Labor and Delivery

I have a whole new respect for mothers in this world. The images I have seen in the past few days have been ingrained into my memory. I’ve seen women give birth on tv in health classes, but it’s not real until you see it in person. Let me describe how it goes here.

Women show up and are admitted into the first stage labour room. They are closely monitored until it is showtime. And just about when the baby’s head is ready to break through, the woman walks herself (usually naked and moaning in pain with her own IV bag in her hand) to the second stage labour room. There are three beds in both second stage labour rooms, and each is lined up right next to each other. There is not much space between each bed and there’s certainly no such thing as a private room, or even a separating curtain. When it’s time to deliver, it’s time, and nobody cares if her body parts are open to the world. There’s also no such thing as an epidural during delivery. These women do it all natural, unless of course there is a complication and she is taken to surgery for a C-section.

It seems like women deliver in no time. Some of them barely make it to a cot before they are ready to start pushing. It’s amazing. After delivery, the nurse then shows the woman her baby, and the baby is taken away for Apgar score and washing. Next step, third stage labour, or delivery of the placenta. Women are injected with oxytocin, and the process begins. With some massaging and a few pulls of the cord, the placenta is out. There is more cleanup involved, but I won’t go into details about this. It’s graphic, and it looks pretty painful. I’ve seen more women scream during this process and the suturing that often follows after giving birth than when they are actually delivering. Finally after the woman is cleaned up and the baby is washed and oiled, they are united for breastfeeding. It’s truly an incredible process.

We do things very differently in the US, and some may even say we’ve medicalized childbirth, but it’s with good reason. There are women all over the world delivering completely natural, with no skilled birth attendant to assist. Those areas are also often accompanied with high maternal and infant mortality rates. Even here, the staff is skilled and well-trained, but there is just such limited staff, space and money, that it’s impossible for every woman to have her own room, with her own private physician and nursing staff, and machines monitoring every vital process. The reason there are no drugs/epidurals given is because they don’t have enough staff to monitor anesthetics. Also, the women here, depending on how busy the ward is that day, are out of the delivery room within an hour.

Yesterday, I saw six births in row within a matter of 45 minutes. Two of the six were complicated. The nurses usually deliver, unless there is a complication. They do a commendable job, and the amount of training they go through to be obstetric nurses or midwives would really be like the equivalent of a nurse practitioner, physician’s assistant or a nurse trained in high-risk pregnancies. They know how to handle emergency situations, but there are still emergencies in childbirth that require the skills of a physician.

The first complicated birth was a breech birth, and so the doctor on staff was called in. The baby made it out with much pain to the mother, but unfortunately the cord had wrapped around the neck. The doctor immediately began resuscitating the baby. After suctioning and applying oxygen, the baby finally took his first few breaths and began to cry. All of the attention was solely on the baby. Every staff member and observer was crowded around the resuscitation table. But the mother was just left alone on the cot, and I could tell she was in-between feeling the need to just rest and feeling anxious trying to look over to see what was happening with her child. The second complication did not end well. It’s hard to tell what actually happened. Unfortunately, with the shortage of physicians, lack of constant monitoring (and machines to do this), lack of access to antenatal care, not being aware of the major warning signs of an arising complication, etc. the infant mortality remains at about 57 deaths/1000 births (or 5.7%).

On my last day spent in the labour ward, I went into surgery and observed a Cesarean section. That’s how I came into this world, and so I found myself in awe of the process. I paid close attention to the cutting and suturing involved. I had flipped sideways, transverse, and was an emergency situation. My mom was cut vertically, while most C-sections are a transverse cut. I had dissected portions of cadavers at MSU, and so I was aware of the amount of layers of tissue that have to be cut through before even reaching the uterine cavity. But still, this surgery was both intriguing to me as I watched the technical progression of cutting, removing the baby and the placenta, and suturing every layer, and also personal as I thought about the sacrifice and healing required from my mom’s body for my birth as her tissues were quickly cut across, intersecting the natural lay of the muscle lining. As I grow older, work within reproductive health and understand that probably within the next ten years I might be having my own children, I feel more connected to my mom. Women endure a lot to give birth.