Last night at work was the night of six minute bradycardias. Scary scary night. We had two back-to- back prolonged bradycardias, and both ended up in emergecny c-sections. I’m not really sure why either happened, because neither of the women were my patients, but I was on the periphery of both, helping to get the operating rooms set up. It’s funny how time seems to change when you’re in the middle of an emergency. Everything slows down to a crawl, while at the same time things are happening so quickly! We were scrambling to get anesthesia and the pediatricians paged, scrambling to get the OR set up in time, scrambling to unhook the woman from all of her monitors and plugs, and detangle the IV lines, and run the bed down the hallway, and then, once she’s in the operating room, there’s complete chaos as everyone tries to get everything done at once, and every minute lost is a minute that could make the difference between a living baby and a dead one (sounds awfully dramatic when I write it that way, and often it’s more a difference between a living baby that’s perfectly fine, and a living baby with some kind of neurological damage, but even so, and you are very very conscious of this thought when you’re in the middle of scramble mode). The sterile packs and c-section kits need to be opened, the instrument count needs to be done (if there’s time for it), the bovie pad needs to be put on the woman’s thigh to ground her, the belly has to be prepped and washed, the suction has to be turned on and hooked up, a foley catheter needs to be inserted if she doesn’t have one already, the warmer needs to be set up….and this is just the nursing tasks which must be completed before surgery can begin. There are a million things involved in a c-section, and usually you have at least half an hour to get all of it put together, instead of 2 minutes. By the time we got the first woman back and into the OR, the baby’s heart rate had been in the low 60s for nearly 6 minutes, after a failed high forceps attempt. The woman was put under general anesthesia and the baby was out in under two minutes, and placed into the waiting arms of the pediatrician and neonatologist.
You don’t see true stat c-sections like this that often, and afterwards, there’s a period of time where you sort of wander around for awhile with a glazed expression on your face, all pumped up on adrenaline, and wondering to yourself “what the hell just happened?” So, you can imagine our surprise when we had just begun to recover from the first nightmare when all of a sudden another woman’s baby bottomed-out into a prolonged decelleration and another stat c-section was called. There was this terrible sense of deja-vu as we were scrambling yet again to get another OR ready (it’s very rare that we have two ORs going at the same time!), although this time, the c-section was not quite as fast as the first one. We were able to do a proper count beforehand, and the woman was not put under general anesthesia.
Praise to all things holy, both babies turned out just fine. The first one went to the NICU with Apgars of 2/8 and the second one went to the well-baby nursery with Apgars of 8/9. It was a bit of a crazy night.
And the questions I am left with are these: how does one continue to believe in the beauty and safety and normalcy of birth in the face of experiences like this? If either of these bradycardias had occurred at home, there’s a good chance that the first baby wouldn’t have survived, and the second baby would have been severely damaged. When people tell you that homebirth is unsafe, they are thinking about incidences like this. And maybe they’ve got a point, if you just look at the last half-hour of both of these womens’ labor: their babies were in distress, and modern medicine was needed to save them. It really sort of leaves you hollow, and frightened, and questioning everything you believe in. But then, do you just ignore all of the things done to these women by modern medicine which may have been what put their babies into such stress in the first place? The inductions, the epidurals, the pitocin, the invasive monitoring, the IVs and near starvation of their mothers while they labored, the supine position, pushing in lithotomy, high forceps…what would these births have looked like if they had been allowed to go at their own rate and time? If the women had labored in different positions? If so many interventions hadn’t altered the course of their body’s rythym? Maybe instead of asking why birth is so scary, and unsafe, and always an emergency waiting to happen, maybe the question I should really be asking is: what are we doing to women in hospitals that causes so many bradycardias?