Mother's Day

Perhaps it is fate that I write this paper on the eve of my mother’s birthday. I cannot help but feel a sense of Mother’s day fever recalling how I felt gratitude seeing mothers giving birth because it gave me an idea how I was brought into this world.

The opportunity to rotate in the WVSU-MC OB-GYNE wards and delivery room not only brought out the grateful daughter in me but more importantly it opened vital academic and practical learning in life.

Labor Watch

Because there were no Junior Interns when we got our chance to rotate, we were asked to do labor watch. At first I thought it was quite boring because we would just sit down beside the patient and count the contractions, record the time, intensity, duration and interval between contractions. As the Doc Tabiling was explaining what we were supposed to do, I could not help but feel anxious if this was all we were going to do the whole night. It seemed that we were going to spend our entire 11 hours duty sitting down and counting “tummy movements.”

This all changed when I met the patient. As I touched her abdomen for the first time and felt contractions, I was amazed on how you could actually feel the change in rigidity of the abdomen during contractions. I was more amazed when I felt my first fetal movement. I realized at that time and that it really sunk in that there was indeed life inside that large globular abdomen. It was an exciting experience to have an encounter with a person, even before he or she was born.

My undergrad was Psychology and I also believe in the Freudian principle that our past, even our birth experience somehow influences how we are today and what we become in the future. Because of this, I tried to make things easy for the mother. Even if the nurses would scold her for being so agitated in bed that she kept on moving, I tried to understand that she was not in a very comfortable situation. Stressing her out meant stressing the baby out was well and I know that psychologically and medically, fetal stress may sometimes lead to undesired complications.

Later, Doc explained that sometimes even if doctors would want to show compassion and patience towards the mothers, it is also sometimes necessary to scold them. At first I thought that it should not be the case afterall it’s really hard to be in labor and give birth. However, I was later enlightened when Doc explained that mothers, especially primigravids or first timers sometimes tend to nag the doctors to make them deliver. They are unaware that if they deliver at a time when the baby has not yet fully descended in the birth canal, there would be more complications. Doc explained that mothers usually just want to end their agony by delivering without really knowing the consequences of delivering at a time when the baby or the reproductive structures are not yet ready to do so.

Our first Natural spontaneous vaginal delivery was stressful delivery for Doc Tabiling because the mother was not obeying her instructions. From the emergency room, she was already pushing the baby out without the proper preparations like being cleaned or prepped or placed on the delivery table or having an episiotomy. As a result, she suffered a tear in her vaginal canal. Doc explained that it was fortunate that she delivered a small baby, or else the tear would have been deeper in to the vaginal muscle. Moreover, she also said that there are cases wherein the laceration would even reach the anus. She further explained that this is one example where doctors have to exert effort to instruct the patient even sometimes get angry also for the patient’s own good. At that point I realized that for things to go smoothly, the doctor must not only have compassion but also have good command over nagging mothers.

Rubber Hands

A person born can be born via cesarian section or natural spontaneous vaginal delivery. He or she may be born in breech or in cephalic position. He or she may be born with or without complications. Regardless of the child’s or the mother’s condition, in the hospital setting, the first sensation that catches the child’s skin are rubber hands.

Gloves are often used to protect both the mother and the child from bacteria that may cause infections. In as much as you would want to be the first to touch and feel your child this is quite impossible in the hospital setting.

Mothers do not usually come in contact with their child until the pediatrician had finished cleaning the child. In vaginal delivery, the child is immediately shown to the mother when he or she does not need to be resuscitated. However, in CS delivery, this takes more time because the mother is still groggy from sedation from the anesthetics.

As I observed or first CS delivery, I could not help but get amazed again by the speed by which the fetus was extracted from the womb. I already expected vaginal delivery to be fast but I did not expect CS delivery to be speedy as well. I guess it was quite logical that upon opening of the uterus, the child must be removed in a matter of seconds so that breathing and circulation immediately is established because it is very different compared to the placental environment. I estimated the extraction to be less than 15 seconds counting from the time I saw the uterus split open up to hearing the baby cry for the first time. It even took longer to clean and close the uterus and the abdomen which required intricate stitching and sponging of blood.

I saw that the apparent delay in maternal and child contact in this case is necessary for three reasons. First, it is important so that risks are decreased in both the newborn and the mother. Second, I felt this was important because for the first time the newborn experienced a sense of individuation and independence from the mother. Finally, I acknowledge that this is also the event where the newborns’ first experience socialization when the rubber gloves introduce a quite foreign presence compared to the maternal feeling he or she already knows.

The Quest for Answers

Aside from being able to see two kinds of deliveries, we were also fortunate to observe 2 curettage procedures. The first one I was fortunate enough to scrub in and assist because there were no interns around.

Unlike deliveries, I found the curettage procedure to be more painful. Sometimes during my observation, I could feel my stomach tighten especially seeing the insertion of foreign steel tools and the scraping and cleaning the uterus for fetal debris that may have been left behind from spontaneous or induced abortion of the fetus. As blood and placental parts were coming out of the patient, it dawned on me that these bloody structures were once part of a life or supported a life, and in effect was also synonymous to the life that once existed within the womb.

Thousands of mothers lose their fetus everyday by mechanical or chemical means. If only they could see this bloody fetal debris and think twice every time they contemplate an abortion. It is sad to know from the doctors and the hospital staff that there is a growing number of induced abortions that come for admission due to complications after the procedure. In one night I had saw both life and death. I saw how it was to be brought into this world kicking and screaming. At the same time I saw how it was to be brought into this world mutilated and lifeless.

Furthermore, there are also thousands of mother’s each day that lose their children due to natural causes. This particular aspect is quite familiar to me. I should have had four other siblings. All four were brought into this world lifeless and ended up either in curettage or a hysterectomy procedure.

The hospital duty for this part opened a quest for answers for me. Academically speaking, it was finding out more about the factors or probably the conditions that resulted in the two blighted ovum and two ectopic pregnancies of my mother. Her first ectopic pregnancy ruptured and she nearly died. I was only 5 years old when it happened and it was not a very nice memory. She was managed by a partial hysterectomy removing the right Ovary and Fallopian tube. Her second ectopic pregnancy resulted in a total hysterectomy and even if it did not rupture, it was more beneficial to remove the structures because the doctor already saw what seemed to be a formation of a mass. In between her two ectopic pregnancies, she still managed to get pregnant but ended up as blighted ovum. On was in 1997 and the other was in 1999.

It is by these circumstances that I became an only child and as I mentioned before, there’s that part of me that would want to know why. Perhaps it is in this quest for answers that more growth as a person and more knowledge as a medical student can flourish from. Her OB-GYNE found her to have endometriosis that may have contributed to her recurrent loss of babies but I’m quite sure that there are other reasons waiting to be discovered.

She often reminds me that she grew up with dysmenorrhea thinking it was natural. Now she knows it not and she is also worried that I might suffer the same condition as she had because I too experience dysmenorrhea during menstruation. This further extends this quest for answers in our part as mother and daughter because her fate may become mine as well.

In the End…

In all the amazement, the learning and the exposure that I encountered in my 11 hour rotation in OB-GYNE, I realize that more to the facts and information of labor, delivery and post partum management, OB-GYNE is such a fundamental branch of medicine dealing with life basics – anatomically, physiolocigally, pathologically and even in the basics of my own personal experience as a person and my destiny as woman.

In this our short experience, I owe my learning and the extension of consciousness to the doctors and most especially to the mothers who are the main characters of these stories of life.