Thursday, October 12, 2006

Screamer

I could hear the woman's screams from far down the hallway. She was in labor, nearing delivery, and was really losing it. When I arrived at her room, she was writhing on her bed, laying partly crosswise on it, making it practically impossible to control the delivery of her baby. Any hope for rational response to instructions had been lost long ago.

In general, there is a fairly "normal distribution" of the amount of crying and moaning that occurs during labor and delivery. As you might expect, some women are fairly stoic, while others are more animated and show more pain. I find it hard to be judgemental of any of these women. I'll never know what it feels like to deliver a baby, but I imagine it as something akin to a bowling ball coming through a very tender part of your body, so I don't blame women for showing some pain. I really don't know how I would be if I were delivering a baby.

Every now and then, though, we get a woman like the one described above, whose response to pain is far beyond the norm, who totally loses control and goes absolutely bonkers. They move around on the bed, they close their legs, they don't push; they are very difficult to care for, and their lack of control just makes it worse for them. I like to think that I wouldn't be like that if having a baby, but who knows?

It didn't help that this woman's obstetrician, who happened to be a woman, was screaming right back at her. It was almost comical to see the two of them yelling and carrying on, although the situation was a little serious for anyone to be laughing. There aren't any easy ways to make a person who's "lost it" get it back, but I really think that calm explanations and instructions have got to be better than shouting at her.

Finally the woman delivered, in spite of herself, and things calmed down. Labor and delivery can be a crazy place, and the people even crazier.

23 Comments:

Blogger Laura said...

LOL
yeah we do see a lot in the delivery room.
me, i have givn birth to a few babies and well, i am the one who delivers them foused, fast and fairly easily sitting up on a birthing stool. i don't know why, i just did. because of that, i feel like my experience doesn't afford me much understanding for some who are out of control like this one you described.
my recent favorite was the young mom dealing with her labor in the same way you described. as everyone in the room encouraged her to push she would just writhe and moan and scream how she couldn't. it seriously looked as though we might be going to OR for a section as she couldn't and wouldn't push. but boy could she scream.
suddenly her mother's cell phone rang and her mother stopped to answer it. the laboring mom was so PO'd she literally sat up in bed, smacked the phone out of her mother's hand and told her now was not the time to talk to whomever it was on the phone.
the next contraction comes and again she moans and screams and writhes in bed telling us all how she just can't push.
while supporting one of her legs, i leaned in and whispered that if she put half the energy she had to yell at her mother into pushing, the baby would be here now. it was funny but it seemed to bring her back to the task at hand because she did focus and began to push with her OBs direction. A healthy baby boy arrived into her waiting arms about 20 minutes later.

8:10 PM  
Blogger Flea said...

My college girlfriend was a screamer.

9:56 PM  
Blogger Judy said...

My personal "favorite" was the woman who was so high she had no idea she was in labor or in the hospital.

Multiple security officers positioned her while the OB delivered the baby. First time for them. They're hoping it's the last, too.

Baby went to the NICU, but did OK.

10:35 PM  
Anonymous Olga said...

Humph. You've just described a typical scenario that drives me batty in L&D nursing...I've seen it too often in my career.
Transition in labor is immensely powerful, surging hormones and chemicals that are overwhelming. And for some bizarre reason--we medical people think the fix is to add MORE stimulation--by yelling, restraining, pleading, bargaining, sticking needles (pudendal or epidural) in their faces. Best bet? Turn off the bright lights, leave her to herself. Maybe with one silent person.
I overheard a wise friend of mine tell a doc once: Trying to stop pushing is like trying to stop vomiting (in regards to the ubiquitous request OB docs give us "don't let her push until I get there")
Eventually, the urge to push will overcome all else--and she'll get down to work. Odds are it'll work LOTS faster than by ordering her to somehow get back the control she can't get until after delivery!

It's a too frequent example of how our (MDs & RNs) need to control and "fix" things can make it worse.

1:21 AM  
Anonymous Justaminute said...

Hehehe,
I've always wondered what you guys have to deal with. When I had my first child the attending nurse said "Wow, that's self control".

I figured I was typical. Apparently not.

Do you think video taping those "ladies who lose it" would be good for the high school health class?

10:07 AM  
Blogger Kelley said...

I'll tell you how badly it hurts. It hurts so badly I couldn't have screamed and writhed if I had wanted. All I could do was hold my breath, close my eyes, wish for the end of my life, and cry despite the fact that I didn't want to. I made it to nine before they gave me an epidural. I was sure I'd die if I had to push without it. I have alawys heard the only thing close was a kidney stone. I agree. I had one of those and it pretty much made me want to die also.

11:48 AM  
Anonymous Dianne said...

