Birth R

She came in laughing, almost dancing around the IV pole she pushed while walking the floor, trying to encourage her cervix to open with gravity. She was able to walk herself right into labor, given a full floor and distracted Residents and Attendings. I was laughing along with her.Then, in active labor, she wasn't laughing anymore. I encouraged her, told her how great she was doing, and that the process would be moving quickly from here on out. We reviewed all of her options for pain medication, and how soon she would not be able to have the one in her IV because the baby was close. She declined.I waited outside the room, knowing that she was in the zone with her support people. One of the Residents returned to the floor, looked at the "board," and saw that my patient's bag of water was still in intact. She then proceeded to berate me in front of the other Residents and medical students about how breaking the bag is a form of induction, how busy the floor was, and how slow my patient was taking. I told her that I was not going to manage my patient's labor based on other patients' progress, and that she knew nothing about how she was progressing beyond what was written on the board. She left, speaking badly about midwives the whole way out.Minutes later, yelling came from my patient's room. She wanted the pain medication. I checked her cervix, and the baby was moments away. She was mad at me, and I worked to redirect that energy into moving with her body and using her contractions. There was a firm bag holding the baby in place, and before I could even get the words out, mom asked me to break the bag.The baby came easily, with a cord looped once around a limb, and went straight to mom's arms. The Family Practice Resident working with me, having heard my whispered command to her to delay cord clamping at a birth earlier that morning, turned and looked back at me and said, "I know you want me to wait." I responded, "The baby wants you to wait. We'll talk about it later." Two medical students were behind us, observing. One of them excitedly came up to the Family Practice Resident and asked, "Are you doing delayed cord clamping? That's so great! I've never seen anyone do that here!"I commended the mom on her work. She was still mad, and told me so. I talked her through how difficult it can be when the process moves quickly, how when it hurts the most that is when the baby is about to come, and how fantastic her baby looked. I told her she did a fantastic job.I took a deep breath, and walked back onto the floor.Birth.