Through a blind man’s hands

Lloyd D. Holm, DO, is associate professor and assistant residency program director, Obstetrics and Gynecology, UNMC. He practiced in southern Indiana for 10 years after completing his residency at UNMC in 1992. He joined the UNMC faculty in 2003. The delivery – publicized in the journal, The Female Patient, as “my most memorable moment” — took place in 1996 or 1997.

Joe sat in the chair beside the labor bed, enveloped in a cacophony of noise. At first it was hard to determine whether the usual noises associated with an actively laboring patient alarmed him, but then worrying about the husband is really never much of a priority. With the second stage of labor rapidly approaching, I was busy arranging the delivery table. As the vertex descended, the noise and potential for chaos increased accordingly.

Nevertheless, my attention kept straying to Joe. Blind since his teens from diabetic retinopathy, he was quite self-sufficient, but his eyes would jump at each new sound. The angle of his head would increase ever so slightly, as this would help him better discern and interpret the sound.

Having delivered four of Joe’s nieces and nephews during the mid-1990s, I had been invited to many birthday celebrations and other family events. I had come to know and admire Joe. I could tell that he was frightened by this strange new environment.

Hospitals used to be quiet places. Street signs would announce a “Hospital Zone,” and visitors were admonished to be quiet for the comfort of the sick. There were no intravenous alarms or in-room telephones ringing at all hours. Now I reflected that for Joe, the silence of the “old days” might be more frightening than clamor. Now, at least he could listen with me to the fetal heart rate monitor and be reassured that his baby was in no distress. I explained the nuances of heart-rate variability, and he grasped it instantly.

It was his wife’s obvious pain that was most unsettling to Joe. With every contraction came the response from a woman with no epidural anesthesia. I could see Joe’s body prepare for and then recoil from each contraction. He quickly became adept at predicting them from his wife’s altered breathing followed by the change in fetal heart rate. Because of the height of the chair relative to the labor bed, Joe was unable to hold his wife’s hand, losing still more contact with the laboring process.

With the cervix now completely dilated and the vertex at a +1 cm station, the labor and noise intensified – as did Joe’s anxiety. It was increasingly difficult to reassure him that things were normal. It was at this moment that I was inspired to ask Joe whether he would like to deliver his baby. Expecting recriminating looks from the nursing staff, I immediately explained the plan: Joe would be scrubbed and gowned, and he would sit on the stool next to me. I would then place my hands over his, and we would guide the baby out of the vagina.

The effect was dramatic. Joe could sense the start of each contraction, and he could feel his baby advance and recede. He was no longer isolated, but had become part of the process.

Joe caught on quickly. He gently held his newborn child in his outstretched hands, while I clamped and cut the umbilical cord. As I attended to the placenta, he rocked the baby. He sobbed quietly while absorbing a whole new world of sounds.

Even after countless deliveries, there is still the occasional birth that brings tears to my eyes. As I reflect on my chosen specialty and career, the privilege of delivering a baby through a blind man’s hands helps me to remember why I do what I do.

Printed with permission from The Female Patient (Vol. 30, No. 11, 22005:27,28).