The Office Birth: Thoughts from a Labor and Delivery RN & Doula

Note: If you missed The Office birth episode (The Delivery Parts 1 and 2) you can watch the whole thing on NBC by clicking here.

I’m a huge fan of The Office, and have always been enamored with the Pam and Jim love story. I was, nonetheless, trepidatious of tonight’s hour-long episode, “The Delivery Part 1 and 2.” Television and film portrayals of labor and delivery are notoriously inaccurate and often play into our society’s fear of birth. Every pregnant mama I work with has mentioned the need to get media images of birth out of her psyche to trust in the process. I do understand that the goal of TV and film is to entertain, but I also know that accurate portrayals of the birth process can be just as entertaining, and probably even more so. With all of that in mind, as I sat down to tonight’s very-special-episode of The Office I decided to blog and watch, providing my doula/L and D RN two cents in terms of what they’re getting right, and what is for fictional portrayals only. Here we go…

#1) Pam and Jim need a doula! They would be able to call her up and get reassurance that with contractions that are irregular and even 7 minutes apart, there is still plenty of time to labor at home (or at the office in this case) before heading to the hospital. Early labor is best done where a mama can move around free from IVs and monitors, and eat and drink as she pleases.

#2) Pam: “I’m not really in labor, I’m near labor.” Excellent description of early labor! When contractions are irregular they can come and go. A+

#3) Michael: “Contraptions! She’s contrapting!” No. But really funny.

#4) This get-to-the-hospital-at-midnight-for-the-extra-day-in-the-hospital plan is not necessarily a great idea. Hospitals are best for acute injury and life-threatening illness. For most other situations being in the hospital increases risk of infection and illness or injury caused by being in the hospital in the first place. I say get out of there as soon as you are safely able.

#5) Along those lines, a lot of people make critical decisions based on insurance. If you are able to avoid this please do. You will be happiest if you deliver with whomever’s practice and philosophy best matches yours, and in the venue (home or hospital) that will support the birth experience you seek.

#6) Kelly: “Did you know that labor can last weeks, and then they take your insides out and just plop them on a table, and sometimes epidurals don’t work and you can poop yourself?” My response in order: Not exactly but kind of (early labor warm up contractions can be felt for weeks by some), the uterus is placed on mamas belly during a c-section–but not plopped on a table, and true, and true. All of which would be well supported by a doula who would do her best to provide you with the informational, emotional, and physical support to help you feel a-ok about whatever your labor may bring. (Even the pooping, which sounds horrible but I promise you, it isn’t. Your excellent nurse will whisk it away and you won’t even know it happened.)

#7) To pick up with the point of when to leave for the hospital if you choose a hospital birth, leaving when contractions are every 5 minutes is generally better than when they are every 7, and many practitioners even recommend 3 minutes. The general recommendations go something like this: “Leave when the contractions are 4 minutes apart, and last for one minute, for one hour.” They call this “411″ and some midwives and docs recommend 511, some 411, and others 311. As a doula, I support my client in leaving whenever she wants, however, for my mamas who want to stay home as long as possible, I work with them to stay home until we see signs that mama’s entering transition territory.

#8) Jim: “Why don’t I just run you down to the hospital and we’ll get you a quick check.” I totally understand Jim’s reaction here as this is all unknown to him. At this risk of sounding like a broken record, this is where a trained birth professional can really help keep everything calm, cool, and collected. And although this may be different around the country, in most NYC hospitals there is little to no chance of a “quick check.” Priority is given to women in active labor or in emergent situations, and Pam would likely spend a lot of time in the waiting room in triage, where she would be less comfortable and perhaps progress more slowly. Also, in many situations once you’re in the hospital they will try to keep you there and then begin “active management” of labor, which means interventions to try to speed it along. Staying home as long as possible (or having a homebirth) is your best shot at being on the time table that is best for you and your baby, not the time table preferred by the hospital.

#9) In her early labor Jim is trying to give Pam room to “listen to her body’s signals,” which is right on (good job Jim!), but just not quite yet. In early labor, distraction is the name of the game just like Pam says. If Pam and Jim were my doula clients I would have helped them create an appropriate Early Labor Plan which helps with the distraction factor early on. I may even recommend they consider an Early Labor Baking Project which can be both distracting and delicious. Of course, none of that would make for Must See TV…

#10) Kelly: “Oh my god Pam, you are a warrior.” Yep, all laboring mamas are. More impressive than Olympic athletes and marathon runners. Hands. Down.

