April 13, 2013

Delivery

"If our patient starts to deliver...what will I get to do?" I asked the resident, tentatively.

"You can deliver the baby, if you want!"

"Really?!" I was incredulous.

This was my patient's fourth baby, so it was hardly her first day at the rodeo. She came in the morning, and right before we examined her cervix, her water broke. We left to do a cesarean section and when we came back, she hadn't changed very much. She didn't change much throughout the morning so we started some oxytocin. She was nervous, maybe because it had been a while since her last baby.

In the afternoon, once the epidural was in, she relaxed a little and her cervix opened right up. By early evening, she was starting to feel like she had to push. We checked and she was just shy of complete, a thin rim of cervix all that remained between waiting and pushing. The resident and I hurried to eat sandwiches we had bought at the hospital cafe and we had hardly finished before the nurse poked her head out of the door:

"She really, really feels like pushing...and she looks like a person who's ready to push."

We went in to the room. I put on the lavender nitrile gloves while the resident put on sterile gloves to check the patient's cervix again. The patient's aunt and mother helped hold up one leg while I held the other, and when the next contraction started we helped her curl her body around her belly while she bore down. The energy in the room was palpable. I had a brief moment of wonder where I realized that the scene I was in was as old as humanity: women surrounding a woman in labor, supporting her and giving her the energy and encouragement she needs to get her baby out of her belly and into the world.

The thing about deliveries is this: the physics and geometry do not seem to make sense. If you've ever seen a circle that is 10cm wide (just barely narrower than the length of an iPhone 4, if you're curious), and if you've ever seen a vagina, the fact that those two configurations could overlap is absolutely astonishing. It shouldn't work, and your mind says, "That baby is not going to fit through that hole!" and yet--it does. In fact, not only does it fit--most birth are completely capable of vaginal deliveries! How is that possible!? The mind boggles.

On the next contraction, the resident could feel the baby's head advancing. "I think I'd better get dressed!" she cheerily announced. I hurried to copy her, shoving my feet into knee-high waders, grabbing a gown and miraculously remembering how to sterilely gown and glove myself. Then I was there, at the foot of the bed, and the resident's hands were at the perineum and the baby was crowning. She put my hands where hers were, and I could feel the baby coming. I tried to pry my fingers into place. Everything was happening so fast! The patient pushed another time and the head was free. I had my hands around the head and the resident's hands were there too, and there was a little resistance, so she took over. I'm glad that she did because the baby came out fast and I would not have been prepared. We suctioned his nose, someone cut the cord, and we turned our attention to the placenta. I got to pull it out while the resident massaged the patient's uterus from above; it came out smoothly and with the same graceful swoop of the baby.

I couldn't stop smiling. My heart was beating so hard! and the adrenaline of it is still coursing through my veins now, two hours later.

This was the most powerful scene I have ever witnessed. This is better than any drug and twice as addicting. Even in surgery, elbow-deep in viscera, there is control and tension and protocol.

Here, there was chaos. Birth is chaos and raw energy and creation and life itself.

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