A Beautiful Birth

It's been four days since my last shift, and I'm still trying to find the words to describe one of loveliest births I've had the privilege of attending as a labor nurse. This kind of birth is so rare in the hospital environment; but the experience has reaffirmed my belief that if a woman truly educates herself, has trust in her body and the Natural Design of birth, and surrounds herself with the appropriate support, a minimally interventive birth can be achieved in the hospital. With the permission of the lovely couple and their doula, I am honored to be able to tell their story here.

The mother is a 32 year old woman G., who was laboring with her first baby. She was accompanied by her husband C., and her doula, S., a lovely woman who stayed by the side of her client nearly every moment of a long, long labor. I came on shift at 7:oo P.M., and the couple had been there since the late hours of the previous night shift. The report I received was that G.'s water had broken at 2:30 in in the morning (so we are now well over 12 hours) and that she, C., and S. had walked for hours trying to get labor started, until finally she consented to have her labor augmented with Pitocin.

When I entered the room, G. was in the throes of full, hard labor. The room was dark and soft music played from their ipod dock on the side table. The labor bed was bent into a "chair" position, with the top of the bed straight up, and the bottom of the bed lowered to support her feet. This was a woman who had determined that her labor would be accomplished on her own terms. She wore her own clothing, a tank top and a short "skirt"...it looked like it might have been a "Binsi" skirt (www.birthbinsi.com). She sat upright on the "chair"bed, bare feet planted firmly on the foot rest. S, a slender (thirtysomething?) woman with short blonde hair perched just behind her, one arm about her waist, the other on her shoulder. In front of her, C. knealt on the foot of the bed, while she rested her forehead on his chest, his hands placed around her shoulders in a soft embrace. Back and forth they all rocked, a single, loving, hard working entity, to the tempo set by G. as she groaned a low, throaty labor song with each contraction. As each contraction slowed, she would exhale and lean back into the S.'s arms, to accept a sip of water or a cool cloth on her face and neck. As another contraction would well up, she would again lean in towards C., S. would take her place behind her, and they would resume the rythm of their labor "dance". Occasionally G. would move from the bed to a birth ball beside the bed, and C. or S. would massage her lower back or perform a "hip squeeze" to help aleviate back labor. As time moved on, G. began standing beside the bed, bending over with each contraction, placing her hands on the bed and rotating her hips through each one. As each contraction would peak, her labor song would progress from a long low moan to nearly a growl...a "she bear", working to bring her baby into the world.

During each contraction (which S. would refer to as "surges"...appropriate, I think), G. seemed to move completely into her own world. As each surge came to an end, she would look up and brightly smile at one of her companions, crack a wry joke about her "situation", or, if I was in the room, ask a question or ask to be checked. What I loved about these times was that she would be completely calm and happily "present", as if the considerable pain she was experiencing during the surges had never happened at all.

One of the things I hear over and over again, from nurses, physicians, anesthesiologists, and from many women is why, with the epidural, women would want to experience the pain of labor. As a nurse, I struggle with complying with the wish of some mothers not to offer them pain relief until they ask for it. We're trained to treat pain. It's difficult to stand by and let it happen. My doula friend C. has helped me by reminding me that the pain of labor does not always mean "suffering". That has helped me when working with mother's who fully understand and want to work with their labor; but so many women equate labor pain with just that...suffering. I've listened to women who've arrived at the hospital with no time before delivery to get an epidural and heard their panicky pleas for "something, anything" to save them from their pain. They truly felt they were suffering. Sometimes I've been able talk them through their contractions, either with my voice alone, or with a visualization, and they realize that yes, they can do this...and they seem to cope better. Other times, no matter how hard I try, the woman is so tightly gripped by her fear of the pain, and of the process, that nothing I do seems to help. This is when I feel the most helpless.

I wonder if some physicians and nurses roll their eyes at a woman who has arrived at the hospital with a birthplan, or a doula, or both, because they are not accustomed to the woman being the one who is "in charge". We're used to setting the pace for labor, of determining in what manner the "outcome" will be achieved. When a woman and her support team call the shots, and call them appropriately, there is very little for us to do. Waiting and watching, listening and supporting, while it is the major role of a midwife, is not something that labor nurses get a chance to do much of; and it's not something that physicians are trained to do. I tend to make myself scarce during this type of labor; I figure the woman knows her support team and each knows what to expect of the other. Particularly when a good doula accompanies the woman, there is very little I can offer in the way of education and support. With G.,s labor, as much as I truly supported and admired the way she was accomplishing it, I felt like an intruder when I needed to replace the blood pressure cuff, or readjust the fetal monitoring system. She was very gracious though, and before long I began to feel welcome as a part of her "team".

Several moments stand out for me in my memory of this labor. The first is a "picture" I will forever hold in my heart. While G., C., and S. rocked back and fourth in their labor dance, there was a moment when C. laid his head against his wife's breast. G., her eyes closed, leaned back against S., face turned upwards, and S., as she rocked with G. in her arms, placed her cheek softly against G.'s hair, her eyes also closed, with a look of pure love on her face. My words do little to describe the sweetness of that moment. I so wished I had a camera to capture it for them. Later on in labor I was able to borrow C.'s camera and take a few photos as G. pushed, lying on her side, while S. and C. supported her, and the Nurse Midwife squatted at the end of the bed, smiling at the progress G. was making with her powerful, grunty pushes (no "hold your breath and count to 10" nonsense here...and she pushed for only 45 minutes. I wanted to pull every nurse and resident on the floor into that room and say "See, you can push a baby out without holding your breath !!!!! Of course I didn't, but I made sure to get the word around afterwards). At one point just a short while before G. began to push, she called me into the room and asked me to check her progress, because "I feel like I'm losing control". She wasn't though...in between those contractions she was as clear and "in control" as any one else in the room. I hope that pointing this out to her...that from my perspective she was maintaining perfect control...was something she was able to "hear" as she continued on in her labor. There were a few times when she would come out of a contraction and breathlessly exclaim "I can't do this any more"...but she was nearly complete at that point...a classic "signpost" of transition labor.

At 1:53 A.M...nearly 24 hours from the time G.'s water had broken...a beautiful little boy tumbled into the world and a family was born. He spent the next hour and a half cuddled next to his mother, nursing, snoozing, occasionally protesting. C. was ecstatic, and G., as exhausted as she might have been, instead seemed to experience a second wind. As she chatted and nursed her son, you might never have guessed that only a few moments before she was near exhaustion. S. continued her constant support of G., helping her position the baby for nursing, providing food and drink, and tidying up the room for the coming move to the postpartum room.

If only every labor could be like this; if only every woman had such a wonderful support team; if only every woman believed in herself the way G. did.

Welcome Little One. You are as fortunate to be born to your Mother and Father as they are delighted with you. I will forever be blessed for having been witness to your arrival.