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In a key scene in the 2012 sci-fi-horror movie "Prometheus" (spoilers sorry), the female protagonist has to do an emergency Caesarean section (C-section)…on herself. Realizing she is pregnant with an alien monster baby, she enters a high-tech surgical machine that lasers her belly open and extracts the squirming, evil, squidlike brat.
Surprisingly, the vivid horror of that scene, aliens aside, isn’t too far from reality, as I saw firsthand during my very first clinical rotation as a medical student.
C-sections are a bread-and-butter fact of life for many mothers, and for a time in the 1980s were even a popular elective procedure over regular vaginal delivery. There was a somewhat incorrect lay perception that C-sections were easier to go through, since you were heavily anesthetized and once you woke up, pop, there’s your baby in your arms.
But recovery times for C-sections are often longer than for vaginal deliveries, because it is still major surgery with its associated risks. Your belly is being cut open, instead of just having your birth canal stretched (albeit stretched very, very wide). If you watch both procedures firsthand as I did, you can see this distinction quite clearly.
During my first clinical rotation, which was the OB/GYN (obstetrics and gynecology) service, I was in a state of shellshock. First off I had to adjust to my new 4:30 a.m. wake-up time in order to get to the floor in time for our three sets of rounds (a term for “rounding” on the patients with interviews and examinations, writing notes, and then presenting your findings to your clinical team).
Despite it being July, it was still pitch dark out at that hour. The morning darkness gave me a weird, jazzy sensation each time when I awoke and drove to work, as though I was stuck in a 24-hour night. I was only glad that at least it was temperate out during the balmy Richmond summer dawns.
OB/GYN is notorious for its brittle combination of estrogen and high-risk surgical procedures. Although perhaps a sexist notion, there seems to be a tendency for “bitchiness” when you have predominantly women under high stress situations managing the sleepless, lawsuit-heavy world of childbirth. “Sorority sisters with scalpels” was how some people termed the OB/GYN residents (doctors-in-training).
They were undoubtedly an impressive crew, often gorgeous and flawlessly coiffed, brilliant and professional with their patients. The few males were usually excellent as well, because in a strange role reversal, they had to demonstrate extra levels of sensitivity and bedside manner to win over potential patients. Patients often preferred to see female gynecologists.
Given this tense crucible of hormones and babies and vaginas, and the fact that it was July, the start of the training year, med students were basically in the way of everything. We had no clue, no idea what we were supposed to do, so we couldn’t really help the overwhelmed new interns or residents. We all often had to sit in the back “holding bin,” and we pretended to read about fetal distress while waiting to hopefully scrub in on the occasional childbirth. We weren’t allowed to do much because the interns had dibs on the procedures, although we could always watch.
There was a board where we would fight to sign our initials next to a case, and we would watch and wait as the board would be updated with the size of the patient’s cervix, indicating how close it was to popping out a newbie. I waited for one case over the majority of a day. The cervical number was still low at 3 p.m., so I figured I could run out to the cafeteria for 10 minutes and grab a bite. Yet upon my return, sure enough, the baby had already leapt out into the world, not interested in waiting for a hungry med student.
I was a squeamish person, and the bloody, messy reality of childbirth was more than I bargained for. It isn’t like the movies, where the baby comes out practically fully dressed in clothes with dewy clean skin.
I finally was able to scrub in on a case while I was on call one early evening. I watched a teenager give birth, and she was incredibly strong-willed; she barely grunted as she squeezed out her little one, wailing and covered in whitish buttery slime and streaks of blood. The way the teenager’s parts expanded at the end was ridiculous; I knew that had to hurt.
The intern kindly asked if I wanted to catch the gooey dark red “afterbirth” or the placenta (and I have no clue how people can stomach eating it, as has become a strange alternative medicine trend). While most students probably would’ve pounced on the opportunity, I shook my head, and the intern laughed at my nauseous expression.
Then I got to scrub in on a semi-urgent C-section. A baby was going into “fetal distress,” where sometimes their umbilical cord gets compressed by the final heavy contractions of labor, endangering the baby’s circulation. You could see the distress on the fetal monitor, a squiggly line indicating changes in the baby’s heart rate.
