At three hours passed midnight the hospital hums gently. It probably hums this way always, but 3am is the only time you notice it. There’s still the squeaking of laundry carts and clogs, the mostly unnoticeable pulsing of fetal heart beats echoing into the hall, but the rest - the chattering, the clacking of key boards, ringing of phones, beeping of pagers, all that is gone. It’s strangely intimate. In this city the windows never turn a sharp shade of black – even at the darkest time of night they’re closer to a murky, viscous brown.
I’ve just finished my admission paperwork, pressing hard with my pen through layers of carbon copies, checking off “admission” and “urgent/emergent” and “obstetrics” and printing and signing and printing again. There’s only one other provider in the room with me, a quiet intern softly dictating her surgery note into the phone.
“The incision was made in a low transverse cut… um, no, scratch that. The uterus was incised at the lower uterine segment at 11:09 pm.” She glances over to me, embarrassed to be dictating in front of someone else. It’s the action of smiling at her that sends my eyes to the glowing computer screen behind her head. Seven rectangles pulse and flicker in a grid, each a fetal heart monitoring strip recording in real time the contractions and the fetal heart rate of each of our patients. The monitor for room 5, my new patient, shows an erratic and normal heartrate, but I can’t help but noticing extra spikes of pressure in the uterus during contractions. She’s pushing. I’m out of my seat in a moment and walking at a brisk pace down the hall when I hear her crying out; first a grunt and a moan, then a vocalization of pure fright. She knows the baby’s coming, she’s pushing without being able to control it, and she’s terrified.
“Baby’s coming!” I shout down the hall and grab a handful of gloves, tossing the ones I don’t need at the side table. My patient is half-sitting, half being held up by her husband, mostly on her side, cries unstopping and tears on her cheeks. I toss back the sheets, relieved to see that the head isn’t out yet. Leaning over, I put my hand on her arm, “Leah, it’s okay. You’re alright. I’m here, you’re safe. Your baby’s safe.” Her eyes catch on mine, some presence of her comes back into them.
My nurse has arrived and swings the birth cart up close to the bed. I pull on sterile gloves and am just helping to get my patient into a better position when the next contraction comes. She’s screaming again, half uncontrolled grunts and half terror. Her labia part, the baby’s head slides into view. She breathes and it sucks back in, but almost immediately she’s pushing again. I keep my fingers firmly pressed against the fragile skull, slowing it down and easing it out.
There’s a thick, slippery, pulsing cord tight around the baby’s neck – I can’t move it out of the way. The baby’s head is out, wet, eyes tightly closed, fat lips frowning, cheeks squished between Leah’s thighs. Her husband is murmuring in her ear, “One push, just one more. Come on, push just one more time!” She cries again, her voice so young and scared. “I can’t! I can’t do it!”
I keep one hand on the baby’s head and catch her eye. “It’s okay. Wait for your next contraction. Your baby is almost here. The head is out! The hard part is done!” The last bit is quick - I put traction on the baby’s head and the shoulders pop out, cord pulled taught. As the body comes I hold the head close to Leah’s perineum and the body squeezes out like a ribbon of toothpaste. I disentangle the cord and plop baby, arms and legs pink and spread-eagle, on his mother’s belly.
The baby squawks just once as I dry him off and wrap a blanket over him. Mom is frozen, panting and confused. I take her hand away from the bedrails and guide it to her baby’s back. She looks startled, as if there’s no way this could be over already, there’s no way her baby is now outside of her body. But she wraps her arms around him and holds him tight, crooning in his ear.
“You’re okay, baby. Shhh, shh, shhhhh, Mommma’s here now. Everything is okay.”
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