Yesterday evening, I had just finished arranging all my things in preparation for a speedy exit, and was starting to get ready for bed, in the full confidence that the young lady who was 4cm at 6pm could not possibly deliver before the early morning.

So of course my phone rang. “She’s 9cm, all of a sudden; maybe you’d like to come in?” At least my driving is safer when I haven’t fallen asleep yet.

The room was full of female relatives: mother, three aunts, and grandmother. Two men were kept in the hallway. The boyfriend was a source of friction: the patient wanted him to be there, and to pay attention to her. He didn’t look to be more than 15 (probably at least 3 years older), and was obviously having trouble staying as focused, for 24+ hours, as his lady wanted him to be. She started complaining of a lot of pressure, in spite of her epidural, so the nurse checked, found her to be complete, and started coaching her to push. She worked hard for an hour and a half, but was obviously becoming more and more uncomfortable, and thus more and more frustrated. We’d warned her that it might take three hours to get the baby out. All she could see was, she was working very hard, doing her best, and seeming to get no results except more pain. She was snapping at all of us. The nurse and I were keeping quiet. The relatives’ jocund attitude towards her anger (“you think you’re never going to get pregnant again? ha!” “pressure? yes, that’s what all my babies felt like; it gets worse”) was not really helping to calm things down. The young man, however, improved when he saw how upset she was, and came and helped hold her legs, and rub her hand.

And then the baby’s heart rate started dropping with contractions: severe decels. Except that the baseline heart rate had gone up to 170+, tachycardic, so even marked decels only got down to the 110s. We got out some oxygen. Even in spite of her frustration, the patient was remarkably good about keeping the oxygen on, just taking it off during contractions as the nurse allowed her to. She remembered to put it back on even when I forgot to help her.

Eventually, the midwife called anesthesia to redose her epidural so she could be comfortable, and sit up to let the baby come down further on its own, and get some rest before pushing more. It was amazing. I was getting very tired of being patient with her. But after half an hour of resting, and after the nurse yielded to her insistence and rearranged the bed so she could push sitting up, she seemed like a new person. She would throw herself into every contraction, pushing wildly, and then resting calmly in between. The last hour seemed to go much faster.

Still, although closer, the baby seemed to be taking a very.long.time coming. The midwife called Dr. Knight to come and vacuum-assist. I willed that baby to come out before he got there, but no. So again, middle of the night, long wait, and Dr. Knight arrives with the vacuum. I tried to help with the rest of the baby, not with much success. It was floppy, and its neck was so long. Dr. Knight kept saying, “Head down, and stimulate it!” And of course in my attempts not to drop it, I kept putting the head up, and doing whatever else I was supposed not to. I can’t blame Dr. Knight for being sceptical about my abilities. After a few minutes in the warmer being suctioned, the baby did very well, crying on its own, and moving nicely.

Remarkably, there was no tearing. However, the placenta seemed to be as firmly lodged inside as the baby had been. Fifteen minutes, pitocin wide open, lots of fundal massage, no progress. So Dr. Knight came and pulled on it, and eventually it came out. And I got neither the baby nor the placenta. Bother. I’m upset with myself for not being happy that the baby was out and well, but I do wish Dr. Knight would. . . do something different.

The man is so dedicated. He had been up in the hospital all the previous night with the residents, worked all the day, tried to sleep for the first time in 36 hours, he said, and then been called to come to the hospital for this delivery. He slept for a few hours in the hospital, then rounded with the residents in the morning, did two circs with me, and then had a D&C. No 80-hrs for attendings.

He did let me do most of the circs, using the much simpler method, which of course I had forgotten how to do, having practiced the complicated one so much with Dr. A lately. I asked if I could help with the D&C, and he said, “Oh yes, you can do the whole thing.” Well, great. Except I didn’t. The poor sweet lady had miscarried more than two months ago, and had been hoping that things would come out on their own. They didn’t. And it was much more difficult to suction them out. Every time we thought we were done, Dr. Knight would discover another piece of the placenta, still hanging on. He let me do the dilation, and two or three passes with the suction – and he did all the rest. I mean, okay, so I hadn’t gotten everything out on the first pass. It took him a dozen tries. Resolved, that when I’m a superior, I will promise less, and allow more. That’s less heartbreaking than being promised everything, and getting less.

Okay. Off to a Csection with the chairman now. I have high hopes of this one. . .