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Author's Note: Birth Day is partly a memoir of my personal and professional experience with birth and babies, and partly an exploration of the fascinating science and history of how humans came to give birth the way we do.There's humor as well, including an account of the first time I ever saw a baby born--and almost had to deliver him, too.

Excerpted from Birth Day by Mark Sloan, M.D.

Chapter 1
Twenty Babies: An Unexpectedly Quick Introduction to Vaginal Birth           
I delivered twenty babies in the summer of 1977. I was hardly more than a baby myself, just turned twenty-four and starting my third year of medical school. At that point I was toying with the idea of becoming a family practitioner or a general surgeon. Babies didn't much figure into my future.

This is how my obstetrics rotation was supposed to work: a medical student was typically paired with an intern, who in turn was under the direct supervision of a senior resident. The senior resident did the complicated cases—forceps deliveries, cesarean sections and such—while the intern handled the routine vaginal births. My role as a medical student was more or less like Cinderella's in her pre-princess days: do the dirty work, like IV starts and blood draws, and stay in the shadows to avoid the wrath of the overworked intern and resident. A “good” student—one with the sense to do his work quietly while openly admiring the skills of his elders—could expect the chance to deliver an uncomplicated baby or two as his reward.

Two things conspired to make this particular rotation different. The first was that it was early July, a traditionally scary time to have a baby in a large teaching hospital, since the interns are only a week out of medical school and generally have less experience delivering babies than the women whose babies they're delivering. The second thing was that, for reasons I can't recall, the OB resident staff was a few bodies short of a full complement. This meant that the interns and residents had to cover many more patients than usual, which didn’t leave them much time for supervising spanking-new medical students.
And so one sweltering Chicago morning I stood in my crinkly white coat before Mitch, a stocky, gruff senior resident with a startled head of jet-black hair and a permanent dusting of cigarette ash down the front of his scrubs. We were in the hallway outside the maternity ward. Gurneys with moaning women aboard rattled by like Model-Ts on an assembly line, pushed by a corps of tough-looking nurses. Mitch had paused between a c-section and a vaginal birth to give me my orders: I was to join Ben, a brand new intern from a tony private medical school, on what Mitch called the “firing line”—a row of wheeled labor beds separated by unadorned canvas curtains.
Mitch clamped his hand on my upper arm like a bailiff leading a felon into court and marched me through the labor room’s swinging doors to Bed 4, where a tiny nurse with Popeye-esque forearms was helping a hugely pregnant woman out of a wheelchair.

“Okay, you had some OB training in your physical assessment class, right?" Mitch asked. No, I told him, I hadn't. My physical assessment class had been at the veteran's hospital down the street. There, I had watched men with terminal lung cancer chain-smoke cigarettes through their tracheostomy tubes, seen others who had lost limbs to diabetes or D-Day land mines, and I had personally examined what a senior resident described as the case of the year—a cabdriver who got scurvy (scurvy!) from a decades-long diet of plain White Castle hamburgers and Coke, period. Not only had I not seen a baby born at the VA, I told Mitch, I hadn’t seen a single female patient. The woman climbing onto the bed in front of us would be the first woman I had ever touched with medical intent.

Mitch scratched the stubble on his cheek. "Well, you've read about childbirth, haven't you?" I said that I had. Just the night before, in fact: half a chapter, with diagrams. Took me twenty minutes.

"No problem, then." He slapped me on the back. "Just sit there"—he motioned me to a rolling stool between the woman's now propped-up legs—"and call me when you see a head." Then he left.

I sat there for two hours. I killed time by rearranging the contents of my pockets, cleaning my stethoscope and, once I had overcome my shyness, by talking to the woman who was to produce the head I had been ordered to be on the lookout for.
Her name was Tonya. She was two months younger than I was, and in between contractions I learned that for the last five years she’d been a secretary at an insurance company downtown. This was her third child—her oldest, a girl, was just two-and-a-half—and she absolutely hated childbirth. She compared the pain of having a baby to the pain of being stabbed, which she had been, twice—both times being cases of mistaken identity, she assured me. But childbirth was worse, she said, because "it's like they won't take the knife out." Childbirth and knifing: two experiences I had never had. I took Tonya's word for it.

Our conversation gave way to long stretches of silence as Tonya’s labor intensified. She panted as her contractions came, her hands gripping the metal siderails of the bed with such force that I thought she’d bend them. Between contractions she stroked her belly with her hands, her eyes closed.

