by Melissa Yi
They don’t chew food like us. They don’t have to. Mom is providing all the oxygen and nutrients. So they just store whatever minimal amount of poop they make in the first nine months, and the majority of them will push it out once they hit the bright lights and big city of the real world. That meconium will creep out of the rectum like a greenish black sausage, but that’s the good news.
Because if they start pooping during birth, it’s a distress call. It means they’re not getting enough oxygen. And then, because they’re still floating around inside of mom, practicing inhaling and exhaling, their caca gets into their lungs, and they can come out breathing fast, sometimes developing a fever and getting sicker and sicker.
I’ve only ever assisted healthy deliveries.
Sure, they had a few crash C-sections when I was a medical student, but the women sailed into the OR for neat, sterile surgery. Aside from the surprising difficulty of manually extracting the baby from the uterus (once, an obstetrician let me try, before I gave up and a nurse pushed the baby out instead), it was a joy.
But I’ve never wielded a retractor, let alone a knife, in a C-section.
Even if I felt up to it, we had no anaesthetic, except for a bit of Lidocaine in case we had to repair a vaginal tear.
I had to get the baby out the usual way.
I made sure to approach Manouchka’s backside carefully, not treading on the small puddle of her amniotic fluid.
For a second, I wished Bastard would slip on the fluid, or on June’s blood smeared in the centre of the main room, and hit his head. But with our luck, that would just set off his gun. And then he’d shoot us all in revenge.
“I’m a doctor,” I repeated to Manouchka, in French. “I’m here to help. Let me get you out of the bathroom.”
She stared at me, her eyes glazed.
That worried me. I’d seen that look before. In babies who have pneumonia, struggling to breathe, too tired to talk or cry, just gazing in the distance like a marathon runner, trying to stay alive. In a man with a heart attack, holding on his chest, his face furrowed in pain and his chest heaving.
She moaned. She must not have gotten an epidural, what with the panic going on.
I didn’t have any medications for her, except for that bit of Lidocaine on the crash cart. Where’s the chloroform when you need it?
I kid, I kid. Except then I could have tried to use it on Bastard.
“You’ll feel better after you deliver,” I told Manouchka. In French, a delivery is an accouchement and a miscarriage is a fausse couche (false delivery). So it sounded like I was trying to get her to lie down, or se coucher.
She groaned again.
She was probably ready to push right now, on the bathroom floor. I’d never checked her cervix, so for all I knew, she’d been eight centimetres when I’d said hello. Now the baby wanted out, and Manouchka was trying to hold it back.
I needed to check her. I said, “I have to wash my hands. Then I’ll check the baby.” The last thing she needed was a puerperal infection, or an infection in her lady bits.
I waggled my hands at Bastard and mimed washing them at the sink.
He said, “Hurry up, bitch.”
Right.
As I stepped to the sink, I considered trying to get the fetal monitor back on her, because it would be a much better sign if the baby’s heart rate was okay.
But Manouchka started rocking back and forth on her hands and knees in a way that screamed business.
Plus, I wasn’t one hundred percent sure how to drag her over to the bed, get the belt on her, hook her up to the monitor, and convince Bastard to dance Tucker over to the screen in the main room so he could yell out the tracing to me. Just thinking about it made my head ache more.
Get the baby out. Now.
I bent at the waist to access the sink right behind the door, neighbouring the toilet. No Jacuzzis at St. Joe’s, but at least I could access the cold, glorious water just by turning a tap. What a miracle.
I washed my hands, scrubbing between my fingers, and a quick scrape under my nails, in case Bastard wouldn’t let me walk back across the room to grab some sterile gloves.
My throat ached. Touching water made my dehydration worse. I wanted to stick my mouth under the tap and drink, but I told myself, You can do that later. After the baby comes out.
I dried my hand on some white paper towels, fantasizing about sucking the water out of them—that’s how desperate I felt—before I focused back on Manouchka, whose head was practically bowed down to the floor. Yes, the baby was coming any second now.
