Before my week on Labor and Delivery (affectionately known as “L&D”), thoughts danced through my head about what I’d be blogging about. Joyous, momentous, wondrous times delivering new humans into the world, tears falling from everyone’s eyes; laughter and hugs and happiness and rainbows and unicorns.
But no no, dear readers, no rainbows radiated from any of my patients’ vaginas. In fact, I felt very little happiness at all. I’ve come to realize that there’s one particular emotion that beats out happiness, joy, excitement, and all that sweetness. And that would be fear.
Now I will be the first to admit that my first observed delivery (the “see one” in the see-one-do-one-teach-one methodology) was crazy happy. It went smoothly, I had been checking up on mom and dad and gotten to know them as well as one can. Tears happily left my eyes as the intern delivered the baby, the woman sighed with relief, and the father, so overwhelmed, didn’t feel as ready to cut the cord as he thought he would. It was a beautiful, amazing, emotional time, and I just wanted to hug everyone in the room.
My first delivery, however, remains firmly under the category “Oh Crap/Fear.”
Baby delivery is not, in a word, pretty. In fact, it is, in a word, ugly. Messy. Dirty. Gross. (And even grosser but somewhat more normalizing to realize we all had to go through the process.) I don’t care what health video you saw in high school, but it clearly digitally-removed most of the blood, fluid, and poop that ends up under the woman pushing. It is not a pleasant affair. From a purely physical perspective, you have a woman pushing a bowling pin through a nostril, and in the process, blood is sliming or gushing out; amniotic fluid (clearish with specs of white floating in it) is seeping out as well. And because she’s pushing so hard, often she’s pooping accidentally at the same time. This wonderful mixture is sometimes accompanied by one more wonderful substance, baby poop (often a sign of stress in the womb), which is sometimes thick and tarry, sometimes clumpy, always disgusting. Luckily I like disgusting, or at least don’t mind it. (It’s a dominant trait, inherited clearly through my mother, who loves popping zits and whiteheads and such.)
And this is only a few minutes around the time of birth. The rest of the time you’re just checking on the woman, seeing how far she has to go before her cervix is fully opened and ready to let the baby out. You check her every 2 hours or so.
For clarification, medicine doesn’t scare me easily. I find almost all of medicine somewhere on the scale between “interesting” and “awesome,” but boy does human-sticking-out-of-another-human freak me out. It’s almost a hypersensitive version of my pediatrics rotation: scared to death that by holding an infant wrong, its head might pop off. So you’re standing there, encouraging your patient to push push PUSH! your other patient out, and everyone else is in there encouraging and yelling too, and then the head gets closer and closer to OUT with every PUSH. You’ve got one hand below the vagina, trying to help support and stretch it out safely, and another head above the vagina, trying to keep the baby’s head flexed toward its chest. And then with the next push, the baby’s head finally makes it out, and then the gush of fluids starts. It’s like a suction cup came off a wall. Everything happens so quickly. You get the head out, push DOWN to get the top shoulder out, rock back UP to get the bottom shoulder out, and the little thing FLIES right out at you! Some clearly insane or memory-deficient person described his first delivery of medical school as “one of the happiest times of his med school career,” but I’m here to tell you, it’s anything but. No happiness chemicals come surging out from your body. No no, dear friends, those would be the chemicals of pure terror.
Mother Nature, in all of her infinite wisdom, forgot to add a gripping pad for babies. They squirm and scream, covered in slimy, slippery goop, and you’re asked to grab hold with one arm, while using the second for various other tasks like suctioning, clamping, scissoring–not the easiest task in the world. In fact, I think my favorite part of the delivery was handing the baby off to mom’s belly. “Here, you hold onto him, he’s your responsibility now!”
Then you think, “Wow, I did it, I just delivered a baby!” only in time for you to try to get the placenta out. You clamp the cord and slowly put traction on the cord, ask the mom to push, and push on her uterus until the placenta comes loose, and you get hit with a second wave of blood. The placenta is this gigantic purple pancake-like thing. It’s freaky-looking.
So that’s the baby-delivering process. The scariest parts are when the baby isn’t coming out, and everyone’s yelling at the mom, “Come on, you HAVE TO PUSH! Harder!” and things aren’t moving. Sometimes you have to get out a vacuum, sometimes you have to use forceps, and the baby’s heart rate is going down, and it’s pretty scary and touch-and-go. But then the baby comes out, and everything’s better. A sigh of relief. (I haven’t seen an emergency c-section yet, but I can imagine it being pretty scary as well.)
I always try to remind myself that we all went through this; that women have been delivering by themselves for centuries; that in most cases they did just fine without us doctors medical-izing everything. But that doesn’t mean that your heart doesn’t skip a beat when things aren’t going as planned. L&D isn’t something I could see myself doing, but I’m glad we have men and women who do it–every so often you find a baby or a mother who need medical and surgical care, where delivering at home would be dangerous–especially with new reproductive technologies and supportive care are allowing many women to get pregnant who even 10 years ago wouldn’t.