I stand at the hospital bedside of a 15-year-old child, shepherding her through her first labor. Blood pressure high, ankles swollen. An automatic blood pressure cuff squeezes her left arm every 15 minutes. Intravenous tubing penetrates a vein in her right arm and delivers a ration of fluid that neither quenches thirst nor relieves hunger. A catheter leads from her bladder to drain urine. Yet another catheter invades her uterus to monitor the pulse of life. Sleep tries to rescue the girl but the rhythmic unrelenting forces of her body hold rescue at bay.
Eyes too experienced look up at me and a voice too innocent murmurs, "It's hurting!" As if this were the first wave of pain and no other would follow. This expectant mother lacked the advantage of preparation in any form for childbirth: no classes, no books, no websites. She has little or no concept of what is taking place in her body. The waves will persist until her baby is born.
The hours pass as I rub her back, slip chips of ice into her dry mouth, prop pillows for support. Frequent position changes of her choice allow a sense of being in command: side to side, hands and knees, sitting up. I speak quiet words of encouragement. Her mother observes how I place cool washcloths on her daughter's forehead and Vaseline on her lips; she takes over these jobs to comfort her daughter. Now, two of us repeating simple comforting actions that also impart a needed sense of time passing. Actions that speak of humanness, caring, and calm.
My feet do not hurt, and my back does not ache. It is my head that throbs with images during the lulls between contractions. Images of young women with spotty access to prenatal care, family planning education, and other medical services. Images of infants born full of promise to children barely past the age of the eruption of their second molars. Images of new mothers with anxious faces who need more from babies' daddies than gifts of baby clothes and balloons.
Who and where is my patient's baby's daddy? My wish is that he will be like last week's father of twins, presenting his babies' mother with a small vase of two flowers and two cards: "It's a boy." "It's a girl." Each card containing a handwritten note of caring, the young man feeling like a king for a day. But I worry. Who will nurture and protect all new babies' daddies so they can be kings for all their days of fatherhood?
Her eyes search mine again as she whispers, "It's hurting." We move again into our routine, nurse, daughter, mother. Now in sync like the best of teams. The girl's hand finds mine and I rub her arm lightly, rhythmically. The wave rushes, peaks, and ebbs. She finds the strength for humor, laughing about wanting her face covered with a cool washcloth. She shows flickers of bravery when she says, "I think I can do this!" The shepherding keeps her from being lost in the intensity of labor. Is there a kind of shepherding that could have prevented her from being here today? That would have had her at this very moment in her classroom chair at school?
Where is the anesthesia to block the pain? Appearing to have absorbed information quietly offered over the hours, daughter and mother steadily gather a sense of control and ask for more time to decide which anesthetic and when. Anesthesia could indeed block the pain. Yet it cannot block the concern over a newborn going home with this girl, both under the care of her mother, an intermittent user of illegal drugs. A newborn thrust into life without a shepherd? Without nurture? Without hope? Without all the health-related services it will need?
Twelve important words never leave my mind: "Mother the woman during labor so she can better mother her newborn." This I gladly do. "It's hurting," she says. Another wave. Her hand finds mine. Position change. I rub her back. I will remember her 15 years of courage.
The images in my head return. It's hurting. The future is hurting. I alone cannot stop the pain.