Today's post is something of a look backward, but also a preview of more to come. I spent about a month and a half shadowing once a week at a hospital near Haverford, and I was extremely lucky... in a lot of ways. I got to shadow in a bunch of departments related to OB/GYN, which is perfect preparation for my Haiti adventures; I was placed with a couple of really friendly, open, warm mentors who were extremely generous with their time and to whom I am very grateful; I got to see such a wide variety of incredible, fascinating, inspiring things, to the point that I am absolutely convinced of my choice to enter the medical field! There is no going back. I'm hooked.
I spent my days between the OB/GYN clinic, the Perinatal Testing Center, an OB/GYN private practice, and the Labor and Delivery floor. Each had something unique and different to offer me, and I got to see really cool things each time! I sat in on a lot of annual check-ups, and it was interesting to learn that those appointments (at least in clinic) tended to include a fair amount of non-GYN-related doctoring, such as for asthma, allergies, colds, etc... I also got to see the cervix, which as it turns out is just a little donut! teehee. On my first day, I was super excited to get to use the Doppler once to measure a fetus' heartbeat! In the Perinatal Testing Center, I mostly just saw a ton of ultrasounds of 2nd and 3rd trimester babies, which was pretty incredible; I didn't expect to be able to see a live, moving image of the four chambers of a baby's beating heart! wow. Technology, the human body, and human development do not cease to amaze me.
Labor and Delivery, however, had the most to offer in terms of AMAZEMENT. One of the days I spent there, I watched (count 'em) three little babies come into the world! And not just any old babies - the first was a C-section (!!) and the second & third were twins (!!), born naturally. What a day! This was the day that really solidified my desire to be a doc. My first day in clinic (i.e. my first day shadowing anywhere in the hospital), I had a sense that I was where I was meant to be, and it all felt right, and I was excited and all that. But this day in Labor and Delivery blew my MIND, and this was when I had a feeling that there's no going back! I absolutely loved every minute of it, and could have stayed for hours more if only to see it all over again.
So... since I was so inspired and excited and interested by everything that happened in Labor and Delivery, I'm going to share the gory details, for those of you who are interested and for myself so I have a record of it later.
--PLEASE STOP READING HERE IF YOU DON'T DO WELL WITH DETAILS ABOUT SURGERY / BLOOD!--
Or keep reading if that's something that you find interesting! :)
I first had to get into full scrubs (yay!), complete with shirt/pants, booties, hair net, and face mask. I wasn't ever going to participate in anything (of course) but I had to suit up, even to just be a fly on the wall. First was the C-section, which was planned and scheduled ahead of time because the docs knew the woman had a vasa previa. That means that there were some larger blood vessels from the placenta blocking the cervix (detected ahead of time by ultrasound), so giving birth vaginally would probably result in rupture of those vessels and excessive bleeding. I'm proud to say that I didn't get even a little bit queasy or nauseated or nervous or grossed out! (Apparently some people faint when seeing their first open-abdominal surgery.)
First, they gave her an epidural, which looked like a pretty big needle was involved and appeared to be pretty painful (although she was also pretty scared at that point, so it was hard to tell what exactly the source of the tears was). Once she was all numbed-up and attached to the epidural catheter, then they inserted a urinary catheter, and everything had to be kept extremely sanitary from this point on. By the way, she was kept awake for the entire procedure (!!), with a curtain of sorts blocking her view of what was going on around her abdomen, and her husband sitting with her by her head. It was super interesting to see them cutting through each layer, one at a time - skin, fat (yellow and bulging), fascia (a thin, tough-looking, white-ish layer), muscle (they just pushed these to either side without cutting them), peritoneum (lining of the abdominal cavity), and then finally the uterus wall. It was pretty incredible how tough the human body is - they were able to stretch and pull pretty hard/roughly on the edges of their incision, without anything tearing! Another surprising thing was the size of the incision they made - I guess I was picturing a C-section as a big slice into the belly followed by a lifting-up-and-out of the baby, but the incision (made side-to-side) was actually only about the width of the baby's head. Anyway, once they hit the uterus and all the blood vessels involved in the pregnancy/placenta, there was suddenly a ton of blood gushing out. They seemed pretty unfazed and just kept moving (quickly), collecting expelled blood with a big grand-daddy version of the dentist's spit-sucking pipe. Before I knew it, the doc had his hand in the incision (i.e. in the uterus) and had the woman "PUSH", and after a little bit of maneuvering, there was the baby, "delivered" through the man-made hole that was, as it turned out, probably about the size of the natural birth canal but just in a different spot! Super cool and interesting and exciting!!!
