In a previous birth story I wrote about the intimacy some couples experience when a woman is in labor. Even when there are other people coming and going, a woman and her partner can achieve a private emotional space. For other women, labor and birth are group events, with sisters, mother, friends providing essential support and respite for the partner. Occasionally a woman will take the group birth concept beyond a circle of intimates. Birgit had one such birth, as you'll see below.
I met Birgit late in her second trimester. She was a lovely, slightly studious-looking young woman who brought her lively five-year old girl with her to prenatal visits. Liv had been born at home and Birgit was planning another home birth for her second child.
I knew her home birth midwife well. Kathleen was one of the most experienced home birth attendants in our community and worked at our clinic as a childbirth educator. Birgit had been lucky enough to have Kathleen present at Liv's birth, which had gone well, and she felt confident that her second home birth would go well, even though she acknowledged the possibility of complications and had a healthy threshold for transferring to the hospital if things went wrong.
I was new to Rural when I met Birgit and not as comfortable with the prospect of home birth as I am now, but I remember believing that Birgit would have her baby at home and I would only get to see her after it was all over and she came to clinic with babe in arms. Still, I had a great rapport with her and when she asked me if, in the event of a hospital transfer, I would attend her birth, I said yes.
These were my early days in Rural. I still had extra free time on my hands and it was easier to commit to being at a woman's birth because I had time and energy. The night Birgit went into labor, I was sitting blissfully at home, watching reruns and contemplating an early bedtime. Then the phone rang.
"Birgit's here," said Holly, one of the nurses at Labor & Delivery. "She says you told her you'd special her."
"Yes I did," I said. "I'll be right in."
Holly filled me in on Birgit's story when I arrived at the hospital. Apparently labor had begun early in the morning and hadn't permitted much sleep. There was a lot of nausea and vomiting with this labor, which hadn't been the case with Liv's birth, and Birgit had made the decision to come to the hospital because she felt exhausted and the labor didn't feel right to her. The pain was constant and achy, with contractions intensifying the discomfort but not promoting labor. Kathleen told me Birgit's last exam had been about 5 centimeters, unchanged from several hours before.
I went to talk with Birgit. She looked exhausted and pale.
"How are you coping?" I asked.
She shook her head. "Not well at all," she said.
Her friend and doula, Jenn, said "Birgie's been really tough but I think she's tired out."
"I bet. What do you think would help?" I asked.
Birgit shook her head again. She kept her eyes closed the whole time. "I'm just so tired," she said. "I wish I could get a break from this."
I thought about it. On the tocodynometer monitor, Birgit's contractions were irregular and some were much longer than others. Occasionally two contractions happened back to back, a not terribly functional pattern called coupling. "How about something simple?" I suggested. "How about some fluid?"
Birgit nodded. "I think that would be a good place to start."
There's no evidence that IV fluids affect labor, but I use to it optimize dysfunctional labor patterns such as Birgit's. The truth is most women don't keep up with their fluid requirements during labor, even if they drink a lot and don't suffer from the vomiting Birgit had. Old school nurses and midwives speak of "dry labor," which sometimes refers to labor following premature rupture of membranes but also refers to a "dry"-looking labor pattern. Birgit's was a typical dry pattern: irregular frequent contractions, with irritability or uterine tension in between. This resulted in the constant achy-ness Birgit was experiencing.
Holly started an IV and I ordered a liter of LR, which is still the standard OB crystalloid. Don't ask me why. I use NS as my default fluid in other settings, but on L&D, I still use LR. A residue of my training. Usually, for the duration of labor the exact fluid formula doesn't matter, but the fact of fluid does.
Birgit had a soak in the labor tub as the fluids ran in. The warm water soothed some of the achy-ness. Derek sat on a chair next to the tub and dozed off in between Birgit's contractions. Within ninety minutes of receiving IV fluids, Birgit's contraction pattern looked more functional, with regular contractions every three minutes but a good period of rest in between. Her waters broke and I examined her.
