It is near impossible to describe in words my first night in the delivery room. I believe it was a Thursday night at LBJ Tropical Medical Center in Pago Pago, American Samoa. I was spending a couple months as a student interning through the OB/GYN department and following around the Chief of obstetrics. My mentor, Dr. AC, is this amazing guy who has spent the last 15 years or so working in Pago, although he's originally from another island called Samoa. I know, it's weird that there are two islands with similar names, culture, and people but are yet run by different governments. Well, Dr. AC is amazing! It's just inspiring to work with people who are so passionate about medicine and taking care of their patients, despite the gruesome hours and lousy pay. But that's another blog story so back to the delivery room...
It's a thursday night and Dr. AC is on call but is catching a few zzz's since the midwife is also on duty. I get a phone call that a couple women have reached about 8 cm's and I rush to the hospital. At the moment of the phone call, I was drinking a diet coke and playing dominoes with my drunk cousins who were all trying to convince me to stay and party with them. But, being the nerd that I am, I wasn't about to give up this awesome opportunity to see a baby brought into the world. So off I went.
The mother is a girl about the same age as me and when I got to the hospital, she was already in the delivery room and pushing. I must admit that I didn't know what to expect when I got there. I always thought the delivery room was a serious place to be, and I guess it could be at times, especially when you have a difficult delivery. But that night, it was one of the funnest places I've been to in a hospital. The nurses were laughing and cracking jokes at each other. The midwife was telling me funny old delivery stories. I was feeling guilty having a jolly good time while the poor patient was writhing in pain from the contractions and pushing a baby that wasn't yet ready to see the world. But who am I to question? Afterall, I am just a student starting out in medicine.
After two hours of coaching the patient through her delivery, we finally see the head of her baby boy. A medio-lateral episiotomy was done to prevent eventual tearing and assist the delivery of the baby out of the vagina. Oh man..when I saw the midwife take that pair of scissors to cut the perineum, all I could do was look at the patient's face to gauge her reaction from the pain she will be experiencing. But...I did not see a reaction from her! I'm assuming that the pain of the contraction was so severe at that point that it masked the pain of the scissors tearing through the tissue. I really don't know how often this procedure is done in U.S. hospitals, but according to the midwife at LBJ, it is a pretty standard procedure that is done based on the decision of the delivering healthcare provider. Being the inquisitive student that I am, I asked the midwife on what grounds she based her decision making process to go ahead with an episiotomy and her answer was that "25 years of delivering babies just gave her an inkling to know which women will pull through without tearing and which women, she would have to make the tear for them." I really don't like this answer. It's like when I ask my dad exactly how much soysauce or vinegar to put into a dish where I'm making 3 pounds of chicken and his response is, "Years of making this dish and you just gauge what's enough soy sauce and vinegar..you throw in a splash of this and that..maybe a half a cup and just season to taste...that's all!" GRRRRRrrrrrr.
Well let's just say that the patient survived my screaming and I survived the pain of seeing scissors cut through tissue without local anesthetic. Yikes! But big day folks! I just saw a delivery. It wasn't what I imagined. I thought angels would start singing as soon as the baby was out and that there would be this unbearable silence as soon as the head poked out..almost like a silent anticipation. Well, I was right about the latter but the angels singing....well that was probably all in my head. But honestly, it was by far the coolest thing I have ever seen! To see a baby poke through a canal that you know in your mind to be a very narrow hole which then transforms to be this gaping hole leading to the inside of a woman's uterus...I mean...wow! The wonders of the human body...well a woman's body in this case!
So yeah, baby and mama were doing great the next day when I rotated through the post-partum maternity ward. It's funny how weird babies look as soon as they're delivered and then you see them afterwards when they are all cleaned up, bundled in a pink or blue blanket, and looking infectiously cute in their head warmers. As I tickled the little guy's foot, I couldn't help but think in my head.."Dude! I was there when you entered the world!" How cool is that?
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