Some of you, O Best Beloved, have either delivered a child or been present at the delivery. If you have, then you are likely familiar with the electronic fetal monitoring equipment. In this hospital, we put two belts on the patient and use no wires initially. One of them is the doppler fetal heart tone monitor - and in most rooms, the volume is turned up to a comfortable level, so that when you walk into the room there is a soft "shoop shoop shoop" of baby's heart, a steady hundred and ten to hundred and sixty beats a minute. It fills the air, comforting. Fetal well being.
J was on vacation last call; his patient pregnant with twins appeared in the clinic with advanced cervical dilation at 4-5 cm. She came to my care and changed to 6 cm dilation. I got the ultrasound out and managed to find both heads - pointing downward; vertex-vertex presentation. It was time to have babies, at 33 and a half weeks. I paged just in case he was in town - nobody wants to miss a vaginal twin delivery if they can avoid it - and no call came back. All mine.
You deliver twins in the OR, because after the first one delivers the second one may turn back around or go transverse or simply undergo "fetal distress", which means that baby needs to be delivered as soon as possible. There is always a possibility of the second twin being a c-section, in other words. At 1 AM and 9 cm we moved to the back and gowned up for delivery. A few contractions later she was complete and ready to push. Twin A came quickly, easily, sliding down the birth canal into my waiting hands - barely enough time to get a good grip and catch properly. He came out screaming, suctioned, cord clamped and cut, handed to waiting NICU and then we turned back for twin B. And this is the scary part.
To determine position, one reaches for the baby's head. And reaches. And I am so glad she had an epidural because I think I had to reach practically up to my elbow before I found bag and head and baby. "Cephalic." And a few contractions later it was a matter of holding the head, breaking the water, guiding the baby toward the birth canal and watching the nurses scramble to find the heartbeat on dopplers. Shoop shoop shoop shoop shoop...shoop...shoop...shoop. Shoop. Shoop. Shoop shoop shoop shoop shoop... Baby's heartbeat came down, slowed, sped up. Attending looked at me. I did the hand-twist and reach that is involved in getting one's entire hand into the vagina and up to find the baby - and my fingers found hard little baby head and stopped. There was something that felt like a thick rope between my fingers. Cord prolapse. Cord prolapse is bad. Cord prolapse is a keep-your-hand-in-the-vagina-and-get-rea
It's all right. But let's put on a scalp lead. She slid the guide on, twisted, withdrew. The leads switched then, the soft shoop shoop shoop of baby's heartbeat replaced by the electronic tok tok tok of the replicated EKG spikes. And tok tok tok it went, the room silent except for the sound of electronic monitoring, verifying what the doppler had suggested. Tok tok tok tok...tok...tok...tok. Tok. Tok. Tok. Tok...tok...tok...tok tok tok toktoktoktoktoktok and so on. She didn't panic. I was starting to. She just lifted her chin, looked at the mother. Now push. Hard. And mother pushed and baby moved; the heartbeat slowed and faded. Tok. Tok. Tok. Tok. And then, at the last moment, the attending slid aside and baby number two went easily into my hands, a limp and faintly purplish creature. Bulb suction, clamp and cut, pass to waiting NICU, who clustered around her and gave her oxygen and scrubbed her down and made her wail. I love that sound.
Baby A did well; baby B spent a few days in the NICU learning how to breathe properly. Twins do, sometimes. It happens and especially it happens at 33 and a half weeks. She should be fine.
More stories to tell; it is 0100 on my last OB call and I have told you nothing at all about the month. Next month is medicine. I am an empty vessel.