Once Again, With Feeling by KRIS BARNSFATHER, MD
“
He’ s such a good boy.”
“ That looks great!”
“ You’ re killing it.”
You have likely said those things or a similar version of them as a physician. They were likely your words of encouragement to a parent, to your patient or even to a student or resident working with you. We know they are supportive and positive phrases. We know that because we liked hearing them ourselves in school, in training and in parenting. However, when my son’ s middle school teacher told me my son was so mature, my first thought wasn’ t pride or positive. My first thought was, so respectful earns you“ mature” these days? It’ s sadly funny, but I get why.
Many of us have teaching moments at work but sometimes, we are the students. I, myself, was recently emotionally schooled. The patient was a first-time mom with a suspected big baby on board. She labored as expected and was pushing around 2 a. m.( It’ s ALWAYS 2 a. m.! Ha!) She pushed for about an hour and the head came out, slowly. I had to free the chin from the perineum with my hand. My obstetrician readers are starting to cringe. I did the initial gentle traction of the head to see if the anterior shoulder would move. It said,“ nope.” I told the nurse,“ Call it” and the shoulder dystocia drill came to life: friends called in for help – episiotomy cut – family moved back – the bed flattened – the legs reared back – the clock ticking...
The nurse tried to give suprapubic pressure to dislodge the shoulder but as I later found out, it was her first shoulder dystocia experience, and she was not able to get the shoulder to move. Truth be told, I’ m not sure it could have been dislodged even in experienced hands. I tried to deliver the posterior arm, but the baby didn’ t want to comply. I am watching the baby’ s head turn blue. I moved to the woodscrew maneuver and was finally able to deliver – and breathe – again. In total, it was 2 minutes and 33 seconds. It was the longest dystocia of my career.
Baby went to the warmer for evaluation with the neonatologist on that night. I’ ve seen this doctor at a few deliveries but had never spoken with this one directly.
The placenta would not detach so I had some time to watch the baby during its evaluation. Kiddo was breathing, moving both
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