This morning I arrived at the hospital, having calculated that there should only be two or three postpartum patients for me to see, and that I could easily do this in an hour. I forgot that I’d asked the attending not to call me with any more deliveries (I felt that after being up Saturday night, and getting one delivery and one Csection, it was time for a night off). So there were two new ward patients and three patients in labor whom I hadn’t heard of.

The attending of the day, Dr. Earl, is a very sweet lady, who is completely natural and friendly with both students and residents. She was on duty with the residents today, as well as having these three of her group’s patients to cover to. There was something funny in the air in the maternity building today: The whole staff spent the entire day careening from one crisis to the other, without ever managing to overlap so badly that the necessary persons failed to be in the right place (always a doctor present for the delivery – although of course the nurses could handle one), but without any real breaks in the rhythm.

Dr. Earl filled out the paperwork on a patient in the midwives’ unit, while receiving phone calls from the residents about final details for a stillbirth that occurred at 7am, preparations for a 17wk delivery, and two Csections scheduled for the day. She went to handle that, leaving me alone with the patient, her husband, and the nurse. The couple were obviously “into” childbirth. She had a special outfit (which made her look beautiful even in labor!), they had soft music playing, and they were both barefoot and striding around the room in tandem. Nice. They were too occupied to say anything to my low-key introduction of myself. So the nurse, being very protective, glared at me and gave me silent signals for several minutes, clearly not happy to have a medical student intruding. I understood her position, but bother it, the doctor told me to be here, this is the midwife’s day off, and if things got busy, I might be the closest they got to a doctor for the delivery. Eventually the nurse managed to get permission from the couple, but it was just as well that Dr. Earl did make it to the delivery, since she could tell the nurse bluntly, “Alice will be doing this delivery.”

The lady was much more comfortable walking around the room, and was confident enough to refuse to let anything be done while she was walking; she lay down to let them check her or listen to the baby when she felt ready for it. Dr. Earl broke her water, and three pushes later the baby’s head popped out. This time I had my hands in the right place, and helped the baby out, and lifted her up onto mom’s stomach. And she and her husband were laughing and crying and clutching at the little girl. We delivered the placenta a few moments later, and mom wanted to start breastfeeding, so Dr. Earl and I cleaned things up and disappeared.

I spent the rest of the day keeping an eye on two patients: the first was a multip who was a little premature, questionably in labor, but 6cm dilated. Eventually she got an amniocentesis which confirmed fetal lung maturity, and was given pitocin to settle the question of whether she was in labor or not. The other patient was in her 30s, her first baby, progressing gradually but steadily till noon, when she was complete and started pushing. At which point her contractions faded away completely. (Management was complicated by her having an epidural, so she couldn’t tell when to push.) After an hour, she took a break, sitting up, to give the baby a chance to come down more, while Dr. Earl and I and the nurse grabbed lunch.

After lunch, we went to break the water of the first patient. Again Dr. Earl encouraged me to do it. It was funny: Dr. Earl is a stickler for using as much sterile procedure as possible even in labor and delivery; while the midwives, although keeping things clean, are not overly concerned with procedure. Their method of breaking the water is to put their hand and tear the bag; whereas Dr. Earl uses the little plastic amnio-hook. Whatever, it works either way.

After another hour of pushing, the other lady did not seem to have gotten anywhere, and her baby was consistently having deep decels with contractions. The nurse announced that the baby had turned its head transversely, and was not descending past zero station. As the patient had now spent more than two hours pushing, Dr. Earl started talking about a Csection. At some point in here, the overworked nurse was trying to keep track of two busy patients at once, and had to leave me alone with the patient and her husband for 45 minutes, watching the monitor to tell when she was contracting, and coaching her through it. The nurse of course was not satisfied with this; but I was thrilled to be alone with a patient. Towards the end, as she wondered whether she was progressing at all, I checked on my own, and could tell that there was no improvement. She and her husband were very nice people. No doubt due to the epidural, she was very relaxed, although starting to tire out, and we had a pleasant time together.

Three hours of pushing, continued decels, and no progress: time for a Csection. By this time the maternity OR had been doing Csections almost nonstop, some of them scheduled and some of them emergency. So it took them awhile to get the space and personnel for this patient, since, although urgent, she was not emergent enough to warrant calling for help from the main building. I got to assist Dr. Earl – just me and her. The nurses again were helpful, but a little surprised that no resident was wanted. Of course, what it really worked out to was Dr. Earl doing most of it. She let me make the skin incision – I managed to keep my mouth shut and not let on that I’d never made a real incision before – and bovie down through the subcutaneous fat to the fascia. Of course I made the incision a little bit wrong, and the bladder was not being helpful, so overall it was more difficult than it need have been, but we managed. Dr. Earl extricated the baby, who looked rather blue, but quickly began crying on her own. She weighed almost nine pounds. The uterus was bleeding a fair amount, so I didn’t get to sew it (maybe next time?), but Dr. Earl let me do the fascia, subcu, and skin. When we started on the fascia, her beeper started going off: our other lady was 8cm dilated. Dr. Earl asked the nurses to please dig up some other attending somewhere to go to the room, because when a multip gets that far along, the baby is not far off. I went as fast as I could (still pretty slow), but by the time we finished that baby had been born. So, two deliveries (one Csection) for the day: I’m happy.

The best part: I didn’t have to go to clinic at all, the whole day.

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