When I was in nursing school, my friend Lori, knowing how obsessed I was with L&D, invited me to shadow her for a day in her job as an Labor and Delivery nurse. Since you never know what is going to happen in L&D, she wasn’t sure what I’d get to see, but I couldn’t wait.
We arrived at 7 am, and Lori’s supervisor, knowing I wanted to see a baby born, assigned us to a patient who had a scheduled repeat cesarian that morning. No other woman was in active labor, and this would be my best chance. Having been a hand-holder, coach, or mother in vaginal births only, I had no idea what to expect. I had always thought there was something so odd about going to the hospital to have a baby when you weren’t in labor. I had seen women in the elevator at the hospital I interned at, going up to have a baby; no pains, no discomfort, nada, just giddy and nervous, laughing with their partner in an elevator. It was curious to imagine waiting for someone to painlessly remove your baby from your belly and hand him or her to you. Knowing the due date, almost to the time of the birth of your child; it seemed surreal.
That morning, Lori prepped the patient, the procedure room, me (sterile gown, shoes, hat, mask, lecture) and dad (more of the same), and we wheeled the patient to surgery. Mom was understandably nervous and said goodbye to dad (someone would bring him back when the procedure was about to begin). The surgical tech was in the room, ready, and she told me where to stand: a tiny little tile at the foot of the bed that I was not supposed to step out of. I wasn’t to touch anything or help out once the procedure started; just watch.
I watched the anesthesiologist insert the spinal while Lori hugged the patient and kept her in position. This was the patient’s second c-section, so she knew a little of what to expect. They strapped the patient to the table, arms strapped out in a T, like Jesus on the cross, legs strapped down at thigh and ankle. This all looked terribly frightening to me, but the patient was already losing feeling in her lower half and hardly recognized what was going on down there anyway. Lori let her know she was going to place the urinary catheter, and the anesthesiologist set up the drape. I don’t really remember anything between that and the physician coming in. I made sure I was in my tile’s borders. Someone brought Dad in.
Because this was a teaching hospital, the OB had a resident assisting her and standing opposite her. The surgical tech was on the same side of the bed as the obstetrician, and slightly behind her, to quickly hand her tools. I was standing still as a statue at the foot of the bed, trying to be invisible and see everything. The anesthesiologist joked with the mom and dad at the head of the bed behind the drape, and Lori was logging things in the computer a few feet from the resident. The patient was draped so that her belly was exposed, and the OB scrubbed the incision site before she began.
Everything happening in that room was fascinating to me, and I wanted to see and hear it all. This is what I remember:
- The OB’s hands were shaking when she used the scalpel to very carefully begin cutting into the patient’s abdomen. I wondered if that was normal. It may have been nerves, or adrenaline, or both, but in spite of the shaking, her cut was as straight as a lance.
- She did not cut right through all the skin immediately, like you might imagine: she made a shallow cut through the first few layers of skin, then another and another, until she was through the epidermis, and into the adipose (fat) tissue.
- By this time, there was some blood, but the resident washed it away between each of the OB’s cuts.
- This was a thin patient, but I was fascinated by the visibility of the collections of fat in the subcutaneous tissue. Holy cow! The fat looked like pats of butter under the skin: shiny, yellow-ish, and appeared in clumps.
- I was utterly fascinated by how much this procedure seems like a highly choreographed dance; everyone knew their part and played it perfectly. The OB hardly said a word for the first part of the procedure, the surgical tech knew what was needed and had it in hand before OB even had to ask. I wondered how long they had been working together, or how long the surgical tech had been doing that job? The surge tech didn’t even have to look for a tool, she mostly had them in order of which ones she knows will be required, in what order. She barely glanced down to grab something. Hardly any time had passed at all, yet so much had happened.
- Slice, slice, slice, through layers of abdominal muscles. By this time, the tissues are bleeding pretty heavily, and it’s harder to see exactly what’s going on, but the team moves like a machine, and the resident is continuously washing away blood.
- In the next moment, I am shocked by all the yanking and pulling. Holy sh*t, the resident and the OB, after each layer of tissues is completely severed, are putting their hands on top and bottom of the incision, and pulling the opening open further. To better see the next layer to be cut, obviously, but this pulling apart is getting more and more forceful, and if you’ve never seen it, it’s shocking.
