Birthing: the miracle of life or “don’t drop it”?

May 26, 2008 at 1:14 pm (Clinical rotations)

Hospital nurses are the front line in any patient’s care. They provide his medications, they clean him, take him to the bathroom, feed him, and dutifully report the night’s events to the physician in charge. OB nurses will take this charge to the extreme. Their years of vast experience tell them that they shouldn’t let medical students or interns anywhere near a patient in labor. Despite my hospital’s policy that medical students should be involved in delivering all babies, the OB nurses will do all they can in their power to ensure that students are nowhere near the event.

For example, two sets of gowns and gloves are required for the delivery—one for the resident and one for the medical student. Medical students are supposed to be involved with every delivery in the hospital. The nurses know this, yet will passive aggressively prevent students from taking part. They will bring only one set of gown and gloves to the patient’s room, and when asked for another set by the resident, they will ignore this request and force the medical student to go on a hapless journey around the labor floor trying to find supplies. In my own case, by the time I got all the necessary equipment together and returned to the room, the patient had already delivered the baby.

The attendings are well aware of this problem. Despite multiple pleas from hospital administration, nurses continue to block medical students at every pass. This weekend was my last day on the labor and delivery rotation. Since I had not delivered a baby by myself yet, my attending told me that I would not be allowed to leave the hospital until I had caught at least one child.

My attending walked me to every nurse on the floor, introduced me, and said, “He’s going to deliver this patient’s baby tonight. Make sure that he has everything ready.” Expecting the nurses to once again have the room prepared for only the resident and not me, I preemptively went around and gathered all the necessary equipment and hid it in the patient’s room so that I would have everything laid out.

At 1:00 a.m., our patient decided to deliver. I threw on my equipment, got between her legs, and prepared to catch the baby as it made its way through the birth canal. The media portrays birthing as the miracle of life. An expectant mother has waited dutifully for nine months for the chance to see her baby breathe its first breath. In the movies, the baby always comes out perfectly clean and very beautiful. In reality, newborn babies look like aliens that are covered in fluid and shit and are very slippery.

The baby I caught came out in just one push. During the entire ordeal the father was holding his wife’s hand and telling her that everything was going smoothly. Meanwhile, I’m pulling out the baby and thinking to myself, oh shit! Oh shit! Oh shit! Don’t drop it! Don’t drop it! Don’t drop it!

I managed to hold on to this slippery creature, cut its cord, and handed it over to the pediatrician. After taking care of the placenta, my resident said, “Great, you finally delivered a baby. Now you can go home.” And just think, she’s going to be there for another six hours delivering more children.

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6 Comments

  1. wealthandtaste said,

    Good insight.

    I’m a medic and during my clinical shifts we were told by the attending that, “I would like every paramedic to have delivered at least one baby in the security of the hospital so that when they have to do it in the back of the rig, they know what to expect.” So while he was receptive to our presence, my peers received treatment similar to what you described from the OB nurses. It seemed no matter how cordial I was, they remained irked by my mere presence.

    Luckily I hit it off with one of the residents and he ensured that I got to “catch” at least once.

  2. MSG said,

    Here, here! OB nurses are hard to get along with – they’re mood is often cyclical, they complain about everything, they hate anyone (including OB/Gyn residents) to be around *their* patient, and try like the Devil to keep med students out of the rooms. I was able to catch many babies, but only because I ensures I knew where the materials were and had them ready before hand. And each time I was thinking the same thing – don’t drop it.

  3. mo said,

    I had an entirely different experience and a med student did most of my exams and I also had a student nurse too!
    Unfortunately my delivery had many, many complications and the staff had to take over.
    I guess things are a little different here or they were way back then.
    It’s in the ICU where the nurses are incredibly territorial, I can say that because I am an ICU nurse.
    I do have to point out one of my pet peeves. I do not get gloves,gowns etc for anyone, not even staff.
    I have my own work to do and I think adults should be responsible for their own practice. Asking a nurse to leave her own work to go get you your supplies is just incredibly selfish.
    Docs forget that all medical staff have their own jobs to do, we aren’t there to do yours too.It’s demeaning and a little arrogant to expect the nurse to stop what she is doing to get you a pair of gloves.
    A good, well trained student should be able to gather their own supplies without comment.
    When I have a new med student it’s the first thing I practice with them. I send them on scavenger hunts so they become familiar with everything in the unit.
    It is incredibly important that all new docs can find anything when ever they need it without having to ask anyone else to do it for them.
    Of course there are exceptions. If a resident has been tortured all night we all will pitch in to make things move quickly and to help avoid mistakes that come from exhaustion.
    Honestly the docs that I have had the pleasure to work with have never complained about being completely self sufficient. It brings down their anxiety levels and also gives them a feeling of competence during a time when they are feeling incompetent most of the time.
    A good doc walks in the room goes straight to where the supplies are(because they did a good orientation at the start) and gets down to work with minimal disruption to the nurses.
    A bad doc walks in the room and starts harassing the nurse to do everything for them. So the Resident who is getting gloves and gown from the nurse? Not a good doc..

  4. Half M.D. said,

    Your hospital must be a Nirvana health care system that allows students and physicians to access the supply cabinets. My hospital leaves us all at the mercy of the nurses. None of us are particularly happy with this setup, but that’s the way it is.

  5. Tea said,

    I had a midwife put one of my kids on my stomach and I screamed something along the lines of, “WTF are you doing? Clean her up!”

    The midwife was snooty– supposedly this would help me “bond.” It grossed me out. She was as you said, slippery and covered in God only knows what. Handing her to me and me not having gloves on seemed unsanitary.

    I like your candor. I started seeing doctors after that hag and there was never a problem with me wanting them to clean the babies up first. They said it was a midwife thing.

  6. Dragonfly said,

    I have been doing my first obs rotation for 2.5 weeks now…and it is interesting to see the friction between midwives and obstetricians. In my experience both groups bitch to me while the others are not around, and no doubt they bitch about the medical student to each other when I am not around!

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