A Tale of Two C-Sections

The first was a section I gave anesthesia for a few days ago. The 37 week twins, active labor, one in breech position. Initially there's a rush of activity when you start a section. First we get the patient in the room, sit her up and do the spinal - easy landmarks, 1st shot yay!!!. Lay her down on her back, tilt the OR table to the left and let the spinal set up. Once the level's good, the incision's made, grandma comes in (dad was squeamish). It's twins, so they page the NICU as a precaution. It's generally less than 10 min from skin incision to delivery and the rest of the time is spent putting mama back together. The twins were beautiful and healthy, 5.5 and 6.5 pounds respectively. There's lots of noise after the delivery, mostly people talking about how cute the babies are, "look at all that hair", and the general murmur of the OR "cut", the count, etc. But it's a happy sound. The babies are being held by grandma, so that mom can see them.

Here is the second, a little more recent. Mom is young (not yet in her 20s) with PIH (pregnancy induced hypertension) on its way to becoming preeclampsia. She's 28 weeks pregnant. She's got 3+ edema in her back and I unbelievably got the spinal on the first shot. I think God had my back on that one (I pray He's watching over the new baby girl I helped bring in the world). Dad was in the room after they started. They got the baby out and of course NICU was present. She only weighed approx 600g (about a pound), putting her in the extremely low birthweight category. The tone in the room was completely different. The baby wasn't breathing well, so they intubated her. There was almost no noise whatsoever, and you couldn't really see the baby because she was surrounded by the NICU staff. The tension in the room was palpable. Mom noticed she couldn't hear the baby crying. Dad was sitting with his head down and I watched his tears hit the OR floor. He was trying not to let Mom see how scared he was. Then the NICU docs came over to talk to them. Mom got to see her baby for a minute in the incubator before they wheeled her off. I hope things go well, but the road is long. Girls at that young of an age do better but now all her parents can do is hope and pray.

Thankfully most of my c-sections are of the first variety. I can only hope that those of the second type are few and far between.