Audrey Moto ’14

A Strange Kind of Birth

Up until the time I started to smell burning tissue, like the smell at the dentist when they’re drilling on a tooth, my observation in the operating room resembled a program on the Discovery Channel.  For the last two hours, I had been watching a laparoscopic hysterectomy on a video screen above the surgeon.  The surgeon wasn’t touching the patient; he was operating the controls of the Da Vinci – a multi-armed robot that was doing the dirty work.  The patient, a 46-year old woman, had been unresponsive to various treatments for her fibroids and was now having her uterus removed.

Three short months had passed since I attended my last birth as a doula in cool, temperate, San Francisco.  There, I met with clients, explored their feelings and offered validation, my vocabulary peppered with words like energy, chakras and breath.  I came to mothers in the middle of the night, embraced them, whispered words of encouragement in their ears as they moaned their way through contractions.  Now, as a student nurse, in hot, humid New Haven, I studied scientific fact and lab values, and communicated in the language of anatomy, disease and interventions.  Any attempt at intimacy was hampered by the sheer terror of not knowing what the hell I was doing.  I was amazed by how recently I traded in the raw, messy warmth of labor and delivery to the precise, chilly sterility of the operating room.

Prior to surgery, the surgical team spent two hours prepping, an activity that I hoped would be educational, but left me feeling awkward and misplaced — dodging cords, equipment and staff, trying not to touch anything sterile, attempting to be helpful, but failing at everything.  At some point, I did strike up a hushed conversation with one of the nurses.  We were discussing my former college when she asked, “That’s a pretty left school, isn’t it?  Do you feel that it prepared you for grad school?”  My mind began to race.  What did she mean, “left” school?  Left like West Coast?  Or left like liberal?  Either way, I resisted the urge to point to my ID badge.  “Yes, my small, West Coast, ambivalent on shoes, but very much pro-ultimate frisbee, liberal arts college got me accepted into Yale,” I wanted to say.  Instead, I gave some canned response about how a liberal arts education prepares you for a variety of experiences after college.  Does it, though? I wondered.  Does it prepare you to stand in a room with a patient you’ve never met and look at her most intimate parts inside and out?  Does it prepare you for this?

My thoughts were interrupted by the surgeon announcing that he was done.  All that remained was to slice the uterus into smaller pieces and then pull the uterus and the cervix through the vagina.  What had previously been an intellectual experience suddenly became a visceral one, my own uterus cramping the way it does at a birth when a mother begins to push.  After three hours of watching, waiting, holding space, the time had come:  I held my breath as the surgeon made two or three longitudinal cuts, turning the uterus into some sort of soft-bodied sea creature.  Then, he instructed the resident to pull.

“Slowly,” he said, “You don’t want it to tear.”

I watched on the video as the uterus made its exit, the cut pieces overlapping, just as a baby’s skull bones fold over one another to ease its passage down the birth canal.  At some point, the resident had to start over and the uterus tried to reclaim its former home, the way a baby slides back into its mother between pushes.  Pull, pull.  Hand over hand.  Keep pulling.  And then it was out.

“Did you get it?” the surgeon asked.

“I did!” the resident exclaimed.

The focus in the room then shifted to the uterus, the prize in all of this.  The surgeon joined the residents in examining the pale, lifeless piece of flesh.  “Look at how big it is!” they cooed.  Reflexively, I turned my attention to the patient, half expecting to make eye contact, to place a hand on her and send her unspoken words of love, gratitude and affirmation.  As I looked over, I remembered that she was asleep — bundled in pads and sterile sheets, cords hanging off and out of her.  The ten feet between us may as well have been a continent.  I thought about how she would feel when she woke up — tired, sore, happy to be done and glad it went well.  My eyes shifted from the patient to the video screen, to the image of the space that once contained her womb — the space that was once so full, now empty.

Audrey Muto will graduate from YSN’s nurse-midwifery program in 2014. After completing her undergraduate degree in Biology, with a minor in Japanese, at Lewis & Clark College in Portland, Oregon, she spent two years teaching English to elementary and junior high school students on a rural island in Japan through the JET (Japan Exchange and Teaching) Programme.  Prior to her acceptance at Yale, she worked as a doula, childbirth educator and prenatal yoga instructor near her hometown in the San Francisco Bay Area, California.  In addition to her studies, she continues to teach yoga and prenatal yoga here in New Haven.