I had an exhausting week. Most of the time I complain that I never get called on my call shifts, but after five straight days of driving down to the hospital at all hours of the day and night, and only catching small cat naps in the on-call rooms, (which, for the record, are much less glamorous than one would think after watching cable TV), I was ready to be done for a few days.
I hit a wall Monday. One of the midwives I work with was inducing a woman with an unfavorable cervix for a postdates induction. An “unfavorable” cervix means that it’s not dilated or effaced at all yet, and the baby is still high up in the pelvis, or maybe not even in the pelvis, applying pressure to the cervix yet. This was a primip, a first time mom, and studies tell us that inducing a woman with her first baby on a cervix that’s not ready yet gives her about a 50% chance of having a c-section for a “failed” induction.
I met the woman the night before to place a drug called cervidil, which helps to soften and “ripen” the cervix. I came in early the next morning for rounds, came to remove the cervidil, and start pitocin, which is a drug that artificially induces uterine contractions. Her cervix was 1-2 centimeters dilated, and I knew we would have a long day ahead of us. Both the midwife and I went to the office to do our morning appointments, and I was back by the afternoon. The laboring woman was getting more and more uncomfortable, myself and the nurse trying different positions, massaging different areas, helping her husband support her through the affront of pitocin-induced contractions, which come more frequently and are more intense than contractions that the body makes on its own.
She was laboring hard, husband supporting her through every step of the process, and as we left the room, I turned to the nurse and said, “these are my favorite labors.” The nurse gave me a quizzical look, and I explained, as she doesn’t see many unmedicated labors in the hospital setting.
Labor, to me, isn’t just a thing that women must get through as fast and as painlessly as possible. This moment of labor, the support, trust, dedication, and teamwork it builds in couples, I believe helps to pave a path for the future. For women raising babies with partners, the experience of laboring with their partner lays a strong foundation for battling through the incredibly hard work of parenting a newborn. This isn’t to say that women who chose epidurals do not experience this same bonding with their partners, but there is something that I think may be lost in the experience of taking away the pain that must be comforted, must be worked through, talked through, massaged through, and especially mentally explored and encouraged when labor is not going as planned.
As a disclaimer, I in no way shame women who chose epidurals, and believe that they are a wonderful option for women who chose them. Furthermore, for women who chose epidurals, this does not mean that there is no work to be done, and that labor is now a walk in the park. Getting an epidural itself is a scary process that needs emotional and physical support, which can similarly create the type of bonding and teamwork I see between partners in unmedicated labors.
In order to return to a culture that supports physiologic birth, we cannot simply rely of individual women to chose unmedicated labors. We need whole system-wide change that supports physiologic birth. We need comprehensive sex education that does not instill fear in young women about birth from a young age. We need providers who are well versed in labor support and who work in hospital systems that allow them to be there continuously through women’s labors. We need better staffing of nurses in hospitals that allow them to have only one patient to care for in labor at a time. We need many many changes before we can fully support unmedicated birth, and it is immensely unhelpful to blame or shame individual women who chose epidurals for their labors as if they are the reason that our maternal health system is in shambles and cannot support normal birth. Ok. Rant on our maternity system over. Back to the story!
By 8 p.m. that evening, her cervix was still just barely 2-3 centimeters, and everyone was exhausted, and disheartened. That can be one of the hardest times in labor, when everyone is tired, discouraged, and then a cervical exam seems to taunt women who are doing so much hard work, but it isn’t reflected in their cervical change. This is the reason that I’m not a huge fan of the cervical exam, which is laden with so much expectation, so much hope, and often, there is so much disappointment because the woman feels like her body should be moving faster than it is.
At this point, the midwife I was with suggested amniotomy, or breaking the bag of waters with a device that looks suspiciously like a very long crochet hook. I agreed, hesitantly, because at the pace her labor was moving, the last thing I wanted was for this woman to have ruptured membranes for hours and hours, which increases her risk of infection significantly. So, we tried it, and had to see another patient for a while.
We came out of the other patient’s room, and the baby’s heart rate was doing some weird stuff on the monitor, and my heart sank. If the baby kept this up for a while, and her cervix wasn’t changing, I had the sneaking suspicion that this labor would be one of the 50% of inductions that end in a c-section, significantly impacting this woman’s reproductive options for the rest of her childbearing years.
I walked back into the room, the lights were low, and the woman was curled up on her side, laboring hard. Her husband had a mostly-full cup of coffee and a half a sandwich in front of him, but was dedicated to pushing on his wife’s back for as long as he could to relieve the incredible pressure she was feeling from a baby turned in the occipit posterior position, or what we call “sunny side up,” where the fetuses back is lined up with the woman’s back. I nudged him over to take my turn rubbing that magical spot until he could slurp down that cold coffee and a few bites of sandwich.
“Will you check? Please?” Came a whimper from the hard-laboring mamma. “I just have to know. I have to.”
I nodded, slipped on a glove and quickly checked. I’m still working on keeping my face neutral, but I think my shocked expression made everyone in the room perk up immediately.
“You’re 7 to 8 centimeters dilated, your cervix is all thinned out, and the baby still needs to come down a little bit, but I can feel her trying to turn!” I exclaimed, all of the excitement returning to my heart. We were going to have a baby soon!
Within an hour her cervix was completely dilated, the baby had turned into a better position for birth, and she was ready to push. Sometimes I am amazed and awestruck by the power of birthing women, and this woman was definitely one of them. It took her a few contractions to figure out where to push, but with our gentle coaching, she figured out her breathing, rhythm, and was the incarnation of power in that half hour of pushing.
Soon, a pink, screaming infant was handed directly into Mom and Dad’s arms, and the elation I feel at every birth rushed over me. It is am emotional thing, birth, full of excitement, trepidation, disappointment, uncertainty, but in the end, always the joy of honoring the hard work of labor, and helping to add a family’s newest member.