"Eight centimeters," I told her. "Good news!" She nodded and smiled at me, but kept her eyes closed. This time it was not from fatigue but from concentration and entry into transitional labor.
Jenn and Kathleen whipped out cell phones and began calling people. Apparently there were some other family members who wanted to be at the birth but who were waiting at home, entertaining Liv and looking after the pets. I hoped they could get there fast, because now that her waters were broken, Birgit was laboring hard.
Fortunately--I think--Birgit and Derek's house was only a few blocks away from the hospital. As their guests began to arrive, I saw that they defined family loosely. The people showing up were brothers, sisters, mothers, mother-in-laws, but also other doulas from the local network, friends, neighbors, and an assortment of children from infancy up to school age. Pretty soon, there were at least a dozen people at a time in the labor room, and another half-dozen entering and exiting.
When Birgit began pushing, I had to stake out a few square feet of space for the delivery table. After that, I kneeled on the floor at the foot of the bed because there really wasn't any other place for me to be. The daybed was filled will spectators, and a double-row of chairs had popped up on one side of Birgit's labor bed. Holly, who is much more authoritative than me, had staked out a corner of the room where she could get to the baby warmer, fetal monitors, and oxygen mask; this was Holly's Spot, she announced, and no one was allowed to crowd it. People were seated around the small dining table near the daybed, and there were almost a half-dozen standees.
Birgit seemed not to notice anyone was in the room but me, Jenn, Derek and Kathleen. She kept her eyes closed and pushed long and hard with each contraction, wincing at the dense pressure of the baby's head as it descended. For me, there was an odd disconnect in the room, with the assembled crowd whispering and shuffling, and the intensely private space Birgit seemed to occupy.
The baby's head began to peek out with pushes, and everyone got really excited. Some of the standees stuck their heads out into the hallway and waved even more spectators in. Holly did some expert crowd control so I could protect the delivery table, and the compromise we all reached was in having the last eight people stand in a semi-circle just beyond the foot of the bed, where they could have a good view of the baby as it emerged. These eight people were all equipped with digital cameras, camera phones, and video cameras. As the baby began to crown, the flashbulbs began to fire.
Derek wanted to "catch" the baby, so I kept my hands over his hands as the baby's head emerged and restituted, then directed him in a gentle tug to encourage the body to be born. The whole process felt slow and dream-like to me. I don't know if this was because of the unfamiliarity of having 20 people in a labor room, or because the strobe effect of the flashbulbs was affecting me adversely, or because of Birgit's profound concentration, but the moment of birth was calm and lovely.
Once the baby was born, the room erupted in cheers. Flashbulbs were still erupting. I passed her new daughter up to Birgit and helped her lie back against some pillows. Now the crowd seemed smaller, as some people left to relay the good news over cell phones and others decided to take some of the younger children home. The placenta delivered, and there were no lacerations (thank goodness; I didn't want to have to suture in front of an audience). I covered Birgit up and congratulated her. It was late evening and I asked her to stay overnight just to get some rest. Always reasonable, always calm, she agreed. She was serene and joyful and I thought: what a wonderful thing, to have a baby so publicly but with such a deep sense of internal stillness.
Weeks later, Birgit brought an album of birth photos to show me. The paparazzi corner at the foot of the bed had taken about 500 shots of the moment of birth and she'd distilled these into a photographic narrative. She pointed to one photo in particular, taken as the baby was crowning.
"You look so wise and thoughtful," she said, pointing to the image of me kneeling on the floor. "Do you remember what you were thinking?"
"Oh no," I lied. "I can't remember what I was thinking ten minutes ago, much less two months ago." We giggled over that.
Why did I lie? Because I knew, by looking at the impassive expression on my face in the photo in Birgit's album, what I was thinking in that moment: There are too DAMN many people in this room! That was the truth, but it seemed so small a thing to be thinking, weeks after the birth and when Birgit was feeling so good about her decision to transfer to the hospital. It was just a little lie. I still sleep OK at night.