I glanced at Bastard and said, “May I have some sterile gloves and gel?”
Bastard repositioned his gun on Tucker’s head and his arm around his neck before he met my eyes. The skin around Bastard’s eyes gleamed with sweat, even in the dim light. His Adam’s apple bobbed again, and he said, “What the fuck are you talking about?”
Tucker managed to nod at me. Even as a hostage, with his neck locked and the gun rubbing him a new bald spot, he was signaling me, I got this. He said to Bastard, in an only slightly-choked voice, “Sterile gloves, so we don’t contaminate the baby. Lubricating gel, so we don’t hurt the mother. We also have sterile gowns and face masks. Could I get those for Hope?” He tried to twist his head to his right, toward the delivery cart against the wall of the main room.
“You’re not going anywhere,” said Bastard.
“Could I get them myself?” I said. I’d never delivered a baby bare-handed, even though they used to do that all the time, I guess.
“No way,” said Bastard, so I started to tiptoe around to Manouchka’s nether regions, which she pointed toward the destroyed shower, away from the men.
Tucker’s quiet voice cut through the air. “Please. You don’t want this baby to get an infection, do you?”
“Aw, hell,” said Bastard. “I’m coming with you. And if you try something funny, or if one of those bitches makes a run for it—”
“Gotcha,” said Tucker, which probably wasn’t the best choice of words, but he pointed at the hand sanitizer on the wall near the bathroom door, silently asking for permission to use it.
“Christ,” said Bastard, but he two-stepped with Tucker and let him squirt his palms.
Bastard relinquished his neck hold only to seize Tucker’s arm with his left hand and shove the gun into his back. It was strange seeing Bastard applying the same grips that he’d used on me while he growled, “I’ve got your covered. Don’t even think about it.”
“I’m not thinking,” said Tucker. He sounded calmer already, now that he wasn’t getting a gun noogie anymore. He crossed over to the delivery cart and said, “I’m unlocking the wheels. That way, I can just roll it over to the bathroom.”
“Whatever!” said Bastard, but he watched Tucker nudge the little wheel locks. Bastard followed on his heels as he pushed it in front of the ruined bathroom door.
I liked that. It felt like Tucker was giving Manouchka some privacy to give birth, so she wasn’t as exposed to Bastard’s eyes and gun. And if/when the cavalry busted in, we also had a shield.
A shield only a little over waist-high, mind you, but it felt like some protection, since Manouchka hunkered down on the ground.
Tucker stopped about two feet away from the door, leaving us enough room to elbow our way out and dash for the exit if we needed to.
I liked the way my man thought.
He ripped open a pack of gloves for me and laid them out on the cart, even emptying a pack of Muco gel on the paper cover that had enveloped the gloves.
Nurses help you like that. If I had to open the gel myself, I’d contaminate my sterile gloves. Tucker had obviously paid attention. He always paid attention. Even though it was a tiny thing, it made me love him even more.
When I reached for the gloves, though, he shook his head and ripped open a blue gown for me.
I reached my arms through the plasticized polyester sleeves. Tucker tied the strings around my neck and waist. I could
n’t help thinking that some men get to zip their women into ball gowns, but Tucker got me into a surgical gown with a gun at his back and a baby practically at our feet.
He held each glove at the wrist so I could plunge my hand into it, wiggling my fingers into each slot.
It sounds like a long time, but actually, he got it all done in less than a minute.
Just one more reason to adore him.
Even Manouchka moaned a little less with Tucker nearby. Thank God he’d imprisoned himself with us.
Bastard said, “What’s the hold-up? Quit dicking around!”
Ugh. The less he spoke, the better. But since he was the one holding the gun, Tucker held his hands up and walked backwards, away from us and toward Bastard, saying, “Everything’s ready to go” while I turned to Manouchka and her meconium baby.
CHAPTER 17
Newly sanitized, with my sterile gloves in the air, I stepped toward the toilet and frowned. I said to Manouchka in French, “Do you want to deliver in the bed?”
