Week 1My 5 week rotation in obstetrics started with 3 births and a cesarian section on my first day. I was thrilled and amazed by the process. It had been my goal to witness my first birth while down here and today I finally had that opportunity. I was surprised by the amount of blood. It just never had occurred to me that it might be extra bloody due to the placenta leaving on top of the bleeding of the mother. Later in the week, I watched a tubal ligation, which was interesting to see, but was not nearly as invasive or intense as what I had seen in the surgery rotation.
Week 2During my second week I unfortunately witnessed my first miscarriage. A lady in her late 20´s was at 34 gestation and gave birth to a dead fetus. While the doctor´s knew that the fetus had died, the reason was still not clear before the birth. When the baby was born, we found the umbilical cord wrapped around its neck. Even after a week of experience in obstetrics, I could see the stark contrasts between a live baby and a miscarriage. The fetus was limp, without the normal rigidity of a normal baby; and had a dark blue skin color. Possibly the hardest part was watching the mother both experience the enormous physical pain of childbirth while crying for the life of her dead child. Even still, none of the nurses or doctors went to her side to hold her hand or encourage her. Generally, I strongly support the Mexican health care system; however, this experience with the mother who miscarried was an exception. The doctors knew upfront that the fetus had died, yet they still didn´t allow the husband to join the mother into the delivery room. I understand that the rule is there in order to protect the privacy of the 5 other women in the adjacent room, but I think they should be able to make exceptions. This is one of the downsides of a system that cuts costs at the expense of privacy and emotional well-being.
Earlier this week, during a cesarean birth, a baby was born with respiratory issues. Normally, the baby cries within 30 seconds of birth. However, even after 30 seconds, it was not responding, nor breathing on its own. The pediatrician rushed it to the other room and immediately began using a mask to artificially breath for the baby. Five minutes later, when the mask was removed, the baby took 3 strong breaths on its own and then stop breathing. During normal births, there is a whole array of measurements and tests that must be done. However, for this child, many of the tests were skipped in order to focus on keeping the baby alive. Unfortunately, I never found out what the baby had or whether it would live. When I asked the pediatrician, she thought the child would live, but she was still unsure.
When I arrived Friday, a mother was screaming in pain from the contractions. While usually painful, rarely do the mothers scream at the top of their lungs. The baby was born without problems; however, the mother continued bleeding even after the placenta had been removed. When the doctor checked the cervix, it was cut in 3 or 4 different parts. I was impressed by his ability to work in such a small area and with limited mobility, and twenty minutes later, the bleeding was largely stopped and the mother was ready for recovery. Earlier, one of the interns had laughed at the loud screams of the patient, but little did he know that her cervix was being torn. I understand how the screams sounded a little obnoxious, but we have to remember that more might be going on than we realize and that it is never appropriate to laugh or smile at the suffering of a patient.
Week 3Week 3 was much more calm than week 2. Besides watching a number of births and cesarians, I had the opportunity to count contractions and listen to the fetal heart rate. While I had seen the process down repeatedly over the last 3 weeks, the doctor explained what I needed to do and the intervals of contractions they were expecting. It was a little uncomfortable at first to touch the stomach of a pregnant mother but I got used to it fairly quickly.
Week 4During my fourth week in obstetrics, the doctors began giving me some more freedom and hands-on experience. I started the week by scrubbing in with the attending doctor during a cesarian section. It was just me, him, and the nurse. Before the baby came, he had me push down on the mother´s abdomen in order to create pressure for the baby to be removed. Then, when we were stitching the mother up, he let me hold the separators and remove the blood from the incission with a towel. The operation took around 2 hours.
The next day I the same doctor invited me to scrub in to a tubal ligation. This surgery is fairly routine and is done through a small incision in the belly button. After securing the fallopian tube, the doctor stitched a section. When it came time to cut, he handed me the scissors and let me cut the section of the fallopian tube. It was a strange sensation cutting perfectly healthy tissue for the first time, but everything went well.
Possibly the most exciting moment of the week was when the doctor let me deliver a baby. During the birth, it was my job to recieve the baby, clear the fluids, clamp the umbilical cord, cut it, and hand the baby to the pediatrician. After the birth, I removed the placenta. Through the whole process, I was fortunate to have the doctor´s help. While none of it was very technical, it took a lot of coordination.
Week 5While week 5 was a little shorter as I was leaving on vacation with my family at the end of the week, I did get a second opportunity to attend a birth. This time they let me do the episiotomy. It was strange being given this much responsibility. Typically when I am scrubbed in I would hold clamps or cut surgical thread, but this time I was doing the cutting with no help. The consequences of messing up were quite higher. If I did this procedure in the U.S., the doctor and I could be in big trouble. Nevetheless, it might have been the medical highlight of my trip. In the end, the baby came out fine and episiotomy was sewed up without problems.
