Baby Making Music

My first delivery was that of MN, a 37 year old polite and petite Asian woman at 39 weeks gestation scheduled for LTCS (low transverse caesarian section) due to advanced maternal age, gestational diabetes, and transverse lie. Having seen several surgeries over the past 3 weeks I felt no apprehension over witnessing the procedure even though the clock had not yet ticked through my first hour on the Labor and Delivery team, I had little sense of my roll in the unit, and was now rushing to introduce myself to the patient as she was rolling from the maternity suite into the delivery room. Adding to my buzz was the fact that the obstetrician just asked whether I would scrub in and assist on the procedure – something I had done only rarely before.
The confident slice of scalpel through skin and fat, dissection of the rectus and pyramidalis muscles and entry into the peritoneum were quick and relatively bloodless but I couldn’t help think how barbaric it seemed to have exposed the innards of a fully conscious woman – like Mel Gibson having his entrails removed during his execution in Braveheart. I trust that she was oblivious to the extent of trauma we were committing against her on the other side of the sterile field – otherwise it is unlikely any woman would consent to the procedure (though having not yet witnessed a vaginal birth it remains to be seen which is the more brutal alternative). Little did I know that the true extent of the violence had yet to begin.
The baby was presenting in a transverse lie across the belly with her back approximating the contour of mom’s diaphram – a poor position for delivery. In order to have access to any substantial anatomy with which to extricate the baby from the uterus, the head or rump would have to be coaxed into a more vertical orientation. The technical term for the maneuver is a “version” but could be more accurately described as twisting, yanking and squeezing the uterus until the baby flips. The process was about as elegant as zipping a fiesty cat into a Dopp kit and beating it savagely.
Only when this step was completed did we cut into the uterus. At that moment the intensity of the room and my perception of time were dialed up 100 fold. Never before have I seen so much blood spill forth and the suction was temporarily overwhelmed. With the volume of blood and the solemnity of the robed figures standing over the woman’s body the scene could easily have been confused for a ritual sacrifice. After what seemed an eternity the bleeding was controlled enough to visualize the surgical field, and within it, the rump of a soon to be newborn child. With a few deft maneuvers (akin to angling a large couch through the turn of a tight doorjam) the healthy baby girl was delivered, suctioned, cord cut, and APGARs assessed. Dad was too anxious to coddle his newborn so a nurse rocked and soothed the child. Pointing out mom’s still extracted uterus she cooed “that’s where you came from!”
Although I wanted desperately to divert my attention to the newest member of the room there was still a placenta to eviscerate, a uterus to scrub clean of debris, stitches to throw and staples to close the gaping wound. In the more quiet and controlled post partum environment my focus was able to expand beyond the exposed abdomen immediately before me and I noticed that the radio had been playing throughout. My ears perked to recognize the tune and frankly “Girls” by the Beastie Boys was not at all what I was expecting.