As an obstetrician, I’ve observed thousand of women in labor. Their reactions run the gamut from extreme stoicism to blood curdling screaming and everything in between. Occasionally, though, there were women whose reactions were decidedly out of the ordinary.
There was the woman who, in the midst of active labor, felt the need to rip off her clothes and run naked and screaming down the hall. She was ultimately led back to her room and the door shut, so she was free to run around naked, in private. She was fine and the baby was fine. No one seemed the worse for wear except, perhaps, the expectant parents who were touring labor and delivery in preparation for their own birth experiences. When the naked, screaming patient caromed into their group, they were startled to say the least.
Another memorable occasion occurred during a blinding February snowstorm. A young woman, on reaching ten centimeters without pain medication was cheerfully told by the nurse that now it was time to push the baby out.
“Oh, no,” the woman cried, “I’m not doing that. I’m done and I’m leaving!”
Whereupon she lumbered out of bed, grabbed her heavy winter coat and headed for the elevators. I’m not sure where she thought she was going to go, or what she though was going to happen, since she was taking her baby and her labor with her. Fortunately, a security guard caught up with her as she was trying to get out the main entrance and gently led her back up to the labor and delivery floor. She had her baby uneventfully only 45 minutes later.
There was one patient, though, who stood out above all others, and whom I still remember vividly more than a decade after the fact. With every contraction, she slapped her husband across the face.
She was not my patient; she was a midwife patient. I always worked with certified nurse midwives and found them to be extraordinarily skilled and competent. I was available as back up in the event of a medical emergency. This time, unusually, I was called for emotional distress … of the midwife.
The midwife had spent the previous twelve hours with the patient and her husband and she looked traumatized. The patient, she said, was too difficult to handle. That was an unexpected admission from this midwife, who was very experienced with all manner of patient difficulties. No, the patient was not running around the room screaming; no, her husband was neither drunk nor abusive; no her family members were not carrying weapons. She was completely uncooperative, but the worst part is that she was beating up her husband.
Really? I found that hard to believe. Most women in labor don’t have the presence of mind to beat up anyone. Moreover, according to the midwife, she had a working epidural that was providing excellent pain relief. The patient could feel pressure with contractions, but did not seem uncomfortable. Nonetheless, she was demanding more medication in her epidural (she already had plenty), she was refusing to push the baby out (she was now 10 centimeters dilated), but most distressing, with every contraction, she slapped her husband across the face.
This I had to see. I slipped into the vestibule of the labor room and observed. Sure enough, with every contraction, her husband crept closer to “help” her, and she slapped him square across the face with the flat of her hand. He had big red welts on his cheeks to prove that it had been going on for sometime. In between contractions, she was being abusive to the anesthesiologist who was patiently trying to explain that it was not safe to put any more medication in her epidural. He tried to reason with her. She had adequate pain relief already; she was feeling only pressure, not pain, and he did not want to abolish all sensation or she would be unable to push the baby out. She didn’t care, she said. She had no intention of pushing this baby out anyway. We could operate on her if we wanted it to come out.
I entered the main part of the room and introduced myself as the doctor on call, here to help her have her baby. The husband and the anesthesiologist looked relieved. I decided to tackle one problem at a time. I turned to the husband.
“I think,” I suggested gently, “that you might be getting a little too close to your wife when she has a contraction. Let’s pull up a chair and have you sit close enough to hold her hand, but no closer.”
“Really? You think so,” he looked dubious. “I want to help.”
“Oh, yes,” I replied. “I’m pretty sure that will be better. Let’s give it a try.”
Next I turned to the patient.
“You can’t have any more pain medication right now. You’ve reached the limit of safety.”
That was greeted with a stream of expletives, and a declaration.
“I don’t want to feel anything at all.”
“Sorry,” I said, “but that’s simply not possible. I’m sure you understand that the most important consideration is the safety of you and your baby.”
Apparently, she didn’t understand. She was defiant.
“The midwife says I have to push the baby out, but I’m not going to push. If you want this baby to come out, you can pull it out with forceps or something, or you can cut it out with a C-section.”
“No,” I said, “forceps and surgery are medical procedures, and they must be used only for medical reasons. We won’t be doing that unless there is a medical need.”
“Instead,” I continued, “I’m going to ask the anesthesiologist to let your epidural wear off a little bit. You might get uncomfortable, but the urge to push will return, and you’ll push the baby out.”
“Oh, no I won’t,” she threatened. “I won’t push and you’ll have to wait for hours.”
I made a dramatic show of looking at my watch.
“That’s okay,” I responded as sweetly as I could under the circumstances. “I’m here for the next 12 hours, so I’ve got plenty of time. The baby looks fine on the monitor, so there’s no rush. Take all the time you want.”
I headed for the door.
“You’re a bitch,” she screamed after me.
I turned.
“Yes, I guess I am.”
Her epidural began to wear off in 30 minutes. The pain began to come back and so did the urge to push. The nurse explained that the harder she pushed, the sooner it would be over, and it was in her interest for it to be over. The longer she waited to cooperate, the more intense the pain would become.
Once she began cooperating, she was able to push the baby out in 5 minutes.
Unfortunately, that did not improve her personality. She handed her son off to the nurse and when he was swaddled, directed that her husband should hold him. She subjected both him and me to a constant stream of verbal abuse while I was delivering the placenta and he was cooing at her new son.
When everything was done, I congratulated her, even though she was glaring at me. I mentioned that I would be calling Social Service to visit her before she went home because it looked like there might be some tension between her and her husband.
“Really?” She seemed genuinely shocked. “Can’t you see? We get along great.”
