolutely. And I asked the question. Is it a 15-minute result? No, it’s three days. Well, I’m going to be at home in three days and they won’t have known whether I was COVID positive or not. And they were already treating me with precaution because I had refused a swab, so everybody was wearing extra PPE, like not just the mask. They were wearing the gowns. Me doing a COVID swab and it coming back positive or negative would have changed absolutely nothing. And at this point, so the baby had still not dropped the last time that they had checked and I had minimal checks, but I could feel her bum still up in my right rib cage, like it didn’t drop. It didn’t change. It didn’t move at all during labor.
So, at this point I’m in transition, and like they’re threatening this care, and I’m like… I was losing steam and I was like, “You know what? Let’s talk cesarean because I’m just… I’m done. I can’t do this anymore.” And it had been… At this point, it was about 30 hours. I used my safe word with my husband because I was like, “Let’s have this conversation now.” And he was like, “Okay. If that’s what you want, I’m fine with that. Before we do that, let’s get you checked and see where you are dilation wise. Let’s see what’s going on.”
So, the resident came in and checked and I was 10 centimeters dilated.
Silva: Yes. So, from that point on, it was everybody in the room, my husband was there, my midwife was there, the resident doctor was there, and then in walked this consultant doctor that had been threatening to refuse me medical care, and I was like, “I can’t believe you have the balls, the audacity, to even come in this room right now.” But I was 10 centimeters dilated and I just started pushing. And I will tell you, I have never made so much noise in my life. I’ve never heard a birthing person sound as terrifying as I sounded. I remember saying to my husband and my midwife, “I feel sorry for any other birthing person in this hospital right now that is hearing me, because I am probably terrifying them.”
Lozada: Were you having an urge to push and your body was going with it and that’s what… the sounds that were coming out?
Silva: That and I just pushed, like I did not stop. They were like, “Oh, take a break.” And I was like, “Nope. I want this baby out. I want her out now.” So, it was eight minutes of pushing and she was out. The only thing that I remember being said while I was pushing was this resident doctor who had kind of been in the loop about what was going on, she’d come into my room to check me, so she knew that I was angry about this whole situation, and she looked at me and she said, “Get angry.” And that’s… That was all I needed. I just let all that anger out while I was pushing and I just stared at that doctor, and I was like, “I’m thinking things right now, but I’m just gonna scream it instead.”
Yeah, so eight minutes later, and then she came out, and there was another huge gush of water, like so much amniotic fluid. My midwife was like… After the fact, she’s like, “I honestly thought we were going to the OR today. I did not think this baby was coming.” When they were like, “You’re 10 centimeters,” we were all like crying. We’re like, “What?” So, it was just like so much renewal in that moment of being like, “I’m getting this vaginal birth. I didn’t get anything else, but I am getting this.”
Lozada: Well, and clearly during those eight minutes, you took all those feelings, and all those emotions that you had had during the past whatever many days, and just released them all as you also released your baby into the world.
Silva: That was the first baby that I’ve had that I’ve cried after. Like I have never cried, like when my other kids were born, I was just happy. And with this one, like my husband cried, I cried. It was just such a release of emotions and we’re like, “Thank God she’s here. This is over now. Now we can just move on and go to the next stage.”
Lozada: How are you feeling after all this with your birth experience?
Silva: I feel good. And I mean, I went into it the whole time saying, “If I have to have a hospital birth, if I have to have an epidural, if I have to XYZ, I will be doing that because I’ve chosen that and I will have exhausted all of my options.” So, yes, I did not get the dream home water birth that I wanted, but I still got to make decisions for myself and say no if I wanted. That’s what’s important, I think.
Lozada: Amy, thank you so much for sharing your story with us. It’s really been an honor.
Silva: Thank you so much for having me and letting me share my story.
Lozada: That was doula, yoga teacher, educator, reproductive and mental health advocate, and mother of three, Amy Silva. You can find Amy on Instagram @journeyandbloomyogadoula. The actions of Amy refusing the COVID swab and then her midwives putting in a complaint to the board of ethics because the OB was threatening to transfer the medical care back to midwives due to the swab refusal created a change in protocol that upholds a birthing person’s rights during childbirth. Soon after, an email was sent to all the midwives within London, Ontario, confirming that healthcare providers could not force people to have a COVID swab.
One thing you can do for you is make sure you understand the current COVID protocols for your place of birth so you can make an informed choice. Whether it be related to the number of people that can support you and if they can swap out with other people during labor, or the rest of your hospital stay, or if you need to have a COVID swab, whether it will be a rapid test or not, and how will the result or your refusal impact your ability to be with your baby in case they are separated from you, like for example if they need to be taken to the neonatal intensive care unit. The one thing you can do for the rest of us is share what you find. You can share it within your immediate community and parenting circles and add it to Birth Monopoly’s hospital policy tracker at birthmonopoly.com/covid-19. If you find that the policies are limiting your choices, you can search change.org to see if there’s an existing relevant petition that you can add your voice to or start your own.
You can connect with Birthful on Instagram @BirthfulPodcast and to learn more about Birthful and my birth and postpartum preparation classes, go to birthful.com.
Birthful was created by me, Adriana Lozada, and is a production of Lantigua Williams & Co. The show’s senior producer is Paulina Velasco. Jen Chien is executive editor. Cedric Wilson is our lead producer and Kojin Tashiro mixed this episode. Thank you for listening to and sharing Birthful. Be sure to subscribe on Apple Podcasts, Goodpods, Amazon Music, Spotify, and everywhere you listen, and come back for more ways to inform your intuition.
Lozada, Adriana, host. “[Birth Stories] How This Doula Exercised Informed Consent Throughout a Long Birth.” Birthful, Lantigua Williams & Co., June 9, 2021. Birthful.com.
About Amy Silva
Amy is a wife and mom, full-spectrum doula, yoga teacher, podcast host, reproductive and mental health advocate.
Amy loves supporting families through their journey to parenthood and helping her community to heal both on and off their yoga mats. She is the founder of the Luna Doula Collective in London, Ontario, Canada, as well as having just launched her new support group and podcast to support people through their healing journey, Where Healing Happens.
When Amy is not busy working or learning, she enjoys spending time with her growing family, practicing yoga/meditation and being outdoors. They love family camping trips and hikes.
You can follow along with Amy on Instagram: @journeyandbloomyogadoula, @luna_collective_london_doulas, and @where_healing_happens.
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