Healthy hate of the OR

Did I mention I hate the OR?

I hate the OR.

I hate for birth to be sterile when it's usually wet and messy and fun.

I hate the blue drapes over everything that's usually dark and warm and tones of reds and browns. I hate the cold, how awful it must be for the baby to come out into the brightness and emptiness. I hate rushing up to a woman's exposed insides to collect the slimy neonate from the surgeons masked and gowned blue alien forms. There's no tiny glimpses of the head, no crowning, no perfect graduality in a C-section. It's just as it would be if it we were removing a tumor or a malfunctioning organ.

The other night a surgical tape was missing and I tore up the room in search of it. It was nowhere to be found and this left the body cavity or somewhere else on the field. An x-ray was ordered, as there was little else to be done. The baby was 1lb 14 oz, whisked to the NICU, but surely the tape was not with her. Perhaps on the floor? There'd been an enormous amount of blood spilled; the patient was abrupting, her placenta separating from her uterus too soon and when they opened her, blood splattered all over the floor in a large gush with plops for the clots. I threw blankets on the ground for traction and perhaps the tape was among them? It was not, the anesthesiologist and I shook them out repeatedly. Finally the tape was found beneath the sterile drape, and it was another night of hating the OR.

Perhaps I'll become more comfortable with time.

I hope I don't though. A good labor and delivery nurse should hate the OR, as should all good OB-Gyns. The OR should be a last resort, and we should all be more comfortable with vaginal deliveries than C-sections because that's the healthier, more natural, and more woman-centered way. Preventing C-sections is probably my top goal at work, second only to (and often interchangeable with) ensuring a healthy baby and mother. As many of my patients are on Pitocin, keeping them out of the OR requires a fine balance. I must deliver enough Pit to cause regular uterine contractions to change the cervix at a rate fast enough that no obstetrician can rationalize a C-section with "failure to progress." But I also must avoid hyperstimulating the uterus, causing fetal distress, and a prolonged deceleration in the heart rate that sends us racing back to OR anyway. I'm still working on this balance. My desire to stay out of the OR also drives me to coaching patient acrobatics: for a posterior baby who won't turn and descend, the patient must try hands and knees. For a risky-looking fetal heart tracing we must try turning to the far left or else the far right, and perhaps a fluid bolus. For stalling out at 8 or 9 centimeters perhaps sitting totally upright and dropping the foot of the bed. All of these positions are made more challenging in that most patients have little ability to move their butt or legs, thanks to epidurals.

I worry that if I got more comfortable in the OR I'd let visits there happen a little too readily, when in reality, it's everyone's responsibility to just use C-sections as a last resort. In certain situations I am incredibly glad that they exist and are an option for us. But I hope I never stop hating the OR and I think everyone in this field should share my reluctance to head in there.