Stories from the Bedside – The Circle of Life and the Miracle of Childbirth

[box style=”rounded” border=”full”]Jun Lao, Mess Editor, with stories hot from the labour ward.[/box]

Maybe holding the newborn cub over the edge of a pretty precarious looking cliff isn't the best idea?

Maybe holding the newborn cub over the edge of a pretty precarious looking cliff isn’t the best idea?

Ah the miracle of childbirth. Amidst the hustle and bustle of modern life it still retains a uniquely romantic and vital status in the eyes of many and for some it is the defining moment of their lives. But how many of us, even medical students, truly understand the realities of childbirth? Not simply the miraculous and joyous aspects but also the upsetting and more unpleasant aspects. For many of us our perception has been largely shaped by movies and television with a rather homogenous and narrow range of experiences represented. These typically range from women looking implausibly flawless whilst practically coughing out a baby in a matter of minutes to women in absolute agony for endless hours cursing everyone around them – though that last one probably isn’t too far from the truth. Yet in reality childbirth is rarely as predictable as TV would have you think. Waters don’t break nearly as often as TV writers would have you believe (i.e. premature rupture of membranes) and rarely do women suddenly go into labour just as soon as their partners become trapped in some sort of farcical situation leaving them scrambling to make it back in time for the birth (I’m looking at you every sitcom ever). These farcical situations have a tendency to resolve themselves and there is always a happy ending. Sadly the reality is that this is not always the case as I have come to learn during the course of my 2 months on Obs and Gynae.

This was originally intended to be a more upbeat and optimistic take on my experiences of Obs and Gynae. But a few encounters forced a rethink and a desire to examine the less palatable and therefore more neglected aspects of pregnancy and childbirth. Perhaps the most surprising thing which I have taken from my time here is the realisation just how common miscarriages are. Roughly 20% of pregnancies end in miscarriage of the foetus (i.e. before 24 weeks). A stunning statistic which I never could have predicted before my placement and that probably speaks to my wilful ignorance of the subject. I had always imagined miscarriages to be an unspeakably tragic yet rare event and as I started my placement I wondered how I would go about broaching the subject with women. As I sat in listening to an SHO counsel women about their options post-miscarriage I wondered how I would cope with that responsibility. Was it something I was ready for? How would I handle it? We have a great deal of training and teaching at medical school in order to prepare us for these moments (oh hey VM/CPP maybe you’re not completely useless) but I can’t help but wonder how I will react when placed in a similar situation for the very first time as an FY1 and how much the time spent honing my OSCE counselling station skills will actually help.

Yet another stark reminder of the responsibilities I will soon come to face came only a few days ago where I witnessed a surgical termination of pregnancy. The indication for the termination was a lethal foetal abnormality known as acrania where the foetus essentially has no skull and thus no chance of survival. The likelihood was that the foetus would either spontaneously abort by itself or it would continue to grow until term at which point it could even be born but would almost immediately die within hours of birth. In light of these horrific outcomes the decision to terminate was made to spare the mother any further suffering from either having to witness her body expel the dead foetus or carry on the pregnancy for 25 more weeks with full knowledge of the devastating end result. In this situation it was the humane decision especially given her previous traumatic obstetric history of recurrent miscarriages. But even with this knowledge witnessing the procedure was an upsetting experience. I was warned that it would be gory. I was warned it could be upsetting. Yet that still failed to prepare me for the sight of what was clearly a tiny foot amidst a mass of tissue floating in a pool of blood. The issue with simply focusing on book learning as a medical student is the failure to fully appreciate things like this. Abstract concepts described on a page of the Oxford Handbook will never fully prepare me for the reality of these situations and this was a very timely reminder.

The file name was group of multiethnic babies. 'Nuff said.

The file name was group of multiethnic babies. ‘Nuff said.

At risk of being a downer perhaps we should head back to the brighter side of things. Babies. So many babies. I wouldn’t say I’ve been particularly proactive over the past few weeks yet I have still managed to see a dozen or so babies being born sometimes purely by wandering onto the ward at the right time. Child birth is undoubtedly an incredibly unique, miraculous and literally life changing event but it is also an intensely personal and significant moment which as a medical student I have been afforded the privilege of bearing witness to. So I am grateful to have seen so many births. But if I’m being completely honest it has become a tad mundane by this point. Yes at first watching a caesarean section and seeing the immense speed with which they actually deliver the baby, mere minutes after the initial incision, is thrilling. And yes a baby has just popped out of that woman’s belly. But as for the rest of the procedure… To call it unstimulating would be kind; mind-numbingly boring would be more accurate. Half an hour or so of meticulous stitching to close up whilst an assistant (me) holds back the fat and skin flaps or passes the odd instrument. It is incredibly important of course to do a good job. But I was practically in tears of boredom after assisting in 2 in a row. Clearly surgery isn’t for me but from the looks of it neither is obstetrics. And then we come onto natural birth. An incredible life-affirming process which is a precious moment for all involved surely? I’d probably agree – the first time I witnessed a birth. It was genuinely a memorable and powerful moment. But that was back as a 17 year old work experience student. Since then each birth I have witnessed has certainly been unique to an extent but I haven’t been nearly as affected by it as I was the first time. And honestly I have been as involved in the births as I was as a 17 year old i.e. not at all which hardly helps with my level of enthusiasm and interest. By this point I am far more world-weary, exhausted from the relentless 8am starts and have an almost cynical disinterest in seeing procedures which I have seen before or doing things which I have done before. I have almost developed a tickbox approach to medicine as a result of the med school’s oppressive procedure card signoff system for each module. Seen a hysteroscopy? Check. Put in a speculum? Check. Sat in on an antenatal clinic? Yes check the BP, do a urine dip, feel the tummy, listen for the foetal heartbeat and then onto the next patient. Check. So blame the med school for my disinterest. I used to be an idealistic young student keen to learn. Now I just want a bloody signature for that prescription I just wrote and maybe an MSR if you wouldn’t mind kind reg (a feedback form on our clinical performance – as fun as it sounds). Look at what you’ve done to me UCL.

But maybe there is hope. I still have a week left on my placement and I have yet to actually deliver a baby myself. Maybe this will be just the thing to reignite my enthusiasm. There I’ll be helping to deliver the baby just as the sun peeks over the horizon. The ‘Circle of Life’ will be swelling up in the background. Doctors and midwives from all corners of the labour ward will gather to bear witness to the glorious birth. They’ll gaze upwards in awe as I deliver the baby and hold it aloft for all to see. They’ll all cheer and stamp their feet. And I’ll get that bloody signature on my procedures card. One can only dream. Hakuna Matata*.

*Yes this was a reference to Lion King. Obviously. And yes I’m aware that Simba wasn’t actually being born in that scene. Don’t ruin this for me.

Quote of the week

Picture of the week - absolutely had to be included alongside the quote

Picture of the week – absolutely had to be included alongside the quote

‘Never, Marge! Never! I can’t live the button-down life like you. I want it all: the terrifying lows, the dizzying highs, the creamy middles. Sure, I might offend a few of the bluenoses with my cocky stride and musky odors – oh, I’ll never be the darling of the so-called “City Fathers” who cluck their tongues, stroke their beards, and talk about “What’s to be done with this Homer Simpson?”‘ – Homer Simpson, The Simpsons


Full Homer sugar speech –

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