14 July 2011 | Mr Christian Barnick | Obstetrician Consultant | The Portland Hospital
Mr Christian Barnick practices at The Portland Hospital as an Obstetrician and Gynaecologist Consultant and still works part-time in the NHS at the Homerton University Hospital. Chris has delivered babies and performed gynaecological operations for more than 25 years. Here he speaks of a typical day in his life as an Obstetrician…
The call at 0145, I knew it was coming. She is one day post dates and has been contracting a bit since the previous day when I had seen her. At the time I had done a membrane sweep in the hope that this would promote the onset of labour, clearly, this has worked!
On assessment both mum and baby are fine but the contractions are rather more painful than had been anticipated. An expertly placed epidural, set up by one of our resident consultant anaesthetists, soon sorts this out sufficiently so that I can seek refuge in my bed.
Waking feeling slightly guilty and surprisingly refreshed at 0530 I get up and head back to reassess the situation. The epidural is working brilliantly and both mother, baby, husband and grand-mother are doing really well. Quite lively and optimistic, only the dark bags under their eyes give away their lack of sleep.
The contractions aren't great so I am not surprised to find that the cervix is only 5cms dilated, but, it is much thinner than before and stretchy, which makes me optimistic that it should dilate rapidly if I can just increase the contractions a bit.
We have a friendly chat about this and we all decided that a bit of Syntocinon should do the trick and the ever-present midwife rapidly arranges this. Grandma and husband are dispatched for a walk to get some fresh air and some breakfast in Regents Park, and an epidural top-up is administered. By this time it is 0700 and we decide that another examination at about 1100 should be about right, unless there are any new developments!
This gives me a couple of hours for a final look through my slides for a talk I am going to give tomorrow for a GP Conference at the Royal Society of Medicine - not the way I normally like to spend my Saturday - but an offer to speak at the RSM doesn't come along that often.
As expected I am called at 0905 ‘are your slides ready yet’ asks the organiser, I should have had them in yesterday, ‘yes’ I reply with a sense of satisfaction ‘shall I drop off the memory stick later today’, result!
I then go and check in on a postnatal woman on the 1st floor, she wants to go home 36 hrs after her elective caesarean, all looks good, she is walking around, the baby is fine and it is her second child, so we agree that she can be discharged but that she will call me on the mobile if she has any problems over the weekend.
Back on delivery suite all looks to be going rather well, the contractions have been coming regularly and an examination confirms full dilatation of the cervix, just as I had hoped. Fortunately the epidural is great, the mother and the baby look fine on the CTG* machine which monitors a baby's heart rate during labour and the mothers contractions, so we opt to wait for an hour to allow for passive descent of the baby’s head.
Meanwhile my previously planned day on the NHS delivery suite at the Homerton is being covered by one of my delightful NHS consultant colleagues. I give him a call and he confirms that all is well but that he would rather swap the whole day. This sounds great to me as it looks as if my patient will deliver somewhere around 1300 (at least that is what I have told her), this will give me time to go through my talk again or to attend a scientific lecture afternoon at the Homerton hospital.
1210. An hour has passed, the CTG shows a few early decelerations, which might indicate that the head is descending in the birth canal and we decide that it is time to start pushing. She is very excited but also looks rather anxious at the prospect!
The epidural is still working really well but despite this she manages to push really well with some encouragement from the midwife and myself. After about 45 minutes it looks as she is getting a bit tired and that we may need to assist in the delivery with a KIWI ventouse, but a change of position is enough to cause further descent of the baby and she has a lovely spontaneous vaginal delivery: I opt for a small episiotomy to assist this as her perineum is really tight and looks as if it will tear badly if I don't.
A lovely baby boy is born in great shape to the sound of laughter from grandma, husband and even new mother. Neither the Midwife nor myself could resist the infectious nature of the situation and we all end laughing together. What a wonderful way to come into the world. In the meantime the placenta is delivered and the episiotomy expertly sutured, even if I do say so myself.
A really lovely experience for all of us and even after all the checks have been made, photographs taken and some tea and toast have been ordered it is still only 1400. A bit too late for that scientific meeting but early enough for a last look at that talk and a little power nap before getting on with Friday night. Just the one glass of wine though as I need a clear head and have another lady who may well go into labour over the weekend. Don't let anyone tell you this isn't a great job and a great privilege.
Mr Christian Barnick can be contacted on 020 7390 8440 at The Portland Hospital.
* Cardiotocographic (CTG)