Polite Dissent

Title: In Which Sam Gets Taken for a Ride

(Sorry for the delay in this week’s review; I was under the weather last night and went to bed early.)

An enjoyable episode of Private Practice with mostly good medicine. The theme this week was sex — as well as the common result of sex: pregnancy. The show also suggested that the only way to have a “sure thing” is not to have “sure thing” (and getting smacked by a pistol helps too).

Dr. Peter Finch and Dr. Addison Montgomery
Susan is a pregnant patient of Pete and Addison’s who is having her pregnancy induced at the clinic followed by a water-birth. She is a recent widow — her husband was a police officer killed in the line of duty. She is also very anxious and has an itemized list of everything that needs to be done for the delivery. Things are going well until she gets in the tub and drops the list in the water. This causes an anxiety attack which leads to a sudden outpouring of all the repressed grief she had been holding in for her husband. She starts to hyperventilate as she worries about being left alone. Addison climbs into the tub with Susan whichenables her to relax enough to deliver a healthy baby boy.
I’m not a big fan of water births. I know that they are somehow supposed to be more natural, but I don’t buy it. They may be more relaxing for the mother (and there’s nothing wrong with that per se), but they can be downright dangerous to the baby. The tubs also weigh a tremendous amount — all that water is quite heavy. For them to be placed on an upper story, the floor needs special reinforcement (and the clinic may have this reinforced floor for all we know).

Dr. Sam Bennett
Sam is called by one of his patient’s asking him to make a house call. When he arrives at the location, he finds that he’s been called to a liquor store in the middle of a robbery where the clerk has been shot in the leg. He is treating the mostly superficial leg wound when it is revealed that the robber is pregnant and her water has just broken. It also turns out that the liquor store clerk is the father of the robber’s baby, and just to add to the drama, he wants nothing to do with his ex-girlfriend, but he has no intention of abandoning his baby. Sam calls Naomi for some advice on delivering the baby but won’t go into all the important details of the situation. He is able to deliver the baby’s head but the shoulders are stuck. He calls Naomi again who informs him that this is “shoulder dystocia” and he’ll need to reach in and manually rotate the baby to deliver it. Sam succeeds and delivers a healthy baby girl. He hands her off to her father before calling the police on the mother.
Sam’s care of the bullet wound was fine.
Is Naomi the best one to call? It’s unclear to me whether or not she is an obstetrician, while we know that Addison is. I would have called her.
Sam’s treatment of the shoulder dystocia missed a few things. Naomi’s instructions jumped right to a later treatment (albeit a more dramatic one) for dystocia. There are plenty of steps Sam could have taken in an attempt to relieve the shoulder dystocia before resorting to manually turning the baby (and he should also have called an ambulance the minute there was a sign of a problem with the delivery). The most obvious step would be to spread Kelly’s legs wider — she wasn’t in a good position at all and it’s no surprise that she had trouble delivering the shoulders.
I’m surprised no one called the cops while Sam was delivering the baby – that would have been the perfect time. They could have called an ambulance at the same time.

Dr. Addison Montgomery, Dr. Naomi Bennet, Dr. Cooper Freedman, Dr, Violet Turner, and Del
Ashely comes in for a prenatal checkup with Addison. She is already the mother of three rambunctious boys (as well as an immature husband) and is looking forward to finally having a girl. Checking the strip, Addison informs her that she is currently in labor. The baby comes quickly, and Del actually delivers the child. The mother is expecting a girl — and in fact is counting on one — because that is what the ultrasound showed. However, the ultrasound was misleading and it’s another boy. This devastates Ashley who feels she is doing all the hard work of raising the boys while her husband just plays with them. The doctors realize that she is not bonding as well with the new baby as expected and they bring Violet in to talk to her. Her husband comes in as well and Del tells him he needs to grow up. Cooper agrees and tells him that he needs to be a parent and not just a friend to the boys. Naomi also puts in her two cents and tells Ashley that she chose to have another baby with no guarantee of which sex it was going to be, so she needs to love it no matter what.
It takes a machine to tell Addison that Ashely is in labor? That makes me worry about Addison’s skill level.
Here we have a fundamental misunderstanding of the ultrasound results. In terms of the sex of the child, the ultrasound can show “boy” or “probably not a boy.” Note that there is no “girl” result. Basically, the ultrasound is used to look for male genitalia. If they are seen, then the baby is a boy. If they are not seen, then the baby is probably not a boy — or it could just be a shy baby, a bad position of the baby, a poor quality ultrasound, or bad interpretation. There is no guarantee of having a girl even if the ultrasound suggests it.
Naomi needs to work on her cut-the-cord technique. She only clamped the placental side of the umbilical cord; she didn’t clamp the baby’s side. Now the baby can bleed out the unclamped cord (especially if the baby is held higher than the end of the cord) and this can lead to a severe blood loss if not caught in time. The proper technique is clamp, clamp, and then cut in between the clamps.