October 15, 2009

If I say birth, it probably conjures up some disturbing, painful, smelly, or unpleasant memories/images. You may think of the video they show in Sex Ed. You may think of the idea that it feels like pooping out a basketball. Apparently, that is somewhat close to how it feels. Or you may have some other things come to mind. I'll leave those to you.

Today I went to my last day of clinical in OB or labor & delivery or however you choose to call it. I have had a great 5 weeks on the floor. I put in catheters! I held lots of babies! I made beds and answered call lights and refilled water jugs and started showers and learned a lot about breast feeding. I would trade all of that for today.

I went into the room on the floor and met the couple at 6:00 this morning. The doctor came in and broke her water, and she was dilated to 4 cm. It's that point in labor where you transition into active labor - everything is getting started, and people get excited. The mom was happy and calm. She sat up, laid on her side, laughed at jokes.

2 hours go by. We came into to "check her", meaning see if she had dilated. Her epidural had kicked in, and she couldn't feel anything. You know what that means people...I GET TO CHECK HER. I felt a 6 cm cervix. 2 hours later, 2 centimeters. Good progress.

Take a break...watch a C-Section on a different couple. The doctor talked me through the process after they got the baby out. I was struck by the unfair advantage the dad has over the mom. I mean, she does the work over the 9 months. Sure, he puts up with mood swings and cravings, but she gets the back pain and swollen ankles and diet restrictions. Anything she does or does not do potentially hurts the baby. Then she gets strapped onto a table and gets the baby cut out of her, laying there while they stitch her up while the dad gets to take pictures and make sure the baby is alright. He stands by, proud, while doctors and nurses control bleeding and stitch up a uterus, then the abdominal muscles, then the fat layer, then the skin. I leave as the mom finally gets to hold her baby - close to 30 minutes following delivery. SHE HAS TO WAIT 30 MINUTES BEFORE SHE GETS TO HOLD HER BABY. Needless to say, I left slightly in a huff. Though the procedure was fascinating to watch.

Return to my couple's room. 2 hours later...and she's dilated to 6 cm still. No change. So we started her on pitocin, against her initial wishes, though she decides she is alright with starting pitocin, as long as it doesn't hurt the baby. The entire day the mom asks whether what her decision is affects the baby. The couple are so invested in this little life they have yet to see. What a beautiful thought.

Move along. Dilated to 8 cm. Eat lunch. Dilated to 9 cm. I check on her 30 minutes later to find her no longer calm, no longer cheerful, but in tears. She is frustrated. She is unhappy. She is in pain. And she is so ready to have this baby.

9.5 cm.

An hour later...10 CENTIMETERS.

And then the work really begins. Take apart the bed, pull up the stirrups, and push. Teach how to push. Deep breath in, push it out. Soothe, correct, encourage, repeat. I stood uncomfortably at the foot of the bed, holding one of her feet, pushing my weight against hers as she pushed.

The cheer is gone, the pain is worse. Next comes anger and frustration. Some common phrases I heard:

"I can't do this."

"It's too hard."

"Can't you just pull it out?"

"Give me a C-Section!"

"Give me a stronger epidural?"

"I'm too tired."

"Please don't make me do this anymore."

Scan to the dad's face. It's white. He's trying to be encouraging. He tries to comfort her, and she pushes him away. She tells him they are never having another baby. Then she refuses to push.

Meanwhile, her temperature is rising, and so is the baby's heart rate. There is meconium (baby's stool in the amniotic fluid in utero) in the fluid, meaning the baby could have breathed it in. That means potential problems. The nurse gets a little more antsy, insisting the baby has to come now, so it was time to stop saying she couldn't and tell herself she could and would.

Somehow my hand was grabbed. Somehow my head ended up by the mom's. And somehow I found myself looking her in the eye and telling her to push. I had no idea what I was saying most of the time, I was just telling her she could do it. And I believed she could. I had watched her come this far. I knew she could make it the rest of the way. Plus, I could see the top of the baby's head.

And on it went for about another 30 minutes. Until finally, the head was out, out popped one shoulder, then another. Then the rest of the body was out, and everyone breathed a sigh of relief.

But then something wasn't right. The doctor cut the cord, not the dad. The 2 NICU nurses took the baby and started working. I started to watch until the mom started to panic.

"Why isn't she crying? What's wrong?"

The nurse begins to try to calm her, and the mom begins to cry. The dad starts to cry. And then, believe it or not, I start to cry. Because I am hearing nothing from the baby. And I am hearing one of the nurses say "The baby isn't responding." Too quietly for the parents to hear, but I hear it.

So the mom is asking me what is wrong, and I have no idea. And I am looking around the room and praying my hardest that baby girl survives. Because throughout the day I have begun to love her and to love her parents. And after all this work, after the fight of the last 9 months, they deserve to have their baby alive. And they deserve to have a healthy baby.

And then, at minute 2:38, the gasp happens. And she cries.

And then we all cry.

And mom is pleasant again. She thanks me again and again for holding her hand and for coaching her through it. And I just tell her how grateful I am for the day with their family. I take their family picture, then I say my goodbyes. It's 15 minutes past my time to leave. But I am stopped by the mom...

"But you have to get your picture with her!"

Meaning the baby. So I scooped up all 8 lbs, 14 ounces of cuddly goodness and smiled.

I walked out of the room, a little stunned, rather joyful, and mostly emotional.

I think I found something that could keep me in hospitals a little longer than anticipated.