I decided to become a midwife in the 9th grade. And not a obstetrician-gynecologist, but an obstetrician. And all because I have a very rich imagination. Once I heard a story from a friend of mine, who was already in my first year at the obstetric department of the medical school, about how they were taken to give birth. She painted the entire biomechanism of childbirth in paints, accompanying her words with different passes, which, as it were, showed all the charm of the obstetric aid to protect the perineum. Others would listen and forget. And I had this picture so vividly drawn in my head that it was simply impossible to get it out of there. I realized that the midwife is very noble, somehow romantic and non-standard, and most importantly - you aren’t lying around such a corner, you still need to look for them. Do you know a lot of midwives personally? That's it. But it seems like after the 10th grade of a school with in-depth study of foreign languages, it is supposed to go to college, at least to the same medical school, and not to the “sharaga”. In principle, I was preparing for the institute, but in my heart I was hoping that I would still study as a midwife. And while my two girlfriends, obsessed with the thought of the medical future, tried unsuccessfully to enter the longed-for honey, I firmly went to the intended goal. The medical school was a couple of stops closer than the medical institute, and this played a fatal role. I didn’t get to the institute. After passing the exams, I was called to the selection committee. 5 pairs of misunderstood eyes looked at me. That this girl, who wrote the composition so brilliantly, passed the chemistry exam with almost no preparation, having managed to solve the problems for everyone present, she forgot at the obstetric? There are those who did not score the required number of points for medical assistant or dental. For a long time they persuaded me to rewrite the application for a dental one. To which I asked: “Is it that I’ve been picking my mouth in other people's mouths? Fuuu ... "For some reason, the prospect of picking my whole life elsewhere did not bother me. The commission looked at me with sympathy and let it go in peace. I later learned that childbirth is not only a (valuable fur) joy from the fact that a miracle is happening before your eyes - the birth of a new life, but also a bunch of all the rubbish that accompanies it, this miracle. Favorite saying of gynecologists: “On the doctor’s dressing gown - blood, meconium and urine.” Because along with the birth of a new life, waste from human life can easily be born if, for example, an enema was poorly done in the emergency room. And together with the opening of the cervix, a gag reflex can occur. And if, before starting to give birth, the expectant mother has eaten tightly, then the midwife has a great opportunity to feel all these food products on herself, for example, at the time the dropper was placed in unknown veins, because for 9 months of constant intravenous picking by specialists of different professional levels veins go into deep hibernation.
, I didn’t get to Rhodes right away. Now any graduate can imagine that she wants to have a baby, and she will be happy to be accepted into her friendly obstetric team, because her hands are sorely lacking, so let at least someone be on the alert. And then the midwives of the Rodzal - it was the elite of the hospital, and it still needed to be grown. Only those who worked and worked well in other departments were taken to the Rhodesal. And now - dreams come true! I remembered my first day in the hospital forever. My mentor explained to me that where is she located, where to take the bikes for childbirth, where to put something, how to set the birth table, how to wash for childbirth and a lot of interesting things, from which only one thought pounded in my head with an annoying hammer: "And what do you the receiver "didn’t sit? it’s quiet, calm, everything is clear, the mistress is to herself, and here? here the birth will begin - where will you run into? where will you run?" childbirth was not long in coming. I do not remember my first birth, most likely it was just an imitation of the fact that I accept them, but in reality there was an experienced midwife-mentor behind her. Most likely I had a complete fog in my head, because it was difficult to realize what was happening around. Everyone does something, each in their own place, move quickly, you need to think even faster. And how can you figure it out if there is fog in my head? Over time, I entered the course of affairs, the mentor stepped aside and then I had to answer for my actions myself, to learn how to make the right decisions. This can be compared to driving a car. When you study, and the instructor sits next to you, it seems that you are already driving smartly, you know everything and know how, and it’s just such an e-gay gay what a driver is. And even then, when the cherished rights are in your pocket and there is a husband, dad, brother sitting nearby - it doesn’t matter, even grandmother, but the main thing is that there is someone nearby - you still remain the king of the road in your eyes. But now, as soon as you drive alone, the king turns out to be naked, because it really gets scary, where everyone goes so fast and what they all need from me, why everyone tries to bite me, cut me off and generally behave inappropriately. Of course, over time this passes, and you again return to the camp of kings and Caesars, but the first single trip is like ... well, this is how to take birth for the first time on your own.
