Stars aligning in OB

Wow, what a crazy day yesterday. I saw two caesarian sections, caught two babies, saw one bicornate uterus (a heart shaped uterus). Raquel was the last one who delivered around 8pm and the stars really aligned for her. She was a first time mom in her mid 20s with a history of bipolar disorder, had a painful fracture in her pelvis, was a half a pack a day smoker and had preeclampsia (a form of pregnancy associated hypertension where you get all swollen up, your blood pressure can get to dangerous levels and you can get seizures). On top of all this, her baby had two cords around its neck which we initially picked up because the babies heart rate got really low during her labor. Despite all of her physical risk factors, she was emotionally one of the strongest and most vivacious patients I’ve met and she had such an amazingly supportive family and OB team around her. Besides myself, Dr. H and Ella her nurse, her husband offered to drive through the rain and slush to get her “whatever meal she wanted” after delivery because the cafeteria food wasn’t good enough and her mother who was so supportive and encouraging, sitting all day with her to pick out a name and never once imposing her wishes on Raquel. The support and strength was apparent because even at the low point in the labor when Raquel was in a lot of pain, had a headache and couldn’t catch her breath, she pushed and pushed exactly as she was told. She was so good that she ended up delivering her baby in 45 minutes of pushing (most first time with epidurals moms women deliver in 3-4hrs). The baby came out with meconium stains all over (meconium is baby poop which is a sign of fetal distress), two loops of cord around her neck and looked a bit sluggish and needed to be actively resuscitated because she was not active or breathing on her own. She ultimately did great but not without a good 20 minutes of uncertainty.

Through it all was Dr. H, who was calm but firm and direct with the patient, telling her what she needed to know as well as constantly preparing for the worst whether it was a c section or a vacuum assisted delivery and when it came time, taking decisive action such as cutting an episiotomy and maintaining a high index of suspicion, realizing that when the head didn’t come through the episiotomy, something was holding up the baby. All this while walking me and the patient through what she was doing and in the process both reassuring and teaching all of us.

Afterwards, she let me write the delivery note, taught me about how to manage a baby with meconium staining, how to suspect a nuchal cord compression by looking at the recording of the baby’s heart, and how to get a patient through a difficult situation. After all of that, she introduced me to her favorite drink after a long night: a pink lady (ginger ale + cranberry juice) and as we sat together sipping, it occurred to me that I had just seen another miracle in medicine.