#11) Michael’s labor induction tips:

• Stimulate the nipples: True–releases oxytocin, causing uterine contractions.
• Walk around: Yes! I recommend a good 3 – 4 mile walk to my mamas who want to get things going.
• Eat spicy food: Maybe, can’t hurt. Some say eggplant parmesan is a good food for labor too (I’ve heard it’s actually the basil and oregano that do the trick).

#12) Jim: “Let’s go to the hospital…let’s go now.” Oh Jim…I will say that I’m not sure who I am of more use to in early labor, the mamas or the papas. 99.9% of men have never seen a woman give birth before, let alone witnessed a number of births with myriad variations on normal. It is totally natural that they would feel better being someplace with people around who did know about birth. The thing is, that is not what is best for mama most of the time. The cervix needs an environment of safety, privacy, and calm to properly dilate, and hospitals rarely offer much of that particular combo. A doula and/or a midwife who will join the couple in their home during this time allows papa to be a wonderful supportive partner, and know that there are other people with the experience to judge if everything is as it should be.

#13) Pam held her ground even though Jim wanted to leave. Not all mamas are able to do this, and in part because they’re scared too. This is an important thing to discuss as a couple ahead of time. Birth should be about supporting mama in what she needs, and anything that may get in the way of that (including a birth partner’s own nerves or fear) needs to be figured out in advance.

#14) Pam: “There’s no rush to get to the hospital. I’m fine. I’ll get there. And if I don’t get there, I don’t get there.” Wow. Pam’s composure is amazing, but rare in a first time mama, so don’t feel bad if you’re not quite so confident. I love this portrayal though, it is so different than the typical terrified and frantic mother-in-labor image. I hope the tone stays like this!

#15) Not being able to walk or talk through a contraction is indeed a sign that Pam has moved from early labor to active labor.

#16) Ummm…oops. To go directly from active labor (can’t talk during contraction) into signs of transition (Pam’s expression that she can’t do it) is not particularly realistic. Though the timing is off, a woman’s sense of overwhelm is virtually universal, and I believe that emotional state gives way to the surrender necessary to fully open up and eventually push the baby out. The best thing to say to a mama in this moment? “You are doing it! You’re doing so good!” (Because she is!)

#17) Contractions are now 2 minutes apart, keep breathing everyone. A lot of my clients like to keep track of their contractions with this iPhone app called Contraption Contraction Master.

#18) You should not attempt to measure dilation with a metal tape measure. Just so you know.

#19) Jim: “Pam’s ten inches dilated now. Sorry, sorry meters. Centimeters. And she’s fully effaced. Which, ah, I don’t know what that is.” Perhaps Jim and Pam didn’t take childbirth education classes, because those are certainly terms that we cover. Taking childbirth education classes with your partner is incredibly important in terms of gaining the knowledge needed to be empowered in a the brand new situation. You will learn cool things like this: Cervix Lingo: Effacement What? Dilation Who?

#20) RN: “Daddy, she’s ready to push.” How do you know you ask? Rectal pressure. It feels like you have to have a bowel movement, but in fact what you’re feeling is the baby’s head. If you have an epidural you may not feel this, although you very well may. With an unmedicated birth you will absolutely know when you’re ready to push.

#21) Michael during Pam’s pushing, “Can we have an ETA?” Not really. The average is from a few minutes to 3 hours of pushing. First time mamas like Pam usually take on the longer side. This is a-ok as it is important that mama and baby have time to work together for optimal fetal positioning and so that mama has time to open up and stretch.

#22) And finally, a beautiful baby girl was born and Pam looks fresh and pretty in a gown and robe. The fresh and pretty part is absolutely true. Every woman I have seen give birth looks unbelievably beautiful right after, it is amazing. None of them have a robe on however. A gown maybe, or a tank, or a belly band worn as a tube top. This is all preferable as you want lots of skin-to-skin contact for bonding and breast feeding.

****Postpartum

#23) When Pam is unsure if the baby is latching or getting anything (what she would be getting is colostrum by the way) and the nurse offers to take her away to the nursery that was just not very helpful. A doula or RN would ideally help ensure that the baby is latching correctly. When mom and baby need a break, it is best to stay close and enjoy skin-to-skin contact and just getting used to each other, and then try again in a bit. Here’s a good video about getting started with breastfeeding, and here’s one specifically about latching.

My conclusions? Not bad! I am pleasantly surprised by how well the writers finessed this episode. Pam was quite empowered, and there were no “emergency” twists and turns. There was also no hint that she couldn’t handle the intensity, or scenes of her screaming for an epidural, which TV shows often portray. All in all I have to say nicely done NBC and The Office, and congratulations fictional Pam and Jim!