My impression, having only gone through one (obstructed) labor and zero vaginal deliveries is that how much it hurts is ideosyncratic, not only person to person but pregnancy to pregnancy. My step-mother says she'd rather have a baby than go to the dentist. Either labor is MUCH easier for her than for me or she goes to the dentist from "Little Shop of Horrors". Personally, I'd rather have my fingernails ripped off than go through labor again. (And yes, I've had a fingernail ripped off so I can make the comparison advisedly.)

12:22 PM  
Blogger WendyLou said...

Sure glad I had a nice calm planned c/s. No way could I have added the stress of labor onto the worry about DD. I prolly would have been the out of control screaming mom.

That said, I don't know what labor feels like either. I had a HSG exam which was VERY painful, and if that is what labor was like, then yeah, I'll be a screamer. (Radiologist failed to read an earlier u/s report indicating a large septum and was jaming instruments into it.)

I don't see how yelling would calm someone down. When I am de-escelating someone, talking calmly, focused, and directly works best.

1:42 PM  
Blogger Dream Mom said...

I had a c-section so I guess I can't really comment. I did think some of the contractions were pretty intense.

The only time I was a screamer was earlier this year when I had severe back pain and had a facet joint injection. The pain was so intense that I screamed at the top of my lungs and it took my breath away it hurt so bad. And after they were done, they decided they needed to do a second injection. I'll be honest, it was the most traumatic thing I have ever encountered; I have never felt pain to that degree. I learned some time later that they probably hit a nerve root.

I guess I am a screamer, when it really, really hurts.

4:25 PM  
Blogger Fat Doctor said...

One of the reasons I like your blog so much is that, completely opposite of my blog, yours doesn't reveal much about who you are as a person.

Now, I have a slight feeling you are a man, because you comment that you will never know what it's like to have a baby.

I, a woman, am blessed that I will never know, either. C-sections rule! I will never have to endure labor or delivery! Ah, the bliss.

What do you want to bet natural birth folks start sending me hate mail?

Overall, I agree with the above commenter who reported that she thinks different women feel labor differently. I've caught babies from screamers and from women who never so much as sighed. The latter often reported, "it wasn't much worse than menstrual cramps." I'm thinking those women have some really wicked cycles.

So, are you a man?

9:40 PM  
Anonymous Anonymous said...

fat doctor--
Profile has a little info beyond the midwest U.S. stuff.

12:28 AM  
Blogger NoEmptyArmsHere said...

LOL!! Having delivered 7 kids myself I can totally attest that not only is each woman different in her reaction to labor and delivery, but each individual pregnancy also.
With my first child, I was calm and very introverted. My mother kept telling me to holler, cuss, do SOMETHING...then my second child, I hollered and yelled so much (transverse presentation of her head) that a doc came into my room (curtained area actually) and put his hand on my leg and told me to calm down...I kicked him in the chest/face...and dont' regret it!

My 6th child, my contractions were off the monitor and the nurses and docs were buzzing, my family and I were watching tv and some were playing cards. I never felt a thing.

So, yeah...individual pregnancies bring individual responses.

1:33 PM  
Anonymous Anonymous said...

Ahh no wonder you hate all that is natural in the order of the (birthing) universe... women should be drugged and quiet for you.
Once again, you have proven that a hospital is a horrible place to have a baby.
I feel sorry for mom. Obviously she needed some help. Obviously no one there knew what to do if they couldn't just shove drugs into her to shut her up.
*no fat doctor, I won't send you hate mail... I'll just wait until you realize and read about the effects un-necessary surgery has and will do to your body... being a doctor I'm sure you have access to them. Perhaps you are Britney Spears hiding behind some other identity?

2:30 PM  
Anonymous Anonymous said...

I screamed during my last labor. I was actually quite unhappy with having Baby #4 induced. With my oldest, things went fairly smoothly but my labor was so long (20 hours, no epidural) that I was glad to push when the time came. It hurt less than any of my other deliveries too.
Babies 2 & 3, I walked around my house for an hour or so before going to the hospital and was at 8 and 9 cm, respectively when I got there. By the time I was admitted and the nurses were ready to check me, I was ready to push. The doc almost didn't make it with #3, so we decided we'd induce with #4.
The problem I had with that was they wanted my on a fetal monitor all the time. It's a nice thought, but lying still made my arthritic hip hurt so I really did have trouble when the time to push came. I didn't scream constantly, but I do remember screaming at my doc that I couldn't push when she asked me too.

6:52 PM  
Anonymous Anonymous said...

Thanks, Olga, for explaining transition.

My midwife and my doctor argued throughout my 16 -hour labor as to how dilated I was. She said 5 cm, he said 6. She said 7, he said 8. She said 9, and he said "push." I felt no urge to push. My contractions were excrutiating, but I felt nothing, no overwhelming urge to push as described in all my pregnancy books.

But I did as the good doctor told me - pushed with all my might. The docs and midwives told me I wasn't pushing. I still can't figure that one out. I pushed and pushed until I came up off the table and they kept scolding me that I wasn't pushing enough. (I'm a pretty strong gal, and an opera singer to boot, and really, I definitely was PUSHING).

