When a mum enters the labor ward, she may have her birth plan all penned out well. She has a doctor, a midwife and medical support available but once she enters the labor ward the natural journey of child birth can take multitude of path and the initial planning usually "goes out the window".
As a medical student, I have been witness of multiple childbirth in hospital. When I had become senior medical student, I had assisted in multiple deliveries under supervision. For the mother it is a journey from conception to lifetime. While for me as an observer and helper it is matter of hours from when mum comes to labor ward till she is shifted to post natal ward. What I see is what I want to write here yet in words I cannot explain what the mum goes through but I'll try my best.
When she enters the labor ward, holding her belly sometimes wheeled in by the wheelchair and sometimes walking in. She shrivels with every contraction as it gets stronger.
This mum who has been coming into hospital for antenatal clinic suddenly gets exposed to the labor ward. With many more mothers there in pain, some with babies already. SHE IS SCARED. Also during this covid 19 pandemic, she is ALONE. There are so many new faces that she does not know and the room is cold and alien to her. Childbirth- labor and delivery alone is a tremendous energy depriving process and when added the fear and anxiety it does not get any easier.
As time passes the mum undergoes multiple procedures that are unsaid and unheard of. Mostly people think that she enters the labor ward and after few hours gives birth. Although there is so much that goes on in between those hours.
First she will be taken to the "prep room" where a vaginal examination is done. A steel/plastic speculum is inserted in her vaginal canal. Her amniotic sac "waterbag" is checked and analyzed if it has ruptured yet. Then swab sample is taken as a precautionary measure. Then the speculum is removed and examiner checks the status of her cervix (birth canal). While already in pain from the on and off uterine contraction that is helping open up her birth canal there is an examiner who uses their index and middle digits to check how much the cervix has opened and how much it is stretchable to. On her fully gravid belly then the examiner performs deep abdominal examination to check how far along baby has descended into her pelvis. Yes, all this is done while mum is lying flat which is one of the most uncomfortable position as her large belly pushes up to her rib cage.
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This is the speculum used for vaginal examination.
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| An animated example of vaginal examination. |
The growing baby had already compressed her bladder, lungs and stomach. She is having difficulty breathing, acid reflux and a barely controlled bladder. On top of that the uterus contracts every 10-15 minutes then 3-5 minutes as labor progresses.
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| Shows how growing baby in uterus pushes other organs |
Upon the examination finding if the mum is deemed to have proceeded into active labor (her cervix has opened upto 4cm and there's progressive contractions and her baby is descending into her birth canal) she is admitted. Here a large cannula guided with needle is inserted into her vein and blood is taken and the cannula left in her vein incase of emergency where she needs fluid or blood transfusion. Then she is transferred to the bed in labor ward.
She may not be comfortable lying down and while walking she stands in hallway as she gets another contraction. As the sound of other mums scream in pain is echoed through the hall. The screaming mum is shushed by a stern midwife as she would feel more chills and fear. After sometime she is strapped to a monitor called CTG where she has to lie down for straight 40minutes as her baby's heart activity is monitored. The level of discomfort is inexplicable.
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| The procedure of CTG |
In some mothers whose "water" doesnt rupture spontaneously (by itself) the midwife/doctor will rupture it for her. Here an instrument called kocher is used. With the two digits of the examiner the kochers is inserted into the vaginal canal of the mother and amniotic sac is snipped at the most bulging area. This would take few minutes as per the examiners experience. The color of the fluid is examined to check for the status of the baby. For example, if the fluid has green color if would mean baby had passed its first poop in the uterus of the mother which would mean that the labor needs to be expedited. If the color is clear then the baby is likely healthy. Post rupture of membrane the labor is expected to progress faster. By then depending on her progress the mum can be in the labor ward from 12-24hours. She is tired, in pain and away from her loved ones from whom she can seek comfort.
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| Kocher forcep |
As the clock ticks by, she is examined again and told the progress of her labor. With pain increasing as time goes by she is unable to sleep. The silence in the ward in the night. Dark and cold. Muffled screams of another mother giving birth. She is expected to wait patiently. With next day if the baby has not yet arrived she is checked again. Her labor status and her babys status is examined. She can be told that Cesarean section is her option to go for. There are still some people out there who see this as "unnatural" and less significant than vaginal delivery. As someone who has seen both the procedures, apart from different health indication a mum going through either of these two process face extreme challenges and has to bear so much pain before, during and after the process of birth is complete.
In vaginal delivery, as she reaches to 10cm of cervical dilatation. She is ready to push. She is told to use her power and the uterine contraction to push the baby out. By now the midwife from another shift has arrived and there is likely a new doctor present as well. The pain is tearing through her uterus and she buries her cries to avoid screaming out loud. The pain so excruciating for her and unimaginable for us as observers and readers. She is told to NOT push and wait for the pain as the baby's head pressed against her cervix and is crowning.
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| Picture of crowning. |
She breathes deeply, covered in sweat and tears, red from the pressure she exerts to push the baby out. Her tissues of her perineum (wall of vagina) feels like it would tear at any moment. With pain she tries to extend and find a hand to hold. But her partner isnt here yet due to restrictions. She holds the bed railing or the sheets and tries harder and harder to push. All her energy exerted out exponentially, her pain medication which she may have received having lesser effect. She gets more and more tired, she tries her ultimate best. When the baby still hasnt made it's way out yet. The midwife would choose to perform episiotomy. Here, before the next long contraction pain the midwife injects (inserts needle) in the perineal tissue and gives numbing medication to the perineal tissue. As the next contraction arrives the midwife takes a surgical scissors and cuts the vaginal wall at 7 o'clock position. This creates more space and with subsequent few pushes her baby is finally born.
As the baby is put on her breast the initial attachment commences. The mum is immediately given an injection on her thigh muscle and the caregiver will then massages her belly to help her placenta to detach from the uterine wall and be delivered as well. This placenta can be from 500grams to 1.5kilogram heavy. Then all the clots is removed from her using a large swab that is held with a large long clamp which is inserted in her vaginal canal. After all the clots are removed midwife will again give the mum local numbing drug, clean her perineum with sterilizing solution and prepare to stitch the incision and the naturally torn tissue. This itself is another painful procedure the mum undergoes after delivery. Then she has a sanitary pad placed and moved from the delivery room.
As the mum is transferred to the post natal area. She hasnt had rest, had food for long hours. She hasnt shower and had gone through a challenge of a lifetime. As she tries to rest, she is told to breastfeed her baby. Then with immense pain she walks to the bathroom to bathe herself.
This is how you and I have been born. Every living being on this planet has or had a mother who has gone through this colossal amount of excruciating pain to give you life. Thank you, Ma.
