Someone, over on Homebirth Debate, has suggested that I should write a book. Hah!
It will have to wait for my retirement, and only if some really crazy publisher will give me a giant advance, but...
When I reminisce about my 40 years' work in maternity care, of course there are cases which stand out. Generally they are not the simple, easy ones, although quite a few have more to do with the foibles of the women or couples in labor rather than complicated labors or bad outcomes.
There was the Black Muslim Birth, where several Afro-American (as they were called then) men, dressed in business suits, arrived with a very pregnant woman in the "uniform" of floor length skirt, long sleeved tunic top, and head scarf, all in the same pastel color. (This was back in the days of Elijah Muhammad, when the Black Muslims had not yet become standard Sunni Moslems and whose main tenet was hatred of the whites). One of the men informed the (white) OB resident that "no damn white man was going to examine his wife", let alone deliver her. But as she was obviously in labor, we could hardly send her away. I was not yet a CNM, but I'd done quite a few deliveries when the residents were otherwise occupied, and it was agreed I'd take care of this woman unless something began to go wrong.
After all the normal admission preliminaries, the husband informed me that it was essential, when I cut the cord, that the stump attached to the baby be anointed immediately with grain and oil and certain prayers said. Fine by me, I said. I was hardly going to argue with a very large and rather aggressive black man. He seemed satisfied, and unrolled his prayer rug, and began his version of the standard Moslem prayers, even though I could have told him that he had the Arabic all wrong and he was bowing with his backside facing Mecca. Couldn't see much point in it, frankly. I was a devil to him.
The delivery was uneventful. As I tied and cut the cord, with Daddy at his wife's head, I used the drapes on the mother's stomach to hide the baby's end, which I'd left quite long, and held up the placental end. "Here", I said, "do your thing" and with much "Allahu Akbar"-ing and other gibberish he anointed the placental end of the umbilical cord with his grain and oil and I saved the baby from septicemia.
Afterward, he thanked me, and told me that it was a huge relief he hadn't had to fight "Whitey" for his religious beliefs. "It's a real shame", he said, smiling pleasantly, "that when we take over the world we're going to have burn all you kikes along with all the other whites."
And then there was the hysterical lady who arrived on a stretcher, flinging herself around and generally behaving as if she was delivering imminently. She was thrashing so much that it was impossible to listen to the baby's heart, but it didn't seem as if she was having any contractions--the abdomen was entirely soft, although she was screaming in Spanish as if in agony and didn't stop. Severe, constant abdominal pain is a sign of premature separation of the placenta, a major complication. One of the residents, suddenly inspired, ran to the delivery room down the hall, and brought back a mask from one of the anesthesia machines, and put it over her face, connected to nothing but room air. "Breathe deeply!" he urged her, in Spanish. Instaneously she went completely limp. So limp, in fact, we had trouble "waking" her up to find out her name. From that time on, whenever we had a patient who was screaming but not in labor, which was quite common among certain cultural groups, we would say "Get THE Mask, quick!" and we all knew what was meant.
My hospital had a lot of women delivering who were in drug detox programs because we had bought a small hospital a block away and turned it into a detox center. One of the problems we had was knowing exactly the drug status of these women, who often detoxed in pregnancy intending to get high when labor began. They knew that normal amounts of painkillers wouldn't help at all with labor pain, unless they reduced their tolerance levels. So we really couldn't give them anything lest we depress the babies. On our blackboard, where all the patients were listed, we would write "DA" after their names, to alert the staff. A new, and very politically-correct, supervisor, objected to this "labelling" as being prejudicial. Thereafter, in the "analgesia" column,, where we could list the patient's request for an epidural, local anesthesia , or other pain medication when it was needed, we wrote "vocal". The lady in question could scream, and having injected herself prior to admission, usually did, flying around the ceiling without any inhibitions.
When I was at the very beginning of my career as a delivery room nurse, we had a patient who, every two minutes, would let out the most bloodcurdling screams: "Ay, dios mio!! Ay, Santa Maria!!! Ay-ay-ay!!!" Every time this happened, I'd jerk, and start to get up to go to her, but my comrades in the nursing station would tell me to sit down, that she was nowhere near delivery. "But listen to her!" I'd exclaim, and they would smile and shrug. Then we heard "Ay, dios mio! Ay, Santa-----" followed by silence, and everyone stampeded toward the patient. You can't scream and push at the same time.