The Baby Factory - Part 2

It's a small room, longer than it is wide. It's lit up by flourescent lights overhead and there are no windows to the outside, so there is no natural light. 7 metal beds, each containing a mother-to-be in labor are lined up on one of the long walls, between them is enough space to walk through. An eighth bed, empty, is pushed up against the opposite wall. Two fetal heart monitors are hooked up to the patients on either end, the volume is turned up so that there is a constant background noise of scratchy fetal heartbeats. On the far end of the room is a desk with 2 typewriters and a laptop computer on it. Scattered around the room are students, interns, nurses, and attendings (it is difficult to tell who is who), most of whom are sitting and staring absently at the women moaning and writhing on the beds. The air is stale, moist, and hot - the atmosphere is stifiling.

This is surreal redefined (I know, I know, I have overused that word. . but really, there is no otherway to describe this). This is the oddest thing I have ever seen. The disconnect between the pain the patients are experiencing and the detachment of the doctors and nurses is unsettling. I am disturbed by the absence of patient privacy and the general atmosphere of inconvenience expressed by all of the health care officials. No one knows the patients' names. No one comforts the patients through their contractions. No hands are held or brows blotted. The patients are only touched every hour when the students and interns listen to the fetal heart rate and check the cervical dilation.

This is how it works (this is somewhat graphic, so don't read if you are squemish)

1) The woman comes to the emergency room and it is determined that she is close to giving birth (this is determined by 3 cm dilation, contractions that are close together, when the water broke, etc.) For more on this, see The Baby Factory, Part 1

2) In the Emergency Room, she is told to remove all of her clothes, put on a gown, and empty her bladder. She is given an enema and then walked to the entrance of Partos (The Birth Room), where she is told to sit. When more than one woman is sitting and/or when a bed becomes available, an ER nurse pulls back the curtain to the Partos and yells for another nurse to come get the patients.

3) The patients are escorted into the room I described above, told to get into the bed, and situated so that their gown is easily lifted up. They are given an IV and told to relax (hah).

4) Once situated, a student, intern, or attending physician looks at their chart, checks their cervix, and asks if they are in pain and if they want any pain medication ( an epidural). The intern on pediatrics rotation goes through a series of questions with them. After about 20 minutes, they are left in peace.

5) Every hour, or half hour if they are close, their cervix is checked and the fetal heart rate monitored. If they are close, they are watched carefully: contractions are counted and they are told to push, push, push. Some of the more compassionate (or bored) interns sit with the patients and coach them, and coax them along, comforting them with words (although I saw none of this sort of patient care until my second night in the ER).

6) Once they have reached ten centimeters AND the head is visible, someone shouts 'Pasa en Sala' (Pass to the other room) and an orderly comes running, grabs the bed, wheels it into a connecting room, and tells the patient to quickly get onto one of two birthing beds. The other bed has stirrups that woman drapes her legs over and little handles for her to grab onto to help her push.

7) While the patient is moved to the birthing room, the student or intern quickly washes up and puts on a purple sterile gown and gloves, and then prepares a sterile field: washes the patients legs and puts on purple sterile drapes over the legs and stomach of the patient. Then the student or intern sits on the stool in front of the woman's vagina and waits.

8) Push when you have pain. Don't cry, it will hurt your baby. Don't cry, it will exhaust you. Rest when you don't have pain. Stop crying. Push harder, push, push, push. That's the dialogue. Sometimes if it's taking too long, another doctor gets up by the patient's head and pushes with all of his or her strength on the belly. Sometimes forceps are used if the baby is stuck. Episiotomies are made on every patient, as long as there is enough time (sometimes they wait so long to move the patient that they don't have enough time to cut an episiotomy. . sometimes they wait so long, or more than 2 woman are crowning at the same time, that they have to give birth in the non-birthing beds). The idea of letting birth proceed naturally is not very popular here. It is forced into a rapid event.

9) The baby is born, the cord is cut, the baby is handed off to the pediatrics intern. The placenta is birthed, and the uterus is checked for left over placenta. This is a barbaric procedure during which the doctor essentially shoves his or her entire hand into the uterus and repeat as necessary. The women groan and scream in pain. In truth, some doctors are much more gentle than others, but my first night, I was appalled by the procedure every time I saw it.

10) Finally, the episotomy is sewn up. Most of these students are not very good at sewing up the vagina and, if anyone ever put that many stitches with that little concern in my nether-regions, I'd be pretty damn upset. But I guess it's gotta get done, and I guess they have to learn. Human rights, let alone patient rights, aren't really the most important thing in this hospital at 3:00 in the morning. Really, most of the overworked, absolutely exhausted interns are just hoping that they can get through a birth without complications and without making any serious mistakes. The stitching up takes about 45 minutes and the woman is exhausted. She is allowed to briefly see her baby (The doctor holds the baby up and says in a very monotone voice, 'This is your baby boy/girl. Give him/her a little kiss. You will see him/her soon after you are finished here and have been given some time to rest. Congratulations.') Upon finishing, the doctor washes the woman off, lowers her gown, stretches her legs out, and leaves her to be retrieved by the orderly (which sometimes takes 20 or 30 minutes. . depending on when a bed is available).

11) If there is room, the patients are moved to the main floor where they stay for 8 hours. If there is no room (which is more common), they are moved to a room inbetween the birthing room and the OR.

And that's the baby factory. . .something like 40 births a day. . on my first night I witnessed at least 7 or 8, not including the c sections that occured through out the night - but I will cover that later.