The Drama of a C-section: It Takes a Team

She pushes her cleaning cart into the bright room. “Looks like the usual mess,” she mumbles to herself, pushing a loose piece of hair back into her blue cap. Methodically, she cleans the room beginning with the operating table, stripping off the bloody sheets. Then cleaning the floor of blood-stained shoe prints, amniotic fluid and bits of paper, needle caps and such, that managed to escape hands and land on the floor. She leaves no traces of the previous surgery. She sets aside the surgical instruments to be sterilized for the next case, mindful to keep the set together. When all is done, she arranges the room for another C-section. Just as she finishes, she is called into a different room.

Three stories down, a father-to-be pulls up to the curb, frantically handing his keys to the valet while rushing to assist his wife out of the car. The valet catches up to him, pushing a ticket into his hand.

“I’ll take care of your car.”

With one arm under the woman’s elbow, he points to the gold elevators, “take that to the third floor.” As the couple enters the elevator, the valet approaches, waving wildly with one arm, holding a flowery duffle bag in the other arm. “You left this in the back seat,” he says, slightly out of breath.

The elevator opens into the check-in area of labor and delivery. The woman is panting, holding on to the rail; her husband is trying to get her off the elevator before the door shuts, the duffle bag dangling off his shoulder. The receptionist buzzes back to the triage area.

“You’ve got an active mama here. She needs to be taken back to triage quickly.”

A nurse comes out and guides the woman into triage while her husband stays behind to check her in. Seeing how anxious he is, the receptionist says “give me your insurance card and driver’s license. I will bring your cards back to you,” and guides him back to triage.

“I’m supposed to …” the woman begins, pausing to pant through a contraction, “… have a C-section next week, but I broke my water, and I started contracting. And now there’s a lot of blood.”

The nurse nodded her head, having already signaled for help, concerned about the blood. Another nurse, a resident and a nurse anesthetist descend into the triage bay. In rapid fire, the resident and nurse anesthetist ask her, “When is your due date? Any health problems? History of surgery?” Simultaneously, the nurse takes the patient’s arm, ties around a tourniquet and without hesitation, inserts an IV needle. Another resident comes in, pulls up the woman’s gown and squeezes gel on her stomach for the ultrasound. While balancing a phone in the other hand, she whispers to the attending on the other end, “You need to come ASAP.”

Metal instruments are clanging as the resident opens the OR door. The scrub nurse turns, her gown not yet tied in the back, “I’m almost ready,” and turns to finish setting out the instruments. The room is suddenly buzzing with an orderliness of bees organizing a hive – one nurse and the resident help the patient onto the operating table while the anesthetist places heart monitors on her chest. The woman’s eyes are big, darting back and forth.

“I know there are a lot of us coming at you, but we must hurry,” one nurse quietly tells her while placing a fetal heart monitor on her belly. Another nurse is asking her to relax her legs to the side so she can insert a catheter into her bladder. The attending takes the woman’s hand: “I need to step out a minute to scrub, I’ll be right back.” The OR door swings open, the scrubbed resident walks in as the attending walks out.  “I’m going to wash your belly,” the resident tells her as she paints her with an orange anti-bacterial solution.

“Let’s do a timeout,” the attending says loudly. The buzz hushes for a moment, and she begins: “This is M. Jones, her birth date is 11/12/75, and we are performing a C-section …” Each person in the room takes turns stating their name and their role.

“You can start,” the anesthetist says with a nod, and the C-section begins. While the nurse anesthetist quietly talks to the patient, she scans her monitors, keeping an eye on the patient’s blood pressure and pulse. Everyone else focuses on the attending and resident as they proceed with the surgery. The team knows the dance, and without words, the scrub nurse hands the attending a scalpel to make the incision, then a clamp and sponge when she sees some bleeding. In equal harmony, the circulating nurse looks to see the suction and cautery are working and then turns on the baby warmer. The attending and resident move quickly to deliver the baby. Upon entry into the uterus, blood comes pouring out with the amniotic fluid. Without hesitation, the surgeon reaches into the uterus to bring the baby’s head through the incision, and the rest of the baby follows easily. The cord is cut, and the baby is taken to the neonatologist in waiting at the baby warmer. Unaware they each had been holding their breath, a simultaneous sigh of relief fills the room as the baby’s cry rings out.

The heaviness in the air dissipates, and everyone begins chatting, their voices lively with relief.  Once the surgery is finished, the attending speaks to her patient and husband: “All went well. I’m glad you came in when you did. Your placenta was separating prematurely. That’s why you had so much bleeding.”  The new mother and father smile, truly unaware of the danger their baby had been in.

As the patient is taken to the recovery room, the members of the team each go their separate ways like a turn of the kaleidoscope – each time forming a new and intricate team, fitting together to form a beautiful reflection of colors that work together harmoniously. Each piece is vital to complete the pattern — from the cleaning woman to the valet to the nurses and so on — missing one would dismantle the perfect balance that makes up patient care.

The cleaning woman stops a minute to adjust her cart in the OR hallway. While rearranging the cleaning supplies that toppled over, she sees out of the corner of her eye a stretcher passing by. She looks up as it passes to see the new mom holding her bundled baby and smiles. She realizes they came out of the room she had just cleaned a few hours ago.

Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN.