Training in the practice of rural family medicine and obstetrics

Correira, Caroline

Sitting quietly beside her, I wait until her contraction is over before telling her how strong she is and affirming how well she is coping. She takes deep breaths in through her nose while forming a tightly wrinkled brow, small signs of the pain and suffering that almost overtakes her. Her husband holds his lips close to her ears, whispering encouragement and solidarity with all his being. Her body shakes with the changes it’s going though, with the adrenaline associated with the process. She’s made quick progress to full dilatation and her baby’s head is making a quick and painful descent.

Despite the fear and the pain, she tells us she’s ready to push. I’m amazed, humbled. The nurses and I guide her efforts, instructing her to wait until the contraction builds maximally before bearing down. “Let your body lead you,” we say. Her husband naturally starts counting for her as she pushes, giving her a goal, a focal point, an encouraging voice to help her. Between contractions, she collapses back on the bed, slowly relaxing the tension from her thighs and face. She nearly fades into sleep when another wave of tightening and burning bring her back to the present moment and this tremendous task. “I’m afraid. This burns so much,” she utters. “You’re doing so well,” we try to reassure her. “Your body is stretching to make room for your baby. She’s almost here, don’t give up.”

With what seems like an impossible amount of stretching, her baby girl’s head crowns and then pushes beyond the perineum as we encourage mom to stop pushing and just pant now. “Find the anterior shoulder,” my preceptor directs me. I ease it under the pubic symphysis then deliver the posterior shoulder and the rest of the body delivers smoothly after that. “Here she is,” I announce. “She’s beautiful.” I transfer her to the towel that’s been laid across her mother’s chest. It’s a moment I love – seeing their expressions as they take their first look at the baby they’d waited nine long months to meet. Usually, as in this case, it is a moment of the purest joy.

Assisting in the delivery of a new life is one of the most significant privileges I experience as a rural physician. In fact, I find the entire process of labour and delivery to be such a refreshing divergence from the usual method of medical practice in that it is a near complete surrender to the patient’s schedule, progress, and readiness. There are no appointments, no time slots, and no distractions to the care of the patient in labour. In the practice of obstetrics, I am learning to assess and wait upon the patient’s physical readiness, adjust my approach to pain management based on the patient’s expectations and wishes, and encourage my patient as she works to deliver her baby. She is the most important person in the room; around her all our encouragement and supports are directed. My presence is for the purpose of monitoring maternal and fetal well being and coaching her through this incredible phase in our life’s cycle. We intervene as an exception rather than the rule. In these moments, we see the physical and metaphysical restructuring of care to encircle the patient. It is a privilege that I cherish and a way of practicing that deeply interests me. It is as I journey with patients through times of intense suffering and times of great joy that I find renewed energy and enjoyment of my work. For that renewal, I am immensely grateful.

Theme: Birth | Naissance
Theme: Health Care Delivery | Prestation des soins de santé
Theme: Relationships | Relations

Stories in Family Medicine | Récits en médecine familiale [Internet] Mississauga ON: College of Family Physicians of Canada. 2008 --.




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