- BIRTH: EVERY MARATHON HAS A FINISH LINE – Veritascara
- I’m sorry it’s taken me so long to finish writing this story, but here it is at last—the next part of my birth series. And because not all babies decide to just fall out—some of them require very, very hard work—I’ve given you just a little taste of what it looks like to spend 3-4 hours pushing and the extra encouragement that is sometimes required to coax these babies out. I should note that this delivery gets a little more intense and graphic than the ones I've written previously.
- Now I know many of you who have recently started following me here on Tumblr may be a little weirded out by birth stories, and that’s okay. I know it’s not everyone’s cup of tea, and you are under no obligation to read it; it’s just what make me happy. If you are interested, however, you can find all of them collected here and a little information on the series as a whole here.
- Much love to all my birth-loving friends, and thanks for all your continued encouragement!
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- Her head lolls back against the pillow. Her eyes fall closed. Her arms gently cradle her prize. He nurses contentedly at her breast, secure and peaceful, still naked against her chest, right where he belongs. They both surrender to the cocooning warmth of oxytocin. Nothing else exists in the world. Not at this moment. Not anymore.
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- I steal a glance at the time on the computer screen again.
- Two hours. That’s how long it’s been since I arrived. My brain makes a quick calculation.
- Three … Three hours. That’s how long it’s been for her. She started pushing well before I arrived at shift change.
- I take a deep breath in and pull the sterile glove off my right hand to throw it in the trash, grabbing a couple fresh gloves from the box over the sink and snatching the clean blue pad and towel from the counter. I move back towards the bed where my patient sits upright in a squatting position, clinging for dear life to the bar attached to the foot of the bed. Her knuckles are white, her face flushed and sweaty from exertion.
- “Okay. We’ve been doing this position for a while; let’s try laying back down on your side again, maybe the left since you were on the right the last time,” I suggest.
- She looks up at me with weary eyes and nods, and her husband grasps her hands and helps her shift back onto the bed. Another contraction hits her, and she moans with the pain, “God, I can’t do it anymore! I can’t do this.”
- “You can do it. I know you can. You’re pushing so hard. Just take a break and sit this contraction out, until we get you comfortable again,” I encourage her, pursing my lips together and holding her right hand firmly in mine while she breathes through the pain of the contraction, suffering through the effects of an epidural that decided to quit working shortly after she started pushing, for what reason, I do not know. She might as well not have one at all.
- The contraction passes, and I resume lowering the head of the bed, swapping out the soiled towel and pad for the clean ones as we help ease her onto her side. I lift the bar off the bed, and put a pillow behind her back.
- “Do you feel okay like this?” I ask her.
- “Yeah, it’s alright,” she replies. She closes her eyes and relaxes all the muscles in her body as I’ve taught her to between contractions, while her husband gently wipes her face with a cool washcloth. I take another sterile glove out of the monitor cabinet and put it on.
- “Now with this next contraction, I want you to put both your hands behind your right knee and pull back on it,” I instruct her. “I’ll help you hold that leg up in the air. And make sure to keep your hips nice and relaxed, putting all that energy down into your butt again.” And to her husband, “You’ll help to support her neck, so she can curl around the baby, and hold her left leg back. But keep it flat against the bed, so she stays on her side, okay?”
- “Yeah, I got it,” he answers me, his voice brimming with weariness, the strain and anxiety of watching his wife do this for hours starting to overwhelm him.
- Another contraction begins, and my patient nearly loses control. “I don’t want to do this. I can’t keep doing this!”
- “You can do this. I know you can! Now take a deep breath, and push as hard as you can, all down in your bottom. You will feel my fingers here. Try to push them out.” I put stretching pressure on her perineum, and she whimpers again but then quickly takes a breath and pushes down with all her might.
- I feel her baby’s head push down forcefully, and very quickly a small portion of the crown, complete with sparse brown hair, is visible without even having to touch.
- “That’s amazing. You’re doing it! Keep going. Keep going. Keep going!” I urge her on. She pushes again and again until the contraction fades, and the baby’s head slowly retreats back into the vagina as she takes her rest.
- “You gotta stay down there, silly kid!” I jokingly address the particularly stubborn fetus we are trying to coax out. The dad gives a half-hearted laugh.
- “Those were great pushes. I could feel him moving down a lot with each one. Keep doing exactly that with the next contraction,” I advise my patient as she slips back into partial consciousness.
