A quiet hospital birth

Just today a family physician friend emailed me this birth story, and I am reposting it with her permission. I thought this story was pertinent given our current discussion about the book Homebirth in the Hospital. Notice how the nurses and physician pay close attention to the woman's personality and desires and adapt accordingly.

I attended an amazingly beautiful birth last week. This is the second birth for this couple and I attended their first as well. This couple does an amazing job of taking over and creating their own atmosphere in the hospital—to the point that the nurses and I feel almost bad intruding on them, yet they are so sweet and pleasant that you want to be with them. It's hard to describe, but basically there is like a bubble of personal space around them.

Mama was 2 days overdue, and had asked me on the Monday before Thanksgiving to strip her membranes as all her family was coming for Thanksgiving. She was a good 3 cms already, 70% effaced, and it was easy to sweep her membranes for her. She told me later that she started having contractions almost immediately. She was able to sleep off and on during the night for most of the night. She's a teacher, and she debated going to work in the morning, but finally decided to call in, as did her husband. They took their daughter to her day care provider anyway, and spent the day together doing errands and walking and getting a little nap. She called me around 2 pm and let me know her contractions were getting closer and stronger, but she wasn't ready to come in yet. I made sure she'd been eating and drinking, which she had.

Labor and delivery called me around 3:30, to say she'd arrived and was 5-6 cms, but smiling and looking comfortable. I was still seeing patients in the office, and so arrived around 4:45 pm. At that point, the nurse had just checked her again because she wanted to get in the tub, and she was 7 cms. I found her in the tub, wearing a gorgeous black tankini swim suit (top and bottoms!) leaning back with her legs crosses and the jets on, and sipping a drink with a straw. She smiled at me and informed me she was pretending she was on the beach. She stayed in the tub until close to 6 pm, and the nurse just checked heart tones every so often, and otherwise we left her and her husband alone, and they talked and held hands, and really didn't need us. Around 5:45 pm, she called the nurse and said she was getting out as the contractions were too intense for the small tub. The nurse asked if she wanted help, and she smiled and said that her husband would help her. We retreated from the bathroom again, and they shut the door.

A few minutes later, she emerged from the bathroom, fully dressed again—in a tank top and long work out pants, looking fresh and rested. She walked around the room a bit, then sat on the ball for a bit, and the nurse continued to take heart tones every 15 minutes. The last time the nurse was in the room, my client and her husband were playing cards! A few minutes after that, she called me in the room and said she just wasn't sure how much more she could take. She was still smiling and when I was in the room for a contraction, she just took several deep breaths and focused hard on her husband, and looked like someone in very early labor—but I knew she'd been 7 over an hour before and she was likely close to having the baby. I asked her if she wanted an exam, or if she felt like pushing, and she said she was starting to feel a lot of pressure like she was close to pushing, but not quite yet, and she didn't wanted to be examined. She said she didn't feel like she should push if her water hadn't broken, and I suggested she just wait for a few contractions, maybe push a little or grunt a little at the peak of contractions and see if she felt better. She agreed, and then sort of refocused on her husband, and I again felt like I was intruding, so the nurse and I stepped back in the hall.

A few minutes later, the husband opened the door and said calmly, "her water broke." Conscious of keeping the quiet mood, the nurse and I got up and walked in slowly, and the second nurse went to get warm blankets and snuck in a few minutes later. My client was kneeling on the bed, and she smiled at me and said "NOW, I want to push" They had pushed the cards to the side on the tray table, but she was still fully dressed. I asked her if I could help her with her pants, and she said "sure!" and we helped her get her pants and underwear off (I got a kick out of this as she was wearing thong underwear with a thong pantyliner which I've never seen anyone in labor do!), which were absolutely soaked.

