Friday, December 23, 2005

what I learned on my OB rotation....

before I delve into the wonders of a med student's experience on the labor and delivery floor I want to thank you for the sweater suggestions. I think I know what's next, but I need to do some swatching before I make any final decisions. My mom pointed out that, for the past 20 years (give or take), I've never followed directions as written. Recipes always wind up with my own twists and additions, fabric patterns were altered and if I thought I could do it on my own without any references, I did. I don't believe in making sweaters out of "pictured" yarns, and still wing some of the things I've knitted. This sweater, the one that I will make for me, will have to be made by the book. I need a sweater success before I go back to flying by the seat of my pants. (it might be a challenge - on lots of levels!)

This week has flown by and I don't have a whole lot to show for it, but I finally feel like I've caught up on my sleep. I've had time to process the past six weeks and feel like it was, overall, a good rotation. There were several frustrating undercurrents that I made a point not to mention (no need to spread negativity) and now that I'm not immersed in the daily routines of being in the hospital I feel like I'm back to myself. One of my classmates taught me the med students creed and if it's the secret to happiness then I'll use it on my next rotation (it's used no matter what the situation): It's all my fault. I'm sorry. It won't happen again.

I've been known to say to people (nurses, doctors, assistants, etc) "I don't know, I'm just the med student and I'm new. " The ones who reply with something that reminds me to remove the "just" from that statement are often the ones who are the most helpful. Others are grateful that I've acknowledged I have no idea (where something is, for example) and exploit it. I tried to remain positive and remember that I'm at the bottom of the pile (nurses are high above me because they can chart, accept orders and administer drugs - this was made known to me over and over again) and my position in the scheme of things isn't permanent, but it's hard to remember when I'm over-tired and frustrated and often the reason for whatever the problem is/was. I never said or did anything that was inappropriate and often remained quiet when I probably should have said something, but it got me through. The doctors were great teachers and one birth in particular really did make the whole time worth it....

I often left notes with my pager number up at the laboring nurses station before weekends - most said that if a woman in labor came in they could page me and I'd love to come in. Saturday Dec 10th my pager went off at 11pm. I was getting ready to head to bed and paused to think about if I really wanted to go in before I called to see what was going on. A resident answered the phone and filled me in on what was going on, and hinted that if I came in I'd be able to "do" the delivery. That was all it took - a quick shower later (I've learned the hard way that when I leave for the hospital I never know when I'll be back again) I was on my way in.

The doctor who was "on" for the birth was a family physician, and he's seen me around and worked with me (and other med students) before. After we talked about the possibilities for this delivery he took the resident off the case and said that we could do it together; this later evolved into me handling the birth with him assisting.

The laboring mom and her husband welcomed me to her process and was comfortable with how things were going. It was their third child and she had a history of quick labors. This labor took a turn and wasn't quite as fast as we'd predicted, but after an hour or two of sleep it was time to be everpresent in the labor room.

The doctor I was working with had spent some time training with midwives and he taught me a technique to minimize tearing; when it came time for her to push, my hands were the ones on the baby and with the help of the doctor, a bright-eyed babe entered the world without any tears or cuts. I was hesitant to apply as much force as I needed to for the shoulder delivery, but he was there to help out and now I have a (first hand) idea of what it takes to deliver shoulders. (doctors do this part of the delivery differently and this was just one technique) It might have taken an extra contraction or two (of her pushing vs. just a quick cut and the baby being out) but as soon as the placenta was delivered we were able to put the bed back together and leave the room without needing to spend more time repairing things. (we went out and greeted the two bleary-eyed-just-woken-up (in the middle of the night) older kids and gave them the news - that was priceless.)

The difference between this delivery and the others I was at are many, but the one that stands out in my mind was the confidence the doctor had in me. This wasn't' t his first time working with a med student, and it wasn't the mom's first delivery. He was right there to help and had enough experience sitting "back" that he was relaxed through the whole thing. His relaxed (but ever aware - he wasn't lackadaisical about it at all) attitude helped everyone in the room to relax - and that, I think, was key to the success. His experiences aren't something I can count on every doctor having. The whole delivery was calm (in retrospect - there was some yelling and some pain but it was short lived and they said well worth it) and the beauty of the birth process was crystal clear to me. It's the delivery I hope to have with my own kids. (and showed me that it's possible to have a med student there...)

other things I learned....

- new, just born babies sometimes look like old men. A few have coneheads. People who have never seen a new baby can be surprised and might need reassurance that the babe is really okay.

- the placenta is still amazing to me, but it's not always amazing to everyone else in the room. Some women don't realize that it will still have to be "pushed" out a few minutes after the baby. We always said that it didn't have any bones and shouldn't hurt. That said, however, women who have birthed more then one baby will probably notice that the afterbirth cramps are stronger and can be more painful. This tiny little tidbit isn't well known and second time moms often remarked that they didn't remember that aspect of the process.

- While on OB I will have at least one pregnancy and/or delivery dream a night. Giving "birth" nightly is exhausting and not good for quality sleep. (I have no idea if I had boys or girls but it was probably a nice mix of both.)

- guessing the correct weight of a baby once will always be remembered. (it was 9lbs 2oz and I will probably never forget it)

- walking, a birth ball, the hottub, rice socks and hot blankets can all be used for pain relief, and what works for a few minutes during one contraction might not work during the next one.

- Pregnant women are not "ill" because pregnancy isn't a disease. Sometimes, though, pregnant women do get sick or hurt.

- sometimes med students feel like crap and need to go to the doctor too. A trigger point injection and some manipulation can leave me feeling 100% better.

there are many other things I'm sure I've learned, but a week away from the floor (no call on the other babe we're all waiting for) has cleared out that part of my mind. (I can't wait til I get a chance to do it again though...)


Blogger margene said...

What an amazing process of learning you are in at this point. May you have time to relax, start the sweater and enjoy the Holiday.

4:22 PM  
Blogger Pumpkinmama said...

Sounds like a wonderful experience overall. Happy Holidays.

6:07 PM  
Blogger Maria said...

I'm catching up on blogreading after my holiday travels, so I'm just reading this post now – great! I love the detail, and you are always so thoughtful. And here's a vote for no cutting or tearing, even if it means another contraction or two. I STILL have occasional pain from my episiotomy, and my daughter is two years, three months old!

10:44 PM  

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