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A Complicated Catch

Posted May 19 2012 1:41pm
She was young, really young. That was the first thought that popped into my head when I walked into the birthing suite on the L&D floor. The mom-to-be was laughing at a joke her boyfriend had just cracked, something about her insides being on the outside when the baby came out. That may have been an amusing punchline, but I remember thinking to myself that they will be surprised by what actually happens.

I stood next to my attending who was checking the fetal monitor. The room was full of rambunctious teenagers, squeezed tight like sardines on the couch and sharing bags of chips and gummy bears. They were laughing and squealing, as if it was just another Friday night after a long week of classes. I felt as if I was crashing a party. But here they were, two kids still in high school about to meet their child for the first time.

Her labor was progressing, and the anesthesiologist was on his way to administer the epidural. The attending announced he was about to check how dilated she was, which was the cue for the crowd to leave the room. Her boyfriend stayed back and watched with wides eyes in horror as the attending manually checked the cervix. "Oh man, that's so gross," he said out loud. His girlfriend squirmed a little as the attending assessed the diameter of the cervix and giggled in response to her boyfriend's revelation.

The next time we walked into the room, my attending and I were ready to gown up in preparation for the delivery. Swathed in sterile blue and knee-high "moon boots", we approached the end of the bed and prepped the patient for the exciting moment. She nudged herself down to the edge and placed her feet in the stirrups. Then, she started laughing. And in between the chortles and gasps for breath she repeated over and over again, "I feel so weird. I feel soooo weirdddd!" I guess the epidural had kicked in...

We urged her to push, cheering her on and encouraging each effort. After a while, it had become apparent that the forceful pushes weren't enough for the large baby to pass through without causing vaginal tearing, so the attending prepared for an episiotomy. Shortly after the attending made the incision through the perineum, the baby's head emerged. But then came issue number two: the attending felt around the head and realized the cord was wrapped around the neck.

I could feel the adrenaline rush surging in me. This delivery was unlike all the other seemingly smooth deliveries I had seen before. Anything that could go wrong was going wrong. But there was no time to worry about it. It was about getting the baby out and making sure the mom was ok.

The attending cut through the cord to relieve the pressure around the neck. Then he placed my hands on the head and directed me on how to rotate it, free the shoulders, and pull the baby out. I don't think I'll ever get over that feeling: my hands hugging the torso of a brand new life, slippery and warm, and praying that I don't drop him/her. Swoosh. That's what it feels like, looks like, sounds like when the baby is pulled out and placed on the mom's chest. Swoosh. That's what happens in the moment when the baby is born.

The nurses were at top speed drying off the newborn. Both the parents were in shock, staring at the face of their new baby girl. As the new parents uttered "whoas" under their breath", the attending instructed me to collect cord blood. Because the cord had been cut earlier, it was more of a stump I had to wrangle to drain into the tube. My gloves, slick from the vernix coating the baby, had lost its traction and I wrestled with the cord retracting back to the placenta that was still attached. And when I thought I finally had control, I released the clamp only for the cord to free from my fingers and spray a line of blood across my gown. I could have been an extra in a horror movie the way I was doused in blood, but I didn't care. I didn't care that my attending was chuckling, I just wanted to fill that darn tube. It was me against the cord.

Eventually, that task was completed and my attending told me to pull out the placenta. Using clamps, I gently eased it out, telling the new mom that she would feel a little more comfortable once the after birth was delivered. A gentle tug and the purply, webbed structure emerged, and just as with the newborn, I focused all my energy on not letting it fall anywhere else but into the collection bowl.

But our job wasn't over just yet. The attending stitched up the episiotomy he had done earlier, and I watched as his skilled hands made quick work of the sutures. But the blood, it just kept pouring out. I watched anxiously as the rich, dark red oozed out, puddling in the plastic catch-all bag. The sponges I held in place did nothing except turn maroon in seconds. I heard the attending ask for methergine as I continued to soak up the blood. And then out of the corner of my eye, my attending began to remove his gown and gloves.

"You're going to do a uterine massage," he told me. "One hand inside, one on top on the outside. Feel for the uterus, it should start to get smaller."

I nodded and did as he said, trying to remain as calm as he had been the entire time, but all the while feeling the adrenaline run rampant through my system. I began the bimanual massage, willing the uterus to relax. I locked eyes with my patient who had been groaning with the discomfort, and I was struck by how pale her face looked.

"I know this feels uncomfortable, but just a few minutes more. You did so well, you have a beautiful baby girl." And I just kept repeating the same sentiment over and over again to her as my hands tracked the slowly diminishing size of the uterus. The attending walked back over to me, after finishing the charting, and told me to remove my hands. He measured the uterine size externally as my right hand slipped out, and with it a large clot passed by my fingers. The bleeding had slowed down and I let out a huge sigh of relief. In the end, both baby and mom were fine. They were stable when my attending and I walked out of the room. But I wondered how their lives would be, parents still in high school and a newborn in their care...

It was a complicated catch, and I thought that things as scary and nerve-wracking as that would make me reconsider going into it as a profession. But it didn't. In a weird and beautiful way*, it made me love ObGyn even more.

*Thanks to Dr. Bob for the brilliant, celestial juxtaposition
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