Standing at the edge of the counter, the nurse has already started on her paperwork. I collect my stack and begin filling out the blanks on the form— name— time of birth— APGARs. It’s so quiet in the room that I hear the scratch of our pens on paper. The texture of pulp. Papers shuffling. The nurse starts to sniffle. Fingers thread and weave, twirling lines and cables, poking and prodding with needles— we rush and mob with violent demand as our hands dance with mom's body. The maddening choreograph of crash. She was alone in triage. Is anyone going to be with you during delivery? No. Don’t worry, we will be there with you, the nurse interjects. I finish consenting mom for a vaginal delivery and we escort her to a bigger room. No one is as helpless as a mother trembling with pen and paper being wheeled to an operating room— stripped naked and cold— skin on metal. Not knowing why exactly but knowing everything is at stake. Precious as a bruise, hard as iron— we feel her belly squeeze and compress. Her eyes are loud. Her face so round— a pot about to boil over. I conjure hope to her that this too will end. The night flashes and she is under. There flies the knife into flesh. A crescent forms and then blushes against pale sky. I was unprepared to receive the baby plopped in front of me— limp— soulless. When I check how dilated she is, I feel strands of hair. Mom, your baby has a head of hair like you! She laughs. And then I see her grimace. The nurse places a wet towel on mom’s forehead and we stand there watching. My fingers shake as the senior doctor tells me speak up. My thumbs wrapped around the baby’s torso— smaller than a doll— ribs like chicken bones. One and two and three and breathe. One and two and three and breathe. The nurse already has mom on her side. Let’s give her oxygen too I say. Breathe through the contractions, it helps baby when you breathe. The monitors flicker. The ticks space out and whimper. We intubated the baby and he was transferred to another hospital. The rest of the team is with mom in recovery. No more yelling. No more beeping. Nothing but the nurse and I huddled at the edge of the table— standing and gathering strained shapes— filling out blanks. Two witnesses sniffling in the dark of the room.
- Safe Prevention of the Primary Cesarean Delivery – “In 2011, one in three women who gave birth in the United States did so by cesarean delivery. Even though the rates of primary and total cesarean delivery have plateaued recently, there was a rapid increase in cesarean rates from 1996 to 2011. Although cesarean delivery can be life-saving for the fetus, the mother, or both in certain cases, the rapid increase in the rate of cesarean births without evidence of concomitant decreases in maternal or neonatal morbidity or mortality raises significant concern that cesarean delivery is overused”
- Fetal Heart Rate Monitoring During Labor – I find it fascinating that we plot the fetal heart rate second by second and interpret the pattern (accelerations, decelerations) to determine interventions. We don’t do this for adults in the inpatient setting or in the ICU.
- Cesarean Delivery in Family Medicine – My residency program had a 1 year fellowship which trained family doctors to do c-sections. “A 2008 survey of graduates of U.S. family medicine fellowships in obstetrics found an overall average of 28.9 cesarean deliveries per year; only 22.5% of respondents averaged more than 30 procedures per year.”