Last Friday night, I shadowed in Labor & Delivery for the night shift. I gotta tell you - it was insanity. In just 6 hours, I saw two C-sections and a vaginal delivery. I will now outline the ballerness of each event:
C-section 1: Emergent
This woman's baby had a falling heartbeat, so her C-section was emergent. Since the decision to do it happened right as I arrived, I didnt get to scrub in but I definitely got to watch from about 4 feet away. It was a whirlwind of..STUFF..that I had never seen. And it all culminated in this moment: The intern performing the surgery had made a slit in the woman's lower abdomen, then a subsequent cut in her uterus. She reached both hands into the women's uterus, and within seconds, managed to YANK out a baby. I mean this baby came out of NOWHERE. Well, I mean, it came out of the mom. But really - it came out nowhere. The umbilical cord was short and wrapped around the baby's neck, hence the need for the quick C-section. But, in a matter of minutes, there was a breathing 9lb (count em', 9lb) baby girl in the arms of her mom. It was emotional; mom started crying and I nearly teared myself. That was the first birth I'd ever witnessed and it was beautiful, gross, awesome, and terrifying all at the same time. On to the next one.
C-section 2: Scheduled
I got to scrub in for this one. The Chief Resident that night was amazingly nice, and a great teacher. She ran me through the entire process of scrubbing in, something I hadn't done before. So many small details I never thought of, like how to run my arm through the water in one swoop without backtracking, then repeating to get off all the iodine soap. I had to pat my hands dry a certain way on a towel, and had the PA assist me in getting on my sterile gown and gloves. I basically thought that was the end of my lesson for the day, but the Chief instructed me to stand next to her at the operating table - sweet! As the cuts were being made, I was able to hold a tool (I should probably learn the name) that held her open so the other docs could work. And then it happened - another 9lb baby was forcefully removed from his mother's uterus. And I saw it first hand. Holy shit. And then, the PA handed me a bucket and said, "Catch the placenta." And I did. Holy shit. Mom got her newborn son, but this time instead of tearing, I was intensely focused on the next task. Cutting sutures. Yes, the Chief and PA and intern all let me cut the sutures that they were so diligently putting in - 1cm from the last stitch, in case you needed to know. I had a little trouble because the splash guard on my mask was fogging up (gross) - guess I was REALLY excited. But it worked out nonetheless. And that's not even the best part. After stitching the uterus, the intern and PA stepped back. The Chief calmly said - "Ready to staple?" ....Um....WHAT?? That's right ladies and gentlemen. I got to staple this lady's skin back together. Now it's not that hard, you just take a little staple gun and do the damn thing. But it was so sweeeeeet. And the Chief was great about. "Great job," she said. "All this woman is going to see of her surgery is what you just did. Beautiful." How's that for encouragement? I got lucky being on her service that night. That was one of the craziest moments of my medical life. Even trumps the open heart surgery I saw standing bed-side. This time, I got to DO something. Is this what being a doc feels like? Holy shit. On to the next one.
Vaginal Delivery w/ Perineal Tear
The last delivery I saw that night was of a very young mom. She was a "bad pusher," as some had said, but since she was so young, they wanted to give her every opportunity to deliver vaginally before resorting to a C-section. So, they took her to the OR to deliver, in case surgery was needed. Now by this point, I'd seen two C-sections. But no vaginal birth, the kind you see in the movies with people crowded around yelling "PUSH! PUSH!" Well this was that kind of delivery. Except while some people said "PUSH!", the PA was yelling "EMPUJE! EMPUJE!" Both mom and the PA were Hispanic - that helped the comfort level. What wasn't like the movies, however, was mom's vocals. Every film with a birthing mother shows her yelling and crying and sweating and maybe swearing. But this mom was a silent pusher. She had tears in her eyes and a look of terror as she looked at her boyfriend and at the PA - but she didn't make a sound. Everyone else around her though, probably a crowd of 5 standing around her vagina, were yelling words of encouragement. And it worked. Mom delivered a near 10lb baby (yes, it was Huge Baby Night). In the process, she suffered a perineal tear, which I got to watch being stitched back up. It was a gruesome scene, of a swollen vagina (ouch) with a tear to the anus (double ouch) and blood and meconium and more blood. But it was a happy scene too. Mom and Dad seemed excited about their new baby boy, and a little afraid at the same time. "I'm not sure if I'm holding him right," mom said at one point. Another teary-eyed moment.
So what did I learn that Friday night? Well - that OB is sweet. I never really considered it before, but the idea of combining such personalized patient care with surgical procedures seems like the best of both worlds. So its definitely on my list of possibilities. However, I also learned that having kids looks insanely painful. Miraculous, but holy shit, painful. So...we'll see about that :)
Sigh.. what a night.
