Sunny Side Up

I liked obstetrics, and I was lucky at it. When the local health department started an obstetrics clinic for Medicaid mothers, I was asked to be their doctor. It was through my work at the clinic that I came to know Heather.

Heather Morrison was a grownup flower child. She went through adolescence in Southern California in the late ’60s and still dressed in clothing from that era. She had long, plain brown hair that hung, usually in a loose ponytail, down to her lower back. She wore peasant blouses and broom skirts over sandals, to which she referred as “Jesus boots,” except in the coldest part of winter during which she wore high-topped shoes—“granny boots.” She wore no makeup and had prominent freckles on her cheeks, giving her a Rebecca of Sunnybrook Farm appearance. She was a very pleasant person, soft-spoken and happy.

Heather was a natural woman. She was a trained and certified midwife, licensed by the state of Georgia and supervised by an obstetrician in Forsythe. She advocated for natural childbirth and made her living off “donations” given by the women she helped through pregnancy, labor and delivery in Baldwin, Jones and Forsythe counties.

I was a bit surprised to get a call from her one fine spring day asking for help. She wearily told me her supervising physician was tied up, and she and this woman had been working through a labor for over 14 hours. Unfortunately, the woman was making no progress. Heather related that she thought the baby was trying to come out “sunny side up” (persistent occiput posterior presentation). She hadn’t been too concerned about the length of the labor since she could detect no prominent decelerations in the baby’s heart rate with contractions, and the mother had been making slow progress until the last hour. She had tried to turn the fetus between contractions, but she wasn’t strong enough to complete the version.

I told Heather I’d be there pronto, asked my nurse and receptionist to reschedule the pending patients, jumped into my car, and roared off into the verdant pine-forested Georgia countryside.

It was the smallest house I’d ever seen—maybe 25 feet wide and 20 feet deep. The front of the house was one room, from right to left, kitchen, dining and living areas. A large loom took up most of the living room space and a double bed took up the rest of that half of the front room. Directly across from the entrance was a doorway leading back to a bathroom to the right and a storage area to the left. Another door directly opposite that led out to a screened-in back porch with a daybed for sleeping on hot summer nights.

Heather introduced me to Carol Jones, a fabric artist whose work adorned the walls and furniture and whose meager digs reflected their marketability.

Carol was lying on her side, her legs pulled up into a fetal position. Her dark hair was matted with sweat, and she looked exhausted. As she rolled onto her back so I could examine her, I could hear the crinkle of the newspaper on which she was lying. Heather used newspapers instead of K-pads to protect her patients’ mattresses because the thimerisol in the ink acted as a disinfectant. I don’t imagine such mercury-containing compounds are in today’s newspaper ink.

I examined her abdomen as gently as I could. The fetus’s left shoulder was anterior, and the head turned to that same side. Heather and I talked about a strategy. I would push on the head with my right hand and on the shoulder with my left while Heather would straddle Carol’s thorax so she could knead the contents of the uterus toward Carol’s left. As soon as a contraction was over, Heather gathered her skirts and jumped onto the bed. I already had a gloved hand in Carol’s vagina and stood along the right side of the bed so I could also reach her lower abdomen. I pushed and Heather kneaded, and all we succeeded in doing was pushing Carol’s head into the headboard. She slid on those newspapers like a kid on waxed paper on a playground slide.

“Well, that didn’t work,” said Heather drolly as she straightened up and looked over her left shoulder at Carol all crunched up against the headboard.

Gently withdrawing my right hand, I asked Carol, “Do you have any whiskey?”

“Oh, I could do a lot with that straight line, seeing as how you just removed your whole hand from my vagina,” said Carol, displaying an incredible sense of humor.

As Heather had been carefully collecting her skirts and getting off of the bed, my mind had been racing. One of the old ways of dealing with premature labor was to get the mother drunk. Alcohol is a tocolytic, it relaxes the muscles of the uterus.

“Here’s what I’m thinking. Let’s relax the uterus, replace the newspapers with towels, and try again. With a couple of stiff drinks on an empty stomach, Carol should be fairly relaxed in 15-20 minutes. If the baby’s heart rate stays okay, we’ll have a chance then to turn him or her,” I explained.

“There’s some Southern Comfort in the kitchen,..” Carol said with an exhausted sigh, “…a never opened Christmas gift from years ago.”

Two generous shots of Southern Comfort and 20 minutes later, Heather and I took up our positions on and beside the bed. A contraction came and went, and amid screams and grunts and groans, not all of which were coming from Carol, the baby turned. Two contractions later, the head was born. Heather pushed down on the mattress to make a dent so I could lower the head to deliver the left shoulder. As soon as the shoulder was delivered, the rest of the body slid out along with what seemed like a half a gallon of amniotic fluid.

Heather threw a clean towel over Carol’s belly as I suctioned out the baby’s mouth and nose. I clamped the umbilical cord with a couple of plastic clamps as the little, purplish, wiggly girl opened her mouth, took in a breath, and cried out her greeting to the world.

With the baby on her mother’s tummy, Heather handed a pair of scissors to Carol and showed her where to cut the cord. Heather cleaned and swaddled the baby while I helped Carol deliver the placenta. Her uterus clamped down nicely with a little massage. Then I sewed up a small tear in the perineum. Carol was so focused on the baby that she seemed oblivious to what I was doing.

With everything cleaned up and the bed clothes changed, Carol sat up a bit, propped up on pillows, to nurse the baby. The baby was pulling colostrum as I packed my bag to leave.

“What are you going to name her?” I asked.

“She is Heather,” Carol replied, and then smiled at the midwife who proudly stood by her side, “and her middle name is Comfort.”

(Originally published: Sunny Side Up. Florida Family Physician, Summer 2007, 55(4):24-25)

Russ Hostetler found his calling as a physician while working in Conflict Management and Crisis Intervention as a Special Police Officer in Dayton Ohio after graduating from Ball State University with a degree in psychology. His medical career included faculty positions at two medical schools, directorships in three managed care settings and a consultative clinical practice in geriatrics. After retirement, he volunteered as a Senior Medical Officer in Marine Corp endurance events operations, is an active member of the Florida Department of Health Medical Reserve Corps, and is a Healthy Community Clinical Director for the Special Olympics. He enjoys building furniture, tennis, writing, cooking and baking, nursing his understanding of the German language, and being grandpa to several delightful children.