How I Remember It

It's a cold winters day in February. Friday exactly, the day most people pack it in, take it all home. I’m on the 2pm to 10pm shift. Not bad. Usually those are peak hours, a good time to work. But on this Friday afternoon it’s a little slow.

I working with one of our new docs. She just completed her residency last year. She’s green, nervous, frequently seen looking up doses for penicillin and the like. She has potential but needs some polishing. I know only I can help this young apprentice to one day be an ER Jedi.

At my hospital there is one thing every ER doc fears……..Delivering a Baby.

In our current health care climate, many hospitals have gotten out of the Labor and Delivery business. Mostly because of profit and liability issues. Anyway, not all hospitals have an L&D suite or staff Obstetricians. At my hospital we don’t have any ER coverage for OB/Gyn. So we don’t birth no babies.

Anyway back to me.

On this blustery Friday afternoon we are strolling along. Suddenly a red truck speeds to a stop outside our ambulance doors. A young man jumps out and appears to be yelling for help through the glass. Sometimes patients do this. We always go check it out, but it better be good.

It’s good......... His girlfriend is in labor.

Tension heightens as the staff help the 19 year old out of the car and checks out the situation. This could be an emergency, the next sounds from the room…

"We need a doctor in here."

The patient is screaming, obviously in the throws of a contraction. She says she is 5 and half months pregnant. That’s 22 weeks. A baby is considered full term if over 35 weeks. A non viable fetus is less than 20 weeks. 22 weeks is no mans land. 22 weeks is premature. 22 weeks is bad. If born, the baby could live, but at 22 weeks there will be complications. We are talking neonatal breathing machines, umbilical IV lines and feeding tubes.

This girl is 19 years old, this is her first pregnancy, she has had no prenatal care. To make things even better she is stick skinny. By that I mean she has a very small pelvis. In Alabama there is a thing referred to as birthing hips. Good birthing hips are wide and the misses can spread her legs far apart creating a wide opening. I’ve seen good birthing hips that you could pass Volkswagen through. Bad birthing hips are small framed girls, tight pelvis and it’s even worse if it’s your first pregnancy. Bad birthing hips define this young mother.

So the first step is to see where we are. I slip on a glove, add a little KY jelly and insert my fingers into the vagina hoping to feel a closed cervix. What I actually feel is a baby’s head. The nurses are staring at me in anticipation waiting on the news....... "We are going to have a baby here." is my response. "Oh sh*#!" is the general refrain.

Accounts of what happened next differ, but this is how I remember it….

The nurses generally begin to panic. There is confusion. Some of the staff are yelling, some are starting to cry, a few passed out and one or two are on their knees praying. This is a scary situation, they need leadership, they need a hero.

So I stand tall and brave between this young girl’s thighs. I take both my hands to my v-neck collar of my scrub shirt and rip it down the middle exposing my pectoralis muscles and 6 pack abdomen just beginning to glisten with sweat. I run my fingers through my perfect hair and raise my hands to shoulder height. "Gloves!" I call, and gloves are placed onto my steady hands. "Gown!" I call and I am draped like a priest giving his most holy service. In a calm, confident tone I look at the charge nurse, "Get me the delivery tray, I am going to usher in the miracle of life."

My young assistant doctor is panicking. "Excuse me Doctor Gibson, but her pelvis is too small! You will never get the baby out! No doctor in his right mind would even try this! What are we going to do?" I have no choice but to slap her firmly across the face. "Dr. Barnett, remain calm. I am no ordinary doctor." Ashamed that she has lost her composure, she quietly gathers herself.

I insert my index fingers into each side of patient’s vagina around the child’s head. I begin to stretch the vagina open with all the strength in my fingers. An IV has been started but I can’t give any pain medications. Narcotics in a preterm delivery could depress the child’s respirations. Mom is going to go naturally. Mom is pushing and screaming. I am stretching, a ER tech in the back of the room just vomited. The contraction subsides.

The baby’s head is facing the wrong direction. Meaning its nose is facing up. Usually babies come out with the nose facing the floor. Ideally I would like to try to rotate the baby but there is no time and the child is lodged into position. Another hurdle I must overcome.

This is getting bloody. I call for suction. I continue to stretch. I can see the head well now. If the baby gets stuck, I am going to have to start cutting. I must stretch, she must push hard!

At the crescendo of the 5th contraction the baby’s head pops out. One more good stretch and I reach my fingers under the child's armpit, rotate the body and with one more push the baby is out.

"Clamps" I state commandingly.

"Scissors!" The child is now free.

I am now holding the child across my right forearm and tap it on the bottom. The room is filled with silent awe.

The next sound we hear are the eeking of a newborn’s cry.

Elation fills the room. Tears of fear have turned into tears of joy. Nurses and complete strangers are hugging, music is in the air and as I listen closely, I can hear the sounds of angels singing.