{"id":2099,"date":"2018-12-03T16:03:12","date_gmt":"2018-12-03T21:03:12","guid":{"rendered":"http:\/\/www.henrydelrosario.com\/?p=2099"},"modified":"2020-02-03T00:55:12","modified_gmt":"2020-02-03T05:55:12","slug":"standing-at-the-edge-of-the-counter-the-nurse-has-already-started","status":"publish","type":"post","link":"http:\/\/www.henrydelrosario.com\/?p=2099","title":{"rendered":"Standing at the edge of the counter, the nurse has already started on her"},"content":{"rendered":"
Standing at the edge of the counter, the nurse has already started on her\npaperwork. I collect my stack and begin filling out the blanks on the form: name,\ntime of birth, APGARs. It\u2019s so quiet in the room that I hear the scratch of our\npens on paper; The texture of pulp; Papers shuffling; The nurse starts to sniffle.\n\n    Fingers thread and weave, twirling lines and cables, poking and prodding \n    with needles; We rush and mob with violent demand as our hands dance\n    with mom's body\u2014 The maddening choreograph of crash.\n\n        She was alone in triage. Is anyone going to be with you during delivery? No.\n        Don\u2019t worry, we will be there with you, the nurse interjects. I finish\n        consenting mom for a vaginal delivery and we escort her to a bigger room.\n\n    No one is as helpless as a mother trembling with pen and paper\n    being wheeled to an operating room\u2014 stripped naked and cold\u2014 skin\n    on metal. Not knowing why exactly but knowing everything is at stake.\n\n        Precious as a bruise, hard as iron; we feel her belly squeeze and compress.\n        Her eyes are loud. Her face so round; a pot about to boil over.\n        I conjure hope to her that this too will end.\n\n    The night flashes and she is under; There flies the knife into flesh. A crescent forms\n    and then blushes against pale sky. I was unprepared to receive the baby\n    plopped in front of me\u2014 limp and soulless.\n\n        When I check how dilated she is, I feel strands of hair. Mom, your baby has\n        a head of hair like you! She laughs. And then I see her grimace. The nurse places\n        a wet towel on mom\u2019s forehead and we stand there watching.\n\n    My fingers shake as my senior tells me to speak up. My thumbs\n    wrap around the baby\u2019s torso\u2014 smaller than a doll\u2014 ribs like chicken bones.\n    One and two and three and breathe. One and two and three and breathe.\n\n        The nurse already has mom on her side. Let\u2019s give her oxygen too I say.\n        Breathe through the contractions, it helps baby when you breathe.\n        The monitors flicker. The ticks space out and whimper.\n\nWe intubated the baby and he was transferred to another hospital. The rest\nof the team waits with mom in recovery. No more yelling. No more beeping. Nothing\nbut the nurse and I huddled at the edge of the table\u2014 standing and gathering\nstrained shapes\u2014 filling out blanks; Two witnesses sniffling in the dark of the room.\n<\/pre>\n
    \n
  1. Safe Prevention of the Primary Cesarean Delivery<\/a> – “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”<\/li>\n
  2. Fetal Heart Rate Monitoring During Labor<\/a> – 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.<\/li>\n
  3. Cesarean Delivery in Family Medicine<\/a> – 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.”<\/li>\n<\/ol>\n
    \"HD\"<\/div>\n","protected":false},"excerpt":{"rendered":"
    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\u2019s so quiet in the room that I hear the scratch of our pens on paper; The …<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_uag_custom_page_level_css":"","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"ngg_post_thumbnail":0,"footnotes":""},"categories":[19],"tags":[37,36],"class_list":["post-2099","post","type-post","status-publish","format-standard","hentry","category-verbal","tag-poetry","tag-writing","column","threecol"],"uagb_featured_image_src":{"full":false,"thumbnail":false,"medium":false,"medium_large":false,"large":false,"1536x1536":false,"2048x2048":false,"slider-thumb":false,"blog-thumb":false,"teaser-thumb":false,"gallery-1-thumb":false,"gallery-2-thumb":false,"gallery-3-thumb":false,"image-thumb":false,"video-thumb":false},"uagb_author_info":{"display_name":"Del Rosario Henry","author_link":"http:\/\/www.henrydelrosario.com\/?author=1"},"uagb_comment_info":0,"uagb_excerpt":"Standing at the edge of the counter, the nurse has already started on her paperwork. I collect my stack and begin filling …","_links":{"self":[{"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/posts\/2099","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2099"}],"version-history":[{"count":7,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/posts\/2099\/revisions"}],"predecessor-version":[{"id":2544,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=\/wp\/v2\/posts\/2099\/revisions\/2544"}],"wp:attachment":[{"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2099"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2099"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.henrydelrosario.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2099"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}