Five years ago I completed an emergency medicine residency. Sixteen years prior I completed a residency in OB- Gyn. For obvious reasons I did not do the Ob rotation during my second residency. I did however shadow a few shifts as a chief resident to see what our residents were experiencing and realized they have very limited exposure to the scary things that can happen during a delivery.
One night,as a new attending, I was made aware of a patient coming from the waiting room. She presented with nausea, vomiting and diarrhea. The tech who was bringing her in said “ I think she is having a baby.” I was up with gloves on immediately. The patient proceeded to deliver a 34 weeker in the wheelchair. I simply kept the infant from hitting the ground. As with every precipitous delivery, chaos ensued. In the mayhem we managed to clamp and cut the cord and get the baby on a warmer. While we were waiting for the bed to be cleaned I gave a gentle tug on the cord. Nothing happened. I looked at the patient and then felt the fundus. It was way bigger than I thought it should be. I then asked the patient if there was more than one baby. “Oh yeah, I am having twins.” As you can imagine things got a bit more crazy. We managed to get the patient on the bed and grab an ultrasound. Gratefully twin B was vertex. OB arrived and took the patient upstairs where twin B delivered uneventfully. The entire thing was quite a scene. Staff was glad I happened to be on shift. I realized how terrifying this could be without an OB background.
Shortly after this exciting shift I began to create an enhanced Ob curriculum. Since I was the sim director it made sense to make it a hands on experience. Fast forward to current day and now I have a collaborator Valerie Dobiesz MD, Director of External Programs at Neil and Elise Wallace STRATUS Center for Medical Simulation at The Brigham and Women’s Hospital and we have founded a company called Special Deliveries, LLC. Our mission is to fill the knowledge gap in Obstetrics and Deliveries in the ED. Emergency medicine residency training requires 10 normal vaginal deliveries. In real life births are rare and high risk in the ED and frequently not normal. Our course is designed to provide hands on and small group training in breech deliveries, shoulder dystocia, postpartum hemorrhage and a number of other high risk obstetric complications (including twin deliveries). We launch our inaugural course in Boston this fall. Hope to see you there!