Hard Labor

by Susan L. Diamond

Overview

An obstetrical nurse who spent nearly a decade working on labor and delivery wards, a prepared childbirth instructor, a mother of two, and now a registered doula (a type of birth attendant), Susan L. Diamond has an unmatched perspective on the impact of modern medicine on the process of birth. In Hard Labor, readers learn that women in labor are routinely dehumanized by artificially established "labor curves" and confined by often unnecessary machinery. Diamond's vision is of childbirth as a natural, normal event which should be enhanced by modern medicine.
Hard Labor introduces readers to dozens of mothers, fathers, and families, and reveals the triumphs and tragedies that fill labor and delivery wards. From the sadness of death in utero to the joy of unexpectedly delivering twins, Hard Labor is a moving reading experience.
For this edition, Diamond has added a section on how she left "organized" medicine to take her message directly to women, and on her recent work as a certified doula.
At the Publisher's request, this title is being sold without Digital Rights Management Software (DRM) applied.

Product Details

ISBN-13:	9781466865570
Publisher:	Tom Doherty Associates
Publication date:	09/23/2025
Sold by:	Barnes & Noble
Format:	eBook
Pages:	381
File size:	930 KB

About the Author

Susan L. Diamond holds a Bachelor of Science in Nursing. Her nursing career was spent in both military and civilian hospitals. In additions to her B.S.N., Diamond holds a B.A. in English. She lives in the southern United States.

Read an Excerpt

CHAPTER 1

THE BEGINNING

Twenty-odd years ago, I had my first baby. I was twenty-six years old. I attended Lamaze classes with my husband, went into labor, used the techniques I'd been taught, and successfully delivered a daughter in a large, midwestern urban hospital without benefit of medication or medical intervention. That task, performed by untold millions of other women, was to be a pivotal one for me. My daughter's birth was the first of a series of events that would shape the middle years of my life.

My labor was short, by usual reckoning for primiparas, or first-time mothers. Three weeks past my due date, I finally experienced real, timeable contractions that increased in frequency and intensity. During the days before, I had watched endless hours of Watergate hearings with my mother, stroking my huge belly and timing false contractions that would tease me for several hours and then cease. I visited the obstetricians weekly and was told "it could happen any day now," only to return a week later, frustrated and heavy with my child.

The evening of July 8, my husband, Frank, and I had hamburgers for dinner. Ravenous as usual, I ate two and was watching TV when uterine contractions began to assert themselves. My eyes were on the clock when the phone rang. It was an old college friend, who asked casually, "What are you doing?"

"I'm timing contractions," I said, with a laugh.

"Are you serious? You sound so calm!" he sputtered.

"They don't hurt, Mark," I answered, "but they're about four minutes apart. It may be the real thing, but this has been going on for weeks now, so I don't know." I surrendered the phone to Frank and walked around for a while, watching the clock, wondering over the inscrutable activity of my body.

At eleven that night, as I sat down on the bed, preparing for sleep, I was gripped by a contraction that startled me with its strength. I couldn't catch my breath. The flavor of the contraction reminded me of bad menstrual cramps. It felt like a dim purple warmth deep down in my pelvis, under my pubic bone, that flared suddenly into a bright red flame as the contraction peaked. Belatedly, I deep-breathed, calling out to Frank as it subsided, "That one wasn't kidding!" After two more similar contractions, I suggested we call the doctor.

Less than an hour later we were driving under a full moon to the hospital. Frank was nervous, I was afraid it was false labor, and we were both elated. I was separated from Frank at the emergency room counter and wheeled off in a chair to the maternity unit. The inexorable routine began then: remove your clothes, give a urine sample, give an oral history, describe the contractions, get an enema, lose your identity, become a "patient in labor." It's relatively vague in my memory now, except for the feeling of being stripped of my identity, of feeling forlorn and alone in the businesslike atmosphere of the hospital. Where was the excitement, the anticipatory thrill of a new life on its way? Where was my husband?

I was using slow, deep-chest breathing with each contraction when Frank appeared, looking worried and flustered. A resident — a physician in specialty training — with large hands checked my cervix and announced that I was two centimeters dilated. I remonstrated with him, "Dr. Russell said I was three centimeters the last two times he checked me!" Dilation being what it is, a subjective call by feel only, it wasn't surprising that this man's big fingers felt less of an opening, but I wasn't giving up a single centimeter! Dr. Russell was in the obstetrical group practice providing my prenatal care and was one of the three physicians I saw on alternating visits. Although Dr. Russell had examined me the most recently, which of the doctors would deliver me depended entirely on their call schedule: the doctor on call when I was ready to deliver would catch the baby. I had no say in the matter.