I think this baby was about 34 weeks, and they took him and cleaned him up, and he cried pretty quickly, so that was all good and fine. (Yay!) Meanwhile, back at the new momma, the docs were cleaning her up. First, this involved pulling out (delivering) the placenta, and then they basically took some sponges/towels and reamed out the uterus! Apparently the human body is way tougher than I thought, because it's OK to be pretty rough with it. One of the most unexpected things during this whole procedure was that at some point during this clean-up process, they were able to just flip the uterus up and out of the body cavity, and set it on top of the woman's abdomen!!!!! It was still somewhat connected to her insides, but apparently it's fine to move it outside to help clean everything up! Whaaaat?!!?! After cleaning everything up (and counting every single sponge to make sure none were left behind!), the docs began suturing. They had to do each layer individually, although they didn't have to sew every single layer because some heal on their own just fine. So they sewed shut the uterus and tucked it back into its spot, and sewed up a few other layers, taking special care to make a neat and subtle line on the last layer of skin (for cosmetic purposes). And that was that! The doc showed me the placenta, where/how it connects to the uterus wall, and then flipped it inside-out so I could see how it interacts with the baby. The huge blood vessel of the vasa previa was also quite visible, and happened to be right next to the incision he made. Close call! So exciting. Everything was so cool to see, and so intense! I had questions the whole time, and an awesome NP stood with me and gave me an oral tour during the whole process. It was great.
So after that whole mind-blowing, amazing, inspiring, life-altering experience, about an hour later I found myself as a fly on the wall again, this time to see the natural delivery of a pair of twins!!! I LOVE MY LIFE. I joined the party after mom had already had an epidural, and once she was totally dilated (10 cm). They got her all set-up with these massive industrial-looking stirrups, and started doing practice pushes each time she had a contraction. But before I knew it (this was probably supposed to happen, but it snuck up on me), these sets of 3 "practice pushes" at a time had actually become real pushes! I could see a little hair from the top of baby's head! Surprise, surprise!! :D Also, at some point, her water broke in a big way, but they had a nifty cloth & plastic bag set up below her bum so that caught a lot of the mess. Mom didn't seem to be in too much pain (thanks to the epidural), but it was clear that she was struggling her hardest to push with all her might. An impressive sight, to be sure! They had her do 3 big, long pushes and then rest until the next contraction, and each time the head would crown more and more...! Finally, after a big strong set of pushes, she hadn't quite gotten the entire head out (although it was sooooo close to being past the widest point!), but she was pretty worn out... so the doc actually just very gently, bit by bit, slid the edges of the vagina back and back and back (ever so slightly at a time) until suddenly... pop! The head was completely out! Then there were a few more pushes and there was a BABY! I actually almost cried, cheesy/cliché as it is. :) SO overwhelmed. Snip-snip and they quickly whisked Baby A over to his clean-up/cozy-up station.
On to Baby B! It turns out that this baby's head was pointed a lot more towards the top of mom's body, with feet down towards the exit, which is bad, so there was a lot of reaching way up inside while feeling/poking/prodding/pushing from the outside in order to figure out how to maneuver this kid into the right orientation. Head-down was the ideal goal, but butt-down can be OK too, especially with a second twin (because Baby A stretched things out a bit for Baby B). At the same time, they were using a live ultrasound to try to put the puzzle together and identify where everything was. Eventually, after no success, they decided to let her keep laboring for a while; sometimes a baby will reorient itself on its own, given time. But about 5 minutes after setting mom up all comfy-like, sans stirrups and all that mess, they were back with another doc who wanted to give the maneuvering a shot himself. He actually managed to right things just enough so that the baby suddenly was on her way out (shortly after the water of amniotic sac #2 was broken) without too much more pushing, butt-first (called a breech)! Let me tell you what, as it comes out, a breech baby looks a lot less like a baby being born - since she was face-down and butt-first, she was just a big mass/blob of white until they turned her around to send her off to her clean-up station next to her twin brother. Baby A was already all wrapped up in a baby burrito by then. :) Back at mom, the docs were doing a fair amount of sponging and cleaning up of the uterus and birth canal (things were stretched enough to reach waaay up inside!!! - but nothing tore during the whole birthing process, amazingly!). The placenta came out, and was significantly larger than that of the C-section I saw earlier that day, which makes sense considering there were twice as many babies attached to it! After a bit more clean-up, that was that!
BABIES ARE AMAZING! AND MOMS ARE TOO! Every moment was such an incredible experience! The vaginal births were probably more emotionally exciting and wonder-inducing, while the C-section was a lot more interesting/fascinating (it's obviously much more of a window into the body), in its own way... but it was all SO mind-boggling and exciting and amazing!!!!! I also feel incredibly lucky because apparently all the things I saw today are rare in and of themselves, so it's very uncommon that I would get to see all of them in the course of 4 hours or so. Wow. :D What. A. Day. (What a world!) Now I just love babies and OB-everything and deliveries and and and... ALL THE THINGS!!!
Thanks for reading, hope you enjoyed it, and hope it wasn't too much gory detail for you! ^_^ I'm PUMPED for more! (Haiti's just around the corner...)