There are events in our lives that hold within their unfolding, the potential for both heaven and hell, with the shift from one to the other occurring in short order.  One such occurrence stands out from my early days of family practice and always brings a smile to my face when a particular song by Pink Floyd triggers its remembrance.  On that night, the pager went off, rousing me from a sound sleep.  I awoke immediately and when my eyes registered the phone number of one of the local hospitals, my body went into its well-practiced mode of simultaneously dressing and phoning in to the hospital. The nurse on the other end informed me that one of my patients was in the delivery suite in active labour and her tone emanated displeasure with the situation.  When told the name of the mother-to-be, I saw the situation in my mind, confirmed by her report.  Yes, the young labouring mother-to-be and her partner are in the Birthing Room.  And they brought music.  Loud music. And she is refusing to lie down.  And doctor, she is refusing any perineal prep.   The exasperation grew in the nurse’s voice; I assured her I would be there within 15 minutes. Yes, I’ll try to come as soon as I can.  It being 3 am, there were few cars on the road, the few traffic lights were green and the intersections deserted, allowing me speedy passage from home to the hospital.  I reviewed in my mind the facts of the situation.  A few weeks prior, the clinic receptionist informed me there was a couple in the waiting room without an appointment, asking to see me as soon as possible and they would not complete our intake questionnaire.   The couple was obviously pregnant and she had not had obstetrical work up.  A brief introduction in the reception area assured me there weren’t any immediate issues, and they were agreeable to an hour wait till my schedule permitted some time with them.  What I saw was a very young couple, quiet in manner yet direct in their gaze and free with their smiles, well muscled and bronzed from the sun.   She in flowing peasant dress and billowy blouse made more so by the very gravid belly.  He in well-worn bib overalls with a tie-died T shirt and a straggly beard vaguely Amish in design. He had a look that combined defiance, intermingled with fear and pleading in his eyes. They had been planning on a home birth but the lay midwife, that was to be with them, was not able to make the trip from the commune which was some distance away in the southern States and while at first he thought he would be able to help his wife deliver the baby at home, they were having second thoughts and since they could not afford a local midwife, they got my name from a local Mennonite midwife.  They presented me with a list of birthing conditions; they wanted to use the Birthing Room and bring in their own music, they definitely did not want an epidural, or an episiotomy, he wanted to deliver the baby and cut the cord and then go home right afterwards.  In hand, he had a well-worn copy of the countercultural Bible of home birthing ‘Spiritual Midwifery’.   When I asked the young lady what it was she wanted, she gave me a steady look and indicated she indeed wanted all the same things, adding,  “And I want a healthy baby”.  A physical examination revealed a completely healthy mother, 37 to 38 weeks by dates and growth, normal fetal heart sounds and a textbook LOA position to the fetus.   I negotiated lab testing as a necessary condition but they both refused an ultrasound on grounds it might be intrusive to the fetus in the womb. The small cabin that they were building was two hours away or more, depending on traffic, from the hospital but their truck was usually reliable.  No telephone, and this being the days before cellular communication meant a 10 minute drive to their nearest neighbours, a Mennonite farm which had a phone in the barn.   I asked that they make their way to hospital as soon as active labour was established, weekly visits were scheduled in the meantime and after some talk of how busy they were with the fall harvest coming soon, they went on their way.  They had not had the lab work done nor come for the scheduled appointments and I had not heard from them till the phone call three weeks later informing me they were at hospital in active labour.  When I walked into the Birthing Room with the head nurse at my side telling me of all the hospital rules that this couple had been breaking as well as everyone being in the dark as to the status of the labouring woman’s cervix, I was confronted with an obviously exhausted couple trying desperately to hold onto a modicum of control in an environment that was totally foreign to them in a situation that had tsunami-like overwhelmed their expectation of what birthing ‘should’ be.  She was squatting, hands white knuckled with the effort of holding onto a post of the birthing bed while he stood behind her trying to support her weight and looking apoplectic every time he nearly exploded with his verbalizations of “Push, push”.  They both looked close to tears. They had been labouring at home for 12 hours before coming to hospital where they were fighting the nurses and the rules; no she would not get into a hospital gown, no they would not have blood taken, no she would not be examined by the nurse and no they would not have a fetal monitor put on and yes they would give birth to the music of the Mahavishnu Orchestra, which was blaring in the background from a well worn boom box. After taking a few deep breaths myself, and sending a silent prayer with but one word “Help”, I asked both nurses to leave the room for a few minutes. Sometimes the angels do gather round and hold at bay the forces in the world to grant us humans a break. It was obvious from her face that the contractions had slowed down.   