The Push And The Pull Of A Delivery

Photo by Alex Hockett/ Unsplash

One procedure I was lucky enough to master in the delivery room during my residency was that of the instrumental delivery. This was used for a woman attempting to deliver vaginally if she couldn’t push the baby out because of exhaustion, or when an emergent event occurred, and the baby needed to be delivered right away. A fetal heart monitor indicates fetal distress if the oxygen supply to the baby is being compromised. I could then use either a vacuum device or a pair of forceps to quickly extract the baby. Becoming an expert in these types of deliveries in a training program required doing as many as possible, in slightly-less-than emergent circumstances, so that when true emergencies occurred, I would be ready.

Over the four years of my residency, whenever a patient was a candidate for a delivery assisted by forceps or a vacuum device, as junior residents, we would be encouraged to practice doing these procedures to be sure we could do them correctly, efficiently, and completely. We were taught that there were absolutely deliveries that could be assisted by instruments, and there were those deliveries that needed to be assisted by instruments. If we learned from the former, then we could best help the latter. A correctly-placed set of forceps during a delivery can be a life saving procedure.

A teaching institution is designed to do exactly that — teach. Fewer physicians know how to use forceps because not enough older doctors are in practice to teach younger doctors the correct method. Patients would end up being delivered by cesarean if no one could do a safe forceps delivery. I was lucky to have done more than 200 of these deliveries by the time I was near the end of my residency. I felt ready to use the instruments whenever they were emergently needed.

One night during my fourth year in residency, I was on a break in the on-call room. The other more junior residents were as usual in charge of the delivery room. Several patients were in labor, and deliveries occurred every two or so hours. One woman, Ms. K, was having her third baby, which usually meant the delivery would go smoothly. She had been pushing for almost an hour when a junior resident, Dr. G, called me to come to the back delivery room, where he was attending the delivery. The top of the baby’s head was visible at the opening to the vaginal area…