“Nooooooooon,” she groaned, turning her face toward the toilet paper dispenser on the far wall.
So be it. We were lucky to have made it this far alive.
Belatedly, I wished I’d asked Tucker to either turn on the bathroom light or flip open the back end of Manouchka’s gown. Otherwise, I was going to contaminate my gloves as soon as I tried to expose her vagina. But there was nothing I could do about it except take a step backwards and hit the light switch with my right elbow.
Manouchka cried out as the yellow fluorescent lights flickered above us. I squinted, too. The light was like an assault on my previously dilated pupils. But I had to see. Well, I didn’t have to—I’m sure experienced doctors and midwives could deliver blindfolded—but five deliveries, belatedly including the one on my psychiatry rotation, did not anoint me into that exalted crew.
I sucked in my gut to make myself as skinny as possible while I scooted between the toilet and the shower wall remnants, trying not to step on Manouchka or her amniotic fluid.
The thin, foot-wide puddle partially hidden under Manouchka’s big belly did indeed contain yellow-green meconium as well as blood. Gah.
I tip-toed past it, toward her hind end. She shifted a little bit, to let me in between her bum and the toilet, but not much. She was losing control now, less interested in accommodating me than in getting the baby out.
I said, “Um, I need to expose the...region.” I’m not sure how to say things tactfully in English, let alone French. “Could you lift up your gown?”
She moaned and shifted her hips from side to side.
“I can help,” said Tucker.
Bastard said, “You’ve helped enough, motherfucker.”
I squatted sideways, grinding plastic shards under my soles as I sank between the wall and the toilet, as I used my left elbow to nudge the gown above her waist.
“I’m going to check your cervix. I’m using my right hand to touch you,” I said. I can speak French fluently, but trying to speak medically makes me sound pretty stilted.
My index and middle fingers were already covered in sterile goo. I used those to reach into the small gap between Manouchka’s legs.
I heard Bastard suck his breath in. I had to smile to myself. He might wave a big gun around, but if I said the word vagina, he didn’t know what to do with himself.
Something to file away for later, along with his blue puffer. Bastard’s Achilles heels: asthma plus fear of birth canals. Not sure how to work that, unless I could sic a giant set of women’s genitals on him and set off a fatal asthma attack.
“I’m touching your thigh with the back of my left hand,” I told Manouchka, belatedly rotating sideways so my left shoulder could venture forth and risk contamination first. I always narrate internal exams, and in this case, the more I could scare Bastard, the better. “Now I’m separating your thighs.”
For a second, Manouchka started to slam her legs together, but she forced herself to relax a few inches.
I shifted forward between her legs and I maintained her legs open with my left forearm before I started to touch her with my right hand. Honestly, the labia always feel like a bunch of folds between the legs, but in advanced labour, when the vagina gapes open, I tend to plunge my hand in and start poking around.
In this case, I couldn’t see anything, from my back-hurting angle, but my fingers marched past the labial folds, sank into the vaginal mucous membranes—not what I was looking for. I wanted to feel the baby’s head and the circle of the cervix.
Now, some skilled people can practically tell time in there. Okay, here’s the anterior fontanelle...baby’s facing this way...I’ve got a nose...the baby wants to be called Adam...
Not me. I’m a newbie. Luckily, my index and middle fingers ran right into the baby’s head no more than two inches inside her vagina.
The baby was coming now.
I pressed her left hip with my left elbow, trying to angle Manouchka away from the toilet and toward the far wall. Really, I’d like her to deliver in bed. Not because I was King Louis XVI who wanted to watch my mistresses give birth (apparently, that’s how it came into fashion to have women give birth lying down), but because we were stuck in the dirtiest, most cramped corner of the germ-infested hospital. But I couldn’t make her walk across the room now. So I just said, “Push!”
Manouchka glanced over her shoulder at me with hazy eyes. She didn’t bear down. I’m not sure what bearing down looks like, exactly, on all fours, but I’m pretty sure it’s not hanging out with your mouth open and your back swayed.
