“I’ve changed my mind!” cries the lady in front of me. Her husband sat, quite possibly, as far away as he can manage whilst still holding her hand. Their fingers are interlocked, his squeezed white in her slightly oedematous hand belying her post dates, heavily pregnant and thoroughly fed up state. He daren’t answer her. He has tried several times, his crooning and soothing immediately shot down. He’d be a fool to try again and it is clear he knows this.
“If you think we’re having a family you’re wrong”, she screeches at him, “this is it”. This could be tricky, she clearly wants him to partake in this discussion. The room inhales sharply waiting to see if he goes for her bait. I personally am willing him to remain silent. “Ok dear” he murmurs, wriggling his pale fingers free and caressing her arm. “Don’t touch me, that’s what got us in this mess in the first place. Don’t you ever touch me again”. He recoils, shifting just out of arms reach.
It’s been a long couple of days for this couple. Induced twice over due to her considerably unfavourable cervix. A Bishop’s score of zero after 3 doses of prostin, I kid you not. Eventually after her 4th dose we were able to stretch her thinning cervix sufficiently to break her waters. And from there on in, with the added help of the hormone drip, her contractions have been fast and furious. So here we have artificially unleashed a considerable amount of pain on a severely sleep-deprived lady, no 0-60mph over 6 hours but full throttle from time zero.
I am in the room to reassess her, to determine if her cervix has began to dilate, if she is in established labour. She’s not. I can’t begin to fathom firstly how she can’t be, I could hear her from the next ward which is usually a pretty reliable indicator. And secondly how I am going to break this to her, and her husband without being physically launched from the room with the expulsion of her vehement roar.
“Well?” she looks at me expectantly. Is that a half smile I can see, maybe it’s a scowl. There’s one thing for certain it soon will be. I shimmy myself round the bed, ensuring there is sufficient distance between me and her. Just in case, she may be 42 weeks pregnant but I’d actually put money on her reflexes being quicker than mine at this present moment in time.
“The first part of labour is the hardest, getting to 5cm, especially with your first, often takes some time,” I am clearly hedging my bets.
“So I’m just a pathetic 5cm, is that what you’re saying? All this and I’m only halfway!” She starts sobbing uncontrollably and her husband shuffles that little bit nearer.
Right, well done me. I hadn’t actually got to the crux of the matter, she is only 3cm, I was trying to soften the blow. Now what? Do I try to time it between the sobs and contractions to tell her. Do I leave it to the midwives to break it to her, now that’s tempting. Do I say nothing and when I come to examine her in 4 hours time hope she has flown past the 5cm stage.
“Now she’s 5cm she can move to one of the delivery rooms can’t she?”, says her husband, clearly trying to make good the situation. I’m with his wife, he is an utter nuisance, and has forced my hand. Well, he’s going to have to deal with the fall out from this. He no longer has my sympathy.
“You’re right, when she is 5cm she can move to one of those rooms,” I look to his wife who has stilled momentarily. “You’re 3cm at the moment, you’re doing really well, as I said this first bit takes the longest”.
The sobbing takes on a whole new tone, that of despair and frustration I’d imagine. Her husband in turn has paled further. He is aware that’s another 2 hours he’ll never get back, going by the 1cm an hour philosophy. Maybe I was a little hasty, I do still feel somewhat sorry for him.
As the sobs begin to slow I continue, “Have you any thoughts about pain relief? There are lots of options, tablets, injections, gas and air, epidural, you could use the pool…..” I know from her drug kardex she has only had paracetamol and the mandatory zantac, she has merely scratched the surface of her analgesic options.
“I want a natural birth!” she replied, more calmly. Her husband interjects as the next contraction comes upon her, they had looked at various options for child-birth including hypno-birthing but never got round to booking a course. He asks if there is anyone on the unit to discuss this with them. I am a little confused but far from I to suggest an anaesthetist would be more apt at this stage rather than someone to discuss the nuances of self-hypnosis whilst 3cm dilated.
“One of the midwives on the next ward is doing a course in hypno-birthing, I can see if she’s free to have a chat”, the couple smile, an actual smile this time. Of this there is no doubt. The midwife assigned to the couple on the other-hand scowls at me, well you win some and you lose some. I realise this is probably a little out of the ordinary. But I figure, even at this late stage, if they can feel empowered by being allowed to make some decisions, to regain a small degree of control over this situation, then there can be nothing lost. Let’s face it she has been artificially induced repeatedly over 48 hours, she has had her waters artificially ruptured and even her contractions augmented and sped up or slowed down as we feel fit. This is by no means a natural childbirth from the outset, but what we can’t deny her is the willingness to try this side of things her way.
Four hours later I head back to the ward to further assess our lady. I haven’t heard anything in the interim period which in itself is a good sign.
I am navigated to a side room on the left of the corridor, rather than the right. This means only one thing – she is in the pool. As I enter I’m not met with whale songs and flickering candles, don’t get me wrong we’ve not had a complete 360 turn here. But what I am met with is a perceptible change from the tension of earlier to a couple very much in this together. She is sucking away on the gas and air as I go in and he is rubbing her back. The contractions are now lasting a good couple of minutes and she is more relaxed with them. The diamorphine will have helped with this too no doubt.
This time examining her is easier, as is the delivery of the good news. She is 8cm dilated and what’s more the baby is in the right position. This is good news, for everyone.
Several hours later she delivers a healthy baby boy with a thick matt of dark hair. She’s done well, it really has been quite a journey.
I think the scariest thing about labour is the lack of control. For many women this is an absolute first, and to relinquish your hold over something you have thought about for 9 months is no mean feat. The very simplest of decisions; whether you use the ball, go in the pool, plan to deliver standing up or lying down, whether you opt for an epidural or plan in some part to go au naturel. You know each and every one of these decisions gives the perception, and security, that you have some handle on what is going to be one of the most defining moments of your life.