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An Unexpected Lesson

Today, something interesting happened.  I witnessed a complicated mid-rotation forceps delivery and my reaction was not what I expected.  I’m trying to think if I’ve ever seen a forceps delivery before; I know I’ve seen lots of vacuum deliveries, but I just can’t seem to remember clearly about the forceps.

This poor woman had been pushing for hours with no progress.  We were consulted for a forceps delivery but the resident wasn’t very confident; She feared that the baby’s head was in the wrong position and that she was too hight in the pelvis still.  So, tears ran down the faces of these poor exhausted parents as they listened to the risks of a c-section and signed their consent form.  But then Dr. “Old Man’s Club” obstetrician came to the rescue saying that he thought a trial of forceps was appropriate… Might as well give it a shot.

We set up the tray with two kinds of forceps: One for rotating the baby’s head, and one for pulling the baby out.  Forceps are scary things and I watched closely and listened intently as Dr. OMC taught us about the importance of choosing the right forceps and applying them correctly.  The senior resident tentatively slid one long metal blade into the unknown of the vaginal vault… higher up that you’d think anything should ever go.  She followed with the second blade and attempted to lock them into place.  She wasn’t doing it quite right and woman began writhing in pain.  Dr. OMC took over quickly and he reefed on the handles of the forceps, pulling them down to the floor and putting unimaginable pressure on the perineum.

I started to feel a sense of panic rise up inside of me.  This is the first time I sensation like that has happened while working in obstetrics.  Dr. OMC seemed confident that everything was in the right place and he handed the reigns back to the senior resident.  She started trying to turn the baby’s head into a more favorable position.  But, all we could see were the handles of the forceps… just hoping that everything was moving the way it should be moving.  Nothing was budging.  Dr. OMC placed his hands over the resident’s hands and probably tripled the amount of force she was applying.  Then you could see the handles turn.  Slowly, Rigidly.  Like a lead pipe (and we’ve learned that that’s a bad feeling, most times).  That panic sensation started to get stronger.  I wanted to do something, but I was helpless.  I watched with the intense feeling that I needed to look away but some invisible force was making it impossible.  Dr. OMC called over his shoulder, loudly telling the nurse to inform the scrub nurse that we were coming down the hall any second.

The woman began to contract again and she let out an excruciating moan.  Suddenly, the rotation was done and the rotational forceps were being removed and replaced with the pulling forceps.  The resident tried to pull.  The woman was yelling in pain; she couldn’t push anymore.  Dr. OMC grabbed the handles from the resident and she clambered aside.  I was squirming in my scrubs, the sensation was almost too much for me to handle and I almost managed to turn away.  An urgency was inside of me, wanting to make me turn around and run – I forced myself to stay and watch.  The baby’s head was bulging in the perineum and Dr. OMC was pulling with what looked like all his strength.  Silently, the resident approached with a set of scissors and she made a long cut in the skin – an episiotomy.  Suddenly the baby’s head was out.  This poor, pale looking face with no expression and no colour.  It seemed to take an eternity for them to deliver the rest of the baby… and then she just flopped out.

Hypotonic and pale blue.  There was no cry, there was a feeble attempt at a breath.  The pediatric resident took the baby and made his attempts to invigorate the newly born baby.  The mother was exhausted and showed only signs of relief that the birth was over.  My anxiety was over and suddenly I felt exhilarated.  Adrenaline coursed through my body and I didn’t know what to do with it.  I watched the baby.  She was moving.  I watched the parents.  They were crying with relief.

The baby let out a loud, newborn wail.

The whole room breathed a collective sigh of relief.

My body experienced it’s first true surge of fear and uncertainty in medicine.

I learned something very important today… and it was not just how to properly use forceps.

5 thoughts on “An Unexpected Lesson

  1. This was a difficult read for me. I’ve been the woman on that table. Vacuum, two sets of forceps, episiotomy, all while six nurses assisted, and a seventh nurse was asking me questions to rush me in for an emergency c-section (which, fortunately, I didn’t end up having).

    People say you don’t remember these things, but I remember it all vividly. I remember the excruciating pain of the vacuum and forceps. I remember trying to scoot off the table. I remember thinking I was actually going to die or that Z would, because there was no way the human body was built to withstand this (and I’ve put my body up against a lot, but his was so tiny and fragile). I remember waiting to hear him cry, while nearly passing out from the ordeal.

    Having had children yourself, I can’t imagine how helpless you felt. Having any inkling of what that woman was going through, while Dr. OMC would have no idea…. I can’t imagine standing where you were standing.

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    1. Meizac,

      I know exactly what you mean… E. was a vacuum baby, which is not nearly as painful as forceps. That moment when you watch someone haul (literally) a baby out of a woman’s body, it’s just something horrifying and amazing all at the same time. I’ve watched a few more forceps since this one, and that irky feeling just doesn’t ever go away.

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  2. But what lesson did you learn? To do second stage Caesareans instead? I hope not. To learn when to use forceps safely. I hope so.

    Here’s a tip. Go back and review the partogram. If it took more than three to to dilate from 7-10cm that’s a warning sign that the forceps was going to be difficult. Ditto fundal height more than 40cm. And where was the anesthetist? Why no analgesia?

    Don’t give up on the forceps. Learn to use them properly,

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    1. Thanks for the tips. However, the lesson learned was more a lesson about myself and my reaction in situations like that. The forceps were definitely used properly, and the woman had a great epidural top-up. Looking back I think the whole experience was a good one; I just didn’t feel as at ease as I thought I would.

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      1. Oh that’s alright. I had misread the original post as a criticism of the forceps delivery. As an OMC obstetrician, myself, I don’t want the old skills to die away. Great blog.. Keep up the good work.

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