The reason for the vertical incision being easier for extraction is the same: generally, in the uterus of the mother, the fetal head-down position offers a more open view for the doctor, unlike the horizontal incision where the doctorâs view and operation are restricted in every way.
Since beauty is important to women, most obstetricians, thinking of their female patients, continue to challenge themselves with the horizontal incision for fetal extraction. When facing difficult fetal extractions, clever solutions must be employed.
For example, if the fetal head is high and hard to extract, the surgical incision can be moved upward.
Todayâs patient has a highly floating fetal head, with some distance from the incision. When the doctor reaches into the patientâs uterus, itâs not only difficult to grasp but also easy to push the fetal head further into the uterus. The problem is that moving the incision upward increases the exposure on the abdomen, making the scar appear very noticeable. In such cases, a vertical incision would be preferable. Therefore, bold obstetricians do not casually move the incision upward. Todayâs Chief Surgeon, Director Yoo, a veteran of countless battles, certainly wouldnât do that.
If you donât move the surgical incision upward, you need to find other ways to solve the problem.
Clinically, many experiences and methods have been summarized to address this.
If the fetal head is away from the incision and floating high, one can press down on the fetal head to make it descend to the designated position. So, with Doctor Pengâs hand placed at the uterine fundus to nudge it, the goal is to bring the fetal head close to the incision for the chief surgeon to extract easily. If thereâs enough space inside the uterus, the doctor might even rotate the fetus half a turn; if the head doesnât emerge, they can expose the fetusâs buttocks first, grasp the babyâs feet and pull the baby out, separating it from the mother.
Doctor Peng pushed with effort. After a couple of pushes, he realized this baby seemed unfazed by the doctorâs efforts, reluctant to come out. Simply pushing the fundus might take a long time, and time was running out, so he urgently called out, "Forceps, forceps."
The doctor couldnât push with enough force, like a cart not moving, and had to rely on pulling force from the front. Forceps can grip the babyâs head to pull it forward. The only problem is that forceps might damage the babyâs head.
Director Yoo didnât immediately grab the forceps but instead inserted two fingers into the patientâs uterus to see if she could manually guide the babyâs head. Her hands, being somewhat larger, had difficulty entering to operate.
"Donât rush, stay calm," Director Yoo said to the other doctors, determined to stabilize the situation.
The anesthesiologist came over; Doctor Peng couldnât push alone, so another person came to help.
Director Yoo shouted to the anesthesiologist, "No need, you keep an eye on the patientâs vital signs."
This patient was slightly malnourished, worried about potential surgical accidents, and the anesthesiologist might be too busy, so itâs best for them to monitor the patient alone.
Immediately, Director Yoo instructed the two students: "You, go help Doctor Peng."
Following the teacherâs orders, Xie Wanying immediately went opposite Doctor Peng, ready to assist with pushing the uterine fundus.
"Put your S-hook in."
Geng Yongzheâs entire body stiffened, and despite his calmness, he was afraid.
This hook had to be placed beneath the childâs head; carelessness could harm the babyâs head. Anyone with medical training knows that compared to adults, a babyâs head is fragile, the fontanelles are not closed, and the neck is very soft.
"Come," Director Yoo guided his hand to place the hook.
The S-hook was inserted to press the uterine fundus, utilizing the lever principle to lower the fetus. At this point, with additional rear pushing force from two other doctors, success followed more quickly. Yet clinically, many babies donât play by the rules and donât follow the doctorsâ intentions.