- Another contraction arrives, and she pushes with all the strength she has. And another. And another. With each one, I feel and see the baby’s head come back down to that same spot—that same spot, but no further. The only thing that gives the impression the baby is getting lower at this point is the increasing swelling developing on his scalp. Really, when I think about it, despite her amazing efforts, we haven’t made any progress at all in the last half hour or so.
- What haven’t we done yet? We’ve tried pushing on both sides and laying on her back. We did sitting and squatting on the bed. We even tried hands and knees for a bit, although she didn’t have the energy she needed to sustain that long. The bar with the sheet didn’t seem to do as much for her as it does for some other moms. Could it be a positional issue? But the baby never felt OP to me. I guess I could try to check again.
- I’ll do that, I decide. I’m running out of options. I only hope it will give me some clue.
- “If it’s ok with you, I’m just going to see if I can feel what position your baby is in right now.” I ask my patient.
- “Yeah, that’s ok,” she replies.
- I gently push my fingers inside again to feel her baby’s head, instantly met by the large amount of swelling covering the crown. I try my best to feel for the suture lines (the breaks between the skull bones) and the fontanelles (the soft spots), but they are so obscured by the edema that it’s all but impossible at this point. There’s simply no way for me to tell which direction this kid is facing. I take approach number two and feel around his head to try to assess how he’s fitting through the pelvis; the pubic arch feels plenty wide enough, and he isn’t tight up against it, so I venture a guess that he’s turned the right direction, after all. Then, why?
- Why are you not coming out, kid?
- I have no answers. We’re right back where we started. Crap.
- “Well, it’s really hard to tell exactly what his position is, since his head is pretty swollen now. But I think he’s turned the right direction—not coming out sunny-side-up. We’ve just got to keep doing what you’ve been doing,” I sigh. I wish I could tell her something more encouraging at this point, but I don’t know what else to say. A tear trails down each of her cheeks, and she squeezes her eyes tightly shut to try to banish more from escaping. I squeeze her right hand gently, while her husband presses a kiss to her forehead. Another contraction arrives, stealing her breath away.
- “Can you push again?” I ask her. And she takes a deep breath and pushes as hard as she can with what little energy she has remaining. In the middle of pushing, I hear the door to the room open and see the doctor enter the room. Tall and nonchalant, he merely observes my patient for the next couple of pushes. He has been dropping in every hour or so to check on her progress, and I know he’ll notice quickly that not much has changed in the past hour, despite the maddening amount of the baby’s head we can see. He remains silent until she is able to open her eyes again and register his presence.
- “Well, it looks like it’s time to have a baby,” he announces cheerfully to all of us in the room. Then he turns to me: “Would you mind calling for someone to bring in some Tucker-Mclanes?”
- Forceps. So that’s where we are. I guess it’s time to pull out the big guns. And in all reality, I’m far more relieved than surprised. Because I know in my gut that this will not happen on her strength alone. Because the end is now in sight. Because, while forceps may be reviled the world over for their (numerous) abuses, used appropriately in the hands of a master, they are a beautiful tool. Because, with this, I trust him; this doctor is one such master.
- I hurriedly pull the phone out of my pocket and dial the charge nurse. “Hey, we’re gonna do forceps. Could you have someone bring in some Tucker-McLanes, and are you able to come help me?”
- “Sure, I’ll grab them and be in there in just a minute,” she returns.
- I call the nursery nurse to let her know the situation, knowing that she’ll call the newborn nurse practitioner to the delivery as well. Extra staff for safety. The situation has suddenly turned high-risk. We must dot every i and cross every t.
- The doctor rolls the delivery table towards the bed and pulls on the protective gown. The charge nurse walks in and helps him secure it. I lift the footrests from under the foot of the bed and rest my patient’s feet in them, then fold up the sides of the lower mattress and lift off the bottom of the bed, laying it out of the way in the corner of the room.
- “Could you raise the bed up for me?” the doctor requests.
- “Mm-hmm,” I acquiesce and do as he asks. I hear the door to the room swing open again and see the nursery nurse and nurse practitioner enter the room, taking their place near the radiant warmer to wait for the kiddo’s arrival. It’s starting to feel crowded in here. It’s hot. Has it always been this hot in this room?
- Another contraction overtakes my patient, and she moans. “Just wait through this one,” the doctor instructs her, and she tries to follow his instruction, panting hard through the overwhelming pain and pressure. Sometimes it really is easier just to push.
