In the previous episode we learned.... Well, just scroll down and read it for yourself.
I gave her some medicine in her IV to strengthen her contractions, and she was able to push the baby down the birth canal. But when it got to the point that the head would deliver all progress stopped. The head was firmly stuck at the outlet of the uterus. This is the reason that we try hard to never do a vaginal delivery for a first-time mom with a baby in breach position. If a mom has successfully delivered vaginally in the past, it is highly likely that she can safely deliver a breach. But with first-time moms like this one, you just don't know, and occasionally the head can get stuck. With a live baby this is a disaster, usually resulting in the death of the baby.
It was hard work, but after about 10 minutes of trying, the head delivered, deeply tearing the side of the birth canal in the process. While this was going on, the nurses told me about the woman in labor in the next bed. She was also having her first baby, but despite strong contractions for several hours, she was not making progress toward delivery. When I could get away, I evaluated her, and realized that she needed a cesarean. Fortunately, the crew had not left after my first call, so I informed them that there would be an operation after all. They waited patiently for me while I sewed up the torn birth canal on the first mom. It was well after midnight when I turned over the last bit of suturing to the Labor ward staff. The evening shift, who should have gone home at 11 PM were still there helping to finish up. I hurried to the OR while Dave went to the ER to evaluate a psychotic young woman.
The operation went well, but as we finished, the phone rang. When the phone rings in the OR late at night, it almost means that there is something else for the doctor to do. In this case it was the nurse on the labor ward, informing me that the patient that we had tried so hard to induce all day long, had gone into active labor, but was not making progress. When I could get away, Dave and I went to Labor to evaluate her. It was clear that the only prudent thing to do was to take her to the OR for a cesarean. I went back to the OR to inform the crew of my decision. As usual, they were supportive and patient. The only comment I heard was, "That's alright. We'll do it."
(To be continued...)
Photo
It's not me, and it's not a cesarean, but it's an operation in our OR, so it will serve to illustrate the story.
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