Hello, my name is Perle Feldman, and I am a birth junkie.
A few weeks ago, I was working on a meditation technique. First, the therapist asked me to visualize a happy moment, a time when I felt calm, in control and comfortable. I then had an image of my last delivery.
Many people find joy between the legs of a woman, but perhaps it is less usual as a giant baby head is distending the perineum. Yet there I was in a circle of women doing what I love so much.
Zhuyin, the family medicine obstetrics fellow, was doing her last delivery as a trainee. After that, she was about to embark on her career. She plans to work as a rural family doctor providing obstetric care for indigenous communities. This is a career path I unwittingly helped set her on when she was a first-year resident. It was one of those case room discussions that we have while sitting in the nursing station, watching the tracing and waiting for things to happen. Although I don’t remember this, she told me that she wanted to work internationally and help underserved populations in her first year of residency. I then asked why she wanted to travel across the world while there was so much good to be done caring for the underserved people of Canada. So here she was doing this final delivery before she jetted off to her first locum in the Yukon.
The nurse, Amina, is part of the cohort of recent grads who bring new energy and positivity to our labour & delivery suite. The patient, a twenty-four-year-old Hasidic primip, was newly married and in the first flush of love. She has an open, playful manner and obvious intelligence. Her husband is a rosy-cheeked smiling young man with long blond payess (side curls). He is from Belgium, their match suggested by a matchmaker. The families knew each other because her father and her father-in-law were friends many years ago in school. Amina, born in Morocco, said that arranged marriages were common in her Muslim community. “I know they can work really well,” she said. “These two are so cute!”
Hasidic men do not usually stay inside the room when their wives are pushing. By Jewish law, they are not allowed to touch them once there is any bleeding or the membranes are ruptured. In addition, COVID restrictions prevented the patient’s mother or sister from coming to the birth, which would be the usual option. So, Amina, Zhuyin and I did our best to be a supportive presence. The husband stayed next to his wife, smiling at her and encouraging her throughout the labour.
Her epidural accelerated her labour, as it sometimes does. We waited until the head came down by itself. The young couple were laughing and joking with each other until the pressure in her bottom became overwhelming. Finally, it was time to push. Then her husband retreated behind the curtain to read psalms and pray fervently for the safe delivery of his wife and child.
Dini, the patient, settled to her work of pushing with energy and will. I took one leg, Amina the other, Zhuyin in the middle, watching the head come down. Pushing and pushing, pushing and pushing, laughing, encouraging and supporting, this is the soundtrack of my life. Every few minutes, the husband called out from behind the curtain. “Is the baby out yet? Is the head coming out?”
“Be patient,” I teased him, “remember the average first birth takes 1-2 hours of pushing.” But, of course, the advantage of being young and strong is that it did not take her that long.
Soon the head was visible. I was leaning over so that I could watch what was going on. We moved from semi-sitting to side pushing, then back again. “Keep your eyes on the prize!” I whispered to Zhuyin as the head started to crown. Zhuyin had the situation well in hand. She had a warm sponge on the perineum, keeping the head flexed as she allowed it to slowly emerge. It took the baby’s head a while to crown. It kept slipping forward and back. The fetal heart was slowing down but returned to normal after each contraction. I looked at Amina and her eyebrows raised. “Can we get a stool next to the bed and another nurse in the room?” I say. She nodded, and Claire, one of the most experienced nurses on the unit, quietly entered, taking over some of the duties and greeting the patient in her soft Caribbean voice. We were preparing for either a shoulder dystocia or a cord around the neck. I got a vacuum onto the table, but I didn’t want to use it.
“The head is coming now,” I called out to the almost dad behind the curtain. “The baby is almost here.”
I look at Dini. “OK,” I say, “I really need you to push hard now. I know I have told you that the baby is coming for a while now, but this is really it.” With a look of total concentration and determination on her face, her mask slipping down to her chin, she gave one mighty heave, and the head was crowning! “Gently, gently now,” Zhuyin said, controlling the head as it slipped over the perineum. I was reassured to see a gush of clear fluid. Zhuyin slipped her hand in and removed a loose cord from around the baby’s neck. “Aha, there’s that bad boy,” I said. Zhuyin tried to deliver the shoulders, but they didn’t come.
“Legs up!” I said as Claire and Amina each bent a leg up to the patient’s shoulders. Then, just as I was ready to get up on the stool to shove on the shoulders, the baby slipped out. There was another loop of cord under the arm which we untwisted as we handed the baby up to the mom. There was an anxious moment, and then a full-throated cry filled the room. “Mazel Tov!” I called out, “it’s a boy!” I looked up and saw the husband’s face, tears streaming from his eyes, a huge smile crinkling his cheeks above his mask. “Are you OK, Dini?” he cried out in Yiddish. “Is the baby OK?”
After delivering the placenta and starting the repair, I saw the young mother examining the baby in her arms, looking with that intense absorption that women do when they see their baby for the first time. This is one of my favourite moments. I love this look. That look is why I continue to do this job. While we were sewing up, Amina brought the baby to his father. Again I watched that look of wonder and joy spread across his face as he held his baby for the first time. I smiled at Zhuyin as she tied the final knot of her residency. It was a job well done.
I looked around the room with satisfaction. Here are my people, I thought, people I have connected to in many ways, all linked through this mystery of birth. I was in my happy place.