Every time
I hear an ambulance coming into the hospital, I subconsciously start chanting
one prayer “God, please, let it be any patient – any illness known to man –
but, please, not a pregnant woman in labour”. I will explain why I have come to
fear pregnant women like the Plague.
Labor is
the natural process of delivery of a baby. It is a complex mechanism, involving
an excruciating amount of pain for a long time. We have been taught that the
definition of “normal labour” is a retrospective term. This means that a
delivery is termed a “normal delivery” only if certain criteria were fulfilled
– the stages of labour took place within specific time periods, the baby was
delivered with minimal aids, the mother adequately managed to prevent excessive
bleeding and so on. I do not exaggerate when I state that there are innumerable
problems that could occur.
I have
immense respect for obstetricians-gynecologists (specialists in child-birth
and the reproductive health of women), having seen them perform incredible feats
in delivery rooms and operation theatres. But what is most commendable is their
infinite patience, considering their tense work environments. There are people
who believe that the birth process is like “poetry in motion” – the act of “one
life giving rise to two”. I would request such philosophers to spend just half
an hour in a delivery room.
A
hospital’s labour room is filled to capacity at any given time. The atmosphere
is hectic on a good day and Armageddon on the worst. During heavy shifts, the
junior doctors usually move from one delivery table to the next, sometimes even
without taking meal breaks. Most women are able to tolerate the process with
minimal pain, but there are always a few who make your life miserable – that
one person who delays till the last moment and then lands up at 3 am; and the
low-pain-threshold patient, who (even though it is their second or third child)
is screaming their lungs out, making first-time mothers nervous.
In rural
health centres, the medical officer is solely in charge of the delivery and the
health of both the mother and baby. This can be daunting for a number of
reasons.
In any
academic institute or major city hospital, you are always surrounded by people
– senior doctors, colleagues and nurses. While examining a pregnant patient,
there are times when you can’t figure out the position of the baby or where
exactly the baby’s heart sounds are best heard. In such cases, you can just
turn to the person next to you and ask them for help. They will curse you for
adding to their workload and wasting their precious time, but they will always
help clear your confusion. Now place yourself in a rural setup – with the closest
doctor at least half an hour away – and you will realize the problems faced.
Also, in
city hospitals, pediatricians and neonatologists (specialists in child health
and newborn health respectively) can be called urgently in case a baby needs to
be resuscitated. You do not have that luxury in a rural health centre, so the
responsibility of resuscitation falls on you. That, as my colleagues will
agree, can be a very scary scenario.
And then,
as always, there are social and literacy problems. There was a patient who had
delivered her sixth child after a painful, prolonged course of labour. Later, I tried to explain to the patient and her relatives about the
need for permanent sterilization. She replied, in a supremely confident manner,
that she does not require it as she will not get her regular menstrual cycles
for the next “two and a half years” (she seemed confident of the exact time). I
have yet to come across any case where a healthy woman, with no prior medical
history whatsoever, can predict something like that. I will not be surprised if she comes pregnant a seventh time.
There was
also one incident I will never forget – a woman, having two healthy beautiful
daughters, came pregnant again because the family wanted a male child.
When the child was born – a girl, as Luck/Fate/Destiny would have it – the
female relative in the delivery room mistook her for a boy. She happily
announced it to the third-time father and he – to my amazement – bowed down
to the child, touching his head to her feet. The nurse immediately pointed out
the relative’s mistake and the smile on the father’s face instantly disappeared
– it was as though we had told him that the child was still-born. He later
apologized for his behaviour and promised to take good care of the girl.
Thus, the
delivery of a baby is never easy, but like so many things in life, one gets
better only with practice. And there are very few experiences that can be more
heartening than hearing a newborn cry.
But “poetry
in motion” ? No, thank you, I do not think so.
