The sun was bright and warm. The sand cushioned my freshly pedicured, bare feet. The breeze gently lifted my hair away from my face. I was enjoying a long walk along the beach accompanied only by the rolling waves and a man with a goatee and a sweet southern twang that introduced himself only as "Tim." He was about to sing to me. I could her the strum of his guitar. It became louder and louder, it was as if I could feel the vibration on my cheek. Then, just as quickly as it all started, it all ended and I realized the vibration was not the musical work of a very hot southern man but, yet the ringing of my phone under my pillow. I tried hard to simultaneously hold my eyes open and focus on the screen (as if I didn't know who was calling). Just as I thought "L&D 208-557-2729." I fumbled with the phone as I struggled in my state of semi-consciousness to recall which button on the screen to touch to connect with the person on the other end of the line. Ah, yes, I remember now, "Answer" that's the right one. "Hello?" "Hi" the all too chipper voice on the other end of the phone greets, "you have a patient here she is 39 weeks 4 days, contracting, she is 4 centimeters and she's worried that maybe she came in a little too early." Four centimeters? How many is that again? How many weeks does she need to be? When does she need to come to the hospital? So many questions that my mind can't really sort out right now. I take a deep breath, turn on the lamp next to the bed and open my eyes, hoping it will help me think. "Ok have her walk for an hour and see if she changes if she doesn't and wants to go home for awhile she can, if she wants to stay, let me know."
I turn the light out and wrap myself in the warm comforter. I hope Tim waited for me. I drift back to sleep but I can't seem to find Tim, he must not understand the life of a midwife-remind me to discuss this with him next time I see him. An hour and a half later the phone rings again, this time I don't have as much trouble answering it. "She's six centimeters now with bulging membranes." I get out of bed and briefly consider just wearing my pajamas in to the hospital but then reconsider. I put clothes on (a black short sleeve tshirt that says "I'm not a Gynecologist but I'll take a look" over a long sleeve white tshirt and jeans) and slip sandals on my feet so I can show off my cute pink nails with the white flowers on the big toes. I walk out into the dark and get into the car. As I back out of the driveway Tim McGraw comes on the radio "ah, there you are" I say right out loud. I drive to the hospital singing like a karaoke queen the whole way there..."and it felt good on my lips!"
Once I arrive at the hospital I change into scrubs (but make the mistake of leaving the long sleeve white tshirt on) and take a few minutes to read through the patient's chart-considering I have never met her-she's always seen the other midwife for prenatal care. I finish reviewing her prenatal record and I'm headed into the room when I see the call light pop on above the door. I go in just in time to hear the nurse say "can you send Natalie in?" I announce my arrival and I see the patient standing next to the bed and a large puddle of fluid on the bed-her water had just broke. Just then she said, in broken English "I need to go to da bathroom." Then with speed impressive for any human being, let alone a woman at 39 plus week pregnant, she ran into the bathroom. Now, this ain't my first rodeo so I know better than just to assume she's going to empty her bladder in there so I follow her in. She sits there for approximately 60 seconds with no results. She then gets up and walks back to the bed, just as she sits down she jumps back up and runs to the bathroom again. This time she makes soft grunting noises as she sits in the bathroom. Between my little bit of Spanish and her little bit of English I am able to convey to her that the sensation she is feeling is the baby's head, but if she's more comfortable pushing on the toilet, I'm OK with that. We realize that we need to make her more comfortable so we pad the pipes behind the toilet with pillows so she can lean back on them while she pushes.
OK, so we are going to have a baby in the bathroom. We get the nursery nurse, Anna (who thankfully speaks Spanish) and we pull the cart with our equipment into the bathroom. Anna looks at me like I'm crazy because I'm on my knees in front of the toilet wearing sterile gloves with my hands in the toilet (OK, not in the water) supporting the crowning head. Now, in her defense, I probably am crazy. I ask Anna to please tell her that once the head is out she'll need to stand up because there is simply not room for the rest of the baby to come out while on the toilet. The mama says she understands this. One contraction later the mama gently pushes the head out. For anyone that's ever had a baby without medication-you know how intense this part is. Once the head was out she had a bit of a hard time maintaining control. Although she did stand up, she was having a hard time remaining standing and kept trying to sit-a few times right on the baby's head! I could see this wasn't working so we helped mama to her hands and knees on a sheet on the bathroom floor. By this time we had noticed that there was meconium stained fluid (we hadn't noticed this before because her water broke on a green sheet!) so we had called for the respiratory therapist. Soon after moving her to hands and knees she pushed the baby into my hands. The sweet, seven pound, six ounce baby girl cried right away! The respiratory therapist arrived about this time-all I can say is the look on his face was priceless when he saw us all in the bathroom! The baby was a little bit pale so she was handed over to the nursery nurse and the respiratory therapist, they took her to the warmer to check her out.
We helped mama get up so we could get her into bed to deliver the placenta and make any needed repairs. As we walked from the bathroom out into the room she looked over to the warmer and I realized this was the first time she'd seen her baby so I said "do you want to go see her?" She did. So, with the umbillical cord in my hand I walked her over to the warmer to see, touch and kiss her baby. I wish I would have had a picture of the RT's face when he saw me holding the umbillical cord that was still attached to the placenta that was still inside the mama!
Even the mama had a great time! When I saw her the next day she laughed about her baby being born on the bathroom floor-I told her whatever works for her works for me! That's the beauty of being a midwife-I let the mama make the rules!