first day back

Theatre list, new medical students to tutor, a week of test results to review, an unexpected foetal death to counsel, late in the clinic and now an abnormal foetal heart rate in an insulin dependent diabetic in labour -not quite ready for vaginal delivery but almost. Is it safe to wait or not? In another room the foetal heart rate is too slow but also not enough to intervene...
now the diabetic heart rate is improved enough to wait. Though it could need urgent action at any time,  the clinic must go on....

clinic finished, no one delivered yet, and now two cases of severe pre-eclampsia admitted for management, need to cook dinner for daughter since no one else home. Up to labour ward and hope there is time to get home for long enough to get a meal ready.

The night entry is dark and deserted. Labour ward is bright. I visit everyone then come back to the one who needs delivery. I follow the rules. If the safety criteria are met then so far mother and baby have always been well. The head is well in the pelvis, cervix fully dilated, position clearly known though directly OP, and there is an effective epidural. Forceps are easily applied, the head easily rotated, then as soon as traction is applied the foetal heart rate drops, then is undetectable, possibly ok but not certain. With the strong epidural maternal push is reduced and delivery is slow. The midwife checks but theatre staff are not in the hospital, so Caesarian section would take a long time. There is gradual descent, but it seems to be barely moving, imperceptible, then minute, then a slight change, and another small advance, while a sickening anxiety seeps into my spirit, catastrophic scenarios flowering in my imagination.
The paediatrician arrives and I feel a little more secure. The head is definitely progressing but is it too slow? I persist in a state of despair. It is now certain to deliver vaginally. I cut an episiotomy which I would not usually do but I want every possible advantage for the delivery... then the head comes through.....but the shoulders are stuck, pulling on the head is not working, so I reach up into the pelvis and then abdomen and grasp the axilla, pulling the shoulder down and rotating shoulder and head so that the other shoulder also comes down and the baby is delivered.

I place the floppy wet baby on its mother's abdominal skin with a sinking feeling....its head lolls back tonelessly. The mother cranes forward and her pale stunned husband leans over and asks if the baby is alright. It is momentarily obscured while I hear a faint sound, and I dare to hope. Next time I am sure the baby has given a faint cry and the paediatrician takes her to the resuscitation cot.

Within a minute she is pink. A few minutes later, when I am suturing the perineum, I glance up to see the little girl looking intently into her father's eyes with that unnervingly direct newborn gaze. There will be forceps marks for a few days but all is well and everyone else seems unfazed. I am covered in a cold sweat, trembling as I stitch, unable to shed my depressing feeling of despondency despite the happy outcome. I struggle with a loss of hope and confidence. After finishing the repair I write my notes, talk briefly to the resident doctor and a medical student then return home to cook dinner for my daughter and myself, expecting to do it all again later tonight, and the next eight days and nights in a row.