Date: 12/7/15

Location: Maternity
I finally had a significant learning experience on L&D. Tonight I got to observe a C-Section, and
Im still trying to grapple with what was one of the most violent but one of the most beautiful
things Ive ever seen in my life. People always characterize childbirth as a miracle, but now I
truly understand what that means.
Ive learned that miracle can be understood in more ways than one. My definition of miracle is
certainly different from that of the mother, who came in to OB Triage with extremely painful
contractions. She was due to deliver via C-Section in just a few days, but her contractions were
so bad that she decided to come in. However, her cervix was only dilated one centimeter. Despite
this fact, the OB decided it was best to perform the C-Section immediately. One of the OB
fellows explained to me that because this patient had had a C-Section previously, there was a risk
that if they didnt perform the C-Section that night and the patient was sent home, her uterus
could actually rupture if she went into labor. This is because when a C-Section is performed, the
surgeons actually cut open the uterus, which is a huge muscle, and although they suture it up, it
leaves a scar which is placed under a lot of pressure when the uterus contrasts during labor. If the
uterus ruptured, both the infant and the mother are at a risk of bleeding out.
It was cool that I got to see the infant before he was even born. One of the fellows took me along
for the US to gauge if the infants head was in the right position before the C-Section. I got to
place the US probe on the patients lower abdomen, right above the pelvic bone. The head
showed up as a big circle because of the cross-section we were analyzing with the US.
Then it was time for the actual C-Section. First, the patient had to be anesthetized. The
anesthesiologist performed a spinal, which is deeper than an epidural. It provides a more
potent effect and is more targeted because the medicine actually touches the spinal cord. It was
interesting to see how it gradually worked its way up the patients body. The anesthesiologist
touched a metal instrument to various points from the point of injection (lumbar vertebrae) up
towards her head and asked where she felt the coolness of the instrument. It was pretty fast
acting, since in a matter of minutes she didnt feel the coolness until the instrument had reached
her shoulders. Another interesting thing was that the patient complained of not being able to
breathe, and the anesthesiologist explained that was because her stomach wasnt getting any
feedback of her breathing because of the anesthetics.
Speaking of the anesthesiologist, I really liked how their role was more patient oriented in a Csection. Because the patient was awake during the procedure, the anesthesiologists took it upon
themselves to always be a reassuring presence to the patient, explaining what was going on and
always asking how they were feeling. They would adjust medicine based on if the patient was
feeling nauseous or uneasy. In surgeries Ive seen before, the anesthesiologist is the one who sees
the patient before the surgery, and is typically a warm presence, but I liked that thats a
possibility even during surgery. I have more respect for the specialty now as a result.
On the opposite end of the curtain (the team made a low paper barrier so the patient could not see
the OBs at work and to maintain sterility), the OBs performed the surgery in a way that was
completely unexpected for me. What threw me off guard the most was the rapidity with which
they worked. Before I knew what was happening, the patient had been butchered open. They

were tearing away through skin and fat and then it was time to cut through the uterus. To make
an opening big enough for the baby, at one point one of the OBs even used some of her body
weight to leverage the opening. It shows how incredibly strong the human body is. Surgery is
something that we think is efficient, but a meticulous process. This was not in the least. It was
like the OBs were a pit crew in a race track. In a matter of minutes, one of the OBs had his
entire arm inside the uterus and was digging out the child. I saw the childs head, and it was a
tight fit in there. We think that the child is floating around in so much space, but for a child about
to be born, its not quite so spacious. There was this huge explosion of amniotic fluid though,
again showing how violent the entire process was as the OBs were hurriedly and strongly
pulling this child out.
But man, when that child was laid out, was it beautiful. When he came out, I teared up a little bit.
To see another human life, so perfectly formed, emerge from another human being was simply
beautiful. And then, when the child gurgled and let forth his first cries, it was music to my ears.
I was pretty surprised by how quickly the child adjusted to life outside of the womb. He didnt
actually cry for very long, and it didnt take long for him to stop being bothered by the lights and
open his eyes. Another set of nurses came in and cleaned him up, the father cut the cord, and he
was all swaddled up and weighed. What I loved too was the happiness and love in the room.
Even though the doctors and nurses had no doubt deliver so many babies on a daily basis, the
birth of this child felt like a special occasion. It was like a party in there, everyone was happy.
And I think that would be an awesome environment to work in. Thats my main takeaway from
the L&D floor. Even though Im kind of miserable on it because theres not much for me to do,
thats because theres so much for the actual staff to do, and they love doing it. You have to not
only be able to handle stress, you have to thrive off of it. But its totally worth it. Seeing the joy
you can bring to these families, thats something that I would love to be around every day.