Sunday, March 2, 2014

House Call

I walked the rocky path up that steep hill. My lungs restrained me, as my feet tried to hurry. I wondered if this was wise. I had my emergency supplies tucked in the bag on my shoulder, along with my lunch (hate skipping meals). It was something I hadn’t done before, so I was a little nervous, and a little excited.

She had said she desired to deliver at home. She knew the risks, and she knew what she wanted. I reluctantly told her that if I wasn’t in another operation or busy in clinic that I would come and deliver her there. So, I finished up two hysterectomies just before the phone rang. The contractions were getting stronger.

I arrived up the big hill, short of breath, and was grateful to find that she was already well into labor. I balanced in my mind the ease and carefree doula approach and the well drilled medical training. If everything went well it was going to be awesome. If things didn’t, it had potential to be awful. I listened for the baby’s heart beat from time to time. Again, a bit awkwardly, I told her that if she wanted anything specific, to just let me know. I would be checking in on her and the baby, and if she wanted me to help any other way, or if anything changed, she would need to tell me. Thankfully, she was content to labor quietly, no drama, no overly specific plan.

I waited. Ate my lunch. Listened to the heart beat. Waited some more. Prayed for mom and baby. Waited. Listened. Small talk. Waited.

After a couple of hours, the forces inside culminated into the deep urge to push. She was completely in control. I guided the head out, then the body. The baby’s lungs filled with air and she strong cries began. She was beautiful (besides slippery and a bit bloody, of course - the norm for all newborns). I breathed a sigh of relief, all had gone well.

I was glad it hadn’t been a long labor. Patience isn’t my strong point. All of obstetrics, of course, has a lot of waiting involved, but the constancy of midwifery-type one on one care is different. I have always appreciated and respected it. A doctor is often more pointedly intentional about the times and interactions with patients. We always are there when the patient needs us, we enter in and bring a trustworthy set of values and skills. But a midwife is there regardless of distinct need, she is a provider, but more relational as a companion and friend. I felt like a strange mix of both, sitting in another person’s home, my tools spread out on the sterile towel beside the bed.

I can say I like both parts. In training, I used to enjoy slower nights on labor and delivery that would allow for more patient interaction than the usual rapid pace rushing from one room to another. Partnering with a patient in labor takes a soothing, calm spirit, only a bit of thrill after a long while of support. There’s something special about the delivery room provider’s relationship as they walk the patient through the pain. I’ve always liked near the end, when their eyes are searching, scared, wild – and then they meet with your eyes, settle there, and find a place to trust and focus.

But then there are the times when everything doesn’t go quite right. And then I’m glad that I’m a doctor in a hospital. All of the sudden, there is the rush of an emergent delivery. The call needing immediate help. The bed rolls quickly, the IV runs, the instruments fly into place. In a few minutes, it is all over. The emergency has been managed.

As enjoyable as a normal birth is, there is something trained up inside me that must prepare for those emergencies. I am not able to enjoy the tranquil, doula experience like many. My right hand is now meant to hold a blade, to cut in case of emergency. My mind is remembering where I have set the medications to treat hemorrhage – just in case. Lists of risk factors for numerous emergent possibilities run through my thoughts.  I am enjoying the awe of new life, but not lost in it. Making their moments special means that I protect them by preparing, even while they don’t know it.

But after the blood, and cries – when life is established and the baby’s lips are firmly latched onto mother’s breast. Then. Then, whether complicated or uncomplicated, I can embrace fully the amazement of what has happened. I can see that what God has made is indeed wonderful. I can protect life, but I can’t give it. What a wonder. I sure am glad that He lets me be part of it. 

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