Baby Business

Shortly after the clock strikes 8 p.m. on a chilled Friday night, the doors of an elevator open up to the fourth floor of Forsyth Medical Center. A young man aides a shrieking woman who’s stagger stepping her way from the elevator to an approaching wheel chair. The nursing staff at the desk greets the young man with a calm voice and simple inquiries.

“Good evening, sir. Would you mind filling this out for her?” The nurse slides a form across the desk as she picks up the phone to ring either a resident physician or another nurse.

The woman’s belly is testing the stretchlimits of the shirt covering it. Her ached gait is the summation of nine months of carrying, feeding, and comforting a child, or in this case, two children, inside of her. Her moans accompany contractions, which are becoming dangerously close. Before she leaves the desk area, it’s agreed that she needs to be rushed to triage because she’s about to give birth.

The nurses act as if this is completely normal, mostly because it is.

In the time it takes me to get acquainted with the handful of nurses and doctors that make up the night shift, the woman I watched exit the elevator was preparing for delivery. Dr. Stuart Winkler, 29, a fourth-year resident obstetrician-gynecologist who will be finishing his residency this coming July, introduced himself at the front desk. He was just told of the woman recently admitted, and who, as it turns out, is already eight centimeters dilated, which means go time for Dr. Winkler.

This is another night at Forsyth Medical Center’s Labor and Delivery ward, which also happens to be the second busiest labor and delivery facility in the state of North Carolina. As of this writing, the tally is over 6,150 babies delivered this year, and that number is expected to top 6,170 given the 12-18 babies-delivered-per-day averages.

The sight of a pregnant woman exiting the elevator on the fourth floor at Novant Health Forsyth Medical Center equates to a customer entering any retail establishment on any given day. The men and women at Forsyth Medical Center who bear witness to this event are all too familiar with the image, but the feeling of excitement is always the same.

“There is nothing in the medical field comparable to delivering a baby,” Dr. Joseph Stringfellow said. At 29, Dr. Stringfellow is in his third year of residency at Forsyth Medical Center after having graduated from the School of Medicine at the University of Virginia. “To be involved at that stage of life is such a momentous occasion for everyone involved.”

The momentous occasion of bringing life into this world has a balance, though, and one that is difficult for many of the nurses to talk about.

“My favorite part seems weird, but most people think labor and delivery is all smiles and giggles. It’s not a perfect world. We do have outcomes that are not so good,” said Deborah Bryant, a 24-year veteran of nursing with 18 of those years spent in the labor and delivery ward at Forsyth Medical Center. “That keeps me doing what I’m doing – moms who lose their babies. They have a special place in my heart, and I remember every single one I take care of.”

There are a lot of misconceptions associated with pregnancy, ones that Dr. Stringfellow partially blames on the fascination with pregnancy thanks to television.

“A common misconception is that labor is – no one expects it to be easy – but I think a lot of people expect it to be quick. A lot of times it can take hours, up to days, to complete labor, but I think of course that’s what films and television shows do – glamorize it,” he said.

Dr. Stringfellow never imagined himself working in labor and delivery, even admitting that it was the furthest thing from his mind.

“I have public health interests, so I liked the idea of the being able to disrupt the vertical transition of poverty and poor health, and taking that idea and being able to optimize the health of women and children.” Dr. Stringfellow guesses that he’s delivered anywhere from 350-400 children since his time at Forsyth Medical Center.

After speaking with some of the staff I inquired about meeting with expecting mothers, or even recent mothers. I was escorted by a nurse down to the mother-baby floor where new mothers were resting with family, feeding their newborn, and recuperating after labor.

I met Emily and Josh Addington, 28 and 31 respectively, who just gave birth to their third child.

“We are both real tired. I think you are always tired and you are excited and you run off a lot of adrenaline,” Emily tells me. We were speaking early on a Tuesday morning, and their son, Enoch, was born less than 48 hours prior.

Although admittedly tired, Emily and Josh were both glowing with pride. Emily proceeded to explain that this time (her third child) was the first time she had to be induced due to the potential complications with a preexisting medical condition. Everything went smoothly for the parents, and baby Enoch was delivered without any troubles.

“They let daddy cut the cord. They let you hold him close to your chest. I’ve always tried to breast feed within the first hour. The staff – pretty much anything you want to do, they let you do it,” Emily said.

Now, one of the most important things to happen after the delivery is getting the baby onto the mother’s chest as quickly as possible.

“It’s the idea that the bonding between mother and child is facilitated with close contact as soon as possible after delivery,” Dr. Stringfellow said. “It used to be to take the child off after delivery and put him/her behind the glass window. We are turning that on it’s head and getting it to the parent as fast as possible.”

Emily echoed these sentiments, but with the emotional connection that only a new mother would be able to communicate. “When he’s born, they put him right on your chest, even while they do everything with the cord stuff… he’s close to your face, and you get to see your baby. I’ve always cried,” she said.

That change in the way of thinking is being applied in other ways at Forsyth Medical Center.

One of the other changes is the forthcoming implementation of Novant Health Mid-Wifery Associates, set to start in February of 2015. The intended goal is have five certified nurse midwives only doing deliveries at Women’s Center of Forsyth. The midwives will be directly supported by Novant Health OB/GYN services.

For Leigh Anne Smith, a current RN at Forsyth Medical Center, this presents a welcomed opportunity. Smith, 31, is currently enrolled in school to become a nurse practitioner, and wants to focus specifically on midwifery as she continues her education.

Smith also emphasized the point about midwifery and the mindset often associated with a less medical-heavy birthing procedure.

“We definitely can help them achieve that, and we are doing a lot better trying not to be so medical. We do what we can to give them what they need,” Smith said.

But in the cases where a mother is coming in expecting to have a pain-free birth, a misconception that Smith emphasized was brought on thanks to television channels like TLC, she said she understands, but every person’s body is different.

“I am the advocate for the patient, for the mother. (My job is) to figure out what she needs to get her through the process,” she added.

I asked the nurses what a regular day is like working on the labor and delivery floor, and each had a similar reply.

“There is no such thing as a typical shift. It’s one of the things about working in a high-risk facility. You never know what you’re gonna get; could be a normal laboring patient with first baby; or a sick patient who is on her fifth child,” Bryant said.

With that in mind, the young mother who I watched come out of the elevator had just successfully given birth to twins, although complications required Dr. Winkler to perform a cesarean section.

“Things are very dynamic and it changes from minute to minute, which is one of the things I love about my job,” Dr. Winkler said, sweat still beading on his forehead from the c-section in the other room.

It’s also one of the reasons labor and delivery nurses love what they do. The constant change of pace, coupled with the roller coaster emotions of bringing life into this world, as well as dealing with loss, are the things that keep them coming back day after day. !