Today, as Tisch Air Traffic Controller (as I have renamed my role), I took it upon myself to become #1 2nd stage of labor coach this side of the Hudson River. That means I pushed with patient’s most of the day and then called in the intern or whomever to do the delivery.
For those of you not in the know, labor is broken into a few stages. Briefly, they are: Stage 1) Onset of labor to full dilation; 2) Full dilation to baby; 3) Delivery of the Placenta.
To be clear, labor = contractions that cause cervical change. That second part is key. You can be contracting, but if your cervix isn’t dilating, you aren’t in labor. This is the sad, terrible news I used to give to women in triage on a regular basis when I did nights.
Anyways, when you don’t have to worry about answering a pager, seeing triages, or doing C-sections, you can go help a patient push for as long as your want and no one will really ask about your whereabouts.
I particularly enjoy “pushing” with patients for a few reasons.
PS – Do not read on from this point if you are uncomfortable with the word “vagina” or “perineum.”
First, you have to teach them how to do it correctly. This is important, I think, because you don’t want the mom to be wasting all her effort for an hour with ineffective pushing. There are a few ways I do this. If you have an epidural, I usually like to push pressure right on the ischial spines or straight down on the rectum (through the vagina that is) to help the patient feel where to push. That way, I can also feel if the patient is moving the head.
Second, the second stage is when things can sometimes go south, so I like to help keep that stage as short as possible so no one – baby or mom – craps out (a technical term for not looking so good).
There is a unique challenge to coaching a patient to push, at least in my opinion. First, you have to kind of assess what kind of person this patient is. To be an effective pushing “coach,” you have to be able to give the patient feedback. But, I find to do this, you have to know how the patient may or may not respond to your feedback so you can deliver it in a way that will work for them.
I’ve had patients who love it when I go all drill sergeant on them and others who hate that.
The challenge becomes when you know the patient isn’t pushing effectively, you’ve told her that, you’ve tried multiple techniques to get her to do it correctly, and she’s getting frustrated. If you’ve assessed that 1) the pelvis is adequate and 2) the estimated fetal weight will “fit” through the pelvis, its frustrating for you, too, because you think “this should happen.”
Sometimes patients really want to stick with it. Other times they give up. There have been times I’ve like willed, screamed, prayed babies out – mostly at 4 am when the last thing I want to do it a C-section. :)
So, yes, in my next life, I think I will come back as a second stage doula. Its kind of like being a coach, except the outcome is better than winning a game. You get a baby! Its like being the stork and a coach at the same time.
That will be my name. “Coach Stork.” My business cards will have a stork in athletic clothing.
On another note, I took a ballet class tonight.
I was actually kind of nervous because, I mean, I haven’t done dance since I was…9? That’s a 20 year absence if anyone is counting. I was afraid I would look like an idiot even though I’m fairly athletic.
Then, I thought to myself, “Would I laugh at someone if they were taking a tennis class for the first time and they couldn’t hit the ball very well?” No. I mean, tennis takes time to learn.
First of all, the whole thing was like sensory integrative overload for me. There was a pianist. There were other people. There were new terms. There was trying to pick up stuff and put it together. My brain felt the equivalent of a squirrel in Central Park – acorn! runner! tree! At one point, the teacher yelled “sous sous!” really loud and I was like all ready to jump and pounce on something – like a squirrel on a new tree.
Fortunately, I remembered some stuff from gymnastics. Unfortunately, my flexibility from gymnastics has since left me and, thus, lifting my leg even close to horizontal is challenging. I think I had to hoist it up onto the bar. It was super graceful. I’m sure they’ll be calling me for Swan Lake soon.
If you ever have the time, you should go to one of these classes. Its like a great “Humans of New York” experience. It is quite the motley crew. I mean you have people like me, who looked dressed for a spin class, to dudes, to, literally, people in leotards and tights. And everyone is very nice and all like “oh that was so good, new person.” And, teacher, calls us all “dancers,” such as in “oh dancers, that was so nice…let’s move on to an adagio now.”
[I think that was what its called. Ballerinas, correct me if I’m wrong.]
So, yeah, all of that combined and afterwards I was like “I need to go into one of those float tanks and decompress all my thoughts.” Instead, I wrote about it here on this blog.
Things I noticed about myself:
1- Generally a little bit fast or ahead of the music (this is not surprising, at all)
2- I’m better at putting something all together than doing each thing individually, most likely because I think about the one thing individually too much and if you have to string a few things together, I can’t think about one thing for too long.
So, see, new hobbies can teach you a little about the world and a little about yourself.
But, tomorrow I will go back to running…
Does this blog have a point at all? I think I’ve written 1000 words and probably bored you all.
I will stop now.
I’m tired, anyways.
Too much jete, plie, sauté.
Until next time…
Daily coffee tally: 2