Examine

one

ASHLEY

"Remember you have two lives in your hands," Rebecca tells me.

"I know," I reply, as I wash my hands thoroughly in the sink. 

Even though I've done this several times throughout my OB/GYN rotation, Rebecca still treats it as if it's my first time. The reminder does not settle my nerves, it's like being on call 24/7.

We enter the room where the patient, Tala, is lying on her side in the bed. A pillow supporting her swollen stomach, the nurse, Joanne, beside her.

 "Are you ready to push?" I ask Tala warmly, all my years of medical training stilling something inside me. 

There's an odd mix of adrenaline and calm coursing through me, as I focus my attention solely on the pregnant woman on the bed. Her black hair is sticking to her face in places, and her free hand is clamping onto that of her husband, Mark, who's sitting beside the bed.

The presence of Rebecca, her attending physician and my supervisor, fades behind me. We have reached the stage where she monitors my progress but does not intervene unless it's an emergency.

I move to the end of the bed. "Let's try a few different positions to push," I suggest. I point out the squatting bars. "You can use these if you want to try squatting."

Tala attempts to get into a squatting position at my request, but halts and lets out a moan of pain. "It hurts."

A flash of concern runs through me, as I think of all the possible things that could have gone wrong since I had done her vaginal exam a couple of hours ago. Her cervix had looked healthy then.

"Where does it hurt?" I ask calmly. "Please be as specific as possible."

"My back," she gasps.

I fly into action. The posterior position of her baby must not have changed throughout the labour. Which means the tilt of the chin of the baby is going to be applying pressure to her spine.

"Okay, Tala, it would be best if you lie back down on your side."

She does, whimpering slightly. Mark feathers a hand across her forehead, his touch soft and caring, sending a pang through me.

"It's okay baby," he whispers to her supportively. He looks up at me, over Tala's closed eyes, his expression is stricken. The question in them clear - it will be okay, right?

I nod confidently at him, before focusing my attention back on Tala.

"Would you like an epidural for the pain?" I ask Tala.

She nods, her hand still clutching one of her husband's like it is a lifeline. Joanne moves to get the anaesthetist.

"It seems like your baby is still in the posterior position," I tell Tala, crossing to her side of the bed so I can gauge her reaction.

I advise her on the two options: delivering naturally and risking perineal tears and a haemorrhage after pregnancy, or a caesarean.

Tala listens to what I say, before looking at me with steel in her eyes. "I want to deliver naturally," she says determinedly.

"Okay," I affirm, preparing to settle down for the long haul, as Joanne and the anaesthetist walk back into the room. "Joanne and I will be with you every step of the way from here on out. Could you please move onto your hands and knees for me?"

  •  •  • 

Several hours later, I gently place the baby on her abdomen. The umbilical cord is still connected to her baby, and I wait a minute before handing the scissors to the father.