Original Video
Video with Behind the Scenes Commentary
This wasn’t my first training video, but it has been the most watched. Over the years, it’s been viewed many millions of times.
This also wasn’t my first delivery video. When I was working with the Navy on a project, I needed a short vaginal delivery video. Fortunately, a husband in the delivery room was videotaping his wife’s delivery and he provided me a copy, with the necessary permissions.
Unfortunately, the quality was not very good. The lighting was too intense, oversaturating the image. The field of view was too wide, so important details couldn’t be seen. Also, the resolution was relatively low. It wasn’t a great video, but since it was the only one I had, I went with it.
Later, I found a patient willing to have me video record her delivery. She understood it would be for educational purposes, and that her identity would never be revealed.
She went into labor and I brought my equipment to the hospital. The videotaping did not go well.
The fetus was presenting direct occiput posterior. I was OK with that, but I felt that the delivery would not be particularly representative of a normal vaginal delivery. Worse, after the delivery, the camera was inadvertently turned off, so I never did record the delivery of the placenta.
As it happened, that same night I had another patient in labor with her second baby. She overheard me discussing the videotaping with the nurses, and offered on her own to let me record her delivery. This was great, since I already had all of my recording and lighting equipment at the hospital. This is the patient I ended up using for my 5 minute vaginal delivery video.
I used several halogen lamps in the delivery room, but they were all pointed at the walls or the ceiling to diffuse the light. I turned off the overhead spotlight as it was too intense for the recording.
For the delivery, I left the bed intact and did not use stirrups. This is how I typically performed my deliveries. The advantages for me were an easy place to set the baby after it was born, and easy access for students or residents who might be assisting me. They stand on the other side of the bed. If I encountered any complications, it was easy enough to reposition the patient and engage the stirrups built into the delivery bed.
This patient had a good epidural in place and was able to push or not push however we directed.
The patient requested an episiotomy. She had one with her first baby and believed that she would heal better with another one. I think she would have done fine without one, but she was pretty insistent, so I went along with it. Having practiced obstetrics during the years when everyone received an episiotomy, up to where almost no one receives an episiotomy, I was pretty flexible about this.
After delivery of the head, I paused, as I’m in the habit of doing, to allow the birth canal squeezing of the baby’s chest to drive out some of the fluid accumulated in the lungs. I also take time to check for a nuchal cord, which this patient had. This was an unanticipated bonus because I could demonstrate slipping a loose cord over the head.
When I went to edit the video, I needed to make a number of decisions.
I wanted to keep the total duration of the video to 5 minutes. This was in part because I had other videos that were 5 minutes in duration. It was also because through experience, it seemed like students were willing to watch a video, so long as they knew in advance it would only last 5 minutes. And 5 minutes is plenty of time to demonstrate most of what I wanted to demonstrate.
I decided on a minimal script, with background music of a classical guitar. This made the video more artistic, but arguably less educational. I justified the compromise based on my view that the video would be watched both my students, and also the lay public. I didn’t want to drive away either group.
Two problems arose during the editing that I had to live with.
The first was that by keeping the video to 5 minutes duration, I had difficulty conveying the realtime aspects of the delivery. It can take a while for someone to push out a baby, and this video doesn’t capture that information very well. The other problem is that while some sub-procedures, like clamping and cutting the umbilical cord, could be shown in their entirety, others could not. The repair of the episiotomy was very abbreviated, capturing not the entire procedure, but only a couple representative aspects of it.
For the narration, I used my own voice, as I have in my other videos. My voice is not the best for narration, but it is free and always available. I worked off a script, recording the narration in a studio-like setting in my basement. The microphone was an Audio Technika 3035 with a spit shield and Lexicon Lamda pre-amp.
I used the free audio program, “Audacity,” for electronic post processing of the audio.
For final assembly, I used Pinnacle Studio, laying down the video track first, followed by the music track, and then inserted individual audio clips.