The night passed. Frank ate a sandwich from the Lamaze goody bag, politely offering to share with a nurse who stood over me, as I huffed and puffed. I remember being furious that he could be so casual, talking about food as I struggled with each contraction. He couldn't use the techniques we had practiced: my contractions were so irregular in frequency and length he had no way of anticipating their beginning. I would just start breathing and he'd time the contraction and write down the times. There was no electronic fetal monitoring and I have absolutely no memory of anyone listening to the fetal heartbeat during my entire labor.

Not long after I had settled into the bed and begun the serious work of dealing with these sensations, a nurse came in and told me I was breathing too fast — I was panting at that point — that I wasn't far enough along and needed to slow down or I'd wear out. She held my hand and breathed with me, slow, deep-chest respirations again. I calmed down and moved into a rhythm. The room grew smaller; I could talk to Frank, become aware of his discomfort. He needed to go to the bathroom; we hadn't packed any aspirin and he had a terrible headache; his ulcer was killing him. I made suggestions and voiced my concern, but with each contraction, he faded into the periphery, outside of this powerful force that gripped me.

I lay in the bed and felt the muscles in my lower back start to tighten. The tightness migrated around to my front, my belly surging upward, becoming rock-hard as I breathed, breathed, breathed. In and out, in and out, in and out. Now it's waning, in and out, belly softens, relax. ... I turned on my side twice, only to experience a strong urge to urinate, mistaking it for the urge to push. Nurses were duly called, my cervix duly checked, "No, you're just five centimeters, just seven ..."

The power within me, this incredible muscular flexing, stunned me. Never had I experienced anything like this. My body had taken over: all I could do was go with it, breathe and attempt to stay on top of the pain. It was unlike any pain I'd ever known. It wasn't that it burned or ached or fired within me: it was just strong and profoundly powerful. My world shrank to become my body, my breathing and my uterus: contracting, thrusting upward, pulling itself open, squeezing, as though a giant's arms were wrapped around my belly, hugging me, forcing my breath out, threatening to pop me like an overripe seedpod. Time expanded: I had no concept of minutes or hours of the day or day of the week. Light changed: the room became gray, gray as the feel of this power within. I lost all peripheral vision, could see only a fog around me.

The panting wasn't working anymore. I began to have difficulty maintaining a breathing pattern through the contraction, wanting to thrash in the bed, wanting to get out of my body and leave it behind to struggle without my consciousness. Frank and I had practiced breathing in fifteen-second intervals, so I searched for fifteen-letter words to spell to myself with each pant. Both names we had chosen worked: I spelled them monotonously with each breath. Go on, see if you can spell this whole name, evenly, regularly. Concentrate on the next letter, focus on the whole name, keep going, spell, spell. Then, oddly, I asked Frank how many letters there were in "antidepressant." Puzzled, he counted fifteen, with the hyphen. I spelled anti-depressant hundreds of times that night, alternating with the children's names. It was the only way I could maintain control through the contractions. (Why did I pick that word? Why did it seem so right? What did my subconscious mean, giving me that word? A message from my future?)

Finally, Dr. Samuels, one of my obstetricians, came in to check me, to my disappointment. I had hoped my favorite, the easy-going, handsome Dr. Russell, would be on call for my delivery. I had no particular feeling for this doctor; he was somewhat cold, and his apparent indifference during my prenatal office visits had turned me off. As he bent to check my cervix, I watched his face: lean, middle-aged, almost ascetic. He announced that I was completely dilated and could begin to push. Aha! Second stage of labor! According to Lamaze class, the fun time! Second wind! Active involvement in the process!

Except it wasn't true. I had no second wind. It wasn't fun, and worst of all, I had absolutely no urge to push. (For many women this is a ferocious impulse, undeniable and almost impossible to control.) But I pushed anyway. Did I ever push! Scrunch up the body, grab the legs, pull them back, and bear down! Bear down! Into my butt, into my ass, push, push, push! Feel the contraction start. Take two deep cleansing breaths, hold the third, and PUSH, goddammit! I pushed for more than two hours. I worked harder, physically, than I ever had before, straining with every muscle in my body to expel this baby. I could feel the mass of her within me, down deep, like a watermelon in my pelvis. I could feel her move, grudgingly, centimeter by centimeter, in the latter half of each push, as though all the effort in the first half was for nought. But I kept pushing.

