Yesterday evening we once again started out with no patients in labor. There was one 35wk-er who was threatening actual labor, and would need a repeat Csection if she did, and a lady with twins, 29wks, one of the twins’ sacs having ruptured, whom we were all hoping would not go into labor. To my great delight, around 6pm a lady arrived, at term in her fifth pregnancy. Her nurse had a big discussion with the residents, because the patient wanted not to be on a monitor, and to go walking around to make the baby come sooner, and the nurse thought it was a good idea, but the intern didn’t dare permit such “risky” behavior without thoroughly clearing it with all of her seniors. Eventually she did, and the lady walked up and down for two hours.

Also yesterday evening there was a first year student, on an observation visit arranged by the OB/GYN interest group. Her presence made me talk way too much; it felt good to be able to teach someone who knew less than me, but I think the residents were amused by my slippery explanations.

The intern agreed to let me try again to deliver the baby, especially since in this multiparous patient (ie several previous pregnancies) the baby should be delivered quickly without needing much help. She got out a model of a pelvis and a baby’s head, and showed how to put one’s hands and pull on the baby’s head, and turn the body so it would come out easily without getting caught anywhere. She also warned me against the “Lion King moment,” an inside joke among the residents ever since one of them, on delivering her first baby, held it in her hands and just gradually held it higher and higher over her head in astonishment at what had happened, until the attending reached in to clamp the umbilical cord and clean the baby’s mouth.

Around 10pm a nurse rushed up to the second year resident, exclaiming that the lady with twins had ruptured again and was contracting frequently. They rushed her to OR, which is where they like to deliver preterm babies, as it’s closer to the NICU. The other student and I stood at the door of the OR and watched as the first twin was delivered within a few minutes. Then, as the resident was trying pushing on the fundus of the uterus, to get the first placenta out, so they could proceed to the second twin, the umbilical cord of the second baby slipped out, and then more of, and more. You can’t do a vaginal delivery over a prolapsed cord, for fear of asphyxiating the baby by its head compressing the cord on its way out. So it turned into a Csection, with the third year resident crouched on the bed over the patient’s legs with her hand inside the vagina, holding the umbilical cord inside and uncompressed, as the other doctors draped the patient and extracted the baby abdominally.

After that commotion the rest of the night was quieter, just checking on the other patient for several hours. Around 3am, after getting an epidural, she was ready to go. She was very nice and waited till we were all properly dressed: gown, gloves, and face shield. I sat down in front and put my hands in the right places, but there wasn’t much to do. The intern had her hands over mine. After the baby’s head was out, we held on, and moved it up and down a little to get the two shoulders out. I managed to not drop the baby, but once it was actually in my hands, I was so amazed I forgot about other details like suctioning its mouth, or clamping the cord. Then I couldn’t find the clamps, and I fumbled getting them on, and forgot that the father is supposed to be the one to cut the cord, and managed to spray blood all over my face shield and the intern. The mother was so sweet, when she saw all the blood, she apologized! I think she had talked with the nurse beforehand, because after the cord was finally cut they handed her the baby right away, and let her hold it for a long time before taking it away to wash it. I think it’s sad how the nurses usually keep the baby for awhile before letting the mother have it. After nine months of waiting, and all that hard work for several hours, not to have the baby seems so anticlimactic, almost cruel.

The intern was understandably not too happy with me, but I don’t mind. I had the baby in my hands. It was so exciting. We’ll just have to see if she’ll let me try again. I know that will be hard for me as a resident, to let go of something I know I can do, and let a student or junior resident do it not as well.

Advertisements