The chief resident in charge of this C-section was notoriously volatile, a tense, crew-cut haired woman who had a penchant for yelling during her surgeries. I pretended not to be afraid; I felt like I was doing the right thing, becoming a real med student by finally getting in on the action. I took the extra minutes to scrub every inch of my hands, fingertips and arms with the special pinkish germicidal sponge, its plastic brush massaging off my epidermis.
I went through the ritual of being gowned and gloved by the nursing staff, with a certain amount of pride. I felt like I was being prepped for battle, and the final step was having someone tie on a large clear face shield over my head and mask.
The overhead lights were as bright as stage spotlights upon the “theatre.” The patient’s body was hidden under blue paper and cloth, but her luminous, giant belly was exposed to the piercing light and painted with dark orange-brown iodine. Her upper torso was behind a slightly raised curtain, where her head, wearing a blue hairnet, moved a little. I realized that she was awake and mildly sedated. This was being done under local anesthesia, a spinal block.
Everyone stood around the lighted area, and I could only recognize them by their eyes as they were all masked. The chief was already starting one of her moods; she barked at everyone to stand still after they cautiously moved into position. The line was already marked with black ink. Then she started to cut. A low streak across the bottom curve of her belly.
The layers of visceral yellow fat and white sinew yielded quickly and glistened gemlike under the spotlight. The metal retractors were inserted into the edges of the new space, like jamming hardware into a construction site. We were ordered to hold them and pull back. The uterus bulged out like a red-pink balloon, taut. Then I noted, with some increasing horror, that the cavity in the belly surrounding the uterus was rapidly filling with a lake of blood. I felt like I was watching "Friday the 13th."
Normally I was very good at staying silent in the face of militant authority or situations where I knew I ought to stay back. But I must have been in some sort of shock.
I blurted out, “Is that normal for there to be so much blood?” It only occurred to me a second later that the patient was still awake. My inner voice had free rein.
The chief glared knives at me through her face shield. “During a procedure like this, the medical student needs to be SILENT!”
I nodded my head, stunned by my idiocy.
Then she sliced open the uterus. Bam, a blast of hot clear amniotic fluid shot out like a laser beam and barely missed a nurse’s face shield. It splattered across the floor.
I realized why we needed to gown and glove so thoroughly now.
The pool of blood continued to grow in the woman’s belly, flooding up to the edges of the now flaccid sac. Hands rushed in and scooped out the baby with lightning speed, and scurried it away. I continued to stare at the mass of growing liquid redness.
Once again, my frontal lobe got jammed, “Ohhh my God,” I said aloud.
“I told you to shut up!”
I must have looked pale or hapless, because the chief’s anger suddenly shifted to concern. “Are you OK? Are you going to faint?”
I didn’t think I was going to faint, but I also knew I’d had enough. I had an exit door at hand, and I was going to take it. I nodded back. She pointed at a couple nurses to rush behind me, and they told me to fall backward slowly and guided me down to the floor. They moved me away and disrobed me, and I left the room.
I felt a rush of embarrassment and humiliation as I sat back down in the holding bin. What a disaster I’d been. I expected the chief to ream me afterwards, but she was surprisingly sympathetic when she ran into me later.
“You’re alright? Poor thing, don’t worry, that happens to us sometimes. You just have to let us know right away if you’re going to faint.”
There was a touch of patronization in her tone, a bit of “Guess you couldn’t hang with the big boys.” (Or girls in this case.) But I was willing to take it given what a pain I had been, and it was better than being yelled at. I was glad to hear that the C-section was a success, and Mom and Baby were doing fine. And yes, that amount of blood was a normal thing during C-sections.
So childbirth remains, despite all our current science and technology, an intense, risky procedure. Hats off to the doctors and nurses who remain committed to caring for mothers during such a physically and emotionally fraught time period, and also to the mothers themselves, warriors who sacrifice their bodies for the noble miracle of childbirth.