The nurse asked her quietly if she wanted to push kneeling, and she said she'd try semi-sitting first. With the next contraction, she pushed hard, and we could already see some bulging of the perineum, although no baby hair yet. She then said maybe she'd rather kneel, and flipped over to her knees again, and pushed hard with the next contraction. She quickly decided the kneeling was too intense, and flipped back to her back. My nurse asked her if she'd like the squat bar, and she thought maybe she would, so we set it up, but as another contraction started very quickly, she ended up just resting her legs on the squat bar and decided she didn't want to get up. With the next contraction, a little patch of baby became visible. Her husband was holding one of her hands and whispering in her ear, and the rest of us were very quiet. With another contraction, the baby's head slowly emerged, turned to line up with his shoulders, and then fell into my hands. My client reached for him and pulled him up to her chest immediately. When the big sister had been born, she'd been just as quiet as her parents, and didn't cry at all, but this guy was having none of that—he let out a huge yell immediately and let us all know that he wasn't too happy with the cool air and brighter lights! Mama patted him and soothed him, and the placenta delivered spontaneously just a few minutes later, and we clamped the cord and the nurse took pictures of the dad cutting the cord. Mama pulled up her tank top and the baby shifted over an inch or so and immediately latched and nursed like he'd been doing it forever.

Unfortunately, mom started to bleed at this point. Fortunately, my nurses are used to calmly taking care of situations, while trying hard not to disturb the new couple. We gave her IM pitocin, then hooked up some IV pitocin, then some IM methergine, and massaged her belly—all while the baby nursed in his mother's arms. She had a small skin tear that seemed to be bleeding, which I put 2 stitches in, and finally after all that the bleeding slowed and stopped. As soon as we were able to step back from them for a few minutes, the dad wrapped his arms around his wife and son, leaned his forehead to hers, and prayed over them all softly.

After an hour or so, baby was finally weighed and given right back to his mom. 8 lbs 1 oz. Mom got dressed again (she is not like some of my clients who prefer to be naked throughout!) and they all walked up to a postpartum room together. When I talked to the nurse this morning, she said the whole family had spent the night snuggled in bed together.

I love a birth like that—where I am absolutely useless! (Well, at least until the postpartum hemorrhage, and then I'm glad it's me and not some birth attendant who panics and turns the whole thing into a circus as we just very calmly and quietly dealt with it while the new family had their chance to be together.) I wish I had pictures of this mom, 7 cms dilated, in the tub in her gorgeous swim suit, kicking back with a drink in hand! It's amazing to be invited in to something like this, and to be allowed a glimpse of such an intense and private event.

Comments about "quiet" birthers: As a birth attendant, I don't want to give the impression that in labor and birth quiet=good and loud=bad. I think it has a lot to do with the personality of the woman, and the situation of her birth—the support people, the location, the expectations she and her team have. Women who are vocal in regular life tend to be vocal birthers, and quiet women tend to be quiet. I've attended some really lovely births with mom bellowing at the top of her lungs—and I enjoy those just as much as the quiet ones.

I was most impressed with last night's birth by how well this couple created their own world and the environment that was most like them to birth their baby in, if that makes sense. This mama is really quiet in real life, and private, and modest. Instead of letting the hospital environment and staff overwhelm her, she somehow created her own space and did it her way. At her first birth, the nurse who cared for her remembers going into the room to first introduce herself at shift change and finding the mom walking in the room with her husband, wearing sweat pants, a t-shirt, and a sweatshirt zipped up to her chin. The nurse said to me "I took one look at her zipped up to here and thought, aha—it's going to be like that!" (That nurse is a master at assisting women to have the birth they want; she meant by that statement that she just knew that this was not a woman who would welcome a lot of touching or have a lot of need for hands-on support, and who would not want to be messed with much. That nurse, like last night's nurse, simply checked heart tones every so often and said, "let us know when you want to push!" and she eventually did.)

On the other hand, I've attended plenty of women who NEEDED to be very vocal, and needed a lot of touching, reassurance, even direction some times and that doesn't make their birth any less perfect. Sometimes, for me, it's nice to be needed! The big mistake many hospital providers make is thinking that a noisy client needs to somehow be shut up—medicated or belittled into keeping still usually. I always tell my own clients that being free to make whatever noise and move however you need to have a baby is what helps us humans have babies—we don't birth under a bush with predators lurking, so we can be free to be as loud as we want!