I got to do another delivery this morning (yay!). I think, though, that the OB cases are progressively getting more complex and more difficult to manage, which is really good for expanding my experience. The most recent was a baby that was sunny side up (ie. looking up at the ceiling), which makes it really difficult for the baby to come out. Then the baby was having a lower heart rate during contractions (which made us all more on-guard…well, is quite frankly nerve-wracking). Then after delivery, everything turned out well and looked great, but then we had another post-partum hemorrhage. :/ I did get to use my ALSO (Advanced Life Support in Obstetrics) training ~ twice. One for doing a manual rotation, to turn the baby to come out looking down at the floor, rather than up, which makes it a lot easier to deliver the baby, if it works. And two, to manage the post-partum hemorrhage.
I keep realizing things that are a change of mindset for me: for example, we don’t do any epidurals here. I forget to use some of the easier, less-interventional techniques that we can do with mamas who are delivering naturally. Like today, maybe instead of doing a manual rotation, having the patient get on hands and knees to gently help turn baby around. We did have her lay on her side, which in combination with the rotation, the baby turned. But for a woman without an epidural, a manual rotation is lots more uncomfortable, and it makes people yell in pain…which in turn, makes me want to just stop and ease the pain.
Obstetrics is hard, because in the moment when it looks like the baby is in distress, you want to do everything to get the baby to be ok. So today when the heart rate was dropping (and for a while it was difficult to find, and I thought there wasn’t any), my first thought was we need to get the baby out, (and I’ve seen lots of manual rotations work wonders for helping a baby that is sunny-side-up deliver quickly). But then again, maybe things would be fine if you take a step back and wait a moment and let things happen naturally. It seems true that based on lots of worldwide studies that we don’t need to be as interventional as we are. And I love home births and I really loved the documentary “The Business of Being Born,” and I want to be more natural in my approach to delivering babies. But then I also reflect back on med school, to our Pediatric rotation, when we got visit with a family who had kids with medical problems, and my assigned family had a son with Cerebral Palsy, who was bright and full of joy, but who couldn’t speak and had severe disabilities, and the mom telling me her story of how it did not seem like the doctors did the right thing during her delivery, and it felt like it was their “fault” for not acting fast enough. Then I get scared of something like that happening, because I didn’t do the “Right” thing. Is there a right or a wrong thing in OB? Studies tell us that we do too much–too many c-sections, too much augmentation of labor, too many interventions during their labor. But case studies of things that go wrong yell louder at us that we have to do more, sooner, quicker. And at the end of the day, we all want a healthy, happy baby and a healthy, happy mom. What is the right answer?
I have much to learn… It makes me feel like I want to run right back to training. I don’t feel ready to be on my own. I want to see how more OBs deal with this type of situation (even though I’ve seen plenty, and the most interesting thing is that they all deal with it differently). and I want to go through OB residency training, and midwifery training. And I want to shadow people who have done it much longer than I have.
I talked to the visiting OB/Gyne specialist about this today, and she agreed~ that when you are first out practicing, like a fledgeling learning to fly, there is nothing so scary as taking those first solo flights. No matter what happens.