Stories From the Delivery Room-The Screamer

Only eight hours before, she had been on a twenty hour long flight that took her halfway around the world. She must have been quite a sight, a full term pregnant woman waddling down the aisle of the plane and squeezing herself into the cramped airline seat. Knowing how often a pregnant woman needs to use the bathroom, I can only imagine her misery as she frequently made her way to the airplane bathroom. Flying when pregnant must be uncomfortable. But, as she was nearing delivery, it must have been sheer torture.

I remember my first sight of her… well actually, I heard her before I saw her. She arrived, screaming at the top of her lungs, being pushed in wheelchair down the hall by her husband. Screaming doesn’t adequately describe it, it was more like the screams of bloody murder. All of us who heard her approach were instantly rattled.

Her flight had brought her far from home, far from her family, far from her culture. She did not speak a word of English and was clearly overwhelmed by the entire experience. There was fear in her eyes and wildness to her vocalization of pain.

For a brief moment, there was silence. She was between contractions as her husband started to sign her into the hospital. Then the screaming began again, blood curdling, ear piercing, inconsolable screaming.

I moved her to the labor room without allowing the secretary to complete the registration process. By the way she was acting, delivery could be imminent. My L & D team worked rapidly to get her evaluated and her exam showed that she was four to five centimeters dilated. We admitted her quickly, as clearly she needed some pain relief as soon as possible.

Once her IV was in, I went over the pain relief options with her husband. Breathing/relaxation techniques, IV pain medicine, or Epidural were the choices on the menu. “Please explain these to your wife and let me know what she would like to do,” I requested.

It took quite a few minutes for her husband to translate the information that I given him. Her words in response were few. “She says doesn’t want anything for the pain,” was his translation back.

Really, I have to admit I was surprised, as I looked at her red-purple faced thrashing, arching, and white-knuckled-sheet-clenching response to pain.

No, she did not want anything to help her cope with the labor. This was fine with me. It’s her labor, it’s her pain. What is important to me, is that a woman is given the freedom to deal with labor as she chooses. Even if she is screaming and crying, if that is how she wants her labor to go, then I accept that. But, I did want to see if I could help her to relax more between contractions and possibly gain some overall control.

Rolling my stool across the shiny linoleum floor, I took a seat next to her. Face to face, woman to woman, I looked her in the eye and spoke to her. Not with my words, but nonverbally. Compassion transcends any language barrier. I silently took time to make a connection. Showing concern, showing warmth, and showing I truly cared for her. With gentleness, I rested my hand on her arm. Seeing her fear soften between contractions, I felt that we were building a relationship. However, the shrieking continued, along with the writhing and the wild grabbing with each successive labor pain.

So, I took a bit of time to do some education. Encouraging her to stop holding her breath, as she had started to do when she was not screaming, I discussed and modeled controlled pursed lip breathing. Nothing fancy, just slow deep breaths, in and out. We practiced together between contractions. The simple breathing techniques seemed too much for her to grasp, and the pitch of her distress increased, despite the efforts made.

I also encouraged her to get out of the bed and stand, or sit on the birthing ball or in the rocker. She seemed agreeable, so her husband and I helped her up, only to have her immediately leap back into the bed when the pain resumed. There was hope that changing positions would help the labor progress, but she could not tolerate being up.

The blaring continued until my ears literally hurt. Needing to regroup, I stepped out of the room. As my foot left the door, I sensed every eye at the nurse’s station glaring at me.“Julie, come on. This is ridiculous, do something to stop that noise,” said the first nurse I walked past, “I’m serious Julie. All of the other patients are freaking out. You need to get her in control.”

“You have no idea, how hard I am trying to calm her. Nothing is working,” I replied in my own defense.

“Try harder! Geez!” the testy nurse shot back.

Hostile, my colleagues were genuinely hostile to me. I needed a drink…water would have to do. I gulped down a glass and returned to the patient room.

Transitional labor was soon upon us and to my dismay, she became increasing out of control. She was clawing at her husband with her fingernails and he seemed to not mind too much. He actually was laughing. I was not amused and discouraged this by gently pulling her hand away.

She was pushing, grunting, breath holding and screaming. Most unmedicated women find transitional labor, the time of labor between 7 and 10 centimeters dilated, overwhelming and have a sense that they cannot continue any further. The sweetest of sweet women swear like sailors during this time of labor. This, however, was transitional labor on steroids.

Although it was only her first baby, I readied her room for delivery quite early. She was so out of control, I wanted to be prepared for the baby to come quickly once she became completely dilated.

After the delivery supplies were in order, I again settled next to her on my rolling chair. Suddenly, I felt a searing pain on my right forearm. I jerked my arm away quickly as I realized that she had dug five fingernails deeply into my skin. She actually had drawn blood! I was astonished.

“Tell your wife, not to scratch me.” I said to her husband firmly, “She can squeeze my hand, but I cannot have her hurting me.”

Years of physical abuse, which I had suffered at the hands of the confused elderly on Med-Surg, had left me traumatized and I would not tolerate pain inflicted upon me. This brought out some old baggage…and anger.

Needing to let off some steam, but not wanting to appear angry, I sat with her calmly through another contraction. Then, I excused myself and went out of the room, asking the charge nurse to step in and cover me for a moment.

Delivery was imminent, so I quickly made my way to the ladies room, washed my wounds, and my face. There was no escaping the wailing, I could still hear her down the hall.

My head hurt.

Looking into the mirror, I was not happy. Now, I was the one with the flushed face.

Quickly composing my self, I headed back for the final inning. This game could not end soon enough.

Within a half an hour the baby began to crown and I called the docs in for the delivery. A healthy baby boy was born. Finally, her shrieking had ended and only the sweet cry of a newborn could be heard.

When the doctors where done sewing up a small tear, I took her legs down from the foot pedals of the birthing bed and helped her get her baby, who was already on her chest skin to skin, latched on.

Finally getting a chance to wrap up my delivery notes, I pulled up a chair at the nurse’s station. One of the annoyed nurses rushed over and sat next to me. I really didn’t want to hear it. But she did ask an interesting question, “Do you think she was going for a good birthing gift?”

“What? A birthing gift?” I asked, I had not heard of such at thing.

“I’ve seen this before by a woman from her region of the world.” She continued, “My patient had an epidural with excellent pain relief. But despite being comfortable, she kept an eye on her contraction monitor and cried and carried on with each contraction. But, I noticed that she only cried out when her husband was in the room. So when he stepped out I asked her about it. She told me that the more she suffered, the better the birthing gift she would receive.”

Well, that was a new one on me.

Labor. Language Barrier. Stress of hospitalization. Culture shock. Birthing gift.

Who can be sure what had led to this dramatic labor.

But, I’m just glad that we at the birth center are the ones who had to ponder this…

Not the 200 or more passengers aboard the 20 hour flight she came off of just eight hours before. It gives me chills to think of what would have happened if she had gone into labor mid-flight.