Midwives, mothers and medical students
During the past five years of medical school, I can recall facing numerous new but strange situations. One such occasion was during my first week of obstetrics as a medical student. I was just three months into my first clinical year and, having just completed six weeks of medicine and six weeks of surgery, had been given the challenge of mastering "obs and gynae." My ignorance at the time was such that I did not even know the difference between the two. On top of this, by some perverse twist of fate, I was to be the first medical student "on call" in the labour ward. Looking back, it is terrifying to think how I was thrown into the deep end, but at the time I didn't quite know what to expect.
I stepped into the labour ward for the first time and immediately noticed the moist, warm atmosphere. The heavy air around me soon filled my nose and lungs with a strange blend of odours, the combined vapours of amniotic fluid, urine, and sweat forming a potent mixture. I noticed how the soft lighting set a seemingly relaxed scene. I spotted a colleague of mine dressed in surgical greens, who prompted me to follow signs to the changing rooms. Suitably dressed and quite comfortable, I now felt ready to take on my first night on call at the labour ward.
I had never before met any midwives but had heard tales of medical students being devoured by them. I therefore decided to start off by simply observing this new breed of medical staff, until now uncharted territory. After an hour of standing at the nursing station, I was finally approached by a midwife. She must have sniffed me out as a lost medical student as she immediately asked: "Have you done any deliveries?" When I told her that this was my first, she smiled and said: "Come to room four in about five minutes. There's a multip who's fully dilated. She should deliver tonight." That's when reality hit home - I was actually going to see a delivery!
As I waited outside the delivery room, images I had seen on television flashed through my head. Women in pain squeezing their partners' hands until they grimaced, women delivering in elevators, and in the backs of cars. I flicked through the obstetrics section of my Oxford Handbook of Clinical Specialties, trying to familiarise myself with the management.
After five minutes I nervously knocked on the door. The midwife answered and hurried me in. On the delivery couch lay a restless figure from whom emanated shouts of "Oh God," and "I can't do this" in between howls of pain. She looked in absolute agony and was puffing away ferociously into a breathing mask. Unsure of my role, I stood to one side until finally the midwife slowly nudged me forward. I stood by the woman, and before I had a chance to introduce myself she grabbed my arm and began to squeeze tightly. Slightly taken aback by this I looked at the midwife, who reassuringly smiled back. I spent the next few hours holding this stranger's hand, helping her to relax between contractions with phrases such as, "you're doing really well," and, "try to relax before the next one!" Out of my depth, I put on a brave face and pretended to be much wiser than I was.
Several hours and epidural top-ups later, the moment arrived. Although I had been with this woman for the past three and a half hours I was still unprepared for the manner in which her labour ended. By now, periodically comforting her and offering her analgesia had become rituals I found myself automatically performing. As her contractions got closer and closer together, I began to feel a sense of urgency. The midwife seemed to be moving around the room with great purpose and efficiency, performing her tasks. Out of a cupboard in the corner she pulled out a delivery pack, and prompted me to get myself a pair of surgical gloves. I was only gone for a minute, but on my return it seemed things had progressed rather quickly. I'll never forget that head popping out, seemingly from nowhere. The rest happened in a flash, and although I now know the stages of delivery, what happened that night is just a blur in my memory. What I do recall is the satisfaction of handing the snugly wrapped newly born baby boy to his mother, and that feeling of contentment as I stood there in a pool of amniotic fluid, quietly reflecting on the past few hours. That night will always stand out as one of my best as a medical student.
Omer Aziz, final year medical student, Imperial College of Medicine at St Mary's, London
studentBMJ 1999;07:394-436 November ISSN 0966-6494