- My next thought is, holy crap, the ‘grabbers’ are out. These are stainless steel “retractors”, and I think I’ll just have to insert a picture for you to get the idea, but once the muscle and connective tissue has been cut through, or maybe before (I don’t exactly remember), these tools come out and they look wicked. They are used to yank, yes, yank, open the hole that has just been cut, and hold it open so the OB can see the uterus and get that baby out. Clearly necessary, otherwise the skin and muscle and facia would just lay flat and how could you see anything at all?
- By the way, now Mom’s intestines are flopping out on her belly. (Yes, c-sec moms, outside your belly, your intestines are slinking out of the incision and laying on your abdomen. Your glossy small intestines, making their appearance on the outside).
- I’ve seen a lot of intestines from the inside of the body, but never from the outside, and I’m fascinated by those sausag-y things. Oddly enough, this (intestines) is what makes me suddenly realize what a damn dangerous procedure this is! One missed nick with that incredibly sharp scalpel could spell disaster, sepsis, but I digress.
- At this point, I don’t know how long I’ve been standing there, seems like just a few minutes, but all the yanking, tugging, blood, and amazement is making me lightheaded. There I am, standing in my scrubs on a tiny tile, trying to be professional and cool, but feeling like I’m about to faint. My mind flashes to “that guy” who passes out during the birth of the baby and I can’t let that be me! A few slow breaths and an iron-will not to make Lori regret giving me this incredible opportunity keeps me on my feet. The next moment makes me SO grateful I didn’t just pass out!
- Amniotic fluid, spewing out like a fountain from the patient’s abdomen! Literally, a fountain of fluid shoots out of the freshly cut uterus, and gushes into the drape. This is remarkable and I am in awe! The OB has just cut into the uterus, that amazing muscle, and we have the first glimpse of why we are here! (Why did I never before consider what happens with the amniotic fluid during a scheduled c-sec? Have you ever wondered?). Now you know it spews out like a beautiful waterfall.
- This next part goes so fast; the OB has her hands inside the mother, almost to her elbows it seems (she’s petite), and out she pulls a beautiful and surprised baby in her grasp! A miracle!
- In my mind, this poor sweet baby: I mean, she had no hints that this was going to be the day she was born: she was just chilling, no contractions, no disruptions at all until someone rudely pulled her out of her warm home and into that freezing surgery room!
- OB scoops the baby out and holds her high, so mom and dad can see her squinched up little face and perfect self. It’s a girl! Mom and Dad are crying.
- The pediatric specialists whisk the baby to the warmer (they were in the room the whole time, I just hadn’t really noticed them them before – they came in with dad).
- I don’t know what to keep my eyes and mind on at this point, it’s impossible to see everything. Mom and dad are laughing behind the curtain, the baby is behind me, under the light on a warmer, getting weighed and poked and swaddled.
- I turn back toward the patient and out of the corner of my eye, I see the OB pull our her placenta drop it onto a surgical tray. Then, shock of shockers, the OB pulls out the patient’s uterus. Yes, she just plops the uterus on the patient’s abdomen, holy crap, among her intestines. She inspects the uterus, that beautiful pink, muscular organ, and then sews it up while it’s outside the patients body. I had no idea this was how it was done (did you?)!
- Once the OB is satisfied with her stitches (and she’s very meticulous), she pushes it (none of this is delicate) back in, along with the intestines that are poking out, and begins the detailed process of sewing the patient back up, layer by layer by layer of tissue.
- This OB is very very particular about her stitches. This is the only time I have heard her teach the resident, and she lets the resident do a couple, with detailed instruction. These stitches would probably make Betsy Ross proud, and after having seen the violence of what a c-section actually looks like from the foot of the bed, I am grateful on the patient’s behalf, for the time and care and expertise the OB is taking to repair the patient as expertly as possible.
- When it’s over, Lori and I follow the patient to recovery and Lori watches her very closely for the rest of her shift. When a mom has a cesarian, the nurse is 1 on 1 hers. C-section complications are serious and Mom needs to be carefully evaluated.
Cesarian sections are so very common today. It can be easy to forget how serious and dangerous and miraculous such a surgery is. Because of this experience, I will never take them lightly or for granted. Little did I know, a couple years later, I would find myself facing the birth of my third child via c-section. We found out he was breech when he was already a week late. I was left to go into labor on my own, but knew he would be delivered via c-section. I was crushed and terrified. Lori was the second person I called, after my husband, to cry to. More on that later.
I hope you all are having a great week! No, my stinking period has not come yet, but I am not pregnant, according to the pregnancy test I took today. Much love!
PS. Retractors above!