February 22, 2008
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Ho-Hum
So its a fairly slow night thus far (at the risk of jinxing myself) with me only having seen one delivery.
The patient was quite fluffy (that’s ob/gyne slang for “well-stuffed” or “fat”). Obesity predisposes to all sorts of problems across the board in health, and pregnancy is no exception. Obese patients have a higher chance of having babies with intrauterine growth retardation (IUGR). That means the baby is small because it doesnt get necessary nutrients, not that the baby is retarded.
However, as with all the deliveries i have noticed thus far, it seems to be a lot of waiting, slow time, followed by a quick burst of action. While the latent phase of labor went on for a while (latent phase being defined by dilation of the cervix up to 4 cm and contractions) once the fetal head was engaged in the pelvis, the active phase of labor lasted probably less than 20 minutes. Just as with other deliveries, the crowning occured, a fleshy, pink colored, slimy, hairy squash slowly corskrewing out of the patients nether regions, playing a macabre game of peek-a-boo with each contraction until finally, a good solid push cleared the head. After that, the shoulders and body followed and voila! instant baby, just subtract water.
This delivery i was fortunate enough to deliver the placenta or afterbirth. This basically entails a lot of waiting, up to 20 minutes or so, just holding on to the umbilical cord with a gentle downward tugging motion. remember, no pulling, you dont want to invert the uterus! The cord is rather spongy and tough at the same time, a difficult thing to describe. The signs of the placenta being ready to emerge are a sudden gush of blood (from the placenta detaching) an elongation of the cord (as it begins to respond to that gentle downard pressure) and a movement of the uterus anteriorly.
All this occured just as it was supposed to, and next thing i know, the uterus glooped out into the tray being held underneath the vagina for that purpose. The darn thing is slippery, that is for sure. No worries i didnt drop it…per se. Even if i did, it was less than an inch as it slid into the tray, and its not like there was anything living in there anyway. SO QUIT JUDGING ME.
After checking the placenta to make sure all the membranes were intact, I examined the cord for the three vessels present, two small umbilical arteries, and one large umbilical vein. Everything present and accounted for, off came the sterile gown, mask and gloves, and i was transformed from being covered in blood to the once again mild mannered everyday medical student awaiting the next time he would be needed…*cue theme music*
…*sigh* guess i will study for the next 6 hours or so til i get off call
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Why Not Zoidberg
Comments (4)
that sounds so gross. so, so gross. but, um, cool?
Cue theme music? What song would your prefer? I’d go for Hero…no, not the one by Mariah, but a song waaaay back and ah yes, here it is. My mistake, it’s called “I need a hero.” That song reminds me of Shrek.
Question about the placenta: What happens to it once it’s out? What is done with it?
This is still so disgusting! But I’m still so fascinated.
By the way, my last ultrasound at 30 weeks measured my baby at 4 pounds. I am now 33 weeks and a little scared of delivering a big baby. Oh well…
It’s a bad, bad thing to say that a call is quiet. With my husband, he seems to have tattooed across his forehead “I am on call today, every body come to the E.R. and see me”. It’s been that way since he was a psych. resident, even moreso as an internal medicine resident, and even when he moonlights as an attending, it’s the same old song and dance. He always caps when he’s on call, it could be quiet for 3 days prior to his call or even for an entire rotation, but when he has a rotation, any rotation, take your pick, he doesn’t rest for a moment.