What if there was no hospital?

(Cross-posted to Puah’s Corner.)

There comes a moment when I have to look in her eyes, this strong and determined woman who has been pushing with all her strength, hour after hour, cheerfully moving into every new position we suggest, squatting, standing, kneeling, lying with her head down and bottom in the air to try to lift the baby’s head out of the pelvis so it can come back down in a better position, flat on her back tolerating the pressure of my fingers trying to help her baby rotate as she bears down with all her might, that moment when I look at her and she knows what I am going to say before I open my mouth to tell her that there is nothing more that we can try.

This story has played out with different variations. This is her first baby, or it is her first vaginal birth after a prior cesarean. The baby’s head is posterior, and possibly asynclitic as well. The baby may have a nuchal hand, or a tight cord wrap, that is making rotation difficult. Her pubic arch is narrower and higher than normal, or maybe it is low and flat.

We go to the hospital – the clean, modern, well-staffed, well-equipped hospital – where we are met by kind, friendly nurses. Where a OB who likes and trusts me treats her with compassion and respect, explaining what is going on and what he needs to do and why. Where her husband, her doula, her mother or sister or friend or photographer, can stay with her for the delivery. Where I can stay with her (even into the OR if that is where we end up, though because the OB who backs up my clients is skilled in what is becoming a lost art, I have actually seen more forceps rotations than cesareans.)

I imagine what it would have been like to be the midwife in this story in a time or a place where there was no option for hospital transport for instrumental or surgical delivery. Only one of the mothers who has been in this situation has ever asked me that question – “What would you do if there was no hospital for us to go to?” She didn’t ask in the moment, but weeks later, when we were talking about her birth. “What would happen to me and to my baby if there was no hospital to go to?

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