See Part 1 here.
The Second Stage of Labor, or the Pushing stage…always full of surprises. Women carry themselves beyond all the physical limits they ever knew they had. I am ever amazed at the power a woman can muster in herself to get through this stage. Pushing can last for hours. The longest I’ve ever seen a woman push was for 5 hours…and she did it…a beautiful vaginal birth. Of course she was so tired that she couldn’t nurse for a while. We held the baby to her breast for her, as any good nurse would do.
And here we were with my patient, whooping and whaling all the way through it. That really doesn’t bother me, I mean; anything that helps them is fine with me. I would only discourage it if it proved to be counterproductive. But she was making progress just fine. It’s the ladies in all the other rooms that were being scared out of their wits at her shrieks of torment.
I continued to help her change her positions: squatting, to side-lying, to hands and knees, to squatting again since it was her favorite position. She never ceased to claw at me. I had my hair pulled, my neck pinched, and my back ached from supporting her weight during her contractions. I continued to clean feces and urine from her perineum and I had been vomited on more than once. I had worked up a sweat by this time right along with her.
Her husband remained dutifully at her side patting her on her back and saying things like, “You have the power,” and, “Just imagine her coming out of you.” But as time passed his encouragements became less confident and by the end of the 2nd hour, he retreated to the couch.
Progress had stopped. I started losing my optimism about her being able to do this vaginally and I probably let my doubt show. The woman suddenly got angry. Screaming, “Get it out of me! I can’t do this anymore!” she reached down into somewhere deep inside of her and miraculously produced a huge powerful push with a gigantic whale, “GGGHHHHHAAAAAAAA!” The baby’s head popped around the pubic bone and stayed down low in her pelvis. I could very suddenly see the top of the baby’s head emerge between her labia.
“OK, stop pushing…breathe,” I said firmly, “we need to get the doctor in here.” I was pushing the emergency button for help. She gave me a panicked look and her face twisted into that bearing down look and a grunt escaped her throat. She couldn’t hold it…I couldn’t blame her. The baby’s head was turning and all of the sudden plowing down her birth canal. Now, understand that it’s bad form to not get the doctor there in time…especially when you’ve been pushing for two hours. But I couldn’t control the speed at which the baby was coming. Another nurse came rushing in to find me holding the top of the baby’s head, trying to keep it from exploding out and tearing her to shreds. The patient was screaming so loud that no one in the room could hear any directions. Her arms and legs extended straight out, and were locked that way. There was no moving her. She wasn’t even taking a breath, just a loud, long scream, with curses, and, “GET IT OUT!!!!”
Her husband took this opportunity to prepare himself for the birth. He started taking off his clothes. He stripped down to his skivvies and waited. Quite a mystery.
The doctor raced in. When I saw that he was ready to reach in and catch, I let go of the baby’s head to ready the stirrups. I disconnected the bottom of the bed and bent over to put it aside. Just as I did that, the woman sat up, gave one more good holler, and out came the baby in one slithering thrust. I barely caught the slippery baby in my hands…juggling it…almost dropping it. Still bent over, holding the sputtering baby, I looked behind me at the doctor. “Good catch,” he said without a hint of a smile. He handed me a clamp and a scissor. He was quite a dry-humored fellow.
In the end, I guess it was a beautiful birth. My patient’s expectations were met. (Everything except the “no pushing” request, but that could not be helped.) I looked at the couple as she admired her newborn and the father smeared amniotic fluid and vernix so romantically over his bare chest (still a mystery.) No thanks were offered to me, no indication that my efforts were at all noticed or appreciated. I hope she was happy with her care. I’ll never know, but I do have the fingernail marks on my neck to remind me that I did everything I could to support her…and I can be satisfied with that.