musingsonwomenshealth.com

Reflections on 40 years as a doctor in Women's Health

Deliver me from evil…


We take a lot for granted nowadays, don’t we? Our individual life-spans are short, our collective memories only slightly longer; most of us cannot even imagine how things were before the advent of modern medicine, before the recognition of germs as a cause of infections, before Semmelweis, a 19th century Hungarian doctor, realized that deaths from puerperal fever (childbed fever) could be drastically reduced by the accoucheurs washing their hands before attending the parturient.

Even I, relatively recently retired from a long career as an obstetrician and although sometimes lulled by our technology, am acutely aware of just how dangerous pregnancy can be -and even more aware that it is a risk only assumed by women. It is a peril no doubt made even more acute by the family dynamics in the past: the need to procreate to ensure there were enough family members to help their aging parents, but without reliable contraception to space or limit the number of pregnancies. Historians tell us that childbirth was the main cause of death for English women between the late 5th and 11th centuries and that the neonatal mortality rate during this period was between 30 and 60 percent.[i]

Every so often I am reminded of the terror that must have gripped pregnant women in times past. A study by Sarah Fiddyment and others at the University of Cambridge reported on the birthing belts used by medieval women[ii] when even the healthiest of women in childbirth had good reason to fear protracted confinement, permanent injury, if not death. Apart from invoking the protection of various saints for help, and the probable physical support of the pregnant abdomen, numerous monasteries apparently offered birthing girdles which were also talismanic, with ritual functions that incorporated religious devotion and magic -the emphasis placed on the encircling role of the artefact, binding and protecting the maternal body.

Of course, that was then and this is now; we don’t use a talisman anymore… do we? I suppose some people carry around a lucky coin, or perhaps wear religious ornaments around their necks, but somehow I don’t think these are really expected to protect anything. Of course, maybe it’s just that I don’t engage in any dangerous activities nowadays, and so have lost touch with the fear that attends those risks. Still, we all have to contend with our inner voices, I guess…

I can still remember a patient I saw for her first pregnancy shortly after I opened my practice across the street from a downtown hospital. Janice was young woman in her late teens, and although supported by a loving family, was unmarried and absolutely terrified about the delivery. Fortunately, she was healthy and her pregnancy was progressing well, so I had some extra time to talk to her about her anxiety during each appointment. Her diet seemed healthy, and her weight gain continued to be appropriate as her pregnancy progressed, but that still worried her.

“Am I gaining too much weight, doctor?” It was a question she asked me at each visit without fail. And despite my continuing reassurances that she was right on track, I could feel her anxiety rising as her due date approached. Apparently her older sister had told her she’d had a long and painful labour with an epidural anaesthetic that hadn’t worked despite several attempts at repositioning the catheter. Janice was sure she was in for the same fate.

“It’s like I’ll have no control no matter what I do, doctor,” she kept repeating at each visit toward the end. “Can you just schedule a Caesarian section for me?” she finally had the nerve to ask me one day, close to term.

I listened to her patiently, and tried to assure her that the nurses and I would keep a close watch for any problems -and a faulty epidural might be one thing that could change our minds about labour management. Even in those beginning days of my practice, I was never one who opted for an early Caesarian unless there were unavoidable reasons for it. “Let’s wait and see if you change your mind when you’re actually in labour Janice,” I said. “But if things aren’t going well for you or your baby in labour, I promise I won’t hesitate to do a Caesarian section.”

Her face seemed to relax a little when I said that, but I could still see the fear in her eyes. “My mom said she had the same worries as me when she was in labour with my sister,” she suddenly said. “She actually delivered at home before dad could get her to the hospital.” She chuckled at her mother’s memory of the event. “She was wearing her best socks, she said. She’d wanted to make a good impression in the labour room, I think.” Janice rolled her eyes at the thought. “But she never tried that again because it wrecked the socks – she just couldn’t get the blood off them, so she saved ‘em as a memento. To this day she thinks wearing the socks brought her good luck for her first labour….” She risked a glance at me to see if I thought that was silly.

We both chuckled. “Yes, things can get a little messy with a delivery, Janice… I’m not sure I’d risk my good socks, though.”

She giggled at that, but there was a change in her expression, and for the first time since I’d known her, her eyes actually twinkled. I felt strangely reassured by that.

At any rate, the next week I was in my office when I got a phone call from the delivery suite that Janice had just been admitted in good, hard labour.

“How’s she managing the contractions?” I asked the nurse in charge.

There was a pause, and then a little giggle. “Just fine, doctor…” -once again a pause before she said anything more. “She said she had a surprise for you… I wasn’t supposed to say anything, but I think you’ll like them…”

“Them?” I asked, wondering if there were several gifts.

There was a full-throated laugh at that. “You might as well come over now; she won’t be long…”

I waved at my receptionist on my way out, and the patients in the waiting room smiled. It was nice to know their obstetrician had an office across from the hospital, and that if necessary, when they were in labour, he’d rush over no matter how many were still waiting for him in the office. It was just how things worked.

By the time I had changed into my delivery scrubs, and washed my hands, Janice was already in the stirrups so the nurse attending her stepped out of the way so I could deliver her baby as her mother watched anxiously from  the corner of the room. As I stood between her legs to manage the head, I thought I noticed some unusual colours on her foot where one of the drapes had come loose. But, to tell the truth, I put my curiosity about them to one side as I busied myself delivering a healthy baby. Despite her worries, Janice had no difficulty with her labour at all. I handed the baby to her for skin to skin contact and finished my job with the placenta.

She could hardly tear her eyes away from the baby, of course, but every so often, she would risk a glance at me. “So what do you think, doctor,” she finally said, unable to keep her secret any longer.

“Think?” I thought she meant about the baby. “A perfect little girl, Janice. Congratulations!”

She chuckled with a mysterious look on her face. “I know that!” she said as she wiggled her toes, now that the nurse had taken her legs out of the stirrups and placed them back on her bed with the rest of her body. “It’s my toes, doctor… Whadya think, eh?”

I lifted the sheet covering her feet and stared. There were different patterns painted in different colours on each toenail.

“I thought that’d be better than special socks,” she explained, as both she and her mother exploded with laughter.

Maybe she was really onto something there…

[i] https://royalsocietypublishing.org/doi/10.1098/rsos.202055

[ii] Ibid.

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