A while back, my partner and I were assigned to the report
of a woman in labor over on the west side of town. I don’t specifically
remember, but I am sure that I ranted the entire way there about how labor
isn’t an emergency and how billions (with a B) of women have had babies without my help.
But that is just a guess based on past experience. Also based on past
experience, I may have made snide, inappropriate comments about having nine
months to save up cab fare. Every time I complain about OB calls, things go pear-shaped
for me.
When we arrived, we found that the patient was a 19-year-old with her first pregnancy, 38
weeks along. She wasn’t high risk, had good prenatal care, and had no
concerning signs or complaints. Her presentation didn’t make me want to lie her
down on the living room floor: her contractions were about three minutes apart
and lasted only fifteen or twenty seconds, her water hadn’t broken, there was
no bloody show, nothing.
When I am on a labor call, one of my primary decisions is
whether to put the patient into the ambulance and drive to the hospital or to deliver the baby in the
patient’s house. If I think I can easily make it to the hospital, we can go to
the ambulance. If I’m not sure, then the house is my preferred choice. I hate to deliver a baby
in the ambulance. I actually put quite a bit of effort into avoiding it, as a
matter of fact. Babies result in a lot of fluids, smells, and mopping. The ladies I see aren’t always the most… hygienic, if you
know what I mean. So I would rather deal with all of that on their floor (or
couch), rather than in “my office.”
In this case, with the mom-to-be being young, at the end of
her first pregnancy, and with the contractions not lasting very long or being
close together, I was comfortable with moving everyone to the bus and going to the
hospital. I didn't think she would be delivering a baby very soon. The patient told us she couldn’t walk, but I explained how the
L&D deck would have her pace the hallways for hours to move things along,
so a little walking now would be a good thing. Walk she did.
We were a pretty long way from the hospital, so I didn’t
feel like screwing around on scene. Having fifteen or twenty minutes to get to
the hospital meant that I could start an IV enroute, rather than needing to do
it before we started out. My partner got behind the wheel and off we went.
On the way to the hospital, the patient was very dramatic.
The onset of every contraction was very easy to time, because the patient
started howling, cursing, and complaining. Some women quiet down and bear through things,
and some shout their hate of the world. This lady was of the second group. I
got the IV into her and had time left to act concerned and engaged. I coached her on breathing (rather than screaming at me) and made the
decision to take her pants and underwear off. This isn’t something I do unless
I think delivery is imminent. I didn’t think delivery was imminent in this case, but I
took her pants and drawers off anyway. I don’t know what made me do it. It was just
something I did.
After a few more minutes, the patient squawked at me: “The
baby’s coming!”
I replied with my usual response to such statements: “Don't
you dare push!”
I still didn’t think there was any way that this infant was
coming out. Her contractions were still two or three minutes apart, and still
only lasted 20-30 seconds. But her complaint was enough for me to take a look
at things.
I spread the patient’s knees and lifted the bedsheet that
was covering her to take a look. Just as I thought. Nothing. Just a normal
vagina. Not swollen, no bulging, no fluids. It was a completely normal undercarriage.
I put the sheet down on her legs again and began to reassure
the patient that delivery wasn’t imminent. “The baby’s out,” she told me.
Whiskey. Tango. Foxtrot. The baby wasn’t even close! Drama!
This was nuts, I lifted the sheet to show her that there was no problem.
Son of a... She was right. There was a newborn lying between her feet.
I need you to understand how fast this happened. It was
totally like a magic trick. Lift the sheet. See? Normal vagina. Put the
sheet down, say the magic words (“The baby’s out”), and TaDaaa! Sweep the sheet
back and there’s a baby! The whole process took literally three seconds.
 |
| Me, screwing up decisions on childbirth calls for decades... Source |
Literally. Three seconds. Maybe two. Like a magic trick.
 |
| Public domain source |
The infant was about a foot out of the birth canal. Between
the baby and her mother was a wet spot where she skipped before landing
between mom’s feet. She was a healthy, pink, angry baby girl. Crying like hell,
and moving all extremities. Shouting like a three-month-old, she was moving so
much air. I didn’t think she needed suctioning, really, she was doing so well.
The first words that little baby heard? “Goddammit. [Sigh] Yo, Dee, pull
over. Gimme a hand back here.”
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