“Sometimes You Have to Just Walk Away…”

There is a particular statement that I have heard on Labor & Delivery units — not just on one, but on every single unit where I’ve attended women’s births. I have heard it from nurses, I have heard it from OBs and anesthesiologists, I’ve even heard it from midwives.

What happens before the statement is made is that a woman is laboring. She is in pain, and she is doing something to express that pain: perhaps she is calling to her family members for help; perhaps she is unable to keep still in the bed, causing the fetal heart monitor to fall off. Perhaps she is saying over and over that she can’t get comfortable, or begging to be allowed up out of bed to walk, although she will not be allowed to because of her epidural. She may be asking why she is still in pain despite the fact that she had an epidural. She may be loudly vocalizing her contractions — she may be screaming as they occur. Perhaps she has been doing some combination of these things for hours.

The nurse has wandered in and out of the room and said that the woman can’t possibly be in that much pain at only 4 centimeters dilated. The anesthesiologist has been called in and swears that the epidural is in correctly and that the woman is just feeling pressure, not pain. The midwife, shame on her, has stood three feet from the woman’s bed and said that she can ask the anesthesiologist to replace the epidural catheter, if that’s what the woman would like.

Everyone clears out into the hallway, leaving the woman alone in her room. And then someone turns and says to me, the student, as if offering some great wisdom: “Sometimes you have to just walk away and then she’ll calm down.”

I am recording this here because this statement should never become normal or acceptable to me, no matter how nonchalantly it is said, no matter how reasonably intentioned the person who says it. Bear in mind that I don’t mean a situation where a woman asks for privacy to labor (privacy being something that she will never get in a hospital), but rather one in which the clinician judges that the woman would be better off by herself.

The assumption behind this statement is, first and foremost, that the woman will essentially be alone in her labor. There is no expectation that she should be continuously supported throughout labor (as has been shown over and over again in research to lead to the best outcomes), no expectation that one should do anything other than spend a few minutes at a time dealing with her.

This statement also represents the feeling that a woman asking for help in labor is, after a certain point, just a complaining, attention-seeking, pain in the ass. Her pain, discomfort, or distress isn’t real — especially if you already gave her medication. She’s just being melodramatic, and what she really needs is for you to ignore her a little bit so that she can spend some time alone in her room. Like a child. You acknowledge that the woman is having anxiety and frustration — and your reaction is to walk out.

I have recently had the realization that the people who make this statement are also fundamentally ignorant — despite being professionally involved with women giving birth, they have almost no idea how to comfort them, calm them, and make them feel cared for. It’s not exactly their fault; most clinicians have lots of patients and are taught to use very few tools to relieve suffering apart from epidural anesthesia. Nevertheless, it is galling to see that this is apparently good enough for them, and that they consider it natural not just for women to be in pain in labor, but to suffer deeply as well. (The difference between these things is a topic for another time, but sufficed to say that they do not have to go hand in hand.)

Finally, this statement begs an obvious question: If you’ve left the room entirely, returning only hours later or when she shouts loudly that she is going to push the baby out right now so you’d better get in here, how on earth would you know if you helped her to calm down?! You left her alone, you fool — you have no idea whether she is curled up in a knot of suffering, or whether she’s actually glad to be rid of your ham-fisted, anxiety-provoking presence.

I know that there are some future midwives reading this post, so my reminder to all of us is this: the next time you hear someone offer you this particular “wisdom”,  remember that a gentle hand, a low voice, and a calm, steady presence can be the difference between a happy, healthy birth and a violent, traumatic one. Go back into the room and stay with her.

6 thoughts on ““Sometimes You Have to Just Walk Away…”

  1. Hell yeah. This is why I hired a doula for my last two births. This way, I am guaranteed someone will hold my hand the whole time. Which is what I want when I am in labor.

  2. no reason why you have to “walk away”. Labor can last only so long and it shouldn’t be a hardship for someone to stay with a mother in labor. That is crazy. My 4 were all easy births but even though I didn’t make a fuss, it is a woman’s right to holler as loud as any man would……………..If she can bear it, someone should be able to listen to it.

  3. I sent this to a neonatal nurse friend. Here was her reply:

    This is so very wise! And it applies across all ages and all sexes. I highlighted what I think is the nut of the matter: Ignorance.

    I think it may be true, as a doctor or a midwife, or a parent, or a teacher, that sometimes you have to walk away –if you’re on the verge of behaving in a way that you should not do. In such a case, walk away, but send someone in so the person in pain is not alone!

    When I was in labor with Lucia, I pushed for a long, long time (and ended up with a C-section). I had an epidural, and it was helping a LOT. My nurse was even more helpful–she was someone I had worked with, and she was a midwife in Africa before she came here and had to start all over again. She was calm, quiet, and held some pressure against my perineum when I pushed. I could feel that, despite the epidural, and it helped to keep me focused on where the pushing energy had to go.

    I don’t know why doctors and such aren’t taught about those quiet, caring, essentially human things to do to help patients in pain. Or, maybe the subject is just breezed through in 10 minutes early on in the course. I dunno.

    Thanks for sharing this.

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