The Bird and the Baby

The title of this post refers to The Eagle and Child, a pub in Oxford, England which boasted patrons such as JRR Tolkien and CS Lewis. Now of course, it makes me think of the proverbial stork delivering babies to expectant mothers (how much easier that would be, I realize).

My three weeks on labor and delivery have been awesome. I've delivered seven babies, and it's really fun. I've gained a lot of confidence in delivering healthy newborns and learned a lot about the process and experience of the laboring patient. The first moment that new parents realize they are such is truly amazing; the cry of relief, the tears, the thrill and happiness - it's pure magic. I've seen the spectrum of deliveries: a multiparous woman going from 2cm to delivery in several hours, the patient whose induction takes 4 days, the stoic who needs no pain relief, the passionate who fights through the pressure, the hysteric who needs every skill, tool, and word of encouragement we can muster. I've seen single moms, lesbian couples, first kids, fifth kids, fifteen-year-olds, forty-year-olds, extended family, terrified husbands, resolute boyfriends. Though normal pregnancy, labor, and delivery can be routine, there's a lot of fun and joy in getting to know everyone involved and seeing them triumph over these challenges of mother nature.

In addition, I've participated in a few C-sections and a tubal ligation, reminding me how much I like the operating room setting and dissection. I've assessed patients in triage for preterm labor, mastitis from breastfeeding, and bogus chief complaints (a fifteen year old came in with her friends because they wanted to see the fetus on ultrasound). But the most interesting patients are often transferred from outside hospitals or fetal treatment patients. We've had a twin gestation where one twin has a life-threatening arrhythmia; how do you selectively control one twin's heart rate? Can you convert someone in utero? We have people with peripartum cardiomyopathy, twin-twin transfusion syndrome, and unstoppable preterm labor. Some transfers are unbelievable: a 23 weeker who was delivered by crash C-section at an outside hospital for an unclear indication (very sad case, the baby is going to die and the mother is a 17 year old). Some transfers are fascinating: a repeat C-section for a patient with achondroplasia. The fetal treatment center here takes patients whose fetuses have complex cardiac defects; I've seen several pregnancies complicated by hypoplastic left heart syndrome, double outlet ventricles, transposition of the great vessels, and coarctation of the aorta. Those deliveries are particularly high energy, with pediatrics and cardiologists standing by to resuscitate if needed.

So as a whole, my time here has been lots of fun. I've learned a lot and realized the intersection between solid medical complexity and pregnancy - maternal-fetal medicine - is really thought-provoking and intricate.

Image is a Victorian postcard, in the public domain, taken from Wikipedia.