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First person: Falling in the breech : Emergency Medicine News


history of emergency medicine, caesarean section


I accepted a locum position right after finishing my residency in 1981 that involved filling in for a small-town doctor who wanted a weekend vacation. He provided cradle-to-grave care (obstetrics, pediatrics, and geriatrics) as the sole physician in Marble Falls, TX, which then had a population of 3,200. Being responsible for everyone’s health, like so many physicians in this time, meant he hadn’t been able to take a vacation for many years.

I arrived at his place where I would stay for the three days, and joined him in his van for a tour of his 60-acre ranch, some areas cleared for cattle but most of the forest intact. Marble Falls straddles the Colorado River, home to rolling hills and beautiful weather. The town was too small to have its own hospital, so we drove 20 miles to Kingsland, a town only slightly larger where I would do all the necessary hospital work. Like deliveries, he says.

” Deliveries ? ” I asked.

“Yeah,” he drawled. “I have three at short notice, but I told them everything they would have to hold them for the weekend.”


I hadn’t counted on that. I had delivered over a hundred babies during my family residency program in Corpus Christi, but I had needed the help of the obstetrics resident often enough to know what problems might arise.

“What if I need help?” »

He winked at me. “That’s why you’re the doctor, isn’t it?”

The dirt and gravel road meandered through rock quarries and brush, crossing a creek bed just before reaching the hospital. The doctor warned me not to cross it during even light thunderstorms and it was the only way to get to the hospital as the main road was under repair.

He treated me to a delicious Texas BBQ that night along with his special margaritas. He wouldn’t reveal the ingredients, but this drink sure kicked Texas’ ass. I wasn’t awake when he and his wife left at 6 a.m.

The call

The mission seemed easy: I would only have to answer emergency calls. I spent most of Saturday enjoying the luxuries of the spacious doctor’s ranch house, big-screen TV (very expensive at the time), and built-in swimming pool. But then I got a call from the hospital at 8 p.m.: One of the doctor’s patients was in labor.

A light rain had started, water gushing out of my tires in 10 inch protest walls as I crossed the creek bed. I arrived at the hospital and I put on a doctor’s outfit: dressed, combed and scrubbed.

I found my patient tied to the delivery table by all four limbs, which was the custom; her cervix had dilated six centimeters. I relaxed for an hour, talking with the patient and the nurses, until the mother told me she thought she was ready. But it wasn’t a crowned head that I felt, to my surprise, but a foot.

I guess millions of women have had breech births over the hundreds of thousands of years that Homo sapiens existed, and breech delivery sometimes goes well. But sometimes the baby may have brain damage and both he and his mother may die. I had never done a breech presentation; all the breech babies I had seen were born by cesarean section.

The delivery

No anesthetist was available at Kingsland. The nearest C-section facility was in Austin, more than an hour away, and the rain had intensified, making the creek bed road impassable. I should deliver this baby, and I should deliver from his seat. I asked the nurse if she had any obstetrics textbooks, and we quickly went over the recommended steps for a breech birth. This involved first pulling the baby’s arms, then reaching under her body, putting my fingers in her mouth to pull her chin to her chest, then pulling her head free. It seemed doable. Maybe.

My patient began to push, and the baby’s legs and lower trunk entered our world. I reached out, pulled the baby’s arms out, and reinserted my hand to find her mouth. I pulled the baby out with the mother’s next push, my other hand pressing on her uterus from the outside, and we were quickly rewarded with the cry of a newborn baby. Hit!

I now think back and shudder how badly it could have gone. Would my confidence have been destroyed by a disastrous childbirth when I was just starting my career? Would I be haunted by the life of a child with brain damage or even a dead mother and child? But it went well. I did the right thing, good preparation for my next 40 years as an ER doctor.

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Dr. Levincurrently works part-time at the Memorial Hospital Clinic in Gulfport, Mississippi. He retired from emergency medicine in 2020 after 42 years as an emergency physician in Texas, North Carolina, Virginia and Mississippi. He served as president of the Coast County Medical Society in Mississippi and of the Mississippi State Chapter of CAPE. He has published 31 books, over 250 articles, stories and poems, and nearly 200 YouTube videos, many of them on medical topics. Follow him on Twitter@PhilipLLevin, and visit his website