K, who is the intern on OB-Gyn and who has taken me under her wing this month, stops by my seat. "Good, you're here. I was going to page you." She details tomorrow's OB schedule, stressing that I am in no way obligated to come to the 0645 lecture on forceps deliveries and then asks, "You are coming to clinic in the morning, right?" I stammer. Sure. "Good, because it's going to be busy, and we need your help. You're so independent, it really helps."
I am not independent, O Best Beloved. I am clinging and dependent and scared motherloving spitless of new situations. But I am even more afraid of being thought to be lazy, and I carry with me the memory of overhearing a group of residents talking: "You should've seen S. We were done early, short-staffed and everything." I have the fortune of being fond of S, and knowing that he is a nice guy, not a gunner, and completely devoted to his work, and I want what is said behind his back to be said behind mine. I am also my father's daughter, and when something frightens me I throw myself at it in a frantic attempt to discern why. And so I have thrown myself at OB clinic and deliveries and today I threw myself at a C-section and sure, I didn't do much but I did it by myself and K was quite impressed.
I threw myself at a circumcision Friday and I did well, according to my supervising resident. I am feeling almost comfortable doing colposcopy, and I think if someone were to suddenly deliver a baby in the middle of Marshall Fields I could probably catch it in all the right ways.
I am going to OB clinic tomorrow morning because they want me to be there. That feeling warms me so much more than the Sam Adams (which isn't a bad beer).
Today I went to the floor to meet a patient who subsequently went from 6cm to delivered in about forty-five minutes, warranted a stat page to K, and of course did it all while I was enduring a positively interminable lecture about practice management. As we were discussing her case, a call came in. "They're sending someone over from $natural_birth_center. Arrested second stage of labor." This happened last week or the week before, and that time when the woman was hooked up to the fetal monitors I studied the strip, turned to a nurse, and said "That's not a happy baby." And eventually the baby was delived in the most unnatural way possible: through a surgical incision under spinal anaesthesia. C-section. This time, the nurses were murmuring. “G8.” Eight pregnancies, including the current. “P4.” This will be her fifth live baby born. “Pushing for three hours.” What? Three hours, O Best Beloved, is far too long for the fifth baby. After two babies or so, they usually just fall out. “I bet she’s not even complete,” someone murmurs.
They checked her cervix when she came in. Six centimeters. Just like the other woman. Just over halfway dilated. And she delivered about six hours after that, after she’d finally been allowed to dilate completely.
I don’t mind natural birthing centers, O Best Beloved. If you want a doula and a midwife and a Jacuzzi to labor in; if you want to walk and stretch and have your labor induced via nipple stimulation; if you like birthing balls and not having anaesthesia and soft music playing, that’s fine. Go to a birthing center and have your baby. Women have been popping babies out for thousands of years without modern medicine.
But when your birthing center is telling you to push against a cervix that is incompletely ready for your baby to pass; when you are VBAC’ing - vaginal birth after Caesarian section - and there is a 5% or greater chance that your uterus is going to rupture, sending you and your baby into hemorrhagic shock unless you are in the OR and delivered within five to ten minutes; when your baby is premature or underweight or poorly developed and is going to need skilled neonatology care as soon as its born to make sure its lungs expand and its heart beats; when something is not completely normal, I do not like birthing centers. I do not like the way they speak of doctors as monsters who interfere with the natural process of birth. I do not like the way they insinuate that a hospital birth provides an inadequate level of personal attention. I do not like the way that medicine is maligned. And I do not like it when people put themselves and their babies in danger, knowingly or out of misinformation.
I hear the birthing center has to undergo an institutional review because of these women. Good. I want it to be a safe place to have babies.
Speaking of having babies, I did perform a delivery on Friday, and into my hands with almost no assistance from staff was delivered a 7# baby boy. No tears. He was beautiful. I love this work.