Lately I feel like all I've had were exciting deliveries. Today continued this tradition - but was more fun than usual since today I delivered the first baby of my very own patient, someone I've followed and cared for throughout her entire pregnancy. My other deliveries up to this point were other people's patients - which are still great, but there is something wonderful about delivering the baby of a patient you have come to know.
This lady is very sweet, from Mexico, and is 41. It's also her first baby. She was actually told in the past that she couldn't get pregnant, and so was very ecstatic about this baby. Her husband has been at most of her appointments and excitedly watched during all the ultrasounds I did. Unfortunately, this has been a somewhat difficult pregnancy for her, complicated by diabetes and high blood pressure. We actually induced her yesterday because she had preeclampsia. This morning, at 11:30, she was 2cm dilated. I figured she'd be delivering sometime tonight. Around 12:45 though, (just over an hour later), I got the call that she was complete and ready to push. I got upstairs, gowned, gloved, and goggled up. I told the nurses to page the attending to come for the delivery. She started pushing and after several pushes, the baby's heart rate dropped to around 90.
And there it stayed. I kept watching as the seconds ticked by, waiting for it to rise. It didn't. The attending still wasn't there. Several of our new interns were there, which was great, but they have even less experience than I do. After 2-3 minutes, I told them to get the vacuum and another minute or so passed before it got to me. Very slowly the heart rate rose, but as soon as she pushed, it dropped again, staying in the 80s and 90s. I kept hoping our attending would come and help me since I've never actually used a vacuum myself. I've watched it done, but haven't actually put it on myself. I even got them to page the OB-Gyn who was on the floor just in case.
Finally, I realized that I couldn't wait and that baby needed to come out now. I quickly applied it and with her next push, pulled the baby out. As soon as the baby delivered the OB walked in, heard the lovely sound of a new born crying, smiled, and walked right back out. It took me a minute to figure out how to get the vacuum off the baby's head. Our attending walked while they were cleaning the baby up.
I breathed a sigh of relief, thinking that the exciting part of the delivery was over. Oh no. I was waiting for the placenta to deliver and gave a gentle tug (like I always do) on the umbilical cord. It ripped off, leaving the placenta still inside. This is not supposed to happen. Nor is it good. I had to stick my hand...er...my entire arm up to my ELBOW... inside the lady's uterus to manually pull the placenta out. I could feel the uterus clamping down on my wrist. I could also feel drips of sweat tracking down my leg as I tried to stay calm and prayed for God to help me take care of this lady.
I've decided there is no feeling quite like having your entire arm deep inside someone else. Placentas, I've also discovered, are quite slippery. I couldn't quite get a hold of it, so my attending finally had to get it out. The baby, I'm happy to report, is a beautiful baby girl who is doing fantastic. She also has these beautiful eyelashes and lots of dark hair. Mom and Dad are very excited to have such a lovely new member in their family.
I figured that was my one exciting delivery for a while, but just now I was watching a colleague do another delivery and I was there to help with the baby. There was a shoulder dystocia (baby got stuck after the head came out) and also very thick meconium (the baby's poop) present in the fluid around the baby. So it took a very long minute or two to get the baby out, and then the baby had to be intubated to suck all the nasty goo out of his throat and mouth so it wouldn't get in his lungs. After that and a few breaths with a bag and mask, he pinked up and started squawling and is doing great.
I've had enough excitement for 1 night.