23 January, 2009

unconventional hospital births, part two

Tuesday night/Wednesday morning, several hours after Luisa's birth (below)...

Virginiana arrived at the hospital at 3:35 am, in active labor with her third child. Pregnant women are first seen and admitted through the gynecology section of the emergency room. So this mama didn't appear in the Sala de Dilatacion until close to 4 am.

She paced around, one hand affixed to her back, puffing through her surges. Also present were one other laboring woman, an intern, and me. Most of the staff (Obstetra & interns) were busy in the Sala de Parto, and the intern floated in and out.

I offered Virginiana some juice which she gladly quaffed. Around 4:15 the intern noticed V still had her street clothes on and promptly proffered a gown. V complied, leaving her undies in place, then climbed into bed and laid flat on her back. Women become subtly transformed when they don hospital vestments; the act establishes an immediate power differential. (read Birth as an American Rite of Passage by Robbie Davis-Floyd)

Despite her compliance with the system, V still labored very much in tune with her inner rhythms. She began to sound grunty at the peak of her contractions. I listened to her baby with my fetoscope and its heart sounded great. V said "Quiero pujar" so I ran into the bustling delivery room and dutifully notified the Obstetra. When I reentered the dilation/labor room, the intern asked me to take V's blood pressure. Um, hello? She wants to push and we are assessing vitals?!!

About 4:20 am the intern had left the room for a moment and returned. V told us again "Quiero pujar" and then mentioned something about cabeza. Alarmed, the intern pulled down in succession the sheets and V's underwear. We saw that Virginiana's bag of waters had burst, and a lime-sized portion of baby head glistened in her yoni.

"Get some gloves!" the intern commanded. Okay. Gloves on. I placed one hand on V's perineum and the other on the baby's head. It was textbook. The head emerged & restituted LOT to look at mama's right thigh. At the next contraction out she came, a 5 lb. peanut girl, covered in vernix.

By this point my friend Liz and a few interns had entered the room. Liz whispered "nice one" and somebody handed me hemostats and scissors. Gently and deliberately I separated baby from mama. A nursery nurse stood impatiently at the foot of the bed, towel ready to receive la niƱa.

An intern jabbed mama in the hip with pitocin as the Obstetra arrived to claim her authority over the scene. A few moments later V's abdominal contour changed as her womb visibly elongated, heralding placental separation. I began to reach for the umbilical cord but the Obstetra wouldn't have it. She then signaled when she felt it was time and I applied steady traction to birth the placenta. I was just about to begin twisting to coax out the trailing amnion & chorion when the Obstetra took over, so she could demonstrate her membrane-delivering prowess. Humph.

After cleanup and perineal assessment (no tears--yeah!) Virginiana remained in the same bed in the Sala de Dilatacion. Mama and baby reunited at 5:10 for cuddles and mama milk, and amazingly, the father was allowed in to see his family.

Birth is not an emergency. It's an emergence.

1 comment:

Sam said...

an emergence it is.