Wednesday, September 10, 2008

24 hour call on the new midwifery service

I did my first 24 hour call shift on the new midwifery service. I was quite busy with things during the day. I started the day by missing a precipitous delivery. A Muslim woman came in with her husband completely dilated and ready to push...and it's her third baby! I'm sitting at home, showered but in my lounging clothes. Damn. So I change and go rushing off to the hospital. I have the secretary call for a resident to stand by cuz there is no way I will make it. And I don't. I walked in as the placenta was coming out. And appreantly it was a whopper of a birth. The baby came out fine but the resident happened to be a male so the woman refused him. They apparently comprised by allowing him to stay in the room while the nurse caught the baby under the sheet. *giggle* Understandably the nurse did not want to be alone in the event of an emergency. So, I show up in time to check out the perineum. They don't want me to touch her there since she is in pain and tired. I try to explain that it will only take me a few seconds to look and I will be gentle but that I really need to look. She finally consents to let me look after I agree to let her have a shot of pain medicine. She has a first degree perineal tear that fortunately can go without repair - whew.

I get the rest of the story from the nurse afterwards. The woman came in screaming and crying...very much out of control. The husband was crying and saying his wife was dying...asking for an epidural...asking for a cesarean section, etc. My conversation with the nurse went something like this....

Me: I thought she had had babies before?
RN: Yes, two of them.
Me: Vaginally?
RN: yes
Me: But they didn't seem to understand what was happening?
RN: Right.
Me: Ooookkay.

Now granted, her first two babies were in another country. So from her perspective I can only imagine what it must have been like to be in your first US L&D room in extreme pain, with a bit of a language barrier, and everything happening fast. But she was very much ok once it was all done and over with, thanking us profusely....(I'm thinking, gee all I did was look at your bottom...but ok, you're welcome).

I went and made postpartum rounds when I get a call from another nurse. She has a doctor patient and was asking me if I could put in an IUPC (intrauterine pressure catheter). Umm, did you call the doctor and ask him? The nurse says no. Well, don't you think maybe you ought to? Oh, ok says the nurse. I told her I would put it in since I was there if the doc wanted me to. She calls me back and says yes please. So by the time I finish rounds and get back there, the patient (who is preterm at 34 weeks) is complete and ready to deliver. So intead of the IUPC, I stand by for delivery until the doc can come. I caught the little peanut and then was off to the office for a meeting and then a few patients to see. I followed that up by attending a lecture on Preeclampsia which I enjoyed. Then home I went.

The night was quiet - I had one patient call trying to determine if she was in labor, which she ended up not being. Slept the rest of the night!

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