Arne Vainio: I was in the middle of a dream when I got the call...

Friday, February 9, 2018

I was in the middle of a dream…

By Arne Vainio, M.D.

I was in the middle of a dream and I was walking behind an elder through tall trees. I couldn’t tell who it was and I could see a stream in the distance. I knew he would turn to face me when we got to the stream and…

My pager went off and it was the labor and delivery floor. I called and talked to the nurse. An eighteen year old girl came in with her boyfriend and her mom. She was due in a week and she’d been contracting for several hours and her contractions were getting stronger. This was her first baby and she was uncertain how this would go.

I got dressed and wet my hands under the running water in the bathroom sink and I smoothed out the hair that was sticking up and I grabbed my jacket and headed for the hospital. It was well below zero and at three AM the stars were bright and Orion seemed close. The heater in my car didn’t get warm for a few miles and my breath fogged the windshield. I thought about turning on the radio, but I was still thinking about the elder in my dream and I wanted silence and I wanted to be alone in the starry night. I took some traditional tobacco from my pocket and rolled my window down enough to put my hand out and the icy wind took my asemaa as I was wishing everything to go well.

I got to the hospital and reviewed her chart. Her pregnancy was uncomplicated and her vital signs looked good and I went in and introduced myself. Her mother and her boyfriend were quiet, but they were listening to me. She denied any illnesses or concerns other than her labor and I explained to them how her delivery would be expected to go. She was in a good contraction pattern and the baby’s heart tones looked good on the monitor. She wanted her mother and her boyfriend present when I checked her cervix and she was at 5 centimeters with a bulging bag and I could feel the baby’s head through the amniotic sac.

I explained what I was going to do and I took a small plastic hook and tore a small opening in the sac and clear fluid came out. I explained to them that her contractions would become stronger as the fluid leaking out allowed the baby to drop and as the baby’s head started pushing on her cervix. She did not want an epidural and her boyfriend and her mother were on either side of her holding her hands and she squeezed their hands hard with her contractions.

She made good progress and over the next few hours and I could tell her contractions were stronger. She wanted to deliver as naturally as possible and finally went to completely dilated. I could feel the baby’s head and couldn’t feel any of her cervix and her nurse and I had her start pushing. I let them know this part could take up to two hours with a first delivery. Between contractions, I told her that I would have her stop pushing when the baby’s head came out so I could check for the umbilical cord to make sure it wasn’t wrapped around the baby’s neck and that we would leave the cord in place without cutting it for a short time.

I told her boyfriend and her mother about what happens as soon as a baby is born. Before birth, there is just enough blood flow going to the lungs to keep that tissue alive. As soon as he or she takes that first breath, there is an opening in the heart called the foramen ovale that has to close and a blood vessel called the ductus arteriosus that starts to squeeze closed and those things force the blood in the heart to go through the lungs to pick up oxygen.

Most of this happens in ten minutes or so and is part of the magic of birth. By feeling the pulse in the umbilical cord stump, this process could be followed and that pulse would get weaker and weaker, then go away once the umbilical cord wasn’t needed anymore. I looked directly at the boyfriend. They didn’t know if this was a boy or a girl and when she had an ultrasound midway through her pregnancy they wanted that kept secret from them.

“If this is a boy, your son, he is going to want to be exactly like you. He will be watching you and he will do what you do. If you’re good to people, he will be good to people. If you smoke or drink or use drugs, he will want to do those things. This is your chance to change if you need to and your life isn’t just about you anymore. How you treat women is the way he will treat women. I have seen countless deliveries, but you and I will never know what it’s like to bring a new life into this world. Only women can do that and we need to acknowledge and respect that.

If this is a girl, she will look to you to see how she will be treated and how she will expect society to treat her. She can be a scientist or a teacher or a doctor or a leader and how she sees you treat women will influence that. Either way, you have an important responsibility and you need to take it seriously.”

The delivery went well and there were no complications. We put the baby to her mother’s chest and I had the boyfriend cut the cord after a minute. I had him and the grandmother feel the pulse in the cord stump and had them feel it several times over the next ten minutes as it became fainter and fainter, then it was gone. Both of them had tears in their eyes as they followed that transition. The placenta delivered in about twenty minutes and I showed them the umbilical cord and the side that was against the womb and the sac where the baby was. She didn’t have any tears in her birth canal or her cervix as I completed her exam.

The golden hour is that first hour of a baby’s life where bonding is first started and this should be the baby and parents only. Her nurse stayed to help her start breastfeeding and to keep an eye on things as the grandmother and I were leaving the room.

The boyfriend was holding his daughter and they were looking into each other’s eyes and he was crying. He looked up at me and I told him, “Congratulations. You aren’t a boyfriend any more. You’re a father. That little girl is why you were put here. You need to read to her and sing to her and protect her and you need to help her find her path and realize her potential.” He nodded to me and reached out and shook my hand.

I finished my chart work and as I was leaving, the grandmother came out of the waiting room. “Dr. Vainio, I had five babies and I never once saw the placenta or knew what it did. Thank you for everything.” She put some tobacco in my hand and she pressed my hand closed.

The sun was up when I walked out of the hospital. It was still cold and I drove past tall trees on the way home. I opened my window and let the wind take the tobacco. I thought about my dream earlier and wondered what the elder was trying to tell me. The sun was shining bright and the winter sky was purple and blue.

Orion was no longer visible, but I knew just because I couldn’t see it didn’t mean it wasn’t there.

Arne Vainio, M.D. is an enrolled member of the Mille Lacs Band of Ojibwe and is a family practice physician on the Fond du Lac reservation in Cloquet, Minnesota. He can be contacted at a-vainio@hotmail.com.