Nearly noon on the 1st of May, I was about to head down from Mt. Sinai Hospital’s obstetrical floor to the basement for a typical hospital cafeteria lunch of starch, fat and sugar – the three basic food groups – when Maria’s call came. She’d just gone into labor.
The past two months Maria had been one of “my” mothers-to-be. Together we’d been preparing her for this day – she was to have her bettered kitchen table (where the home delivery would take place) covered with newspapers (not only sterile in themselves but they kept everything they touched germ-free), ready the requisite pads and linens, and provide a warm receptacle for the baby.
The world-renowned obstetrician then heading Mt. Sinai’s Department of Obstetrics had assumed that position well past retirement age. As I recall he was in his mid-80s when I (then a 23- year-old, fourth-year medical student) was rotating through my three-month obstetrical “clerkship”. Though Mt. Sinai’s obstetrical service was in most respects identical to that provided by every other teaching hospital / medical school, it was set well apart by our chief’s singular half-century practice and enduring conviction: wherever possible, childbirth ought not take place in a hospital but belonged in the safety of mother’s home.
She’d never need worry about “getting to the hospital in time” nor gamble that both she and her newborn will steer clear of the uncommonly lethal pathogens known to lurk exclusively in hospitals. After all, healthy babies had been born without a hitch well prior to the first stirrings of “civilization” and long before the emergence of hospitals and obstetricians. Even as recently as the first half of the 20th century, hospital deliveries were rare. A hospital was where you went if you were really sick; some thought them primarily a place you went to die. Back then almost all would agree that a hospital was an odd setting in which to usher in fresh new life.
But here in modern times our Chief was near-universally perceived as a medical Neanderthal with archaic notions that flew in the face of contemporary science. But check out any dispassionate statistical comparison of his Department’s incidence of maternal / newborn morbidity and mortality with that of conventional obstetrical services and it’s the critics who come up short. Our Chief’s practices might have been a vestige of the past but a priceless, life-preserving remnant supported overwhelmingly by the day-to-day clinical evidence. Consider:
Almost all babies delivered in the United States now take their first breath (and on occasion their last) in a hospital obstetrical unit, whereas in much of the rest of the world, home deliveries by midwives or even family members are still very much the norm. And while maternal mortality has been declining in almost every other nation where delivery in the home is standard practice, maternal mortality in the United States has increased sharply year by year. In 1989 our pregnancy-related fatalities were 9.9 per 100,000 live births. In 2018, three decades later, that number had risen to 17.4 deaths per 100,000 — keeping this supposedly scientifically-advanced “first world” nation dead last in the percentage of healthy deliveries.
There was certainly nothing 19th century about the prenatal preparation and postnatal care our Mt. Sinai patients received. And if – either because of fetus or maternal fragility – giving birth could be a “hazardous” rather than a routine act of nature, without hesitation delivery would immediately shift to the hospital where state-of-the-art emergency equipment was at the ready.
We were also alert to a host of possible medical adversities that might never have emerged but for the pregnancy – hypertension, intractable bleeding, stroke, preeclampsia and postpartum depression / psychoses. And finally, given that most of our home deliveries were performed in so- called “underprivileged” neighborhoods, we were especially conscious of the role race could play in obstetrical outcomes: e.g., black women in the United States are three times more likely than Caucasians to suffer a pregnancy-related death. Clearly, whether a home or hospital delivery, for our maternal population there was no room for error nor lapse of vigilance.
My patient, Maria, a late-20s, single mom, lived in a neighborhood dominated by Latinos of modest economic means. They took their Catholicism seriously, had numeroso children, and on the whole knew a great deal more about birthing than I did. My patients understood that I was almost but not quite yet a doctor, traditional black bag, stethoscope and starched “whites” notwithstanding. But my state-of-the-art “backup” assistance was much appreciated. In turn, I was privileged to rotate through OB/GYN clerkship for the invaluable, practical learning experience my patients would provide. And on that day I received one hell of an education.
Maria, who already had one child, had phoned with a guesstimate of about two hours. A mere 20-minute drive from the hospital to the housing projects, there was plenty of time to enjoy this absolutely lovely day (a description rarely given to May weather in Chicago) and make a brief detour to a street kiosk for a bag of the first cherries of the season. As such they were puny (save for the pit), an anemic light red and barely sweet but they were a definitive signal that spring had finally come. At last!
I recall that March, even April had been especially rough that year. Not a few Chicagoans were still trying to remember where they parked their cars before they their vehicles disappeared in that first October blizzard. And though today the sun was bright and warm, huddled here and there against the curb, dirty hard knobs of snow still clung defiantly to life.
I arrived at Maria’s tenement and started up the stairs just a few minutes short of an hour since her phone call, my doctor’s “black bag” in one hand, sack of cherries in the other. Plenty of time to settle in, check Maria’s preparations, wash up – but as I reached the fifth floor landing I heard Maria’s voice ring out:
“Oh mia! Oh mia!”
The front door of Apartment 503 was slightly ajar. I pushed it open. There perhaps 10 feet away, directly in front of me was the head of an infant. It was emerging from between Maria’s thighs that were propped up, as instructed, on pillows. The mother-immediately-to-be was on her back atop a newsprint-covered table, alone save for her first child, a two-year-old, asleep in a nearby crib.
As I flew through the doorway Maria gave one last involuntary push. The rest of her baby was not only going to pop out, but with Maria’s perineum positioned close to the end of the table, could well tumble to the floor headfirst.
Dropping both medical and cherry bags, I made an NFL dash and a Hail Mary catch, the baby safely in my arms – all lungs and vocal chords, indignant over the callous, cliffhanging manner in which he’d been obliged to begin the first day of his life.
Incidentally, this event offered me an opportunity to actually use the phrase “near miss” correctly. By just a few seconds and a bag of cherries I very nearly missed Jesus’ arrival.