Articles and Case Studies

There’s a First Time for Everything - Catching a “Primip’s” Baby | MDA National Student eNews

18 Mar 2013

By Thomas Boosey – third year medical student, Griffith University

It’s 7am as I warm my hands in the beanie I’ve worn to fend off the morning chill. Sure it’s only a Queensland winter but today my hands need to be extra warm as I’ve been promised my first “catch” on the birth suite. The night staff meticulously hand over to the morning midwives and I am allocated to a “primip” or soon to be first-time mother. An erroneous reference – as my consultant obstetrician semantically points out – short for “primiparous” which actually means a woman has already delivered once. Perhaps it is symbolic of the positive projection by midwives who hope for a routine delivery that will keep the obstetrician at bay.

Today, as I am in the charge of a midwife, I must adopt the lingo to ensure effective inter-professional communication to optimise the care of this “primigravida” woman through the home stretch of her first pregnancy.

As with all medical student-patient interactions, this one begins with informed consent, facilitated by my midwife and the registrar who pokes her head in. It seems only fair that someone who will be privy to one of the most intimate events of a woman’s life should be well introduced, but this is also a major legal obligation. As such I document the verbal consent in the partogram and have it countersigned by my supervisor – the first of many entries into the record to be made today.

Fortunately, this primip is as enthusiastic about having me there as I am, at least for now before any regular and painful contractions have set in. Her young partner is also present and will prove to be a terrific support – a seemingly uncommon occurrence in the demographic of this particular birth suite.  They’re both around my age, perhaps helping in establishing a most valuable rapport. Throughout her labour we will share stories and moments of doubt, vulnerability, and ultimately joy.

12 hours later

It’s now 7pm as I wash my hands thoroughly before donning a pair of sterile gloves in final preparation for the “catch”.  I’ve survived three midwife shifts, each with the same meticulous handover and reintroduction of “Thomas, the medical student who would like to be involved in your care”. 

My primip has survived several hours of painful contractions with the support of her partner and more than a few puffs of gas – a form of analgesia initially refused by many of the women I’ve seen, but almost universally requested once true labour kicks in.

Alas after almost an hour of pushing, this petite primip has been unable to deliver naturally although baby’s matted hair is visible.  I am asked to leave the room to notify the head midwife, as the latest midwife continues the trend of today’s predecessors in ensuring there is barely a moment where my primip is unattended.  It is decided she will probably need an episiotomy and so the doctor is called.  Within minutes, the room is buzzing with a meticulous handover from two midwives to the birth suite resident in between cries of agony from my primip, followed closely by the registrar on call who then informs the consultant obstetrician who has also arrived. I retreat to the corner…

An episiotomy is made after the appropriate consent is obtained and the bed is lowered for a forceps delivery, but she is pushing again with a major contraction and baby’s head can be seen on the brink.  Cool, calm and collected as a camel, the consultant turns to acknowledge me and asks rhetorically “whose catch is this, I don’t need the practice”. My hands are sanitized for the thousandth time, more sterile gloves are donned and consent is obtained again and for the last time.

The consultant is by my side and tells me to get ready, so I crouch down to the level of the bed and he chuckles. “Get up here, you’re not wicket-keeping!” With the bed raised by one of the midwives, and a big push by my primip, the baby’s head is born as the consultant teaches me about the mechanism of delivery. An unforgiving minute passes andI begin to fret that after 12 hours of meticulous observation taking and recording, and extreme patience on everyone’s account, this baby’s body is not fitting through the passage to the outside world. My concern is abated as the consultant directs me to free up baby’s shoulders with a simple rotation on the inside and in a crashing wave of fluid and baby with the next push, we jointly deliver him onto my officially-primiparous, new mother’s chest.

Yet the event is not over by a long shot. The paperwork continues, baby’s APGAR scores are noted at 1 and 5 minutes and show a healthy baby boy on preliminary check and of course, there is the placenta yet to be delivered. There is no further complication, such as the post-partum haemorrhage that threatened the woman after the first delivery I saw.

With congratulations swapped and a photograph with the proud new parents I am dismissed from my student duties by the team as another doctor arrives to suture my primip’s episiotomy incision.

As I walk to the hospital car park warmed by my beanie, hands buried deep in my coat with the fuzzy feeling from today’s experience, I realise I never even saw the sun. What I did witness was a professional team effort in a notoriously litigious setting. Despite my fatigue, I am satisfied with my day’s work as today I felt useful, regardless of my being important or not, although the new parents and the team assured me of that too.
 

 

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