Monday night was my first of three on-call nights for my family medicine clerkship. There are two different on-call services that I will participate in: maternal child health (delivery of babies and care of both mom and baby afterwards) and the family medicine service (everything besides women giving birth). My first call was with the pregnant moms.
I worked at the clinic during the day (with a few hour break to teach fifth graders at a local elementary school about the ear). The on-call night began at 5pm at the hospital that my clinic is associated with. There was very little to do at first. I met the resident and attendings on-call as well as two other med students who were working there. I found the on-call room and got my things organized and changed into scrubs.
After that, I walked around with the physicians to check on several patients who would potentially give birth. I have finally come to understand why women say that they have no shame after giving birth. I don’t think that there is any more of an invasive time in a woman’s life than while she is pregnant, and increasingly so when labor begins. For some reason, I didn’t realize that a woman’s cervical dilation was a digital exam. I guess I thought that you used a speculum like when you visualize the cervix for a pap or other cervical swab test. I also didn’t know that there was much more that is checked with the digital cervical exam besides the width of dilation – there is also the thinning of the cervix and the distance that the baby’s head is from the cervix. Either way, these women have a lot of fingers up inside of their most private areas – checking the cervix, stretching the perineum, feeling for the baby’s head, etc. It can’t be comfortable and it must be a least a little embarrassing, especially with other random people (like yours truly) around. But I guess these mom’s get so tired and are in so much pain that perhaps this is the least of their concerns.
I saw a patient around 10pm who was 20 weeks pregnant and worried she might be having contractions. After talking with her and doing a physical exam, fortunately it turned out to just be a yeast infection.
All the action really started around midnight (of course!). I went to one room to observe a mom in labor with her 5th child. Her next youngest child was born over 6 years ago, so the labor was much more like watching a first child be born. Even though she was already 10 cm dilated, the baby was positioned in an unusual way so the end of labor lasted a long time. There was a lot of amniotic fluid left over that kept squirting out. Finally the baby was born. I was relieved that it was over. It’s such a tense situation. Afterwards, we helped mom deliver the afterbirth. The umbilical cord is one of the most mystical appearing things of the whole process. It’s all white and shiney and weird. It’s very foreign looking. And just as I was appreciating that, I ton of amniotic fluid overflowed the plastic protector and flowed all over my leg. Gross.
There was no time to worry about my wet leg though, because then my other patient rapidly progressed in her dilation and I rushed out with my attending to deliver the next baby. When I got there, she was in very active labor. Her baby was also in an unhelpful position. Mom had to get up on her hands and knees (I’m not sure what it accomplished). She pooped herself. This to me is one of the most aweful parts of labor. I don’t ever want to defecate on myself. Yuck. Anyhow, finally her baby was born with one huge push. Unfortunately, mom tore her perineum. Her labor progressed so quickly that there wasn’t a lot of opportunity to stretch her perineum. The highlight of my night was getting to help suture up her tear.
I felt relieved when the babies were born, but I didn’t feel overwhelmed like some people say they feel. Watching women push bowling balls out of their vaginas is not pleasant. It is not beautiful. It is not magical. And the last thing it made me want was a baby. No maternal insticts were stirred. Maternal instincts were squashed.
What was stirred was a desire to sew. It killed me to have to watch the attending sew up the vaginal tear. With my recent trainging, it was clear that I have better sewing skills at this point than the family medicine attending. Of course, she doesn’t have to sew things every day. My skills will deteriorate too without practice. Anyway, I miss surgery…