I recently read an article that made me smile on the Mothering magazine’s website entitled “Juicy Labor” by Esty Schachter. Schachter writes about her labor with her second son as involving lots of walking around her apartment for most of the day until eventually deciding to go to the hospital after breaking her bag of waters. One thing I found endearing about her story is the description of her experience in the triage area of the labor & delivery ward: “I said I wanted to push, but no one except Jon [her husband] seemed to hear me. That’s when I should have realized a vital bit of information: quiet women in labor will not get attention. Labor is simply not the time for restraint or subtlety.” Schachter describes the initial skepticism of her doctor and the triage nurse that she had actually broken her water and was in labor followed by shock when it was realized that she was fully dilated (or as the doctor described it, “good to go!”)
I have been in this very position myself many times in my short career: woman approaches desk in wheelchair, restless, doing the “one cheek sneak*,” but very in control, turns out to be 9 centimeters with a bulging bag of waters! The funny thing is that there is an inside joke around my department that if a patient approaches the desk calm, somewhat apprehensive, and without any luggage…she is probably in labor. On the contrary, if a patient approaches the desk hooting and hollering with six suitcases and two pillows, chances are, it’s not the real thing! Despite this inside joke, by default hooting and hollering always ends up getting you more attention, as Schachter so eloquently described!
What really hit home for me when reading this story, however, was the interaction the author describes in the delivery room between the nurse and the obstetrician. Maybe it’s the adrenaline rush of hurrying a stretcher down the hall, clumsily setting up the delivery cart and baby warmer, and barking orders at each other and the mother (“Don’t push!,” “Start an IV!,” “Break the bed!,” “Get me that…!”) that many doctors, and even some nurses, thrive on. However if you think about, if a woman comes in ready to, or almost ready to deliver, it is more important than ever to try and keep things as cool, calm, and collected as you can, not only the mother’s emotional wellbeing, but for the progression of labor as well. I have tried to explain this very concept to many of the new residents at work: A woman in transition or one ready to give birth is not a medical emergency! True, we must all work as a team to provide appropriate care and support in a timely and efficient manner, but we don’t need to be busting through doors and screaming “PUSH!!” I love how the nurse in Schachter’s story told the author to “do what nature told [her] to” despite the brash doctor’s demands. It is a line I have used quite often in my own practice as an L&D nurse, right after I dim the lights and demand some level of quite from the bustling staff around me J. At that moment, my attention is on mom and her needs, not the needs of anyone else.
To all the attending obstetricians, residents, and old school L&D nurses out there (who are probably not reading this post J), let us try to remember that when push comes to shove (no pun intended!), the admission assessment, IV, history & physical, and other paperwork can wait. Your job at that moment is to help support the mother and include her partner or other labor companion in doing whatever will assist her the most. She is, after all, the one doing all the real work and you are, in truth, privileged that she is even allowing you to be there to catch!
*Note: The “one cheek sneak” is the affectionate name used to describe a move that is typical of a woman in true labor (although it’s meaning to L&D nurses is a bit different than it’s meaning per the late George Carlin!). The rectal pressure from the baby and the back-to-back contractions make it difficult to sit without lifting one of your buttocks off the chair, all the while trying to maintain your composure and pant through the contractions!