She, this unknown baby, moved down, slowly, slowly, and never ceased to let me know she was there (as if I could ignore a watermelon in my rectum!). She kicked all the way out. After two hours of pushing every four to five minutes for the duration of the contractions, some of which were two minutes long, I got angry. A nurse was tapping my perineum, shouting "Push here! Push here!"Where do you think I'm pushing, you bitch? I screamed at her in my mind. An unidentified man came into the room, stood at the foot of my bed and watched me silently as I pushed. He was another resident, I supposed, since he was dressed in green scrubs. He didn't identify himself or say anything at all to me, just stood there inspecting my exposed genitals. That made me truly angry. What is this, some goddamned sideshow? I fumed as I grunted with effort. Then I overheard him telling Frank that he didn't think I'd be able to deliver vaginally. The baby was posterior (facing up instead of down toward my tailbone), making for a longer second stage since she had to be rotated with the pushing efforts in addition to being forced down the vaginal canal. Even though I was pushing well, I was wearing out, so he thought I probably wouldn't make it.

Unknowingly, that unidentified man provided me with just enough furious motivation — Oh yeah? I'm wearing out, huh? I can't keep this up, huh? Just watch me, you bastard! I worked with renewed determination. And then, suddenly it seemed, it was time to go to the delivery room. The baby was crowning, I was almost there! The move to the delivery room was horrible; I felt tossed and tumbled somehow, rolling down the hall on a gurney with my knees bent and sprawled open, this urgent weight on my bowels. As I was transferred to the delivery table, Dr. Russell entered the room to do the delivery. Garbed in traditional scrubs, his feet slapping the floor in thongs, his beard barely covered by the paper mask and cap — I was delighted to see him.

Feet in stirrups, genitals exposed to the lights, I pushed a final time and felt the baby's head emerge, then the slippery slide of her body leaving mine, with several final kicks as she swam away from my body into the air and Dr. Russell's hands. The sensation of the umbilical cord trailing after that huge mass was almost orgasmic. A girl, a daughter! "Oh, Rebecca, I'm so glad it's you! I didn't like 'Matthew' at all!" Dr. Russell held her upside down by the feet, just like in all the movies, and I watched her take her very first breath of air, her bluish torso shuddering, ribcage expanding, a pink tinge moving outward from her chest. Oh, it was magical to see her breathe!

She looked just like her paternal grandfather. I laughed with amazement that recognizable features were there, that this child was so apparently an offspring of her father's father! She had dark hair, too, something totally unexpected, since her father and I are both blond and fair. I always thought I'd have a blond, baldish, Diamond-looking baby. The process of claiming, recognizing, and imprinting this new being began instantaneously, as I lay there on the table, waiting for the placenta.

It wouldn't come out. Dr. Russell massaged my belly so fiercely I thought he would puncture my abdomen. While pushing, I had popped the IV right out of my arm and now I thought I would pop myself. But then, there it came — plop! into a basin. Dr. Russell held it up for my inspection, announcing that it looked "about three weeks old." Frank was at the warmer, watching the nurse with the baby. I could see her tiny hands waving. Then he was at my side, holding her, grinning and talking nonstop about the whole experience. I was glad he was the first to touch her, to hold her. I hoped it would help him bond to her. I was also absurdly pleased with myself. I had done it! I had gone through labor and delivery without any medications, without any interference, and wow, it felt fantastic! I was so proud of myself! I wanted to get off the table and dance around the room! I wanted to shout out to everyone, "I had a baby! I had a baby!" I could hardly think of the baby, I was so filled with myself. I had never gone through any experience so rigorous, so demanding; I had never felt such an extraordinary sense of accomplishment.

My mother had delivered five of her seven children without benefit of analgesics or anesthesia. She was my role model. Her ability to give birth with such apparent ease was the one attribute for which I ever heard my father openly praise her. When I'd told him I was planning a natural childbirth, he snorted and said I'd never be able to do it, that I didn't have my mother's strength. Now I had proved him wrong. My elation was indescribable.

Rebecca was born at 8:54 A.M. I breast-fed her for the first time in the recovery room, still ebullient, engorged with pride in myself. That evening, when my mother arrived to visit, I was out of bed, bustling around the room, filled with energy. Visibly startled to see me up, Mom laughingly told me of her first experience after delivering my oldest brother in 1944. They hadn't allowed her to sit up or get out of bed for nine days; when she finally did, her legs were too weak to stand on! I was not only standing; I was walking, flying on the ceiling! Such self-delight, what a high! When I called my father the next day, I cried as I received his gruff praise.

*
Four years later I was once again heavy with child. Frank and I had attended Lamaze classes again, but I had difficulty getting him to practice with me. He scoffed at the need to do so, saying I had done so well the first time it seemed kind of ridiculous. This pregnancy hadn't been as much fun, though. I couldn't sleep whenever I wanted to, as I had during the first, since I had an active four-year-old. The child within felt heavier and kicked me so violently I had a permanent bruise, quite tender to the touch, just under my diaphragm.

