Magic, magic, magic! I’m walking on air right now! Tired, elated, giddy, bouncy, prone to fits of giggling and wide smiles. I caught my first baby today!! Unbelievable. In fact, I couldn’t have asked for a better first day of clinicals. I am so blessed, and so very lucky.
The day started bright and early with report at 8:00 am at the busy Brooklyn hospital where I will be doing my clinical rotations this semester. The hospital is very unique in the fact that there are no residents there, only midwives and doctors. The midwives are employed by the hospital, and basically run the floor, with one to two doctors on the floor serving as back up, consults and managing the high-risk patients. This set up is very similar to the way they do things in England, I do believe. The midwives handle the majority of the births, admitting and watching the patients, writing orders, delivering the babies, and the doctors are there when needed, for difficult cases or emergency cesareans. Another very neat feature of this hospital is the fact that there are no private attending doctors bringing in their patients to deliver. The only women who come to this hospital are women who’ve attended the prenatal clinic run by this hospital. Everyone is a clinic patient, and I think this allows for far fewer inequalities among patient treatment, and far fewer egos and personalities to deal with. The population served is primarily Hispanic and Polish, with a fair mix of Haitans and West Indians as well.
I am pleased to announce that not only was I on time, I was early. Report was a bit chaotic, but the midwifery director was great when it came to introducing me to everyone and showing me around the unit, and really going out of her way to make sure I felt comfortable. While trying to fix the clock on the wall above me during report, she accidentally dropped it on me. In a way, I sort of feel like that was my good luck charm of the day, the ice breaker, sort of as if this hospital has claimed me as its own. I took it as a good sign, small lump on my head and all.
The preceptor I was working with today for most of the day was great. UNBELIEVABLY patient, and very laid back. We spent the morning taking care of three different women who were all being induced for oligohydramnios and were still in early labor, while at the same time keeping our eye on the only woman on the board who was in active labor. By 10:30 she was fully dilated, and after that I spent most of my time in her room, only stepping out briefly to check up on my preceptor, and to draw bloods on a woman in triage. Before I knew it, the head had come down to the point that you could see it in the vaginal opening even when the woman wasn’t pushing, and my preceptor was helping me to gown and glove. The baby continued to crown for awhile, but it just couldn’t quite pass through the vulvar ring, so my preceptor snipped one of the vaginal bands on the right side (these are the tight, stretchy bands of muscle which surround the inside of the vagina—I believe it’s the bulbocavernosus muscle, but don’t quote me on that). It wasn’t an episiotomy; she left the skin of the perineum intact. It was more like a small snip inside the vagina, just to create a little more give. My hands were on the perineum, gaurding and supporting, and occassionally my preceptor put her own hands over mine, showing me where to put my fingers, how much pressure to apply, etc. (I know many midwives advocate a hands-off approach, while many others believe in supporting the perineum. As a student, I was taught to support the perineum with my hands, and as a student I’m in no position to disagree with my preceptor about this, so for the time being, I’ll be delivering this way. But, for the record, the jury is still out, and someday I would like to try a more hands-off approach, just to see how that goes, and then make an informed choice about which method I prefer. But….now is not the time. Now, I’ll do it just the way I’m told, because what do I know? And how else will I learn this?)
Anyway, within three pushes after this, the head was out! I couldn’t believe it! I surprised myself with my calmness, because I’d anticipated absolutely falling apart at this point. Shaking hands, tears, gods only know…However, I think I was too busy concentrating on what needed to be done to even think about the significance of it (that didn’t hit me until later), and I did exactly what needed to be done. I checked for a nuchal cord. I supported the head while it restituted from direct OA to ROT. My preceptor helped me deliver the shoulders, and before I knew it, I had a squirming, very slippery, squalling and dusky pink baby in my arms!!!
I dried the baby, placed it on the mother’s abdomen, tried to hold off on cutting the cord for as long as possible, but was eventually instructed to cut it, because we needed to take a sample for cord gases (again, a point of contention, and in my future practice, I hope to someday leave the cord intact until it stops pulsing, but this hospital has a policy that requires cord gases on every baby, and I’m not going to argue with that). And then we waited, for about 20 minutes, for the delivery of the placenta. (As it turned out, not only was there a true knot in the cord, but it was a two-vessel cord, instead of a three vessel cord, which was also supported by earlier sonographic findings. Very interesting stuff, although the baby seemed to be fine, without anomalies or defects, and the sonographic findings also supported this).
After the repair (which went pretty well, though slow, with my preceptor telling me exactly where to put the sutures, and helping me identify landmarks etc.), the woman asked me if it was my first delivery. I told her that it was. She seemed relieved when she learned that I was in fact 29 (she told me that I looked like I was 20). And then I told her that no matter how many babies I caught from here on out, I’d always remember her, because she was my first. And she told me she’d always remember me as well, because I had caught her first baby. And then we smiled at each other in a very special way, and I must admit, this brought tears to my eyes. What a spectacular day!
I also did several vaginal exams, for the first time ever, and was able to identify cervical dilation pretty well, although station and effacement absolutely mystifies me. I placed two doses of cytotec in two of the women who were being induced for oligohydramnios, did lots of explaining and teaching, took a history, did an admission and physical exam….altogether, an absolutely, breathtakingingly beautiful, amazing day.
And now, I’m going to lay my weary bones down, get a brief 7 hours of sleep, and wake up tomorrow morning to hopefully do it all again (and perhaps catch the babies of some of the women I met today who were in the early phase of their inductions, but will hopefully be ready to give birth by tomorrow morning! Woo!)