The labour room

As part of our training in our final year MBBS we had a residential posting in Obstetrics. Where it was mandatory for us to conduct 20 normal deliveries and maintain a diligent record. This was to give us a hands on experience of the child birth process. It was a real eye opener.
In Obstetrics there is an adage, “what begins in the night, ends in the night”. Most of us were conceived in the night so we also chose to enter this cruel cold world in the night or in the wee hours of the morning. Unless it was a planned Caesarean Section, then it’s according to the convenience of the Obstetricians. There are also the ‘Mahurat Caesars’, where an auspicious day and time is chosen after consultation with an astrologist or priest. It is believed that the day and time of the birth determines the future. So being born on an auspicious day and at an auspicious time, would give the child a head start in life.
In order to be available 24 X 7, we were allotted two rooms just above the labour room, one for the boys and one for the girls. At some recent past this must have been one single room but then was divided into two by constructing a wall in between which stopped short by a foot from the ceiling. Possibly there may have been some difficulty laying the bricks up to the ceiling. This gave a convenient gap in which an electric bell was affixed, which was audible to occupants of both rooms. The bell was connected to the labour room and as soon as a lady in labour was admitted, the nurse would ring the bell and the residents of the rooms would turn by turn descend down and take down the details of the lady and monitor her progress until she delivered.
This was our first experience of sleep deprivation and most of us would be going down muttering under our breath, as to why this innocent soul chose this unearthly hour. Sometimes the nurses were charitable and told us to go back to sleep as the lady is not in advanced labour. They would call us when she’s ready to deliver. Others would play by the rules which say we should monitor the lady until she delivers. The labour room which wore a desolate look during the day, was chock a block with ladies in various stages of labour. As the auspicious moment for each lady approached the contractions of the uterus became more frequent. Each contraction was associated with pain and every lady began remembering their mother and their God. So on one bed you had a lady screaming with each painful contraction, ‘Andavane Muruga!’, or just ‘Muruga!’ Muruga referred to Murugan or Kartikeyan, son of Shiva and Parvati and brother of Ganesh, who is revered in South India. ‘Andavane Muruga’ roughly translates into ‘Oh Lord! I believe in you!’ But Muruga in Hindi means a Cock! As in Rooster and not what you’re thinking. Pun unintended! The next bed you had a lady wearing a hijab and shouting ‘Allahaa’! When repeated over and over again, it sounded more like ‘La la laa’. The next bed you had a lady shouting ‘Yeshu Swami’! All the major religions of India represented in one room and all entering into this world in a similar manner. In other words we are equal in birth and in death.
Then as the appointed hour drew nigh, it was heralded by an increased intensity of screams and supplications to the Almighty. Indicating an increased frequency of labour pains. To determine the stage of labour a pelvic examination was done by a resident. Two gloved fingers, the index and the middle finger were introduced in the vagina and the effacement and dilatation of the cervix or in plain English, how much the mouth of the uterus had opened and stretched thinly over the baby’s descending head, was assessed.
There would be a bulge of the amniotic membrane over the advancing head in what is called fore water. This was ruptured by the resident, an ARM or artificial rupture of membrane to speed up labour. We hear it often in movies or serials, “My water just broke!” Indicating an imminent delivery. Then the lady was transferred to the labour table.
The labour table as one layman commented resembled a medieval torture table! Often seen in places like the Tower of London. There are stirrups to string up and part the legs and the foldable lower part of the table, allowing the buttocks to be at the edge. The student was seated on a stool between the parted legs, wearing cap and mask, gloves and a plastic apron hands placed in the classic catching stance of a fielder, waiting to catch the child. A resident would be standing behind and guide the student. Cheer leaders consisting of student nurses and staff nurses, lined up on either sides, cajoling her to bear down. The chorus they chanted in Tamil was “Mukh Ma! Mukh Ma! Viraday Mukh Ma! Vellilay pon madari Mukh Ma! Which roughly translates into “Bear down! Bear down like when you go out to defecate!” Meanwhile the others would massage the abdomen and apply pressure on to fundus of the uterus to stimulate it to contract. If the lady so much as to dared to scream in pain, she would be rewarded with a slap and an admonition, “chumma kataaday!” or don’t shout unnecessarily. Definitely shades of medieval torture or police third degree.