After about a half hour, I snapped and started screaming at them that I was too pushing and how dare they be so arrogant and demotivating as to tell me I was not pushing.

Finally they pulled him out with the vacuum extractor.

I KNOW what happened - the midwife was right. I was at 9 when the doc told me to push. I pushed and pushed a baby who was not ready to slip out with a cervix that was not completely dilated. Somewhere in the middle of all that pushing, I reached transition and started screaming at everyone.

So you docs call us "screamers" ?How utterly rude.

7:10 PM  
Blogger neonataldoc said...

FD, I fess up to being male.

Anonymous 7:10, I want to be clear here. This post was not about a woman who has a "normal" amount of screaming, yelling, or whatever in labor. It's about a woman who has totally lost control. It doesn't happen very often.

8:51 PM  
Blogger NoEmptyArmsHere said...

Well, if you want my opinion...no man who has never pissed a grape out his penis can judge what is a "normal" amount of screaming or losing control.
As for some being elated at never having been thru labor thanks to c-sections? My last 2 children were delivered by c-section. I would rather birth triplets with no epidural than go thru that again. My last section almost cost me my life! But...everyone has their own opinion on this...to each their own I say!

9:16 AM  
Blogger stockingup99 said...

Let her out of that bleeping bed. Keeping a woman on her back to delivery is cruel and unusual punishment.

Even in the tub I made some sounds which the midwife needed to assure my hubby were normal. I screamed for six weeks of labor, before the last hoorah which only took a couple hours. (Yes, six weeks a doctor never would have let me wait until my due date with a 9.5 pound baby.)

(in)Hospitables are a cruel placce to try to birth a baby. I feel low risk moms are much safer at home, with a nearby hospital.

It sounds like that woman couldn't find a good postion. A competent midwife may have gotten her upright, and made it much easier.

For my first birth, they had the gaul to tell me to stop screaming, it might scare the other moms. What about all the hollering they did tryin to get me to do purple pushing. one, two ,THREE. FOUR.. Hold your breath and push like we say, or we will cut you open against your will.

I know NeoHero, you are just an observer at before the birth. I'm just trying to show you the other side. Help us take back our birthing rights.

9:16 AM  
Anonymous thankful canadian hbac mama said...

Flea, in his humour was actually the only person who was making a lot of sense here...
Thanks for showing up Stockingup99 and noemptyarmshere (wish you had a blog)....
Whew. And here I thought all the rational had jumped ship.
Anon who realized nd likes his patients quiet... and flat on their backs obviously....
C'mon flea... We all know you could have fun with that one!
;-)

11:16 AM  
Anonymous Anonymous said...

Sounds more like a doctor who had completely lost control of herself and the situation. The patient was in the middle of transition- what's the doctor's excuse?

6:55 PM  
Anonymous Anonymous said...

laughs and laughs and laughs

11:17 PM  
Anonymous maribeth, cnm said...

This post was not about a woman who has a "normal" amount of screaming, yelling, or whatever in labor. It's about a woman who has totally lost control. It doesn't happen very often

I'm bummed I'm late on this one too because nobody will get to see my response. PEOPLE! DOCTORS! You are insane! Has it occurred to ONE of you that this woman probably has a history of sexual abuse? With statistics suggesting that 1/3 girls has been sexually abused in her lifetime, I would expect professionals to have more insight and sensitivity towards this. Gee, why could it be so hard for her to lie down, be still, be quiet, and open her legs for an authority figure??? I'm shocked no one has mentioned this possibility (probability?). For those of us working in birth, it's a very real thing.

12:34 PM  
Anonymous Anonymous said...

well I was a screamer.
I screamed and begged them to kill me and how much I wanted to die. I told them to tie my tubes. I've never felt pain like that in my entire life. I kicked and reared up off of the bed. I was 20 hours into a labor and in such horrible pain from something else I couldn't even feel my contractions. This pain broke through my epidural and any extra they gave me. I beat on my husband, screamed at him, screamed at my mothers, broke into sobbing fits of just wanting to die and then after pushing for 2 hours and the baby going no where I refused to push anymore unless they gave me pain medication. I kept telling them I had this awful pain in my hips and back. I tried pushing on my side and on my hands and knees and nothing would give.

They told me I wasn't pushing right, I wasn't pushing hard enough, the pain wasn't that bad, I was scaring the other mothers, that I needed to calm down and yelling at me to push. I felt so helpless and alone because I knew something was wrong and the baby wasn't in there right. I kept screaming it to them and no one would listen. I demanded a c-section and refused to push anymore. They tried to lift my legs up to push and I literally kicked them out and almost kicked a LD nurse in the face. Low and Behold not only was the baby face up presentation but while her head was in the birth canal, her butt and body was hanging over my left hip somehow.

10:43 PM  

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