Ready or Not, Here ICome

By Carey Andrew-Jaja, MD, FACOG

Dr. Carey Andrew-Jaja retired in 2019 as clinical professor of Obstetrics, Gynecology& Reproductive Sciences and attending physician at the University of Pittsburgh Medical Center, UPMC Magee-Womens Hospital in Pittsburgh, Pennsylvania. His forty-year career was dedicated to direct patient care, medical staff leadership, and the education of future physicians. He is a lead author and co-editor ofEveryday MedicalMiracles.

Story:

There she was, shorter than all the other Emergency Medical Technician (EMT) students who waited in the auditorium for the lecturer to arrive. Many friends had wondered whether Maya was physically strong enough to handle grueling tasks out in the field. But she never let her diminutive size hinder her at her summer job as an EMT. Maya felt competent enough to handle most situations. And yet she had her own questions: What is a rising college senior doing in an EMT class? And what’s happening to all her ambitions to become a doctor or a lawyer? She was ruminating on those questions as the obstetrics-gynecology (OB-GYN) lecturer, Dr. Jay, approached the podium to give his lecture on “How to Deliver a Baby Out in the Field.”

Dr. Jay’s resonant voice grabbed Maya’s attention. “Most of your deliveries will be smooth and easy, but you better be ready to handle the surprises. Imagine that you are the first responder to a pregnant woman’s home. She is in the late stages of labor and tells you that she felt a tiny kick in the vagina. What if you check and, indeed, the baby’s foot is there in the upper vagina? Do you grasp and drag out the baby? No. You call the OB unit at the nearby hospital you are heading to, so they are ready for skilled assistance while you monitor the baby and reassure the mother. Then, you get moving. Run intravenous fluids to help decrease the intensity of uterine contractions. If the mother feels an urge to push, ask her to pant, not to bear down. Above all, do not pull on the baby. And do not hasten the delivery until the buttocks appears at the vaginal opening. At that point, delivery is inevitable and necessary. You should then encourage the mother to push with contractions while you gently support the baby. If the baby is in distress or no further progress is happening, there are advanced maneuvers to facilitate a safe delivery. Beyond these lectures, you can learn the essentials at practical workshops with me. Feel free to sign up. Next scenario: What if the head has come out first, and you see a loop of cord around the baby’s neck? Yes, you will encounter this situation about 25 percent of the time. This is what you do . . .” Dr. Jay continued his presentation on obstetrical emergencies as the class listened and watched the projected slides. Maya absorbed it all and was eager to return to the field for her nextchallenge.

But before she knew it, life moved fast, and that summer of 1985 was over. Back to campus for se