But I have worked in the extreme South, Central and North of India and have found similar rituals, transcending cultures and languages. When I was doing my bond in Maharashtra, the cheer leaders used to chant, “Laga! Laga! Laga!” Roughly the same meaning only for in a different language and it used to sound like “Lagalagalagalagaaa!”, in one breath.
Then came the stage of the ‘crowning’ of the head! The head would emerge from the vaginal verge and the verge would form a ‘crown’. The resident directing the student from behind would ask him or her to take the episiotomy scissors and make a radial cut on this crown at the 7 o clock position. This was to give space for the head to come out and avoid haphazard tears of the vagina. One consultant once opined “I prefer using a scalpel as invariably the scissors are blunt”. However one question always troubled me as to how he managed to avoid incising the crowning head.
Then the head of the child emerged and once mouth of the child was visible, suction was given to remove any secretions in the throat and nose. The head is caught by passing the index and middle fingers of both hands on either side of the neck and applying traction downwards and out comes the child. Then the child is held upside down and suction to his mouth and nose is given. The child is initially patted gently all over to encourage him to cry, but if it doesn’t cry then the pat becomes akin to a slap. Next the student is supposed to tie the umbilical cord in two places with a sterile thread. Then cover the tied area with the left hand and severe the cord using a cord cutting scissors with the right hand. The idea of covering was to prevent blood splattering around as the cord becomes engorged. I once didn’t cover and the spray hit a senior nurse’s hat. Least to say she was not amused and if looks could kill I would have fallen dead on the spot. The student would then have to wait to deliver the placenta, examine it to determine if it was complete or some part remaining which could cause a post partum bleed. Then along with the help of the resident the student was taught how to suture the episiotomy wound. This was our first exposure to suturing and therefore was very exciting. The residents mainly females varied from having a motherly attitude to being impatient or being an outright bitch. One of the nicer ones encouraged me and praised my suturing, she also prophetically said “you will become a surgeon!” God Bless her!
The child meanwhile is wiped and cleaned by another team of nurses, an identification band is placed on the child’s wrist to prevent a mix up and wrapped in a blanket. A paediatrician examines the child for any congenital anomalies.
I once read that the famous cricketer Sunil Gavaskar got exchanged at birth and was almost being taken by the wrong set of parents but was saved by an observant relative and the correct child was given to the parents. Otherwise he commented he would have been a fisherman rather than a cricketer.
The next step is the child is shown to the mother and she is asked what sex did she hope for? The mother invariably gives a diplomatic answer and then the child’s genitalia is uncovered to reveal the sex of the child. Mother being a mother accepts the child whether boy or girl but the relatives waiting outside may not be so altruistic.
During our COP or Community Orientation Program, we stayed in a Village Mottupalayam for 15 days and interacted with the villagers. There was one family which had 3 daughters, the first was named ‘Tamilselvi’ or pride of Tamils. When the next girl was born they named her ‘Ventam’, meaning ‘don’t want’, hoping that God would get the hint but when the third girl was born there was mourning and chest beating. They realized God does not take subtle hints so she was named, ‘Inniki pothum’, or enough is enough!
Now I know why it’s called labour! Maybe fulfilling the Biblical prophecy by God to Eve for the original sin, “I will make your pains in childbearing very severe; with painful labour you will give birth to children Genesis 3:16
The Greek hero Hercules was given 12 labours by King Eurystheus as penance, but I think all of them paled in comparison to what a woman faces.
My appreciation to all the women of this world for all you have to face in life but still emerge  smiling.