She was losing it, at the worst time.
“The baby needs to come out now,” I said, in French, trying to draw her eyes on mine and take her out of her cocoon. “Push.”
She shook her head. Her ponderous belly swayed from side to side as well.
“Please,” I told her. “Your baby will get sick.” I didn’t want to tell her that it was already sick.
“Get it out so you can get my baby,” called Bastard.
My shoulders tensed, but I ignored him. He could shoot us, or not shoot us, but right now, I had a job to do.
I needed Manouchka to help me, though. Why was she so out of it? When I first met her with June, she’d been tired and pushing, but alert. Was she shocked by the bloodshed, or could it be something else?
Like eclampsia?
I’ve seen pre-eclampsia, which is not only high blood pressure in pregnancy, but evidence of kidney impairment (swollen hands and eyes, protein in the urine). But full-blown eclampsia is a medical emergency because the woman starts seizing. Plus, I seemed to remember that eclampsia was more common in black women.
Holy fucking shit.
CHAPTER 18
What if she started seizing with a baby on its way out, on all fours, in the bathroom?
I knew the treatment was magnesium, but it wasn’t something we kept tucked in a corner of a room just in case. I’d have to order it. Someone would have to bring it to our room, Bastard would have to allow it through the door, and we’d have to load it in a syringe.
Manouchka didn’t even have an intravenous lock. It’s part of our “look, we’re family-friendly, just like midwives” policy. Normal childbirths don’t require IV’s. Too bad her birth had done a 180.
I’d already seen Tucker insert IV’s like a champ, but did we have any saline locks or IV bags and poles in the room? Probably not.
Focus, Hope.
I squinched my eyes shut and shook off the doubts. She wasn’t seizing yet. I didn’t see any signs of high blood pressure, if only because she wasn’t wearing a BP cuff. If she seized, Tucker and I would deal with it. But until then, get the baby out.
“Manouchka!” I snapped, before I consciously gentled my voice. “Listen to me. Push your baby out. Now.”
She shook her head and lowered her head toward the ground. But at least that meant that, if I wedged myself with my bum practically inside the broken shower stall, her hind end was relatively front a
nd centre for me for what I assumed was her next contraction.
I started massaging her perineum, that skin between the vagina and rectum. One of the obstetricians was very into that. He said that it reduced tears. The one woman I massaged with him didn’t tear, so maybe it worked, but what I really wanted was to bring Manouchka’s attention back to her baby through the power of touch. Even with my limited experience, I was pretty sure that with a few good pushes, she could get this babe out.
I used my lubricated fingers to stretch her vaginal opening, drawing the elastic skin toward me, moving from 2 o’clock to 10 o’clock and back again.
Manouchka tried to inch away from me, but I said, “Please! Your baby’s coming!” I could see the infant’s creamy brown skin now, surging toward the air, and maybe even a little bit of hair, under the harsh fluorescent light, although her body cast a shadow. “Poussez! Poussez, poussez, poussez!”
She gave a mighty effort that pushed her bum toward me, but then she sagged forward. Her contraction was over.
I bent over her head. “You’re so close,” I told her quietly, intimately, as if were just the two of us. No men, no gun. I was trying to recreate the spell she’d woven with June. “Your baby wants to see you. I could see the hair.”
Her head perked up. She could hear me. I was getting through.
“Your baby wants to come out now. I want you to try as hard as you can on your next contraction. I know you’re tired, but if you can just get your baby out, I can help it breathe.”
“And then he’ll kill it!” she shouted.
Even if Bastard didn’t understand French, her tone was clear.
She was right. I tried to keep my voice steady. “Yes. Maybe. But he might kill us either way. Your baby...needs more oxygen.” It was hard to explain meconium without getting too technical. “I can help your baby once it comes out. Can you push?”
She shook her head, but the next contraction hit. She lowered her head and started to pant while I massaged her perineum again. And then I remembered one other thing.
I called to Tucker, “Turn the incubator on.” I’d forgotten to do that, with all the excitement.
