End Notes
Attitude
By Nancy Baker, M.D.
The call came at 3 a.m. “Nancy, I have a 14-year-old here in labor. She’s ruptured and 8 centimeters dilated. Fetal heart tones look good.”
“Fine, I’ll be there in 10 minutes.” As I drive through the black night, I am apprehensive. Will everything go all right?
After 25 years of delivering babies, I still feel some discomfort before each delivery. Fourteen-year-old girls, like most women, are strong and able to deliver their babies with minimal assistance. However, I’ve not met this young mother and don’t know how prepared she is for this heroic feat. There’s also the chance of something untoward happening. Though that’s unlikely, I rehearse emergency measures in my mind—just in case.
Then, I think of her age. Fourteen. What was I doing at 14?
I was doing reports about the nation’s presidents, writing poems about such things as vegetable steamers that looked like spaceships, and learning geometry. I was taking health class. I remember looking up from my notebook at the filmstrip to see an erect penis and saying to myself, “amazing.” From the corner of my eye, I saw others fidget and quickly look down as if they were taking notes. Mrs. Nelms didn’t miss a beat as she narrated, describing how an egg is fertilized. Conception. I had no idea.
As I rush into labor and delivery, the nurse in charge tells me the girl has just started to push. I change into scrubs, knock on the door, and walk in to see Angela hard at work. Her nurse is opening up the instrument packet on the table. The resident is putting on her gown and gloves.
Angela’s mother, sister, best friend, and aunt stand by the bedside. “1 … 2 … 3 … 4… 5…,” they count, in unison. “Push, Angela, push. Breathe quickly, and push again. Come on baby, come on. You can do it.”
I hear the fetal heart monitor beeping. The contraction ends, and they laugh as someone says, “We can see the baby’s hair.”
Angela looks tired but smiles as they lay a wet washcloth across her brow. “How much longer will it take?” she asks.
“Not long,” says the resident, “Would you like a mirror to see the baby’s head?”
She nods, looks, and is amazed. She had no idea.
I step back and consider my role in this age-old ritual of birthing. Seven women surround this young mother who is laboring. As Angela’s breathing becomes more rapid, as her anguish intensifies, her coaches and attendants seem to sway and chant in concert. The rhythm of our counting, the chorus of our voices becomes a kind of spiritual. We slowly move inward, closing the circle as if to protect, yet hasten, the birth process.
Between contractions, Angela’s eyelids flutter, and she moans softly. Momentarily, we are silent, waiting. As the baby moves closer, it feels as if we should shout, or pray. The resident gently touches Angela’s skin as it stretches around the infant’s head. Slowly, the brow, the nose, and the ears appear, and the head turns to the right. As the shoulders move downward, then up, a small cry can be heard amidst the gasps and panting.
“It’s a girl!”
Grandma cuts the cord. The tiny, wet, and wrinkled babe is suctioned, dried, and wrapped in a warm blanket. I chuckle when I see her tightly closed eyes and defiant, protuberant lower lip. Angela’s best friend cries out, “Oh Angela, has this baby got attitude!”
I walk from the room, complete the delivery summary, change out of scrubs, and return to my car in the early morning light. I’m joyful but apprehensive thinking about this new, young mother. Where is the baby’s father? Who will help Angela care for her infant? Will she return to school and graduate? Will she and her daughter live in poverty? Will her daughter’s attitude make them both strong? Will everything go all right? MM
Nancy Baker practices family medicine at Smiley’s Clinic in Minneapolis and is a clinical associate professor in the Department of Family Medicine and Community Health at the University of Minnesota.