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When the delivery goes wrong: A med student’s reflections

Certain details in this entry have been omitted or changed to protect the identity of the patient.

babyLabor and Delivery is a pretty strange place. It's perhaps the only place in the hospital where a patient tells us she's in pain and we say, “That’s a good sign!” It’s a good sign because that kind of pressure pain is a sign of active labor -- that things are progressing as they should. It's also the only place in the hospital where “the patient” is actually two patients: the mother and the baby.

The vast majority of pregnancies and deliveries are uncomplicated and don't need medical intervention. Women have been giving birth for thousands and thousands of years, so why do we recommend that healthy women with healthy pregnancies deliver in the hospital? Because we can’t predict with complete accuracy which pregnancies are going to have complicated deliveries.

I had a patient just like that: She was healthy and her pregnancy had been uncomplicated. Her husband was with her and throughout the hours of her labor he was incredibly attentive. They had studied books on parenting and delivery, they had taken classes, and when we talked about how she should push, she and her husband both knew what we were talking about. They had researched that as well. When her cervix dilated to ten centimeters, her husband called everyone in their family to announce the good news: The baby was almost here.

And then we waited.

And waited.

And after hours of the patient continuing to push with no descent, we had to concede that the baby wasn't coming down. The medical term for this is failure to descend. The reason was that this little baby was facing up, her face pointing towards her mother’s pubic symphysis rather than facing down toward the sacrum. When babies are born, they're supposed to be face down so that they can bend their neck to allow the rest of their body out, movements called the cardinal movements of delivery. When babies are “sunny side up,” the diameter of what has to descend through the pelvis and then come out is larger. This baby was stuck.

The doctor gave my patient options: She could continue to try to push or we could go to caesarean section. Each option had risks and the husband asked us detailed questions about everything, but my patient made her decision from a gut feeling: She didn’t think she could push more. She was exhausted.

In the operating room, the procedure began normally. But when the doctor reached in to pull the baby out, nothing happened. For more than a minute, the baby didn’t budge, and I could feel tension mounting among the whole team. Finally, with a loud sucking noise, the baby popped out of where she had been stuck in the pelvis and she came out. I felt tears prick the back of my eyelids because I knew this baby was going to be fine. She was a little bit blue, like most babies because of their thin skin, and her arms were curled. But unlike most babies, she had a ring around her face showing where her face had been pressed against the pelvis, where she had been stuck.

She took her first breath and then the pediatrics team took her. We finished the c-section, and through the door we could hear my patient’s husband cooing over the baby, welcoming her into the world. He was now a father.

My patient needed a blood transfusion because of blood loss during the procedure, but when she woke up from anesthesia, she got to meet her daughter. I watched my patient for a moment, thinking about the discomforts that women experience when they deliver in the hospital: uncomfortable beds, tired doctors, loud noises. But I was so thankful that this patient chose to deliver in the hospital because her delivery turned out to be one of those deliveries that really did need a doctor.

I bid my patient and her family goodbye because I had to go check on another patient, and I'll never forget what happened next. The husband looked at me with tears in his eyes and thanked me for saving his wife’s life and for bringing his daughter safely into the world. I had to explain that really, I didn’t do anything – I’m just a medical student. But maybe someday I will be like that doctor. And hopefully I'll be able to help a woman through a delivery that otherwise wouldn’t be safe.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category.

Natalia Birgisson is a fourth-year medical student at Stanford. She is in her second year off and writing her first novel, which is described on her site

Photo by Bridget Coila

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