The scrub nurse kicked me out of the OR twice: once for not wearing a facemask with eye protection and twice for wearing a ring. Once finally scrubbed in and gowned up, I found my place next to the attending on the patient’s left side, while the resident and scrub nurse placed themselves on her right. The conscious patient separated from us by a drape, with the anesthetists conversing with her and checking in regularly. More drapes covered her lower body, exposing the lower portion of her gravid belly.
During this scheduled C-section, I quickly developed the hot nervous sweats of a novice while they placed the first incision. The resident and attending gave me quick, clipped instructions on how to be useful during the procedure. “Hold this retractor.” “Let go when we touch.”
They made quick work of the delivery. First, a transverse incision of the skin and subcutaneous tissue. Cauterize any blood vessels along the way to keep the surgical field clear. Second, a vertical incision through the rectus, or six pack muscles. Lots of blunt dissection and forceful traction to reveal the uterus, a large vascular mass. Finally, another transverse incision across the lower segment of the uterus to reach the amnion.
Then, the water broke. A flood of clear-yellow liquid. A blue monster swam up from these depths. The resident pulled the head out and laid the beast by me, between the mother’s knees. A nurse appeared by my side with a bulb in hand, suctioning out the newborn’s mouth. The attending and resident dried off the still-blue skin with vigorous rubs and pats. I stood there, frozen, staring at this creature.
Finally, a cry.
Pink replaced blue as the limbs moved and the ribcage shuttered. The nurse continued to suction. The attending clamped the umbilical cord in two spots, with a few inches in between. The resident grabbed a pair of scissors and directed me to cut. In a bit of shock, I worked the tool and separated the babe from mother for the first time.
While the attending continued to jostle the baby, the resident directed me on cord blood collection, first a syringe then a test tube. Eventually, we handed off the baby to the nurse who moved the now-pink squalling bundle to the bassinet with overhead heater. There, a team of NICUers measured, weighed, and foot stamped the infant while we turned our attention back to the gaping wound in the mother’s abdomen.
The attending and resident pulled the placenta out of the maw and began to vigorously clean the mighty uterus of blood. With a physicality that reminds me of my mother salting cabbage for kimchi, they pressed white cloths into the low incision and removed thick red clots. They inspected the uterus for any retained products of conception and then began to suture the wound together.
The next morning, I walked into the hospital room and immediately sensed the tension in the air. Grandmother and grandfather stood to mother’s left. Father paced nervously off to the side. The resident attempting with great frustration to verbally guide me on sterile gowning procedure while the mother endured contraction after contraction.
After some finagling, I assembled the clean gown for the dirty process ahead: vaginal birth. The resident took up a stool at ground zero and the attending placed herself over the left shoulder. I stood back a few feet with a good view for observation.
A contraction. I see the effort in the quivering of her legs. The crown begins to poke through the birth canal. Some heavy breathing and lots of encouragement from the nurse at mother’s right. The grandparents pat her shoulder. Father holds her hand.
Another contraction. The head presses further, almost to the ears, before retreating back into the canal. Mother gasps. She grunts and tells us she doesn’t think she can do this. The resident has her right hand on the perineum, left on baby’s head, and assures mother that she can. Baby is almost here. No going back now.
A final contraction. Mother screams. I watch the head expand through the impossibly small opening. The resident pulls the head down, exposing baby’s right shoulder, and grabs the tiny armpit. Then, she lifts the baby up and out.
Grandmother begins to sob. I tear up. The mostly pink baby cries and wiggles. Resident places the little nugget on mom’s chest as the nurse begins to wipe the creamy white coat off the skin. Dad stands there, mouth agape and eyes locked.
The attending clamps the cord and asks father if he would like to make the cut. He accepts the scissors with that same overwhelmed look. With great care, he cuts the cord.
The resident begins massaging mother’s belly, gently pulling on the umbilical cord. After a few moments, she hands the cord to me and shows me the proper technique for uterine massage. I mutely accept this task, still fighting back tears.
Then, the afterbirth arrives. I hold the placenta like a cat by the tail and the attending directs me toward the proper bag for storage and disposal.
Long Form Sundays
- On newborns, mud, and shoes (or a taste of Spring)
- On feedback and reflection (or the kick for professional development)
- On confidence through repetition