"Doctor Huang, keep your hand steady, move it in a bit more, and then push some more medication." Du Haiwei carefully observed Huang Zhileiâs actions while giving precise and important instructions.
If it werenât for having to block the breech with both hands, one would typically administer the anesthetic themselves. Administering local anesthesia in this area requires the doctor to use one hand to feel the ischial spine inside the birth canal to guide the needle, preventing any misplacement or mistakes.
Following Boss Duâs directions, Huang Zhilei carefully adjusted the needleâs direction and regulated the speed of the injection. Finally, the anesthetic was fully administered, and it would take three to five minutes to take full effect. During this time, the rescue work continued methodically and in an orderly fashion.
Perhaps seeing everyone so calm, Li Xiaobing became less and less nervous. Despite the pain, she couldnât help but joke with Cao Yong amidst her suffering: "By the time my husband gets back, I might have already given birth."
The patientâs improved mood was a good thing. The problem wasâa whole group of people might be putting on an act of calmness.
After administering the anesthetic, Huang Zhilei stepped to the side, grabbing a towel from a junior colleague to vigorously wipe his sweat, startled by Li Xiaobingâs words. It seemed that there might be some truth to Fu Xinhengâs jokes behind Zhu Huicangâs back about Li Xiaobing being different from ordinary people.
Doctor Tang handed the surgical scissors to her husband.
The truth about an episiotomy is that it might not be performed with a scalpel, but with surgical scissors.
The choice of surgical instruments always depends on the actual needs.
The perineum is not the vagina; it is a soft tissue area primarily consisting of skin and some muscles. The broad definition of the perineum includes the urethra and anus, while the narrow definition refers only to the area between the anus and the external genitalia. The site for this episiotomy falls under the narrow definition of the perineum, generally at the five oâclock position.
Understanding the five oâclock position can be challenging, but you can refer to a wall clock at homeâthe marked position left and down in the surgical area is where the doctor will make the incision.
Given the nature of soft tissue and the doctorâs angle of approach, using surgical scissors is preferable to using a scalpel for cutting.
When cutting, the attending doctor must first sense the position of the descending fetus before making the cut.
If the cut is made too early, the perineum, with its rich blood vessels, may bleed excessively, increasing the risk of infection. Delayed cutting is also problematic if itâs too late to have the desired effect.
The ability to cut at just the right moment tests an obstetricianâs technical experience.
In this breech delivery scenario, the most suitable timing is when the fetusâs intertrochanteric diameter reaches the motherâs ischial spines. Here, "trochanter" refers to the prominence on the babyâs femur head where many bones have bony landmarks, not just the femur head. The motherâs ischial spines can be felt by the doctor inside the birth canal, and doctors typically measure the distance between these spines to determine the pelvic width.
When the fetusâs little rear reaches this position in the motherâs pelvis, it signifies that the baby can begin to be delivered.
The reason Du Haiwei previously had to push the fetus back was mainly because the motherâs birth canal was not ready. The inexperience of the two young doctors led to the mother exerting force too early. Fortunately, they realized the initial mistake and corrected it in time. Now, with the boss present, they are ready again to proceed with the episiotomy.