By Michelle Collins
August 20, 2020
For 17 years I was a labor and delivery nurse at a hospital in a North American city. During that time, I loved almost every minute of it. I loved teaching parents-to-be in childbirth class; their excitement, awe and anxiety at becoming new parents was palpable. I relished being the one to greet a woman in labor, to touch her hand and say, “I’m going to take good care of you,” and see that look of relief come over her weary face. I was humbled to be allowed into that sacred space where new life is ushered in and newborns take their first breath. I was invigorated by assisting new mothers in putting their babies to breast for the first time and seeing the look of accomplishment in their eyes when their baby latched, as if they were saying to themselves, “I can do this, I really can do this!”
Yet, after 17 years, I quit. I found I could no longer be a participant—even a reluctant one—in a medicalized obstetrical system that methodically disregarded women’s preferences. In my role as a nurse, I withheld food from women who needed nourishment to get them through the hardest work of their lives by upholding NPO (nothing by mouth) orders the physician gave me. I kept women in bed, again abiding by the physician’s orders, when walking the halls would have benefited them far more. I assisted women to urinate on bedpans needlessly when the physician’s order forbade them from getting out of the bed once the water bag had broken. Most of all, as an L&D nurse, I was often the one selling women the physician’s bill of goods for a host of unnecessary and unwarranted interventions, such as the use of Pitocin® to “speed up” labor, or giving fluids intravenously when women were capable of drinking the fluid they required. I dutifully followed doctors’ orders even though they frequently contradicted best evidence and were contrary to physiologic labor and birth.
Physiologic birth, a term not common in lay literature, refers to birth that occurs via the direction and power of the woman’s body, not controlled or directed by external forces. Physiologic birth is important because, let’s face it, Mother Nature is pretty darned adept at birth. It’s hugely challenging to do a better job at initiating labor and birthing babies than women’s bodies already do. As a nurse, whenever I could I tried to incorporate physiologic-positive practices into the births I attended by encouraging women to bear down while squatting rather than lying on their backs, or helping them blaze a trail in the labor room when I couldn’t get clearance for them to walk the halls.
One day, I attended Anna’s* birth. Anna was already in active labor when my shift began. It was not her first labor or birth, and by the time I arrived, she was progressing well. I watched her breathe steadily and slowly through her contractions, enduring each wave with calm and grace—I was in awe of her and the way she was laboring. I helped her to the bath, which was not usual practice at this hospital but something I knew I could get away with without too much difficulty. Soon I could see that she was involuntarily beginning to bear down, and I assisted her to the bed since a waterbirth at that time in that hospital would have been unheard of.
As I was helping her situate, an entourage of physicians, medical students, interns, and residents sauntered in. The chief resident asked me for a status update, and I declared that she was close to giving birth. Because resident physicians are required to have a non-resident (attending) physician present in the room when the baby emerges, the chief resident took out his phone to call his attending physician, who lived a good twenty minutes away. In these situations, L&D nurses are supposed to tell the woman to “not push” or “hold it in”, a practice I could never bring myself to do. I trusted that Anna and her body knew exactly what to do. I was not going to stand in the way.
As each of Anna’s contractions resulted in more grunting and involuntary pushing, I asked the resident—who was now far removed from the bed and looking out the window—if he would like to put gloves on since the baby was coming. Without as much as glancing at the woman he answered, “She will not deliver until the attending gets here.”
So I put on my gloves, knowing that this strong woman was not going to accommodate her newborn’s timeline to suit anyone but herself, and rightly so. During the next few contractions, she gracefully bore down and ushered a beautiful, pink, slippery child into being while the resident remained in the corner looking out the window. Finally, at the sound of the baby’s cry, he turned to face us. His shocked expression was priceless, as if he could not conceive that Anna would give birth before he had granted her his permission to do so.
There are experiences in our lives that are pivotal, that we can pull out of memory and replay as clearly as when they happened. Anna’s labor and delivery was one of those experiences for me. I had seen Anna labor as some women do, in that they need nothing from any external source—all that they need to give birth is within them. And I had seen the modern medical obstetrical system, as represented by the chief resident, try to manage and control a woman and her body. I cherished being part of that birth; there are few things holier than being included in such a sacred event. But it also crystallized my belief that all women deserve the kind of care that allows them the freedom to labor as they need to, not as they are told.
After the residents and medical student left the room, as Anna snuggled with her baby at her breast, I leaned in and thanked her for teaching the residents such a valuable lesson about who’s supposed to be in charge at birth. Without words, her smile to me spoke volumes that we both understood. Anna and her newborn settled, and having reached the end of my shift, I changed back into my regular street clothes, shuffled out of the L&D ward into the early morning and never looked back.
*Names have been changed to protect privacy.
Photo by Jonathan Borba.