Friday, October 22, 2010

A "Noisy" Birth

Arriving for my early shift one morning I was greeted with the sound that only a midwife could truly enjoy.  The sound of ten women in labour and it was clear it was going to be a busy shift.  As we listened to handover it was immediately clear who the team leader was planning to assign me that day.  There was an absolute cacophony in delivery room 10 and as the whole team was well aware of the type of women I enjoyed looking after most, those that made me work the hardest, it was easy to guess and I was right.

Mrs H was newly arrived in Australia from the Middle East and this was her fourth birth and the first out of her home country.  In fact, her previous births had taken place at home attended by her village birth attendant, family and friends and the hospital was a terrifying place for her.  She was particularly distressed by the fact that a male doctor ( or indeed in our unit, a male midwife ) may attend her labour and catch her undressed and she remained nearly fully clothed throughout her labour and birth.  As I entered the delivery room I was startled to see they had allowed eight women to stay with her.  Taking handover from the attending midwife, who was clearly rattled by the noise and wailing, she stated she had repeatedly tried to eject some of the women from the room without success and was now waiting for the interpreter to be free. 

When she had left I introduced myself as best I could, listened to the baby and satisfied myself all was well and sat  quietly for a while pretending to attend to the paperwork while I observed the dynamics of the group.  As no one spoke English I was unable to determine who were family and who were friends but I guessed the two older women were mother and mother in law.  Mrs H was only 4 cm dilated and had a way to go before the birth however having had three previous babies her birth could advance faster than expected.

Mrs H would pace about the room between between contractions, muttering and talking and perhaps reciting a prayer.  Half the women would follow her with at least two touching her or massaging her back and shoulders.  When the contractions arrived she would stop and start rocking, throwing her arms in the air, her voice would rise and she would call to Allah.  All the women would copy her behaviour and at the peak of the contraction the noise in the room was amazing. A hassled looking resident appeared at the delivery room door to try and do the admitting paperwork.  I asked him if he could come back later when the interpreter was here and he was more than happy to agree.

As her labour progressed, the ebb and flow of women in the room became like a dance as they swayed and sang and called to Allah.  It was clear from the ecstatic face of Mrs H she was receiving all she needed to get her through the contractions and I kept myself as unobtrusive as possible as I monitored the baby's heartbeat.  The midwife team leader appeared several times asking if Mrs H required pain relief.  I explained she was not at all distressed despite the noise.  Looking dubious, at one stage she strode into the room and tried to talk Mrs H into an epidural.  When her question was finally understood, there was an overall look of horror and the elderly women escorted the team leader to the door with much 'tut tutting' and quickly returned to their dance of labour.

It was not long before I could hear the catch in her breath as she exhaled that indicated she was nearly ready to deliver.  I could see I wasn't the only one to notice as the group began to smile and nod knowingly.  I retrieved the birthing mat and set up all I would need on a low stool.  The ladies led Mrs H to the mat and helped her to squat.  This immediately triggered a strong urge to push and in three contractions the baby delivered into my hands.  I handed him up to his mother as the women rushed for the beanbag and helped Mrs P to sit comfortably.  The sound in to room changed pitch and reached new levels as the women delighted in the birth of a boy after three girls. With the placenta delivered I was surprised to find one of the women approach and clearly indicate she wished to examine it.  I turned it over and went through the usual examination to check it was complete and she grunted her approval.  By the time I turned back, the baby was securely wrapped and happily suckling at the breast, the women were rushing in and out to announce the good news and returning with sweets which they handed to anyone who passed the door, including, by the way, other women in labour!  

Mrs H glowed, the birthing team of women were giggling and laughing like children.  As I left the room to start the paperwork I was bemused that this lovely natural birth had taken place in an oasis of calm in large teaching hospital with the chaos shut firmly outside the door.  The hassled and stressed looking team leader appeared and said " Thank goodness it's over!  How could you stand the noise and chaos in there?"  As I licked my fingers clean of the sticky honey of Mrs H's celebration pastry I replied, that except for a bit of ringing in my ears it was one of the most beautiful births I had attended.  And it was true......mind you it did take a good three hours before I could hear properly.........