One of my daughters recently gave birth to a healthy little girl after a relatively short labor induced because of a few decelerations noted on a nonstress test. (Haven’t we already figured out that fetal heart monitors cause more angst than they are worth?) Anyway ... apparently as labor was nearing completion, a few more deep decelerations raised the tension in the delivery to the point that there was a stat call for a pediatrician to come and stand by.
That’s all my daughter recalls until a couple of minutes of suction-aided yanking resulted in a pink and crying baby she was able to cuddle and feed. I asked, "Did you see or talk to the pediatrician in the delivery room?" "No." She didn’t recall seeing him until later in the day. "I was too busy enjoying being a new mother again."
I said to myself, "Now, that was an experienced and sensitive pediatrician." When it was clear he wasn’t needed, he took a quick look at the baby and vanished into the haze of postpartum amnesia.
"I wish I could say that as the decades ticked away I became immune to anxiety that accompanies a birth, but I haven't."
I can’t even guess how many times I have been called to the delivery room stat only to watch the delivery of a vigorous and healthy baby. Fortunately, my standing around time is usually measured in minutes. But, there have been times when it took the obstetrician more than an hour to realize that a C-section was inevitable. Once I had checked to see that the laryngoscope light was working and the selection of endotracheal tubes was complete, there wasn’t much to do but stand there and listen to two or three people who aren’t in pain encouraging one poor woman who is. Of course, from time to time, I will discover that the warmer hasn’t been turned on, but for the most part, well-trained nurses armed with complete checklists have seen that everything we’ll need is within reach.
I wish I could say that as the decades ticked away I became immune to anxiety that accompanies a birth, but I haven’t. However, I did gradually develop the skill of at least appearing unconcerned as tension filled the delivery room. I have seen enough obstetric disasters to know that stuff happens.
But when it doesn’t happen, the pediatrician must seamlessly change roles from potentially being the star of the show to becoming just another member of the audience watching a truly miraculous transition. One moment we are the must-be-there person. Then in less time than it takes to say "Apgar of 8," we have instantly become Dr. Who?
How we handle this sudden demotion says something about how we see our role in the bigger health care picture. Once that healthy baby sees the bright lights of the extra-uterine world, it needs to see and be close to its mother. But something (mostly risk management concerns, I suspect) urges us to do a thorough exam. Heck, we’ve been standing around for a half an hour. Don’t we get to do something?
This is a time for compromise. In my view, and it sounds like the one shared by my daughter’s pediatrician, the need for family building easily trumps our need to feel important or at least be thorough. A quick pass of the stethoscope over the chest and a two-finger trip around the abdomen can easily be done while the nurse is doing a quick wipe off. Let’s be honest, when it comes to newborns (and maybe all children) 90% of our exam is done with our naked eyes. There will be a better time later in the day to abduct hips and demonstrate a symmetric Moro reflex. It may not be a better time for us, but it will be a better time for a new mother more or less recovered from the emotional explosion of childbirth.
As I slip out of the delivery room I might mumble, "Good-looking baby." But, at that point, my words would be superfluous. There would be plenty of others to tell these new parents how beautiful their baby is. They don’t need to hear the terrible truth from Dr. Who. All newborns are ugly while they are still wet behind the ears. Even my grandchildren.