My minor omission

BMJ 2004; 329 doi: (Published 15 July 2004) Cite this as: BMJ 2004;329:144
  1. Michael Burg, residency programme director
  1. department of emergency medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands

    “Push, push, push, puuuuuush,” I command. The labouring woman in lithotomy position before me focuses, bears down, and complies with a vigorous effort.

    The nurses on either side supporting her legs encourage as well: “Give a good push, dear. Come on, push this little baby out into the world.” We labour together, the mother, as always, doing most of the work. The nurses, my “assistants,” know more than I do at this early point in my medical career. However, as an intern on rotation to obstetrics and gynaecology, I feel that I must have attended a billion deliveries this month. “I could do this in my sleep,” I think, which is a damn good thing because I am practically comatose, the result of far too many hours in a row on duty in the era before 80 hour weeks for residents. I'm literally bobbing and weaving while mother pants and blows.

    Finally, the baby's head emerges. I suction mouth and nares; it's a textbook spontaneous vaginal delivery. “Nuchal cord,” my tired brain cautions. “Check for a cord around the neck.” I do. It's not there. I'm entering the home stretch, cruising; the obstetric resident isn't even in the room. After this one's out I can lie down for a few minutes. I want the bed so much I can taste it. One more small push and minimal downward pressure by me, and the anterior shoulder delivers, easy. A bit of upward pressure, and there's the posterior one as well. The rest of the body glides out smoothly. Gently I grasp the flexed, wet infant. I haven't dropped one yet, and I'm not going to start now. I quickly dry and wrap my slippery new charge and begin to step away from the bed, ready to present the world's newest citizen to the proud mother.

    Halfway through my first pace away from the delivery table mother begins to come with me. “What's this?” I wonder in a fog, “Why is mom following me to the warmer?” She actually slides ever so slightly down the table toward me, issuing a vaguely alarmed moan. Even the normally unflappable nurses seem more than a little concerned. In an instant it hits me. I've made a “minor” oversight in my well practised delivery sequence. How does it go again? The baby is connected to the umbilical cord, the umbilical cord to the placenta, and the placenta to the mother, at least at this stage of the proceedings. With my brain just about asleep, I almost walked away from the mother with her baby still attached.

    After profuse, red faced apologies, much propping up from the always supportive nursing staff, and the true completion of all the labour stages, I exit the scene feeling slightly lower than a snake's belly. The thoroughly overworked mother ultimately understood and thankfully was distracted by more pressing concerns. I crept away to bed, and, despite overwhelming fatigue, stayed awake for approximately two seconds mentally kicking myself before sinking into a dreamy reprieve from shame.

    No harm was done, except to my then fragile psyche, but I've never forgotten the incident. Fatigue coupled with a momentary lapse of attention could have resulted in disaster but thankfully only produced enough embarrassment to last me a lifetime.


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