Two birth stories

My very nice, very complicated, Polycystic Ovary Syndrome, infertility, history of placental abruption leading to intrauterine fetal death, gestational diabetic on insulin, morbidly obese--BMI 57.5 patient had her baby by elective c/section due to suspected fetal macrosomia this past week.  It was my first NZ section.  Unless it is an emergency--they are all called elective. They do support TOL or trial of labor for many women. However, I was so appreciative of this decision to do a section or  "caesar" [yea, I know-I picture a salad too] as it is called here. It was virtually impossible to monitor the baby's heartbeat due to the mom's body habitus. She has classical truncal obesity--and antenatally it sometimes took as long as 15 minutes to find the heartbeat for momentary glimmer of audible heartbeat with an external monitor.

Of course, the surgery was delayed a couple of hours--hospital time which = "hurry up and wait."  I was quite extraneous to the whole thing, but my patient was very pleased that I took the time to come, as she did not have her midwife at the last section--or her partner.  I spent time in the room with her and her partner waiting for the blessed event. It was nice getting to know more about her and her family in which just about everybody has had a fetal death and several have diabetes and have died quite young. ;-(

In the surgical suite or "theatre" as it is referred to here--it was packed full of staff. Most who I had no idea what they do or who they were.  Many male staff--three of whom wore no socks with the Croc knock-offs. I can't imagine that being acceptable in the USA?  Even the anesthesiologist was sockless.

There were two OB-GYNs in attendance, one from the Philipines and one from the US--South Dakota in fact---she sounds right out of a Coen movie.  US doctor did the surgery--both docs were really short, standing on stools to reach over the operating table. They had this bar that went over part of the patient's abdomen, and using very wide surgical tape--they literally taped her tummy to the bar.  A whole new meaning for "Belly Up to the Bar!"

The challenge of getting a big baby out of the masses of tissue were apparent--it was the longest incision-to-baby that I have witnessed. Baby did fine--all 10# 3 oz of him.  Everyone was commenting on his size--and granted it was a gestational diabetic-caused macrosomic infant...but I have seen plenty of goodly infants--especially in the homebirth days.  I think I witness smaller babies here in this country due the high amount of cigarette smokers.

After the baby had been extracted by vacuum, through the incision--it was handed to the slighly quaking hands of the medical student and carried over to the warmer.  The pediatrician talked the student through the nuances of a newborn exam.  GUESS WHAT???? Even c/section babies don't get bulb syringed!!!! Finally a country that has figured this out--and guess what---they do not have a high rate of neonatal death due to "mucous."  

Two days later--the partner of one of my first time mommas, called to let me know she was in "pain."  She had taken castor oil the previous day--as she was pretty desperate to NOT have to be transferred to the big hospital--although she was only 40 + 4/7 days when she drank the wicked potion. After I talked with him-- describe the pain--like are they contractions? Yes, how far apart? How long? Some teaching on how to time contractions and a plan to contact me when they were five minutes apart.  I kept busy going to check on a five week old baby and mother. When the next call came in--the report was good-and she sounded seriously uncomfortable in the background, so I went over to the maternity centre and prepped for their arrival.

On admission she was 8 cm and I quickly put her in the bathtub. She loved being in the water.  I called my nurse and ob-aide to let them know things were hopping.  About an hour later--spontaneous rupture of membranes while in the tub--clear fluid and soon the unmistakable sounds of bearing down began.  She ended up getting out of the tub--it is a long, skinny bathtub and she could not manuever around at all.  She eventually got on the bed, kneeling for a long time, and then turned over and was semi-sitting for the final pushes.  Out came a beautiful baby girl, over an intact perineum, quick somersault to unravel the nuchal cord and onto mom's belly. Some drying to get the baby crying, viola! she pinked up right away.  Slight peri tear that didn't require sutures--oh happy day.

What a great loving couple they were too. So tuned into each other. I appreciated the dad telling her how good she was doing.  Later on he told me--I just love how my soft my baby's skin is.  Of interest to this secret anthropologist, they say "f**ckin' A" like some people say "um" or "like."  Let me tell you--from them it did not even sound like swearing. So like, um... f**ckin' A what a beautiful birth!