- A minute later, the contraction eases, and the doctor carefully feels for the direction of the baby’s head, then slides one half of the forceps in on one side, followed by the other on the other side, locking them together at the middle. Salad spoons, I’ve sometimes heard them called. That description isn’t half wrong.
- “All right. Next contraction, you’re gonna push, and I’m gonna help you a little bit,” he tells my patient, bright confidence coloring his voice.
- “Okay,” she responds, her voice quavering a little bit with the intensity of the moment. I see a myriad of emotions flicker across her face—fear that something might go wrong, worry that this won’t work and she’ll end up in the with a c-section, lassitude from the hours already spent pushing, and hope, just a flicker of hope, that maybe this will all be over and she’ll be able to meet her son in the next few minutes.
- Another contraction hits her hard. “Okay, deep breath and push!” I urge her. She fills her lungs, closes her eyes and pushes with every last bit of energy she has, while the doctor pulls on the forceps with steady strength.
- “Harder, harder!” We urge her, the charge nurse joining in with my cheering. She pushes again.
- “Keep going, keep going, keep going!” I chant. Another deep breath, another big push. The doctor continues pulling, and with an audible, sickening pop, the baby’s head lurches forward. The unknown obstacle she’s been fighting against all this time is breached—her tailbone, broken. My own almost aches in a sympathetic response.
- She groans loudly with the sudden change in pressure, following it with a powerful primal scream as her senses register the searing pain of her skin stretching. She shakes all over, grasps the bed linens frantically, arches her back, and tries to straighten her legs out—anything to keep the pain at bay.
- “Breathe. Take a breath. Try to hold on,” I tell her now. She fights hard to do so, to bring her mind back to her body long enough to follow my direction, and she succeeds at last. The doctor uses the opportunity to unlock the forceps and slip them out. She’s got this all on her own now.
- “Push again now,” the doctor instructs her.
- “Oh God, I can’t!”
- “Yes, you can do it! Push through the burning. You’re so close. He’s right there. Push through the burn!” I try to encourage her.
- She wails. She sucks in a breath. She pushes, long and powerful. She screams again as she stretches and stretches.
- “Breathe! Just breathe now,” we all command her as one, and her baby’s head slowly slides out, rotating to the side as it does.
- Rapidly checking the baby’s neck for the umbilical cord, the doctor places his hands on either side of the baby’s head, and tells my patient, “One more big push for the shoulders now.” She pushes again, and one shoulder, then the other, quickly slips free, followed by arms and body and legs that all tumble out in a rush into the doctor’s waiting hands. He lays the baby briefly in his lap, drying his face with a towel, grabbing the bulb syringe to suction his nose and mouth, then clamping the cord and offering the scissors to the new dad to cut it.
- The tiny boy grimaces and then squalls in protest. He’s here, and he wants everyone to know it.
- “You did it! Congratulations!” someone exclaims.
- My patient exhales a long-held breath and opens her eyes, near disbelief written on her face. The doctor lifts her son up to her, laying him on her belly, where the nursery nurse begins to dry him off. His cries become louder, and my patient lets out a series of laughing sobs. Matching tears stream down her and her husband’s faces—every emotion they’ve been holding inside unfurled and set free.
- I unsnap the shoulders of my patient’s hospital gown, and the nursery nurse lifts her little boy to her chest and lays him against her skin, where he calms after a few minutes and opens his eyes to look at his parents. Somewhere in the shuffle, the nurse practitioner smiles and exits the room. Everything is beautiful; she is not needed. The rest of us continue our swirling motions, the charge nurse turning lights on and off as needed, putting a suture on the table for the doctor to repair a small tear, and packaging up the placenta when it delivers a few minutes later. I smile and breathe a sigh of relief as I turn my attention towards the computer to chart.
- I am so very glad that is over.
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- It has been forty-five minutes since my patient delivered. The room is now quiet—the pain and misery of the last few hours all but forgotten. My patient’s husband steps out of the room for a few minutes to talk to their families waiting eagerly outside. I watch my lovely patient out of the corner of my eye as I finish cleaning up the room, erasing every trace of childbirth: every drop of blood, every piece of equipment, every bit of trash gradually disappears. Her head lolls back against the pillow. Her eyes fall closed. Her arms gently cradle her prize. He nurses contentedly at her breast, secure and peaceful, still naked against her chest, right where he belongs. They both surrender to the cocooning warmth of oxytocin. Nothing else exists in the world. Not at this moment. Not anymore.
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