Reflections on Labor & Delivery and Starting Peds EM
Oct 29th, 2008 by Christo & Melissa Philip
It has been a busy first week on pediatric emergency medicine for me as I’ve just finished a stretch of 7 overnight shifts in the pediatric ER at Children’s hospital. Thankfully I get a couple of days off before I do my last overnight shift for this block on Friday (Halloween…should be an interesting night) before switching to two weeks of day shifts. I have absolutely loved my time at Children’s so far. It has been a great place to work primarily because the staffing and resources are adequate to meet the needs of the patients that are seen there. While many of the nurses in the Parkland ER are stuck caring for 5-10 patients at a time, the nurses at Children’s are assigned no more than three rooms at a time and thus patients can be cared for a lot more expediently. In fact I’ve found that the number of patients that I can see in a shift has almost doubled with the extra staffing and efficiency of the system at Children’s.
As I’ve been thinking over my three weeks of labor & delivery I wanted to jot down some quick thoughts and reflections on my time in the OB-GYN department at Parkland. Labor & delivery at Parkland was a time of mixed blessings. In my three weeks in L&D I delivered a little over thirty babies on my own. I don’t think I can say that I feel completely comfortable with any complication that might arise during a vaginal delivery but I feel fairly confident that I can at least manage things until I can call for help from an OB-GYN doctor. Thankfully with most deliveries there is very little that the doctor has to do other than just encourage the mom to push properly and thus that gives me at least some relief when thinking about delivering babies in the ER.
It was also a good month of learning how to deal with some of the most common complications in OB-GYN like pre-ecclampsia, repair of lacerations suffered during delivery, shoulder dystocia and excessive post-partum hemorrhage. I even got to do about four precipitous deliveries because the babies came so quickly that we did not have time to get the mom back to the delivery area…at least I didn’t have to deliver any babies in the hallway this month! The OB-GYN residents that I worked with who were interns and several of the second and third years were a pleasure to work with although a couple of the fourth year residents got way too stressed out for it be a good learning experience. As I spent time on L&D, I realized just how important it is to be an encouraging teacher to others that are learning from you and how important it is to keep your cool so that a student can learn in a positive and supportive environment. This way of teaching was ingrained into me during my medical training at Mayo by a great man of God and a wonderful clinician, Dr. Philip Fischer, who is the chair of pediatric and adolescent medicine at Mayo. I can still remember him teaching on morning rounds and how he set a great tone for learning by always making encouraging comments to his residents and students on the service. It was great to work with him because you knew that Dr. Fischer would teach you well and that even if you made a mistake he would be there there to guide you through it. As I’ve started to work with medical students it has been gratifying to see that students are so appreciative when you take time to teach them in a nonthreatening environment. Students seem to learn so much better when residents are not yelling at them when they make a mistake but instead encouraging them and making them feel comfortable as they are learning. I think perhaps that is the hallmark of being a good teacher, allowing enough freedom for your students to make mistakes but being confident in your skills enough to correct whatever might go wrong.
Labor & delivery in the high risk section at Parkland was definitely busy. I think the slowest night was when we had only 6 patients in some stage of labor while on the busiest nights every room was filled along with hallways and even a clinical classroom…but if there are that many women in labor what else can be done since you can’t send them home to have their baby. Perhaps the hardest days for me where the days when I delivered a still born baby. It seems like there were quite a few babies who were full term and stillborn. The most heart-wrenching was a baby boy born to a Hispanic family. This was the third baby for this family. The pregnancy had been going well until the day before when mom realized that baby was not moving anymore and came to the hospital. An ultrasound confirmed what mom had suspected - the baby had died. The parents seemed like they were dealing with the loss well when I took them back to the delivery area to give birth to their still-born son. However, I was not prepared for the grief and emotion that came after I delivered their son. The dad who had seemed so stoic throughout the entire process just started to weep uncontrollably after the delivery. Soon he was so distressed that he was on the ground and the tears just flowed while mom held her son in her arms. I had to fight to keep back the tears because I could just imagine how difficult it would be to look forward to the birth of a new baby and then to find out that he had died. How I wished I knew how to speak Spanish fluently so that I could say a comforting word to them - to let them know that God knew their pain and that He shed tears over this little one. I did the only thing I could think of which was to lay my hands on his shoulders to comfort him while at the same time feeling so impotent. In my heart I cried out the verse from Revelations 22, “Come Lord Jesus, Come.”
The other observation about my time on L&D was the lack of good medical knowledge of many of my Hispanic moms - especially the moms that did not know any English. Many of my Hispanic patients seemed to have little access to information about things like family planning and anesthesia during labor & delivery. A lot of moms having their third or fourth baby would still say that they wanted to have more babies in the future - it seems many times with the prodding of their husbands. In many ways I felt like we did a very poor job of even counseling women on considering family planning because many of the women came from a low socioeconomic background and it would be extremely difficult to care for five or six kids on a minimum wage job even if both parents are working. The other thing I was surprised by was how often Hispanic moms refused epidural anesthesia because they had such a misunderstanding of what it was and how it would affect the baby. There was the mom who thought the epidural would raise her blood pressure, the mom who though the epidural would hurt her baby more than IV opioids for pain relief and the many who would not get an epidural because their husbands said no. I got especially frustrated when a mom would be screaming in pain during her contractions in a prolonged labor while the husband watched on and I would ask again and again about getting an epidural to relieve the pain and the husband would shake his head no.
Near the end of my three weeks on labor and delivery I also got to fly out with CareFlite on one my days off. As you might have guessed from previous posts, flying is something that I’ve always loved since I was a kid and so getting to fly along with the CareFlite team to care for patients was a great experience. I flew three missions with the team - all of them inter-hospital transfer of patients. I got to see some great views of Dallas and the surrounding counties although I was a little bummed that we didn’t get to do a scene flight (a scene flight is where the team actually flies to the scene of an accident). Perhaps that will happen the next time I fly. So since I’ve been writing about flying I thought I would post our pictures from the Forth Worth Alliance Air Show we went to a couple week ago along with pictures from my day with CareFlite.
As always just click the link below to watch the slideshow or you can click on individual pictures below to view them one by one and just use your arrow to key to navigate between the pictures. Also if any of you are interested in photography there is a tab at the top of the page that has quite a bit of information about the camera, lenses and software I use to take pictures. Hope its helpful!
Wow, Christo! Powerful experiences on OB, not unlike mine at UCDavis. Great careflight pics, too! How goes Melissa’s pregnancy?