Ben, the intern, came and went in a sweaty blur, muttering to himself as he lurched up and down the row of beds. He shook my hand on one pass. “Everything okay here?” he asked in a strangled voice. “Good,” he said absently, not waiting for an answer. He patted my shoulder and scuttled out the labor room door. I went back to my pockets, moving my reflex hammer, tuning fork, pens and alcohol wipes from one side to the other and back again, while I waited for something to happen.

A sudden eruption of curses drew my attention. Startled, I looked down between Tonya’s legs and saw the top of a tiny head peeking out from her vagina. I shouted for Mitch and then Ben, but neither responded. The nurse who’d been working the firing line was gone, too—off helping them, I supposed.

A pale student nurse appeared behind her clipboard at the foot of Tonya’s bed. “I think they’re doing an operation,” she said. Her eyes widened at the sight of Tonya’s baby’s head. “Maybe I should go look for them?” She dropped her clipboard in my lap and took off at a half-trot. The double doors swung shut behind her. Now it was just me, the swearing Tonya, and the top third of a birthing baby’s head.
I remembered a picture in my night-before’s reading where the obstetrician has his hand placed confidently on the emerging newborn’s head. So I did that. I put my gloved right hand on Tonya’s baby’s head. It was warm and wet, and squishier than I had imagined it would be. Contact made, I exhaled for the first time in what seemed like an eternity.

My relief was short-lived. I had mastered the art of placing my hand on a birthing baby’s head, but what came next? Would the baby just kind of fall out of Tonya on its own, I wondered, or was I supposed to grab onto that puckered patch of scalp and pull? I silently cursed myself for not finishing the chapter. Caught between pulling and not-pulling, I chose a middle, temporizing route. Like the Dutch boy at the dike, I put my hand on the baby’s head and pushed back, hoping to convince it to pause just long enough for Mitch or Ben to come and save me.

Tonya’s curses were getting personal now. She had finished damning her absent husband for putting her through this agony not once, not twice, but three times and now she turned her attention to me. “Get that damn baby out of me!” she shrieked, glaring at me over the top of her belly. “Get it out now or I’ll cut you!”

Dutch boy be damned. I was losing the battle. There was now an entire head under my hand, face and all. Amniotic fluid bubbled from its nose. Its mouth opened and closed in some horrible parody of breathing. Caught between threats of mayhem and my feeble attempt to hold back eons of childbirthing evolution, I closed my eyes and surrendered myself to whatever came next.

Suddenly a pair of hands pushed me aside. Mitch reached in, grabbed the baby's head and yanked with so much force that I was afraid he was going to tear it off. He pulled the head sharply downward—the right shoulder appeared at the top of the birth canal—then up, and the left shoulder popped out from below. The rest of the body followed, like a rabbit being pulled from a magician's hat. Mitch plopped the baby in my lap—a big, squalling, slippery boy—and then clamped the cord with a pair of long hemostats and cut it in two. A minute later he tugged on the remnant of the umbilical cord and out came the placenta.

A nurse wrapped the baby in a white receiving blanket and handed him to Tonya, who cried and smiled and cootchie-cooed her third-born, seeming to have forgotten for the moment about killing me. His name was Robert, she said, because he had his grandfather’s cleft chin.

"That wasn't so hard now, was it?" said Mitch, as he jotted a note on Tonya’s chart. I didn’t answer him—couldn’t, really. I just sat on the stool with my mouth hanging open, dumbstruck. My scrub shirt was soaked in sweat. There was blood on my socks and shoes. Mitch stripped off his gloves and tossed them in a trashcan at the foot of Tonya's bed. He yanked me into the hall, where two more mothers-to-be in wheelchairs waited. "Okay, then," he announced. "Time for the next one."

Had I been a little more observant—and less panicked—I would have noticed that Robert’s head had rotated one way as I held it, and then back again as his body emerged. I would have pondered the pushing, pulling and pain of having a baby, and the torpedo-ish shape of the baby’s head when all was said and done. I would have marveled at Tonya’s rapid transition from swearing attempted-murderess to doting new mother, and at her ability to ignore the gaping wound in her vagina, the one that Mitch came back to sew up after he’d moved me on down the line to watch for another head.
What I had witnessed, had I had the time to process what I had seen, was a highly compressed history of the last several million years of human evolution.

Copyright © 2009 by Mark Sloan, M.D.. Excerpted by permission of Ballantine Books, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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