Yes Doctor, Do You Take Cream and Sugar?

Since I went back to work, it's been nothing but HUGE babies and c-sections. Honestly, I'm beginning to think that I'm jinxed. Actually, I've been thinking that maybe IK was my good luck charm (she was with me in utero from the first day I worked on L & D).

In eight months on L & D I never had a baby bigger than ten pounds. In the last four shifts, I've seen THREE eleven pounders! After hours of valiant pushing all three mom's ended up in the OR. I'll be the first to admit that in all cases a C-section was indicated, but it's never been more clear to me that some sections are better than others.

Scenario A: Midwife attended delivery. Mom pushed for two+ hours in a variety of positions, after laboring down (meaning that she waited a while to push after she was fully dilated -- this allows the baby to descend using the strength of the contractions rather than having the mom push with the baby in a high station). When it became clear that the mom's pushing wasn't bringing the baby down, the midwife consulted a physician who agreed that a c-section was indicated. The parents were involved in every decision and went into the OR feeling confident that we'd tried EVERYTHING to make a vaginal delivery happen. Though it wasn't the delivery that the parents hoped for, the vibe in the OR was happy and everyone celebrated the arrival of the 11-pounder.

Scenario B: MD attending delivery is covering for the doc who provided all of this patient's prenatal care. He proclaims the patient fully dilated and instructs me to start pushing with her right away while he reads the directions on the Via Cord cord blood collection kit (he'd never seen one before... RED FLAG). So we start pushing though the patient is totally numb from her epidural and has no urge to push and no sense of when she's contracting. We push for an hour and as far as I can tell she's making no progress. At my hospital nurses don't do vaginal exams so I pop out to check in with the MD. He's MIA so I ask the resident on duty to page him, "You mean he's not in there pushing with his patient?" Nope, I say and she rolls her eyes and picks up the phone. He moseys into the patient's room fifteen minutes later, does a dry glove vaginal exam, declares that she's pushing great & disappears again. By the time he comes back, she's been pushing for two hours -- we've tried a few different positions to no avail. He walks in and seeing no baby about to enter the room he announces that it's time to do a c-section. The patient says, "No, I can keep pushing. I don't want a c-section." To which he replies, "The risks of C-section include blood loss, organ damage, infection and death." (I swear those were his exact words). The patient asks for a second opinion.

Long story short, we end up in the OR. By then I'd mopped up the situation to the best of my ability -- tried to soothe her fears, answer her questions and offered my speech about childbirth being great preparation for parenting. So the 11 pounder is born and in the midst of the cord blood collection the MD sticks himself with the needle. He strips off his gown and gloves and goes out to wash his hands. When he returns he asks me to get the patient's chart so he can see the results of her last HIV test.

From that moment on he never stops putting himself first -- he asks the resident a litany of questions over the patient's open abdomen (what are the side effects of AZT?, what are the chances that he'll get hepatitis if she has hepatitis?, etc.). Keep in mind that the patient is hearing all of this. So then he orders me to draw blood on the patient for new HIV & hepatitis tests. I ask if it can wait till we're out of the OR (since I'm supposed to be attending to the newborn AND have to do three more counts to make sure he hasn't left any instruments in the patient while he's busy worrying about himself) and he doesn't answer. So I go about my business until he stops me in the middle of an instrument count to order me to draw her blood for labs NOW. I explain that we're not supposed to stop in the middle of a count and he says he'll walk out of the OR if I don't draw her blood. I should have told him to go, but instead I threw him a look and stopped my count to draw her blood.

Never once did he offer his happy congratulations on the birth of this beautiful child. He never spoke to the patient again except to ask for her consent for an HIV test. The whole thing made me so sad.

My point, I guess, is not to have you pity me for having to follow this a-hole's orders, but rather to warn anyone out there who might not yet have met their OB's covering doctors. Sure, this patient picked the hunky young MD who gives his patients every chance in the book to deliver vaginally and is willing to put the time in to help her push to make it happen. It's not her fault that she had her baby on a Sunday and therefore got the dorky old doc with a self-aggrandizing attitude problem and a penchant for c-sections that allow him to be home for lunch.

Word to the wise. Ask the hard questions about what happens if you have your baby on a weekend or a holiday or during a week when your doc is pool-side in Cabo. And remember, it's probably not too late to switch to a midwife.