Part 2: How to be a good assistant at a Caesarean Section

Part 2: How to be a good assistant at a Caesarean Section

Sep 29, 2021 0
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In part 2 of our 3 part Obstetrics & Gynaecology podcast series, we review how to be a good assistant in a Caesarean Section as a junior doctor.

 

Summary Writer:  Laura Park

Script Writer:  Rebecca Taylor

Editors:  Rebecca Taylor and Jane McDonnell

Interviewee:  Rebecca Taylor

Interviewer:  Jane McDonnell

 

About Dr Rebecca Taylor

Dr Rebecca (Becky) Taylor is a 6th year O&G trainee. Originally hailing from the UK, she trained at the University of Edinburgh where she also completed her internship and residency, before moving to Australia. She undertook her basic O&G training at Royal Prince Alfred Hospital in Sydney. Rebecca is currently undertaking a two year Gynaecology Fellowship at Royal Prince Alfred Hospital. When Becky’s not knee-deep in amniotic fluid she is a keen swimmer and free diver, a terrible cook and married to an anaesthetist she met at a Cat One Caesarean.

 

About Dr Jane McDonnell

Dr Jane McDonnell is an Obstetrics & Gynaecology Registrar based in Sydney. She completed her medical degree at The University of Notre Dame after completing a Bachelor of Medical Science from The University of Sydney. Jane has a Masters in Public Health from the University of New South Wales and has completed an internship at the World Health Organisation in Geneva. In 2019, she was awarded the JMO Teacher of the Year at Royal North Shore Hospital. Jane is interested in women’s and refugee health, teaching and research. Outside of medicine, she enjoys running and sudoku.

How to be a good assistant at a Caesarean section

With Dr Rebecca Taylor, Obstetrics & Gynaecology Fellow and Dr Jane McDonnell, Obstetrics & Gynaecology Registrar, based in Sydney, New South Wales, Australia.

 

Introduction

In this part 2 of a 3 part series, Rebecca Taylor provides a comprehensive review on how to be a good assistant in a Caesarean section as a junior doctor. She takes us through a step-by-step journey of a Caesarean section and specific tasks junior doctors can help before, during and after the Caesarean section. These tasks include essential skills such as proper catheterization, surgical scrubbing, and assisting in the delivery of the baby.

  • Find out the reason for the Caesarean section (e.g. foetal distress, failure to progress, trial of instrumental)
  • Introduce yourself to the patient and all staff members in the operating theatre (e.g. write name on whiteboard)
  • Assist in the “time out” process
    • Check name/DOB/MRN of patient, consent, allergies, need for antibiotics, DVT prophylaxis, valid group and hold, and whether the paediatrics team and midwives are present
  • Make sure patient’s partner is present and feeling comfortable
  • Patients are usually in supine left-lateral tilt position or in lithotomy position
  • Wash hands at scrub bay, enter the operating theatre and dry hands
  • Get nursing staff to help patient’s legs into frog leg position
  • Clean urethral area with betadine or chlorhexidine
  • Insert catheter and see urine draining before inserting 10mL water injection for balloon inflation
  • After catheterization, ensure patient’s legs are secured and calf compressors are on, and make sure diathermy plate is attached to the patient’s thigh (usually at 40-Cut, 40-Coag)
  • If it has been a while since you have scrubbed into surgery, ask someone for help to re-familiarise with the steps
  • Open sterile gowns, place gloves on the table (know your glove size and whether you would like to double-glove) – use a no-touch technique throughout this process
  • Make sure you are wearing a mask or eye protection
  • Once everything is ready, scrub – there is usually an instruction sheet over the scrub sink
  • Put the gown on and ensure your hands remain inside the gown
  • Put gloves on without exposing your hands outside the gown
  • Get someone to tie the gown for you
  • When walking into the operating theatre, keep hands over your chest until reaching sterile field
  • Provide the surgeon with a good non-obstructive view
  • Use suction if bleeding or any smoke from the diathermy
  • Use diathermy if there are any bleeding vessels
    • Either directly onto the bleeding tissue or
    • Touch forceps on the side with the diathermy until the surgeons says stop
  • During the delivery of the baby:
  • Using two hands, apply constant downward pressure on the fundus
  • When delivering a baby in breech or transverse position, speak to senior about how you can help when delivering the baby
  • Help the surgeon with suturing by keeping tension on suture thread and cutting the sutures
  • Ensure patient has all relevant medications charted
  • DVT prophylaxis, analgesia, laxatives
  • Ask the surgeons’ preferences before the surgery – there are many ways to perform surgery and each surgeon will be different in how they like to do things!
  • Practice scrubbing, knot-tying or hand-tying before the surgery
  • If you are keen in a career in O&G, make sure you let the registrar and the consultant know to get the most out of your term!

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Tags: #Caesarean Section,#O&G,#obstetrics,#obstetrics and gynaecology

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