Elizabeth

competent care. My role has always been clearly defined in the hospital setting, but here in the jungle, what could I do to help Elizabeth have a safe and supported delivery? I decided I would let Elizabeth guide me. Elizabeth, stoic, with beads of perspiration on her forehead, not making any sounds, and with dark fluid running down her legs, was guided into our makeshift clinic hut. Helping her to get as comfortable as one can be on a mud floor, I examined her. I was impressed by her calm demeanor. Culturally, African women silently endure. Elizabeth had learned well by observing the women of her village. Because she was 9 cm, vertex, and had thick meconium in her amniotic fluid, the team began setting up for Elizabeth’s delivery. As I watched people scurrying around to prepare for delivery, I saw the village women peering into the window-like openings within the hut’s clay walls. All the women were quiet, and unknown to me, waiting to assist once we were finished with the delivery. I watched Elizabeth gently sway from side to side with each contraction. Quietly she moved with the forces of labor and to the night sounds of the African jungle. I watched in awe as her uterus tightened and observed her second stage unfolding. With each contraction, Elizabeth’s uterus was nudging her baby down. Elizabeth remained quiet and rested between each event. I didn’t need to intervene. Elizabeth was in control of her birth; I was just an observer. I began strategizing in my mind a plan of care, should something happen outside of the normal process. As a fetal monitoring expert and educator, I struggled with the realities of not knowing what the baby’s heart rate was doing, especially in the presence of thick meconium. I found comfort in my knowledge and experience and simply asked Elizabeth, through an interpreter, when she had last felt the baby move. I was reassured that recent movement meant the hope of vigor at birth. Anxious to know how close to delivery we were, we examined Elizabeth and found her to be completely dilated with the vertex at +3. Elizabeth didn’t need me to tell her to push; she did so with each powerful dictate of her

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uterus. She pushed side-lying, always moving, yet still never making a sound. The anticipation of delivery was all encompassing to me. In my mind, I was rehearsing the delivery maneuvers that I had been witness to for all those years. I, like Elizabeth, had learned well from the medical and nursing mentors in my work environment. I waited, watched and prayed. Elizabeth’s son delivered without complication and without injury to his mother’s perineum. Elizabeth had controlled his coming with the tender patience of a mother and with such ease! Once delivered, the waiting women in the village came in, took the baby and cleaned and dressed him while celebrating his coming. Elizabeth remained quiet. She completed her work by delivering an intact placenta. The baby was placed at her breast to control the bleeding and she breastfed him with a natural competence. I learned a lot about being a labor support person from Elizabeth. My many years of exposure to prepared childbirth experiences and family-centered care paled in comparison to this jungle experience. Elizabeth came to us, who the villagers called the “American doctors.” Women come to us here in the United States. The differences between Elizabeth and American women delivering in hospitals are many. Elizabeth delivered in her way with health care workers as observing participants and the women of the village as supportive caregivers. In every childbirth experience, whether it be the structured environment of an American facility or in a mud hut in the heart of the African jungle, women want to be safe and want their babies to deliver safely. From this experience, I learned to wait and watch more; to listen when words are not spoken; to stay back or step forward at the mother’s discretion; and I learned the importance of “others” being present at this momentous event. Women, Elizabeth taught me, know what they want and want the health care world to know what they want. It is their experience. We are just observers. NWH

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Elizabeth was in control of her birth; I was just an observer

Susan Coakley, RN, BSN, is a registered nurse CNIII at the Birth Place at Southern New Hampshire Medical Center in Nashua, NH. Address correspondence to: [email protected] DOI: 10.1111/j.1751-486X.2009.01387.x

©©2009, 2009, AWHONN AWHONN

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a author bio

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Elizabeth Susan Coakley, RN, BSN

After trekking barefoot for more than 6 hours through the jungle of Cameroon, West Africa, 16-year-old Elizabeth arrived at our village hut without fanfare, and in labor. The black African night, hiding everything but this young girl and her very pregnant thin frame, illuminated by a small flashlight, reminded me that I was not in the Birth Place at Southern New Hampshire Medical Center (SNHMC). Elizabeth stood alone, wide-eyed and expressionless, outside my village hut. As a first-time short-term medical missionary nurse, I was immediately humbled by both my surroundings and this young woman who needed help.

Nursing © 2009, for AWHONN Women’s Health

Twenty-five plus years of inpatient obstetrics had prepared me well as a labor and delivery nurse. I was certainly qualified to care for Elizabeth, but the immensity of caring for her and the baby without the usual support staff of trained professionals created a sense of incompetence to which I was not accustomed. I would soon learn that this experience would forever change my thoughts on family-centered care. Much like the women who come to SNHMC, Elizabeth came to us. Women come to the place where professionals offer safe and

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