Miracle of Birth

Miriam Sibley, for instance, has her prenatal clinics mystery-shopped in an effort to make sure that even illegal immigrants are getting the right level of customer service. Parkland runs a van service -- the "Mom Mobile" -- for pregnant women who don't have their own transportation.

And at a place like Parkland, the staff is self-selecting. "This is not the kind of job you come to just to get a paycheck," says Tammy Rogers, an RN who started at Parkland as a nursing student. "It is so busy. It has to be in your heart."

Idella Williams has a special connection to the place: She was born at the hospital. "I've always known that I wanted to work at Parkland," she says.

When Bridgette Drayden, a new LVN, is asked how she made the decision to work at Parkland, she smiles as if no one has ever asked her that question before. "I was a pregnant 16-year-old, and I came here to have my first baby," she says. "They didn't treat me like I was illiterate or an ignorant girl just because I was black or 16. They treated me like a pregnant woman. I never forget the care they gave me here."

Dr. Michelle Holt, a chief resident, is often in delivery and operating rooms just to supervise the more junior doctors. But in a C-section, she is often the first person to leap to the mother's head, behind the drape, to offer exuberant congratulations, sometimes in Spanish, and to report the sex and weight of the baby.

Amid the heavy, ceaseless crush of work, Parkland L&D even manages to do the most difficult things with grace. On a recent Wednesday, the first delivery after dawn is a routine C-section. A woman is about to give birth to her fourth child. The mother doesn't speak English. Although there are seven people in the room with her -- three nurses, a doctor, a nurse-anesthetist, an OR tech, and a translator -- OR 5 is unnaturally quiet. The mother has asked her husband to stay out in the waiting room.

The C-section begins just before 8 AM. Reina Duerinckx is training two LVNs, including Drayden. Duerinckx is careful to keep the mom covered. She shows the two junior nurses exactly how to fill out the baby's birth certificate. "Here are the ink pads for the feet, and the camera for pictures. Make sure that you get the baby's toes down on the certificate -- they're the cutest part."

An hour after the prep has begun -- with the mother's belly scrubbed and the epidural anesthesia in full force -- two young surgeons come to scrub and to begin the C-section. Just as they're about to start, Duerinckx calls on the intercom for two more-senior doctors, who observe.

No music plays, and except for the occasional soft request, or bit of advice, the room is quiet. Sixteen minutes after the first cut, Dr. Laura Heinlen says, "Here comes the baby. It's a girl." The two LVNs take the little girl -- 7 pounds, 3 ounces -- and clean her up carefully and gently. They get her footprints, and they dress her in a tiny, yellow lace gown, complete with matching booties and a yellow knit cap. They take three pictures, then Bridgette Drayden carries the girl to her mom, who is waiting patiently behind the blue drape, while the surgeons do the tubal ligation that she has requested.

The nurse-anesthetist unstraps the mom's arm, and she cradles her daughter, whose mouth is curled into a small frown, to her own cheek. Drayden gives her a sympathetic squeeze, and although no one hurries her, the mother hands the baby back after just a minute or two. A tear rolls down her cheek.

The little girl is dead. She's a full-term, 40-week baby, and just a week earlier, during a routine exam, the baby was alive. On the patient-status board on L&D West, the case had been listed "IUFD" -- intrauterine fetal demise. Even at the busiest maternity ward, a full-term stillbirth retains incredible power. It's a permanent sadness for the mother, a palpable failure for one of the safest maternity wards in America. As with everything at Parkland's L&D, the staff has a special way of handling IUFD. The mother will get the certificate with her baby's footprints, the pictures, the yellow lace gown.

It is the first time that Drayden has had such a case. "I wanted to make sure that the mother was as comfortable as possible," she says. "It would be the first and last time she'd see her baby.

"The thing is, whether the patient leaves holding this brand new bouncy baby or she's had a baby die, you want her to feel that the care was there in either case, that she wasn't alone. And for the next delivery, she'll come back, and we'll smile with her."

But Drayden is not smiling. Not now. "I walked around sick all morning," she says. "I had to go get pictures of my kids and look at them."

Charles Fishman (cnfish@mindspring.com) is a Fast Company senior editor and the father of two young children.