When there are childbirth scenes in films, it is always very interesting to watch them. It’s rare when you can really see the truth. Most often, I would like to advise the director to attend in person at least once, talk to the staff, and not rely on the dubious experience of the actress. Maybe in her memory they were imprinted precisely with her, but this has little to do with reality. For example, fights - they never start insanely hard right away and do not pass through three cries into attempts, especially in primiparas. There are, of course, rare women who do not really notice them very much, and then abruptly realize that it is time to give birth, come to the hospital with full discoveries, quietly without fuss (well, or with vanity - that’s how it turns out), they lay on the Rachmaninov’s bed, they make three correct attempts, wa-wah-wah - their right child screams, everyone applauds, the child gets his well-deserved 10 points according to Apgar *, the pediatrician wipes away a tear, the placenta is born easily and naturally, as it should be 10 minutes after the child, blood loss - 100, no gaps, iodine, p Please blow right now, thank you all, all well done. Weight 3500, height 50 cm.
Something little I remember for my 13-year practice of such cases. There were, yes, but few. More often, everything is much more prosaic and not so beautiful. More often, these are prematurely amniotic fluid (especially to the growing moon often, and to the full moon, although there are also waning ones), lack of labor, injections, dropper with prostaglandins for all 12 hours of birth, prevention of hypoxia, prevention of bleeding, unproductive attempts, after which the woman in labor at best has a face with a small blue spot, because the blood vessels burst, or red eyes for the same reason. A birth tumor in a child is on the head the size of the head itself. Ruptures of the neck, perineum, which then must be collected in such a way that it is better than what was originally laid by nature.
And if in cinema the main character at the birth table is a doctor, then in life he is a midwife, at least in our country. The doctor, as a rule, is nearby, observes, listens to the fetal heartbeat after each fight, writes the history of childbirth, holds the woman in labor, helps her to push (do not ask how it is a professional secret, each has its own cherished way). The best births occur when the doctor and midwife understand each other from a half-view and the idea of what a normal birth should be like, they agree on most points. The best midwife for a doctor is one who does not crawl with her advice on how to conduct the first and the beginning of the second period of labor. The best doctor for a midwife is one who does not crawl with his advice on how to conduct a second stage of labor. They will lead the third period together, and there it is no longer the essence, there is the aftermath, other risks.
Childbirth is not only the birth of a child, it is the hard work of the woman herself and the whole brigade. And if everyone works as a whole, then everything will go well. But as soon as someone starts to get out of this mechanism ...
“Why did I sit on the bed?” Transfer to the ball, your opening is already good, your child’s head should go down, and you won’t give it.
“And it doesn't hurt on my bed!”
- I say - the child’s head drops!
- Yes, it hurts me differently, I do not care about everything!
- I can not.
-. The child himself is unlikely to be born. Push, the battle is on!
- AAAAAA, I can’t, it hurts me!
- So push, it won’t hurt, push on this pain!
Oh Lord, how your back went numb! It is there, in the cinema, that the doctor takes birth, comfortably sitting in a chair. In reality, it’s so convenient only when the child is not born with his head, but even vice versa, with the other end born. Well, even if the perineum does not care. And in other cases, in order to maintain the integrity of the skin of the woman in labor, you need to bend the letter “si”, stand on the side of the table, hold the crotch with your right hand, grasping it around the child’s head, gently move the tissues from the head with the edge of the left palm, even more accurately, otherwise, the clitoris will then be on its own, separate from the rest of the community. It would also be nice if someone poured oil directly on the hairy top, which appears from the birth canal. Then the probability of a break is reduced by a few more points. The ability to maintain a crotch is a unique talent, and such midwives are usually called for all “thieves”. Because there will always be many luminaries leading the process, but someone's crooked hands can easily spoil the whole raspberry. Here you need to clearly feel the line between the “preparation of the perineum by stretching the tissues”, which is what beginner midwives really like to “indulge”. They think - the more stretched, the better. But no. The second side is swollen, or rather swollen from your excessive exercises to stretch the fabric, which are torn at the expense of "time", as if they were not held tight. You can not discount the very quality of those same fabrics. If the midwife sees that there is nothing to save here - everything loose, eaten up by the infection, then an episiotomy done on time, that is, cutting the perineum a little to the side, gives a good chance to save all the remaining household and then get a neatly fused seam and fully and correctly functioning organs at the exit. Cutting heals better than lacerated.
So, the break between the fights is over! And the midwife starts her mournful song with a growing crescendo:
- Push-push-push-push-push-push-push! Sooooah, one more time! Come on, come on, come on, come on, come on! Soooo. Well done, the head came up, in the next fight we will give birth to a head. Breathe ... Breathe I say. Listen to someone's heart! Now there is no fight? BREATHES! Why are you pushing? Well, for some reason they gave birth to a head without a fight. Damn, entwinement! Now I’ll take off the umbilical cord, such an infection! Now push, shoulders will give birth.
- I can not. I have no fight.
- Why do I need this information? I say - push, the head turns blue, almost black, why do you squeeze your legs? Legs, legs wider do. Here is the head of the child. Not mine, by the way, yours! Crush it! Lord, somebody hold her legs! Come on.
- Booooooo! Ahhh! Fight!
