About an hour after the delivery, the attending was able to come look at my patient. She put in about a bottleful of lidocaine, without the patient becoming much more comfortable. The attending was convinced she actually had a fourth degree tear (right through to the rectum). So, she had the patient taken back to the little OR in the maternity building, and anesthesia gave her a spinal, so she could relax, and we could poke around enough to repair the tear properly.

Upon further investigation, in a more convenient setup, the attending decided it was really only a partial third degree (partway through the anal sphincter); but it was very long, and Y-shaped, and complicated. She had me do most of the sewing, picking pieces up to show me where to go next, and doing some of the most complicated parts herself, but I did most. Not that I would have had the slightest clue how to fit the puzzle together without her to tell me – again, I couldn’t even tell which planes belonged together. As we finished sewing, the attending – the ob/gyn whom I first talked to about my confusion re: surgery – said, “That was good. You should really be an OB/GYN.” Ach.

But I feel guilty about that girl. There were two of us there, the midwife and me. I’m supposed to be responsible and semi-intelligent these days, unlike a week ago when I was only a third year. I had been told many times that one must keep one’s hands on the baby’s head as it comes out, precisely in order to prevent disastrous tears. There was no information lacking on my part, only a lack of belief. Having never seen anything bad happen, I couldn’t quite practically believe that it was important to hold the baby’s head. Not that that changed my behavior. The baby wasn’t even really crowning when I decided to put my gloves on. (Although I do need to practice getting the thumb in the thumb-hole, that would have speeded things up if I had been putting the gloves on right. . .) But I was one of two people who was responsible for not letting the baby fly out, and I didn’t do my part. And now the mother has a nasty tear, which hopefully will heal without many consequences, but it was still an awful experience for her, after she had been persuaded to keep the baby (she came from one of the pro-life clinics in town), and had decided to try to go naturally with a midwife, and made it so far through labor – and we let her down, and necessitated her having a spinal after all. . .

So, now I really believe that “something bad will happen” if I don’t hold onto the baby’s head. Next time I see her, I will ask the midwife which would be a bigger error – catching the baby without gloves on, or not catching the baby. Also, we shall not both turn around to put on gloves at the same time. And, I will do it sooner, like, as soon as the baby’s head is visible.

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