Gentle arrival

Patey, Paul

The nine-month pregnancy has gone well. The happy couple frequently came to prenatal clinic together. Labour started spontaneously; it was hard work but steady progress. The cervix reached full dilation about 30 minutes ago, and thereafter the mother responded well to the biological urge to push with her contractions.

Now her husband sits on a stool near her right shoulder, snuggled close with his left arm behind her neck. With his other hand he holds a cold wet cloth to her forehead. When the contraction and the urge to push comes, she leans forward, supported by his left arm. Between contractions she rests her head on his shoulder. The baby has moved down enough that its head presses snugly against his mother's bottom. The head is crowning; a circle of wet scalp, four centimetres in diameter, is visible and enlarging.

The mother grunts and makes short pushes as her bottom stretches and stretches. I wait. Rather than rushing the completion of Birth, I wait. My hand lies against the head to prevent any sudden expulsion. At this point the back of the baby's head lies toward the mother's front and I know its head is bent down onto its chest. The nurse reports the fetal heart remains normal.

The rounded back of the head bulges outward. As it continues to slide downward, I feel and see the movement indicating that the head is starting to extend. The hair line at the forehead is emerging. Then forehead, eyes, nose, mouth, and chin slide smoothly and promptly into view as the head fully extends. Swiftly I slide my finger along the head and neck to see if there is a loop of cord around the neck. There is. Smoothly I slip it forward over the baby's head. At the same time the nurse gently wipes a bit of mucus from the infant's nose and tightly closed lips.

Meanwhile, with continuing descent, the extended head is now flexing and turning to the right. The baby's right shoulder is sliding under the mother's pubic bone and into sight. Again, my hands slow down the expulsion slightly so this shoulder emerges fully before the other one begins to appear. Then I hold the baby forward so that its right shoulder is snug against the mother's pubic bone, thus permitting the other shoulder to emerge without putting excess strain on her bottom.

With both shoulders born, the remainder of the baby slides smoothly out, again slowed a little by my hands, as chest, arms, belly, bottom, legs and finally tiny toes depart from their first home into the wider world. All this the couple has witnessed with joyful enthusiasm and great wonder, with his head beside hers, over her right shoulder, as she has strongly yet gently delivered their child inch by inch into the world.

I place the baby on a small, warm, dry towel the nurse has placed on the flat surface at the foot of the birthing bed. The baby had a normal blue colour and good muscular tone. I grasp the cord, and feel in it the pulse of the baby's strong heart beat. The little boy opens his mouth, takes a breath, and then a big, big breath. A small amount of mucus is gently suctioned from the baby's mouth. With another warm towel I gently dry the baby. To him I say, "Welcome to the world."

The baby makes a few loud cries but very soon settles into gentle breathing while moving his limbs further and further from the fetal position. The baby is now a beautiful pink. Meanwhile the beating in the cord has rapidly subsided and ceased. I clamp and cut the cord, and collect samples of cord blood. Then with one of my hands under his bottom, my other behind his shoulders and head, I lift and place him on to his mother's belly. There he is welcomed by four eager hands, the father patiently letting his wife touch their newborn child first before his hands join hers. They rejoice.

I await the placenta. I think of the magnificence of the miracle of Birth. So many normal things happen normally. So many things can rapidly go wrong, but usually don't. My job is to attend, to observe the normal and its variations, to do a few useful things, to detect trouble early and to initiate prompt, appropriate management. But I am attending more than a biological process. Birth has great relevance to the parents' minds and Relationships and to their perception of what is meaningful in their lives. It pervades all four dimensions of our being: physical, mental, relational and meaning.

I look up and see the newborn child, wrapped in a blanket, and enfolded in his father's arms. The infant is very alert. Dad stares into the bright new eyes. Gently I tap the side of the tired mother's thigh to get her attention. She looks toward me and silently I point toward her husband. She turns and watches the two most important people in her life staring at each other. She smiles at them. I think, "Love does not divide, it multiplies."

The third state of labour is soon complete, the placenta expelled, the uterus firm and the elastic perineal tissues that stretched so well have rebounded towards their usual position. The baby is I back in his mom's arms, with his face snuggled into one of her breasts and his mouth automatically sucking on the nipple. Dad sits so close, his arms I enfold them both.

Six years later a little boy asks: "Daddy, where were you when I was born?"
"I was there."
"And what were you doing?"
"I was hugging Mommy."

Theme: Birth | Naissance

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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