As Dinya, the clinical officer, prayed, I quickly pushed the ketamine into the patient’s IV. I watched her carefully; she was struggling to relax. After thirty seconds or so her face began to relax. Dinya began pinching folds of skin on her abdomen, while I watched her body language for tension, to ensure she was numb enough to begin the c-section.
Five months in, it was my first time running anesthesia for a c-section independently. Since we’ve moved here, I have been working at the hospital on Thursdays. Matthew stays home with the kids and I am grateful for a husband that’s willing to jobshare a bit so I can be part of the action. It is true, though, that coming in only once a week has made for a slow onramp to feeling anywhere close to confident. Anesthesia in particular feels like something a nurse should have, oh, at least an additional Master’s degree in.
My preceptor, Kitty, poked her head into the OR. “You ok?” she asked. But I was; I was feeling like I could anticipate solving several problems independently before I’d call her for backup. It had helped that we’d been together with some difficult cases. “All right. Let me know if you need me.”
I turned back to the patient, and I watched the monitor as her oxygen level promptly dropped from 100… to 96… to 92… to 87. Right. I propped her jaw forward to open her airway further. Nothing. Time for oxygen. I watched her oxygen saturation rise again, and offered a quick prayer of thanks.
It was clear even a few minutes in that she was metabolizing the ketamine quickly. She began to grimace a little, to sing a little. I watched her carefully and prayed; sometimes ketamine just makes you talk. It can also cause uterine tension and make baby a little slow to start breathing. I really didn’t want to have to give her any more if I didn’t have to.
The blood pressure machine was broken, so I assigned a midwife student to take the patient’s blood pressure every few minutes manually for me. I also decided she needed a little more ketamine, explaining to the visiting doula who was shadowing why I was hesitant to do so.
A few minutes after that, Lo and Dinya pulled a 3-kg baby out. The cord was wrapped around the baby’s neck three times. “Right,” Lo said matter-of-factly in her Irish accent,. “this one definitely wasn’t coming out normally.”
In America, having a c-section can be a mark of shame for a woman. My first child was delivered via cesarean; when the doctor announced that, at the eleventh hour, Naomi had flipped into breech position, and with my water already broken, a c-section was our only option, quiet tears rolled down my face. I remember talking a friend through feelings of disappointment that she wasn’t able to deliver her baby vaginally, receiving positive e-mails from a VBAC (vaginal birth after cesarean) support group listing tips for talking to your doctor, reading in a childbirth book about ways to delay c-sections, and trying to drum up as many suggestions as possible for convincing your doctor to give you more time to do it yourself, as it were. To be fair, there are reasons why c-sections are not preferable to vaginal births. I pursued a VBAC with our second child, and was glad for the easier recovery. But as the baby’s cries rang in the air, indicating health and liveliness, I was reminded, again, that having a c-section available to me, done by competent health care professionals was, and is a gift.
It was a gift that multiple competent doctors were ready at that hour of the morning when we went into the OR for Naomi’s delivery. It was a gift when Dave, the scrub tech, walked into the OR and cussed audibly because I was sitting on the table getting my spinal block put in. It was a gift when Rose, labor and delivery warhorse that she is, kept a close eye on my heartrate when it dropped into the 40s after surgery. And my anesthesiologist, Tom, was definitely a gift, as he explained to me what was going on behind the curtain– despite the fact that I had been in c-sections as baby nurse before, being the patient was a little scary for me. He walked me through it with a caring manner and kept me pain-free.
I took the bucket containing the placenta and blood out to the pit behind the incinerator. Emerging from the OR into the sunshine was a breath of fresh air. I made a mental note to bleach my shoes the next day. What a gift.