"I
started my internship hours on Wednesday, 18JUN13. I arrived at The Sanctuary
Birth and Family Wellness Center for 1300 in order to do requisite
confidentiality paperwork and got a brief familiarization with office procedures
such as prepping files, keeping track of client due dates, etc. Dr. Fischbein
had 4 clients scheduled for the day. I got to participate in 2 ultrasounds,
both were 20 week anatomy scans and both families wanted to know the sex. One
of his clients is pregnant with twins. After Dr Fischbein chatted with
patients, he referred to me if I had any questions and gave my direct patient
contact time. I also took a fundal height using a tape measure on the twin's
mama's belly. Because one of his clients canceled, I used the most of my hours
at the clinic to read up on the twin situation and review the chart to see if
the twins were monochorionic and/or monoamnoitic or not.
Dr
Fischbein prefers to sit with patients in his office fully clothed first and
discuss their concerns before they go to an exam room. He likes to take his
time with patients. So we did another ultrasound, this time a vaginal one to
try to get a gestational date because they are more accurate for crown rump
length that early than the belly ultrasounds. It's was a struggling pregnancy
and before the end of my internship it did result in a miscarriage. Then there
were 3 pap smears with 3 CBCs and 3 breast exams.
The
internship continued in this fashion. In order to meet my first goal of learning
about the birthing process, I attended on home visit with Dr. Fischbein, one
homebirth, and one post-partum visit. The homebirth was very intense for me.
Initially I just observed quietly while she labored and pushed in the birth
pool. Occasionally the midwives asked me to fetch warm water for them and such.
Dr. Fischbein mostly hung back on the couch so that the midwives could do their
thing without him interfering as he is there for backup. This mama had been
laboring for many hours and was getting tired so they called Dr. Fischbein into
action. After mama did some solid pushing in the tub, on the birth stool,
seated in her husbands lap, and in their bed, everyone agreed it was an ok time
to help with some forceps. Dr. Fischbein always found a way to pull me in and
give me lessons on things, so while mama was pushing from her own bed, she was
at the edge with a foot up on my shoulder and I held her leg so I was right up
close and personal with this birth. He first assessed the head by finding the
sulcus because he told me you can only use forceps when baby is in certain
positions, otherwise it is too dangerous. He explained the risks like
bulldogging shoulders and dystocia to the mama and daddy. Once he determined
baby was in a good position for what type of forceps he would be using, he
numbed mama with some novocaine in case he ended up doing an episiotomy. I got
to see him get the forceps in place, again right up close and personal with a
foot on my shoulder and her leg in my hands, and with each contraction mama
pushed, he wedged the forceps with baby out a little more, and I had a front row
seat to all of this. He did end up doing the episiotomy, a quick clean cut
which gave more room for the forceps and within seconds baby was out and on
mama's chest and she had the drug free homebirth that she wanted after all. It
was amazing. The cord stayed attached for quite awhile as it finished pulsing
so that baby could get all her good oxygen and blood from there. The family had
their time to be gentle and relax and the midwives went back to work with the
rest of it, helping the placenta, etc, and then Dr. Fischbein was back in the
game to repair the tear. He explained that sometimes mamas get tears along the
sides from forceps but this mama luckily didn't. I held the spotlight while he
repaired the cut. I'm not going to lie, it was a lot of blood. A lot of blood.
Once he got done with the repair, it hardly looked like much had gone on down
there at all.
Overall
I participated in over 20 ultrasounds, some for pregnancy, some for fibroids,
some for cysts. By the end of the internship, I was able to start making out
images on my own. Like anything, it is its own language in a way, and you have
to develop fluency in it. Ergo, I was easily able to meet my goal of learning
how to use ultrasound as a diagnostic tool.
In
order to achieve my third objective, like all the previous objectives, it
depended upon what the patients presented. Nobody needed an external version
and nobody ended up being a breech vaginal delivery. I did, however, do urine
tests, which is really simple and just involved dipping a color-changing wand
into the urine and comparing the results to the answer key if the urine had any
protein or sugar in it. I also attended LE Leche gatherings and was able to
assist pre-natal mamas in preparing for breastfeeding. One mama asked if
drinking beer really helped to increase supply and I was able to provide her
with sound, good guidance. It was pretty nice that Dr. Fischbein would just
refer to me when any of his patients had breastfeeding questions.
I
enjoyed everything about this internship. It was an absolutely amazing
experience. The only thing I really felt disappointed by was that I didn’t get
to see more breech work or a breech delivery. I’m very grateful to SMC for
having such an opportunity to design one’s own internship and incredibly
grateful to Dr. Fischbein for patiently allowing me to walk in his shadow for
two months. I am also amazed by how much I learned and did in just 2 short
months with Dr. Fischbein. He was an incredible
mentor."
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