I did not actually sleep last night; I moved from room to room, baby to baby. I caught a nap at four-thirty, when the night nurses scolded me: "Go, sleep. Come back less weird." It had something to do with my decorating my nails with strips of surgical tape, I think. At four-fifty my pager went off again, and I was back on my feat, arguing with a girl much younger than her age, coaxing, commanding. You become, at some point, no longer uncomfortable when talking to a woman who is naked from the waist down, splayed and spreadeagled for the very most possible pelvic room. It is no different than talking to a woman who is clothed. She wanted to give up.
I hear that a lot, in the labor room, usually at about ten centimeters dilation, +2 station, pushing. I hear it wailed more frequently than I would have thought. It is mostly at the stage where the baby's head moves from tucked tidily behind the pubic bone to moving steadily out in front of the pubic bone (see this diagram, if you are confused), and in a first-time mother that stage can be very long. It is long, and it involves active pushing, and that, O Best Beloved, is the formula for complaints. They are almost formulaic: mothers wail with each push, a long exhalation that robs force from the effort of pushing. They give one decent push, one halfhearted effort, and one scream with each contraction. And then, between, come the pleas. "Pull it out. Take me to C-Section. I can't do this any more. I can't push."
Please believe me, O Best Beloved, and if you do not believe me then ask any of the women you might happen to hold dear about childbirth: this is marathon-quality effort. It is a cardiovascular effort the likes of which many human beings would not believe themselves capable of putting forth. Even with an epidural there is pain, and so many times the pain overwhelms the anesthesia. The average baby's head, O Best Beloved, is between 13 and 15 inches around. That's about four to five inches across, on average, and it is squeezing through some of the most delicate and sensitive territory on the female body. A first baby with an epidural can push three hours on the average, and we're asking for every last iota of effort with every push. I am not saying that these women have no right to complain and cry and whine. I am saying that it is my job to turn the energy they are pouring into their tears toward getting the baby delivered.
And so I argue, I cajole, I order. The nurses are far better at it than I, but I am listening and I am learning and I am beginning to understand the tricks of the trade. Once the baby turns the corner of the public bone the pain is not over but things move much faster. If you can get the baby there then it is merely a matter of convincing the patient that one more good push might be the last. Thus far, every woman begging for a C-section or a vacuum or forceps has delivered on her own as long as the baby looked well.
It is hard. It is emotionally exhausting to be in the room, to argue, to keep my voice calm and authoritative and soft and nurturing and soothing and encouraging all at once. It is hard to watch a woman in agony and to tell her that the only thing to do is keep pushing, through and past the pain. It is hard. It can be done. After an hour and a half, it was done, and all of her screaming and crying vanished with the wet
and warm infant on her belly. Better than an opiate.
Yesterday's totals: one urgent C-section, five vaginal deliveries, one laceration I did not have to repair. I have settled the affair of the call I did not have covered and I will pay back the karma I am due in spades. I slept from seven AM to eleven-thirty, went to noon conference, went to the resident meeting and came home. I couldn't sleep any more; I am tired but not able to stay still. My father is out in the garages (we have the single-car garage that came with the house, and a second garage that was added on later) jackhammering a hole in the wall so that we can get from one building to the next without going outside. I have scolded him into wearing earplugs and eye protection. My Angel is at the boys' night out, eating buffalo wings and perhaps going to watch a movie.
I think I will go and watch the destruction.