The final three weeks took on the aura of a nightmare as I shared the agony of my best friend's delivery of a handicapped infant. I had frequent nightmares during which I dreamed of being in bed, surrounded by unknown people clad in white coats, who stared solemnly at me. Performance anxiety dreams, I think. How would I do this time? Now I had an idea of what to expect. Would I be able to do as well? And what if something is wrong with my baby? None of these thoughts had entered my mind during the first pregnancy. I was blissfully ignorant then. Now I knew better.

Each night before falling asleep, Frank and I would talk about my friend's baby, our fear almost palpable in the quiet, dark air-conditioned bedroom. I would silently reach for his hand, gripping it tightly until I slipped into sleep. I worried about how I would cope with another child; whether I could ever love another child as I loved my daughter; and I wondered how another child could possibly hold my heart as my glorious little girl had done for the past four years.

The night my labor started, there was no doubt in my mind. A contraction greeted me with a ferocity that caught my undivided attention. It was one day before my due date; there had been some false labor, but nothing like with Rebecca. When it was time to go to the hospital, the contractions were four minutes apart and the gray-edged pain of them was familiar. I sat on the bed, dressing, realizing that I'd forgotten precisely how true labor pains felt until this moment. Ah yes, I remember this. How could it have ever faded from my mind?

It was raining hard outside at 11:00 P.M. when Frank preceded me down the stairs with a sleeping child in his arms, off to the neighbors for the night. I walked down those stairs more slowly than I ever had before, wearing my favorite blue maternity dress, stroking my abdomen, staring at the bannister, trailing my hand along the wall, feeling a great sadness sweep over me. Go slow. This is the last night you'll ever be pregnant. My reluctance to leave the stairs, to walk out of the house, surprised me. It was as though all the months of pregnancy had passed too swiftly; I felt distinctly unprepared and unwilling to give up this inner being.

(Continues…)

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Excerpted from "Hard Labor"
by .
Copyright © 1996 Susan L. Diamond.
Excerpted by permission of Tom Doherty Associates.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

TITLE PAGE,
COPYRIGHT NOTICE,
DEDICATION,
AUTHOR'S NOTE,
ACKNOWLEDGMENTS,
PREFACE,
Chapter 1. THE BEGINNING,
Chapter 2. BIRTHING BABIES,
Chapter 3. PREPARED CHILDBIRTH,
Chapter 4. LABOR PAIN,
Chapter 5. NURSING SCHOOL,
Chapter 6. DOCTORS,
Chapter 7. ON-THE-JOB TRAINING,
Chapter 8. A FAMILY'S TRIUMPH,
Chapter 9. MOTHERS AND FATHERS,
Chapter 10. SAYING HELLO AND SAYING GOOD-BYE,
Chapter 11. THE WAY IT CAN BE,
Chapter 12. THE QUESTION OF PRIVACY,
Chapter 13. GERMANS AND OTHER FRIENDS,
Chapter 14. FRUSTRATION,
Chapter 15. DISENCHANTMENT,
Chapter 16. FINAL THOUGHTS,
Chapter 17. THE BIRTH OF ZOE,
COPYRIGHT,

Editorial Reviews

A rambling, highly personal memoir cum exposé by a labor-and-delivery nurse fed up with the American way of birth.

Fascination with childbirth, plus the realization that her own childbearing was over, led Diamond to become first a prepared-childbirth instructor and then an obstetrical nurse. After receiving her nursing degree, she spent the next eight years in various hospitals, both miltary and civilian, sometimes on staff and sometimes under contract with a nursing agency. Her account of those years is chockful of horrendous stories of childbirth, mostly demonstrating how dehumanizing the hospital system is. Hospitals, she says, have adopted a pathological/technological model of childbirth that regiments a natural process and gives rise to a host of intrusive procedures. As the nurse performing these, Diamond frequently felt caught between the needs of the patient and the demands of the doctor. Complaints about doctors abound—she describes some as arrogant, indifferent, and insensitive, and their behavior as downright disgusting. She also has harsh words—rude, lazy—for coworkers. Nor is she easy on herself, frequently bewailing her own lack of assertiveness. Finally, exhausted and depressed, she turned away from nursing and to writing. This angry book is the result. Anyone wanting to experience childbirth vicariously will relish these graphic stories of labor and delivery, but pregnant women should perhaps be warned away. If Diamond's picture of current childbirth practices is as accurate as it seems to be, women already committed to a hospital delivery may be in for an unnecessarily rough time.

As an insider's look at current hospital obstetrical practices, this has the ring of truth, but the details of so many births become repetitious, and the author's emotional ups and downs tend to get in the way of her central message.

Kirkus Reviews