What giving birth really feels like

No one likes to work on a Friday night!

Yet that is what my Friday night was all about. When everyone was winding up their week, making plans to kick back, relax and usher in the weekend, I was getting into my scrubs and preparing for a long one. My Friday night date was going to be with dozens of screaming wet, gooey, three kilogramme little persons taking their first breathe.

When you work in a busy maternity hospital, you work fast. Teamwork is everything. We started the labour ward round with the midwife, coordinating like a well-oiled machine. The mothers were clerked, examined and had intravenous access set up in a flash. We had 47 mothers to see and the 47th one had to be seen within the next three hours, to enable us to prioritise the high-risk ones for closer attention.

When we got to the 11th bed, Nana* looked at us fearfully and sat up. She got out of bed and crawled under it. She would not come out. We were all confused. When she spoke, her soft, shrill voice betrayed her panic. The nurse at the triage came in to explain that Nana had adamantly refused to be examined at the admission desk hence we had no idea how far along in labour she was.

I perused her file while the admissions nurse filled us in. Nana was 24. She was brought to the hospital by her aunts, who had gone back home to await the news of the baby, as our unit could not accommodate them to support Nana at the bedside. Her husband, a long-distance bus driver, was on his way back to Nana but unfortunately, was still too far away.

Nana weighed a measly 52 kilogrammes at full term. She was not only timid but also remarkably petite. We needed to evaluate her and figure out how her labour was progressing. Unfortunately, she couldn’t find it in her to cooperate. We gave her time and went on to review the rest of the patients in the ward.

By the time we came back to her, she was even more terrorised. She was shaken from the sight of all the other mothers in various stages of labour in an open maternity unit with not much privacy. Her eyes were the size of saucers and she was trembling. She even forgot her own pain.

No amount of convincing, cajoling or pleading would get Nana to agree to an examination. We eventually negotiated with her that we would simply watch her and listen to the baby’s heartbeat periodically. At about 1.00am, her labour finally picked up. The contractions were building up and getting intense. We were all anxious, wondering how far along she was and whether at her tiny frame, she would be able to push out the little one.

In the midst of all this, the heavens opened and a heavy downpour visited upon us. It was so heavy we literally had to shout around the ward to hear each other. Most of the babies had been born and the mother-baby pairs transferred to the postnatal care unit. It was that time of the morning when the ward experienced the calm before the storm.

My philosophy in labour ward has always been that labour and delivery is a temporary state of insanity for the mother. She is not accountable for the crazy decisions she may make. In Nana’s case, this is when the absolute insanity came out to play. She would scream with every contraction, slide under the bed and lie on the cold floor, or attempt to climb up the railings set up to mount curtains that separate beds in the cubicles. Her primary midwife kept talking to her, trying to reassure her, but Nana was deaf to it all.
 
Suddenly one of the midwives called for help. A mum had delivered in the next cubicle and developed postpartum hemorrhage. As we scrambled to intervene, the rain came down even harder. We did not have eyes on Nana for a few moments there. When we finally settled the bleeding mum down, we noticed Nana was not in her bed, or any other bed for that matter. She was gone.

Just as we were about to raise the alarm, three security officers from the gate strolled in to the ward, escorting a dripping wet Nana, soaked to the skin. Her hair was plastered on her face and her clothes were dripping wet, leaving a trail behind her. She was meekly staring at her feet, the spirit literally knocked out of her.

Nana was quickly wrapped in a blanket, dried off and tucked into bed. She did not protest as we listened to the baby’s heartbeat and ascertained all was well on that front. When we asked to examine her, she simply nodded. The baby was almost here. I broke her waters and the warm liquid gushed out, shocking her further, but she simply bit her lip as the contractions came in waves, with her knuckles wrapped around the head board of her bed. It appeared that the shock of the cold rain washed away the fight in her.

In less than an hour, Nana was pushing her baby out, silent tears streaming down her face. A beautiful baby girl came into the freezing cold world yelling lustily, weighing 2,400g. She was just as petite as her mum and perfect in every way. She was vigorously wiped down and wrapped up, keeping warm in the rescuscitaire while I finished up the delivery and stitched up the small tear Nana sustained.

An hour later, Nana was lying on a clean bed, her little one tucked right next to her, making her first attempt at breastfeeding. Nana and her baby were a picture of contentment. Later, as she was being transferred to the postnatal ward, she shyly looked up, apologised for the madness and thanked everyone for their help. She was reassured with warm congratulations.

In a meta-synthesis on women’s psychological experiences of childbirth by Ibone Olza et al, published in the British Medical Journal in 2018, it is noted that childbirth is a profound psychological experience that has a physical, psychological, social and existential impact both in the short and long term, which can be positive and empowering, or negative and traumatising.

How a woman responds to the heightened anxiety precipitated by the process of labour is driven by her own perception of the ongoing physiological and psychological aspects of labour and the medical and social interventions in place to support her. This is modified by her own personality, past experiences and response to stress.

When she is unable to handle the anxiety, pregnancy and delivery can end up being traumatic, resulting in post-partum challenges such as difficulty bonding with the newborn, poor lactation and breastfeeding, postpartum blues and outright postpartum depression and psychosis. In order to prevent this, we must continuously aspire towards building a patient- and family-centered maternity care service for all, encompassing the antenatal, intrapartum and postpartum care periods.

Dr Bosire is an obstetrician/ gynaecologist