I turned down the music and knelt down next to the young couple.  “You’re going to have your baby very soon and we are all going to help you with this as much as we’re able and to the extent you allow.  I need you to trust me that in order to ensure that baby is okay I will need to examine you and I’d like you to get into a hospital gown so that baby has a clean environment in which to be birthed and in order to have a sense of how baby is doing I’m going to ask the nurses to put on a fetal monitor.”  Miraculously they agreed to this and whilst the nurses helped her into the gown and the birthing bed I took the husband outside and told him that his wife needed extra energy, might he have some technique to help with this? He quickly seized on a Buddhist synchronized breathing technique that involved a chanted mantra.  And we need a quieter, more rhythmic music, might he have something like that?  Just the thing, he said and went off to change the tape.  After quickly changing into the hospital greens, finding out who the OB on call was, I returned to the room to find mom lying on the bed, eyes closed with the fetal monitor showing a normal fetal heart rate and the drawn out guitar riffs of Pink Floyd providing background music.  When I examined her, she indeed was fully dilated with a bulging bag of water.  Contractions were coming back strongly now.  I recalled some of the training in hypnotherapy and guided imagery from my Family Practice mentor and asked mom-to-be to recall a peaceful quiet place just for a few minutes to rest in, and explained that I was going to break her water and that this would make the pushing process more intense.   She was not to push till the nurse gave her the go ahead.  Husband bent over at the head of the bed putting his forehead on hers and started chanting in rhythm to her breathing.  When the amniotic sac was broken I noted that the fluid was not meconium stained and sent a prayer of thanks. The next few contraction were strong and she was able to give effective, strong pushes at the urging of the nurse, with husband going from chanting to a humming sound with the pushes.  The baby made progress down the birth canal.  During a rest period where I again encouraged her to rest in her imaginary place, the monitor indicated the fetal heart had slowed down. Not a good sign, baby was likely in some distress.   The nurse went over to adjust the monitor so we could hear the heart sounds more distinctly.   She looked to me with a questioning look.    Mom opened her eyes, sensitive to our concern, asked with urgency “Is the baby Okay?  Is something wrong?”  In the background Pink Floyd was beginning the gentle guitar riff of their song “Wish you were here”.  How timely I thought.  I looked at the young woman whose face blended deep exhaustion with frantic worry and said “ We need to have baby out…I want you to go deep inside yourself, find all the energy you can, and when nurse tells you to, you push with everything you have and you’ll have your baby safely in your arms.  That’s what you want, right? ”  She gave a determined nod.  Pink Floyd’s song began ‘soooo, so you think you can tell…’. Nurse told her to start preparing herself to push as the song continued ‘ heaven from hell…’.  Dad started up his chanting again, interspersed with a humming sound.  My fingers could feel the head making its way down the canal as I stretched the perineum and gave whatever sound of encouragement I could with my semi whispered ‘push…push’ intermingling with the nurses more forceful voice and dads chanting.  And as Pink Floyd got into the chorus “howww…how I wish you were here” the baby’s head emerged and did its spiral turn in that incredible process of birth.  I immediately applied the manual suction device in its mouth and sucked out the contents.   With another gentler push the rest of the baby’s body came forth into the world and then to the relief of all present, that first cry of recognition issued forth from the little boys lungs.  Parents were weeping as baby was placed onto mother’s body by the nurse, as I inspected the perineum and waited for the umbilical cord to stop pulsating to then have dad cut the cord.  Pink Floyd’s music was still reverberating in the background….’ Two lost souls…..’         The sun was rising, giving off its rosy glow as I emerged from the hospital into the brisk air heading to the nearby coffee shop.  Mom and baby were sleeping, while dad was watching over them in a continuation of a ritual as old as humanity itself. How fortunate we are to be living in a time when the outcome of birth is not tragic, I thought.   And I sent out again a prayer of gratitude for the guidance and teaching on birthing by the Obstetricians and midwives that taught not just the mechanics of the birthing process, but the natural rhythm that needs to be respected with different couples.

As expected, the couple did not come in for a follow up visit and I never saw them again.  One day about a year after the events recounted I opened an envelope without a return address but postmarked Tennessee with a photograph of a happy, healthy looking infant in his mothers arms both perched on a tractor and the word “Thanks” written on the back.