So, here’s what I’m taking this semester:
Intrapartum
Neonatology
Postpartum
Intro to Teaching
And eeegads, that’s a lot! IP and Neo alone are enough to snow someone under, and then they’re putting postpartum and teaching on top of that? When am I going to breathe this semester, let alone eat, sleep, work and blog? But it’s been absolutely wonderful so far, I can’t even begin to tell you! All we’ve done this week is talk about labor and birth. I’ve had more knowledge packed into my brain these past three days than I have all summer, and I feel like my understanding of labor and birth has already increased dramatically. Wednesday was all about normal labor: what it’s like, what it sounds like, what it looks like, the phases of labor, what to expect etc. etc., and then the afternoon was devoted to the mechanisms of labor, which just absolutely blew me away. The baby goes through 7 very specific manuevers in order to successfully navigate the maternal pelvis, and it’s such a tight fit! How in the world do those babies actually get through that bony pelvis? And yet they do it all the time, every day. It’s amazing how perfectly adapted for labor they are, and how the natural curve of the head, when it’s well flexed and in an occiput-anterior position, fits so beautifully into the natural curve of the pelvis. The two were absolutely designed for each other, with only ONE centimeter or so to spare! The widest diameter of a baby’s head (the biparietal diameter), when it’s well flexed, is 9.5 cm. The narrowest part of the pelvic cavity (the bispinous diameter, between the ischial spines) is 10.5 cm. That’s not a whole lot of wiggle room!
Six hours of class a day, with our model pelvis in our laps, and our dolls in our hands, going over the mechanisms of labor until we have them down cold: descent, flexion, engagment, internal rotation, extension, restitution, external rotation and then finally birth by lateral flexion. Pelvis, doll head-down and in, internal rotation, head out, shoulders turn, shoulders out, body out, and again. And then flip the baby sunnyside up (or “face to pubes” as our professor jokingly calls it), and go through the mechanisms all over again for posterior deliveries, both long arc and short arc. I’m telling you, this is the coolest stuff in the world! And having read a little bit about anterior and posterior babies in nursing school, and documented the position of the baby at countless deliveries (always by asking the doctor what position the baby was in, LOA, ROA, ROP, LOT etc. etc.) I finally feel like I understand it well enough on my own now that next time I won’t have to ask the doctor…I’ll just watch, and see for myself what position the baby was in as it restitues and externally rotates. Such a huge leap of knowledge in such a short span of time, and school has only been in session for 3 days.
Today was spent going over procedures we’re going to have to know how to do: rupturing membranes, how to check to see whether a woman has indeed broken her water or not, inserting scalp electrodes, and delivering a baby. Just a basic, standard delivery, with the baby in plain old Right Occiput Anterior (ROA), nothing fancy yet. But it’s an amazing start. And I have a lot of practicing to do. Where to put my hands while the baby is crowning, how to assist the head, then check for a cord wrapped around the baby’s neck, and then wait for the baby to rotate, and then support the shoulders as they come out. We have a rubber model of a woman’s torso, with a pregnant belly and a baby inside, and as your professor pushes the plastic baby out through the pelvis, and you stand there with your gauze and clamps, ready to catch, it begins to dawn on you: you’re actually going to be catching real babies, very very soon.
And here’s my note to self: It’s a huge, overwhelming amount of material. Lots and lots of mental stuff to cram into your overwhelmed brain, and learn, and relearn, and know. But in the midst of all this mental exertion, don’t forget about the heart. When you’re shaking and nervous and approaching your very first birth, EVER, in the role of the midwife, the one with hands out and ready to receive…remember that you’re standing in a holy place. Birth isn’t in the textbook. It’s in the mother, grunting and sweating with exertion. It’s in the father, kissing her forehead and urging her on with gentle words. It’s in the baby, wiggling, wriggling, working so hard to navigate that bony pelvis, pushing up towards the surface. Try to focus on that, while you’re struggling so hard to master all of the didactic knowledge, and clamp the cord correctly, and remember to check the placenta, and assign an apgar. Your heart has called you to this profession, this work, this path. Let your heart shine through, and not your nerves.
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