Pregnant women

Today i attended my first antenatal clinic. It was good. I got to perform Leopold maneuvers.

Leopold Maneuvers

I have never touched a pregnant abdomen before and i was glad i was not too nervous about it. (I think i was more freaked out about taking blood pressures, because i have not taken blood pressures in 6 months and i was confusing myself over which way i should place the damn cuff. It got sorted out eventually. I need to stop psyching myself out. Confidence is what i need.) Anyway, back to pregnant bellies. I had to palpate for the top part of the uterus, something which i need to work on more. I can’t tell the difference, but i have got a couple more weeks to figure that out. I just need to palpate more pregnant abdomens to get a “feel” of what normal is like. Then i had to palpate for the fetus’s head near the pubic symphysis to see if the fetus was in the correct position for delivery (head down would be preferable, sometimes the fetus ends up wanting to come out buttocks first – known also as a breech delivery). That was even more challenging. So far in all my palpation of abdomens, all i ever needed to do was to feel for lumps and characterize it. Now i am supposed to take it one step further, to try to delineate whether the lump i was feeling is a head, and whether it has engaged into the pelvis (descend far enough into the pelvis to know that delivery is imminent).

Then i got to seek to out the baby’s heartbeat using a handheld device (what is it called? I was told by friends it was a Doppler, but how can it be a Doppler if there are no sonograms, let alone coloured sonograms for us to see directions of bloodflow??). And i thought heart murmurs were challenging. This was even worse. I had to differentiate between the mother’s heart sounds, the placenta noises and finally the fetal’s heartbeat. It was all a bit mad. I could not get any fetal sounds in the first two patients but after observing and hurriedly picking up the subtle tricks and techniques the consultant was using; i got the hang of it. Now i just want to feel more comfortable doing the whole process.

Really love the outpatient clinic. Actually it really brought the point home today as to how much i love physical signs. I really love being able to palpate for masses, and looking for hard clinical signs on physical examinations. This is why i like surgery so much – it is a specialty built on physical signs. I mean, if you don’t have convincing physical signs, you would not be sending the patient into the operating theatre to be cut open in a jiffy right? That’s why surgeons are so good at picking up such subtle signs. It is an Art, an Art that i would really like to learn.

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