Messy birth

Someone asked me once how I can stand to be around birth all the time, with all its sights and smells and liquids and mess. I told this person that honestly, I very rarely notice it, and it doesn’t bother me, obviously, or else how could I continue to do this day in and day out? In fact, many of the sights and sounds and smells of labor are very encouraging, and when you see them happen, you know that things are going well. The unique, clean, slightly chlorinated smell of clear amniotic fluid, for example, when a woman’s water breaks (at least, it’s always smelled a little chlorinated to me, or maybe that’s just because amniotic fluid is a base, as is chlorine, and I’ve come to associate chlorine with a basic smell)…and how reassuring it is to smell that smell as opposed to the smell of meconium, or foul amniotic fluid that smells of infection. Or when a woman is pushing, how reassuring it is to see her push out a little bit of stool with every push—when you see that, you know that a woman is pushing effectively, and that before long, you’ll be seeing the baby’s head. When you’re watching a baby crowning, the last thing on your mind is the stool. Birth is messy, sure, but it’s so beautiful that you hardly notice the mess, if you even notice it at all.

Even so, some births are definitely messier than others, and I think I just had one of my all time messiest births last Friday. The woman was a multip giving birth to her second baby. She came to triage in active labor, already six centimeters, and things were moving right along for her. We got her into her room, and she spent another hour walking around while we monitored her baby intermittantly. After awhile, she sat down on the birth stool and began to push a little bit, but because she had had a partial third degree laceration with her last pregnancy, we moved her off of the stool and on to the bed, where the delivery could be more controlled and her perineum better protected this time around. She was fully dilated at 7:00 pm, and her bulging bag of waters spontaneously burst at 7:05 pm, and didn’t just burst, but BURST, with water spraying everywhere. We cleaned up as much of it as we could, but there was a lot of it, and more of it continued to flow out with every push. The baby moved down quickly after that and was crowning in no time at all, with the usual amount of stool involved, and we let the head crown slowly so that the perineum could stretch.  The baby was born at 7:20 pm, a gorgeous, squalling 8 lb. girl, which we put on the mother’s abdomen while we went about the rest of the delivery, collecting cord blood after the cord had stopped pulsing, then delivering the placenta, and finally doing the repair (she only had a 2nd degree this time around, which is not great, but at least an improvement over the 3rd degree she’d had last time, and the head had been well controlled and the laceration had occurred in the same line as the original tear). While all of this was going on, the baby decided to demonstrate to all of us that all of her organs were working and all of her orifices were patent, and proceeded to pee all over the mother and then pass a healthy meconium as well. By the time we were done with the repair, the mother and her sodden hospital gown were covered in every possible human body fluid: amniotic fluid, blood, sweat, urine and meconium, and it wasn’t just on the mother, but all over the bed as well….even dripping off the bed and down into the cracks. It was a very impressive mess.

Thankfully, the mother was too overjoyed and caught up with her baby to even notice, and we were quickly able to clean up her perineum, take off her gown, give her a clean one, swab her down, change the chux, and get her and her husband comfortably settled in with their new baby. Even so, she definitely still needed a thorough shower, the baby needed a bath, and my own scrubs needed to be changed as well. No one ever said birth was clean, but have you ever seen a more beautiful mess?

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