Presence

The phrase, “at one ment” to me means completely living in the present, living moment to moment and making the most of every single one. Being completely authentically present with yourself and others in every moment of everyday. One analogy I have for this is that of being in labor. I am hoping to have an intervention free labor with this baby and have been reading in preparation of doing so. One of the books I find especially inspiring is, “Birthing from Within” by Pam England and Rob Horowitz. In it they say, “…mothers aren’t at their births, they’re in their births: they’re in labor, in a trance, in their body, in pain, in joy! (pg. 50)” When you’re in labor the pain is unlike that of anything else and yet women do it, without the interference of medications and epidurals, every single day. The medical model teaches pregnant women about the phases and stages of labor from a medical perspective. The hospital birthing classes encourage mother’s to bring pillows and spend a little time on certain breathing techniques while the woman is comfortably snuggled up to her significant other relaxing on her pillow. Does anyone really think those relaxing moments spent in birth class will prepare a woman for the pain of childbirth? No way! Although, without anyone to tell her any different, the woman believes these are the tools that will help her bring her baby into the world. I know this because I believed it too. With my first son I took the labor classes and felt like I knew what to expect in labor, I held the ice cube and used the breathing techniques that they recommended and thought I had a pretty good understanding of how to ‘do it’. I also knew the medical interventions were just around the corner and were there for me to use if the pain was too great. I thought I had a pretty high pain tolerance so I wasn’t too worried. I also felt the medication would be safe (after spending more time dedicated to the procedure of an epidural than that of a water birth) I felt completely educated on the process and effects of medication in childbirth. However my son’s birth was a completely different story.


My water broke at 7pm, I was 40 weeks and 4 days pregnant and more than excited to get the party started (so to speak). I knew they wouldn’t let me eat once I was admitted to the hospital and with the excitement of my water breaking and getting the bags in the car I completely forgot to eat. By the time we arrived at the hospital I was ravenous. I quickly shoved a couple cookies in my mouth and headed, happily into the hospital. When I got there they explained that they had to check to make sure my water had broken. This check was performed with my hips awkwardly on a bed pan and no lubrication (because it would skew the results of the amniotic fluid testing). It was incredibly painful. I laid there, feeling completely exposed with searing pain as the resident shoved a speculum inside of me. Tears poured down my face as my husband looked on helplessly. Why didn’t they trust my account that my water had broken? Why did they need to subject me to this painful testing? No one had warned me about that in birth class.

Once it was confirmed that my water had indeed broken they started pitocin. I was contracting regularly but my progress was deemed insufficient for the hospital’s timeline and the medication was initiated. The contractions were like nothing I’ve ever experienced before but I was coping. The nurses continuously offered pain medication. While I was tolerating the pain thus far I thought to myself…if they want me to have it so badly they must think I’m not tolerating it well enough or the pain is going to become completely unbearable and they don’t think I’ll be able to handle it…I better take the drugs.

They gave me a medication called stadol. At first I was completely giddy, giggling and laughing. I completely lost all grip on reality, I didn’t know where I was or what I was doing. Then, suddenly, out of nowhere a contraction would come, a raging, tearing, pitocin contraction would rip right through my body. I was so out of touch, not even remembering I was in labor that the pain would completely blindside me. At one point I remember being on all fours on the floor near the foot of my bed. I was retching and throwing up and the pain literally felt like it was tearing me in half. At that moment I looked up into my husband’s scared eyes and told him that I was dying. I was completely convinced that this pain could only mean one thing and I was dying. It was absolutely terrifying. There was no nurse in sight.

Finally my husband begged the nurse for an epidural and before I knew it I was sitting on the edge of my bed. The contractions were ripping through my body yet the anesthesiologist told me to be still, be quiet and shoved my shoulders into a hunched position. My enlarged uterus made it nearly impossible to breathe and yet he was shoving my body over top of it leaving very little room for air exchange. The haze of the stadol was fading however now I felt like I was suffocating, unable to catch my breath because of the awkward position I was being forced into. He paid no attention to the monitor, did not look to see if I was contracting or not, just expected me to sit there quietly and hold my breath until he was done. He shoved the long needle into my back, I winced in pain, he pulled it out and without warning shoved it in again in a different spot. After several attempts he threw the entire tray and began to yell at me for not telling him that my spinal anatomy wasn’t ‘normal’ (something I’ve never been told in my life). Finally he placed the epidural but it was quickly discovered it wasn’t placed correctly, my left side was completely numb but my right side felt everything. The pain of the contraction was no longer distributed over my entire uterus but was concentrated into one small area on the right side of my body. It was horrible. Finally after several more painful adjustments the epidural left me completely paralyzed from the chest down. This was frightening in its own way; I remember laying there in the dark desperately wanting to turn over but being unable to even reach the call light. I wondered if I would stay this way forever.

Finally the doctor checked my cervix and told me I was completely dilated, it was time to push. I had no idea how to do it, I couldn’t feel a thing. I was worried my baby would never come out. At one point she rolled her eyes and asked the nurse to call her husband (from my bedside phone). The nurse dialed the number and said, “What would you like me to tell him?” The doctor said, in a completely frustrated and annoyed tone of voice, “Tell him I am stuck in the middle of a delivery and will be late getting home today.” This made me feel even worse. I pushed even harder, unaware of the sensations in my own body but trying desperately to please the doctor who had become so despondent with my progress. Then suddenly my door burst open, several medical students ushered into my room (without any consent from me), all with a view of my exposed perineum. One of them looked at me and said, “Cool! You’re having a baby!” and gave me a thumbs up. It was humiliating and only made me want to cover up, roll over and disappear.

Finally my son was born. He was very quiet, barely made a sound. He was pink at first but quickly became blue. His oxygen saturation was dropping. Within a half an hour he was rushed to the NICU. I laid in my hospital bed that night feeling as though I had failed. I failed myself, with my poor pain tolerance and weakness by needing pain medication and I failed my brand new baby boy. I could hear the newborns crying in the rooms next door and felt completely empty inside. My birth class didn’t prepare me for any of this.

How I wish someone would have told me labor and birth is hard work! It is painful but you can do it! I would have relished in that encouragement from the medical staff. I wish someone would have told me that there are side effects on the baby when systemic, opiod medications are used. I wish someone would have encouraged me to trust my body, to trust that it will tell me how to breathe and what positions are best to get the baby out safely. I wish someone would have told me to be present in my labor to take it one contraction at a time, one moment at a time. That is what at one ment means to me, to be completely present in the moment to make the most out of each breath and to trust your body, your soul, your consciousness.

I am hoping to translate this into my daily interactions. I like to tease that women are the best multi-taskers and maybe we are! But the truth of the matter is if we want to do something really well we need to completely focus on that task. I want my focus to be presence. There is such a difference between feeling like someone is really being present with you and when they're not. When I am talking to someone I can feel is distracted I find myself cutting it short, not even telling them what I truly want to because I can sense they're not listening to me anyhow. I want my patients (and peers! and family! and friends!) to feel as though I am completely listening to them, to offer them the opportunity to truly be heard. Who knows, maybe we unintentionally make patients feel this way so they cut their own conversation short and leave out important details regarding how they're feeling or new symptoms they've noticed because they get the sense we don't really care to hear them. Being authentically present with someone is more than just a touchy-feely idea it could be a critical tool in our assessment.