What Counts as Experience?

According to my birth log, a notebook I have updated since 2000, I have attended 476 deliveries.  For almost all of those 476 births I have recorded the mother's name and--variably, depending on my memory and state of exhaustion--her age and parity, the date and time of the birth, sex and weight of the baby, and whether I attended the birth while on call, on night float, or because I was there to "special" the woman on a day off.  As time has progressed, the entries into this book have occasionally expanded to include detailed notes about unusual labor patterns, unexpected rotational dynamics of the baby, psychosocial drama occurring in the birth room, my own exasperations, and the redemption of hope when--despite all of the above--a woman gives birth and holds her newborn baby in her arms for the first time. 

Lately I've been reflecting upon my experiences with birth and how my philosophy towards childbirth has changed since I was a student.  When I think about the evolution of this philosophy, I look at the 476 entries in my birth book and think:  "Is that ALL?"  The impression the last decade of sleepless nights and long, crouched-down labors makes this number seem absurdly small.

The problem, I now realize, is I have only counted/annotated the births at which I was primary attendant, or had my hands on in one way or another at the moment the baby was born.  The 476 entries in my book therefore exclude:

• Births I attended as a teacher or preceptor to medical students and junior interns (several dozen)

• Births I attended as a standby in case the newborn needed resuscitation (somewhere between 100-150) 

• Births I witnessed just because I heard a commotion in the labor room and ran in just to make sure everything was OK (countless)

• C-sections for which I was primary surgeon during residency (about 50) and first assist during residency and beyond (well over 150)

• C-sections I attended in case the newborn needed resuscitation (over 200)

• Births occurring after my involvement during the mother's labor, either observing or actively managing (uncountable hundreds during residency, and a few dozen since)

• Births or C-sections which I did not attend or labor with, but was involved with complications following the birth of the infant (several dozen very notable cases)

No wonder 476 seems like such a small number.  The truth is, my experience of birth is informed as much if not more by these births that "didn't count," and therefore didn't get numbered or entered into my birth log.  There must be over a thousand such cases or stories, many more than births I actually attended, and not to mention the thousands of prenatal visits I've done.

I now realize how limiting it is to count only the cases or procedures you've "done" with your hands.  So much happens before, during and after a birth that it is the collective experience of these events that represents the foundation of a provider's ability.  The same could be said for any process in which we value wisdom and a long memory.

Now that I'm smartening up, I'm going to begin recording all the birth experiences I participate in, either in my personal journal or in some other format like the birth log to which I have been so faithful.  I'm also going to share some of these stories on this blog (following my usual confidentiality principles) under the category heading "Labor Files."  Some of these stories are quite wild and wonderful and affirm the good outcome of natural birth processes.  Others are darker and discuss unexpected developments during labor and birth.  I think the full range of experience needs to be told, here and in all forums, because these experiences inform what we do as childbirth attendants, health care providers, and consumers of childbirth services.  

So look for the Labor Files, coming to a Rural Doc near you.

Comments

[Christine @ Live to Learn]

Can't wait to hear from your birth log. I find birth fascinating, having personally had 5 births of my own.

[dragonfly]

Cool! I love your birth stories.

[DrCris]

This is always an interesting topic. We have experience logs for surgical procedures and it is considered really poor form to include cases you have witnessed, and been less than first assistant. I agree with that, but it does mean that if I see a liver transplant, and therefore understand something of what that procedure involves, standing there for 6 hours, that experience is not counted.

Those experiences are vital to how we develop as doctors. But it is difficult ot quantify that experience, as its impact is different for each practitioner.