- Push! Help! (The doctor grabs the opposite side of the birth table with his hand and begins to replace the abdominal press of the woman in labor with her shoulder. Oh, one of the secrets, however, has tattered ...) Push the doctor’s hand out with his stomach! Well done! So, gently, breathe, do not push now. Breathe-Breathe-Breathe. (in these words, if a woman nevertheless continues to push, an experienced doctor will pinch her nose, and she reflexively begins to breathe through her mouth - as required) So, the second shoulder was given birth, it was squeezed. All ... Boy!
And here begins the tears, snot, sometimes not only with mom, but also with the entire on-duty team, because they gave birth to everything, helped to push, breathed, and all participated.
“Why doesn't he cry?”
“Why would he cry?” Well, you nearly strangled him with your feet when you said “pushing” —not pushing, when not pushing –– pushing! Who jumped on the table? Yes, everything will be fine now, do not roar. Right now, they will release the airways from what he swallowed while you talked about contractions. Girls! Why prevention ** lies, nobody entered? Quickly! The placenta is already separating.
- Uhhh! Ohhhh!
- Well done, scream, come on, dear! So, quickly process the child in PIT ***! - commands the neonatologist ****.
Neonatologists - they, of course, are worried about the baby, but the midwife also has a lot of troubles besides him - to give birth to the last, to make sure with the doctor that all the lobules and membranes are in place, to examine the birth canal if there is not much work. And around hungry sharks, interns who like to practice and uncover a separate set for suturing, which then wash the same midwife, treat with special solutions and again wrap up for sterilization. And we are not proud people, instead of a needle holder and a ***** we sew, if necessary, the needles for this case are always in a separate packing, the strings from the last birth have been clean for alcohol.
- Len, wash your baby, pliz, I’ll sew here, sort of a bit so as not to reveal the extra set.
The interns sighed heavily and went to write stories. There, some diaries need to be dashed off - ooooh, there will be enough work for a long time. And you will learn to sew at home on a piece of meat. Then hand over the set-off to your leader, and maybe they will let you into someone’s body.
So, the neck is on the clip, we look - it’s normal, on the other hand - it’s fine, although the aunt is great, nevertheless they saved one set, for example, arches, vagina, lips. Well, a little crack - we’ll cauterize (namely, we’ll cauterize, in any other way), well, only mend the back commissure - praise my golden hands that the crotch still held - a couple of injections - inhale - inject, exhale - puncture, and that's it, now voooooh - aaaaaaaa. Not the most pleasant moment when you are cauterized with 5% iodine birth canal. Five minutes and everything is ready, otherwise the interns will be transported now, they will nakronat tables and start playing doctors before the second coming. No, let them write for now.
Everything, you can call a nurse - clean. Although the right nurse - she is already right there, also always on time and when necessary.
A child with a blue muzzle has already been taken away, a woman whose muzzle is no better after her attempt tomorrow, has already phoned all relatives and told how terribly she gave birth, how painful she was, how she broke up to the priest (such a grebe, this is after of what I did for her - I kept everything intact, and cracks are not considered at all), how many stitches were put to her (counted all the injections and punctures, multiplied them by three, which is already there), said that she would never give birth again will be (yeah, heard, know), asked what is the name of the doctor on duty and hen his next duty (pancake again all the credit to him), asked more questions Boys oh boys on different topics, and finally fell asleep. Well, all, silence, you can write your part of the history of childbirth, tell them in colors - what and when was done, to compare this with what the doctors and interns were heating up during all the births. If the data do not agree, go to the residents' office and show that the balance is not in their favor. To smoke this business. Return from the smoking room and again find a new woman in labor at the viewing room.
- What happened?
- The waters have moved ... it seems ...
- Clear. Are there any contractions? Not? Well, then sit for about 5 minutes. Now they’ll bring you the linen, show you the place in the room, and they’ll invite you for an examination.
And to the whole long corridor in a loud voice:
-Ira. Bring lingerie - a woman brought!
And all over again. And so 13 years. Day, night after night, night again, day and night.
Smart work, honestly)) I still sometimes have dreams about Rodzal.
Why did I leave the midwives? So I did graduate from the medical institute. And left the midwives. To the insurance. Doctors are needed there.
* Apgar scale - assessment of the condition of the newborn on a special scale. The scale involves a total analysis of five criteria, each of which is evaluated in points from zero to two inclusive. The result of the assessment can be in the range from 0 to 10.
** “Prevention” - saline solution with oxytocin injected into the syringe to prevent postpartum hemorrhage, is administered immediately after the birth of the baby.
*** PIT - intensive care unit
**** Neonatologist is the same pediatrician, only works in the neonatal ward
***** Kocher - Kocher clamp, hemostatic clamp with special teeth at the ends, allowing you to firmly hold tissue. As a needle holder, it is extremely inconvenient.
What is the difference between an obstetrician and an obstetrician
|Obstetrician||Medical assistant obstetrician|