# A birthing



## RedBlanketRunner (Oct 24, 2019)

Carol Burnette once described giving birth as taking your bottom lip and stretching it over your head. I'll take her word on that.

Where I lived we had a lot of home deliveries. Even had a midwife course taught by a nurse practitioner. My interest in birthings was peaked when I attended a friends home birthing, a water birth. Words can't describe how it was watching the kid swimming around. Reminded me of a scuba diver exploring a reef. Then ever so gently the midwife moved the kid to mom's chest where it fell asleep. Pure magic.

Thanks in part to an OB nurse who did midwife duties off shift word went around that I was always happy to attend birthings and the midwives were always happy to have an extra pair of hands. I would add, that group of midwives were pros. No prob for me to stay out of the action and just observe. And learn. One thing about pre hospital work is rarely a run goes by where you don't pick up a little new trick or technique if you pay attention. Recalling a green EMT showing me how to maneuver a leg to relieve cramping as example. 

Dial on through a few years. Northern Thailand. A birthing and would I be willing to lend a hand. I was installed in the back of a pickup truck with a nurse. In her white uniform and wearing one of those silly hats. Thai nursing is a little behind the times. Only in the past 5 years or so have I seen nurses regularly wearing scrubs.

Chatting with the nurse. Friend of a family member where we were going. Graduated earlier that year. Had she ever attended a birthing? Had been in a gallery to view one. Ever been on a code blue? Two. Ever deal with an A bleed? No. Worked OB? No. Okay, she's still a nurse and must have the basics down pat. Free form time.

I was still getting my feet wet in third world pre hospital. We drove for over an hour out into the country. I got to thinking about an ETA to a hospital if things went south. Then about a half hour or so on meandering side roads and another half hour up a dirt road to a village. I was doing pretty good keeping an anxiety attack in check. I once did CPR for well over an hour and would never like to be in a situation like that again. 

So we checked in with the family and I was identified as a physician. At that time nobody in the country had even heard of a paramedic and every time I tried to correct and explain it only served to confuse things.

We went in the house to check on mom and... please excuse my digression here. There are certain groups that spend a lot of time in third world countries. Self appointed authorities of life, they rarely if ever hesitate to tell people how to run theirs. This often extended to the realm of medical: If you beieve in (religious person of great repute) you can't contract HIV as one example. One of these groups had given that particular village a major, call it mis-education.

There was mom, alone, on a bed in a corner lying flat on her back, covered by a heavy blanket. The nurse helped explain, this was the proper procedure and position that had been taught for delivering a baby. Alone in the dark and wait it out. The house was sweltering, up around 130F. Mom was sweating rivers. All windows and the door closed. 

Time to clue the nurse but first things first. Open all the windows, lose the blanket, and now, the pep talk. You, mom, are in charge. We are merely here as assistants if you need us. You can do anything. Assume any position that makes you comfortable. Eat anything, drink anything except alcohol. Take charge. Take over. Would you like your friends and family to come in?

It took a few minutes to explain and get the message home. While nurse translated I took vitals and did an assess. Second baby, no complications first time around. Strong farmer woman in very good shape. My anxiety started to dial down. She invited in her friends and relatives. Took a couple of minutes for them all to understand they were welcome. No men though. Local segregation mentality. And gals, bring food and drinks. Let's have a party. This is not a medical crisis and with a little luck that won't happen and we don't even need to be here.
Female friends and family came trickling in, slowly filling the room. Fans were borrowed from all over which lowered things below sauna. I started in on lecture two. A little blessing in disguise. MEDICAL AUTHORITY speaking. Everyone immediate went silent. It took quite a while with nurse translating. First the breathing techniques then the positions she could assume to relieve discomfort. I had nurse and a couple of the gals help demonstrate various positions. Mom discovered the tiny stool common in those villages, all of 6 inches tall, was the cat's meow. When the contractions started to get to her on hands and knees worked quite well.

And the party commenced. The women panting with her. Everyone chatting. Mom was a trooper, now and then grtting her teeth, panting through her nose and grinning, making everyone giggle. Eventually we had close to 20 people in the room and it was getting pretty noisy. When the sharp contractions hit a make funny faces competition got going and the shrieks of laughter made me head outside a few times. The men crowded around on the porch were all wondering just what in heck was going on in there. 

I schooled nurse a little on checking dialation, how many fingers, guesstimate is fine, and let her take over. I came in now and then to check vitals then scrammed. It was making my ears ring in there. 

And anticlimactic. Maybe 15 minutes of sharp contractions then mom opted to sit on the floor leaning back against some of the women for support, crowned and out he came. Mom was priceless, gasping for breath, panting then laughed a little like, that wasn't so bad!
From then on nurse ran the show, me just offering a little advice here and there. Good on you gal. Doing great. Thinking of working OB? We went into a little training session where I schooled her a little on taking a trend for mom and baby. That's our big job. Mom did all the work, we just cover the little details.

Cleaning things up a little, nurse and I were dealing with the afterbirth when dad was brought in. And rag doll. He took in mom, the baby, then one look at the afterbirth and down he went. Nurse finished the job while I went over and elevated his legs. Then grandpa came in and took in mom and baby with a smile, afterbirth with raised eyebrows, and then his kid. He did a 1+1 and went back outside. A moment later he came in with a bucket of water and splash. 

On the way back down the mountain I went over the what if scenarios and watch fors, giving some practical pre hospital savvy.  The psychogenic hit that the dad had taken led into a long discussion into the various forms of shock, circumstances and indicators. Apparently this, along with a lot of other field training had been overlooked or even ignored in her classes. Even though she was pretty worn out she was very attentive and asked numerous quite astute questions.
When I got back to my house I ordered her a book from Amazon, my bible at that time, Comprehensive Guide to Pre-Hospital Skills, Butman, Martin, Vomacka, McSwain, ISBN 0-9404-3209-9. It's outdated now and at around 4 lbs it's not exactly a pocket reference guide but covers the basics of the spectrum from EMT 1 through paramed. 
I gave it to her as it would give her a leg up on medical terminologies in English if nothing else.


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