An OB Emergency is When It All Came Together

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The nurse’s instructions were simple. “You two guys just wait here until Amanda gets back.”

Then she handed me the other guy and walked out of the room. There I was holding, Michael, my newborn son. He and I were together and totally alone. And that is when it all came together.

First Bath

About 10 minutes earlier I watched, photographed, and cried as the nurses confidently washed and swaddled Michael. His full head of black hair stood straight up off his skull like a mad muppet. In one hand the nurse capably balanced Michael and with the other she washed his hair. “They usually don’t have this much hair,” she said mostly to herself. I was surprised too. I just thought, for no particular reason, that babies came out bald.

Cut Right Here

Just before the bath the doctor showed me where to cut the umbilical cord, “Just between these two clamps.” I hesitated for a moment and he said “Go for it.” So I did. I was hoping for a cleaner and more authoritative cut.  Instead I hacked through the cord like a lefty using scissors in art class. Fortunately, the jagged cord was destined to fall off a few days later.

Clear the Airway

Before I cut the cord I watched as the pediatrician expertly guided an endotracheal tube into Michael’s trachea for a bit of deep suctioning. Lots of goo, but nothing too concerning came out. At that point I didn’t know what I should be doing. Lamaze class didn’t mention anything about what dad does after delivery – at least that I could remember. I also realized that the only book I read during 9 months of gestation was by Alan Thicke – the dad from the 80s comedy growing pains. Probably could have done some better preparation. What was supposed to happen next was a complete mystery to me.

Get em’ in the Boat

Before being whisked into the warming bed and the waiting hands of the pediatrician everyone in the operating room began to breathe, smile, and talk again. As a medic student I had been in the OR. The atmosphere was always light, music was playing, and OR staff made idle chit chat in the down moments. This OR was much different. Three physicians, with another one in the room next door waiting for Michael, several nurses and tech, and me on a stool sitting next to Amanda’s head barely exhaled. Once the c-section surgery began hardly a word was spoken until the assisting OB doctor announced, “This one is a keeper!” In case you don’t fish, a keeper is a fish that is big enough to keep for dinner.

Sure enough Michael was a keeper. When the doctor lifted him out of the womb; the room sighed, smiled, and cheerfully laughed. Michael was 10 pounds, 8 ounces, with a full head of long black hair.

It’s Never Like TV

We had both looked at each other. This was not the birthing process we had in mind, but we knew it was time to opt for the c-section with general anesthesia. Due to some anatomical fluke Amanda’s epidural would not hold bilaterally. She needed to be intubated. We were not going to have one of those made for TV births with yelling, swearing, pushing and crying. Instead she laid still on the table, sedated and paralyzed, with a tube coming out of her mouth. Her eyes were taped shut and I watched her chest gently rise with each mechanical ventilation. I sat next to her wondering and waiting.

Exhaustion

More than eighteen hours of labor had taken its toll on Amanda. She was physically and mentally exhausted. The epidural was intermittently failing, contractions were not increasing in intensity and frequency, and the monitor was showing fetal heart rate decelerations. Something was wrong. It was shift change and the new day’s on-call doctor came in. He said, “Let’s take a look.” I also looked as he looked. The pad Amanda was sitting on was soaked with a lot of bright red blood. That is not right.

At the time I was seven months into a nine month paramedic program. The week before we had finished pediatric advanced life support and neonatal advanced life support. I knew just enough about OB emergencies to get really worried. Was the baby OK? Was Amanda at risk? “Have you thought about a c-section,” the doctor asked? We hadn’t so he started to lay out the options. The choice was obvious to Amanda and me.

Pit Crew Jumps the Wall

The next few minutes were like being on pit row at a NASCAR race. The doctor poked his head out the door and said, “We are doing a c-section now.” Staff flooded into the room. In minutes Amanda was moved into another bed, had a second IV placed, a urinary catheter inserted, and her gown changed. Things were happening fast. The joyous phone call I had planned to announce the baby’s birth changed from “We had a baby” to “Amanda is going to surgery right now.”

For forty-five minutes I sat in a rocking chair and simply held Michael. He was pretty tired from a stressful few hours so he made things easy for me. His umbilical cord had been over his shoulder. With each contraction his cord was compressed against Amanda’s pelvis which caused the heart rate decelerations. He wouldn’t have gotten out on his own with his size and cord entanglement.

Now Michael is a healthy, happy, athletic, and smart five-year old. I can’t be prouder of him and more grateful to my wife for what she went through to bring him into this world. I will always treasure the forty-five minutes he and I spent together while Amanda was being sewn up because that is when it all came together.

Author note: this is my submission to the May 2010 edition of the Handover Blog carnival hosted by Steve Whitehead at theEMTSpot.com. This month’s theme was “When It All Came Together”. Steve will be compiling all submissions into blog post. Thanks to Steve for hosting and I am looking forward to reading the other submissions.