Friday, March 6, 2009

The Continuation of Crazy Call

After I finished in the OR, the lady in the tub was dragging her feet...or her cervix I should say! She was hanging out at 9cms. And decided she had had enough and wanted an epidural. She was not interested in trying anything further for pain management so one epidural coming up. We let her rest for a bit and she progressed to 10/100/+2 about an hour and a half later. She was pushing with the nurse when I came in to check on her. The ladies in the room (the family is from Africa) motioned for me to come and cut her to get the baby out. She had been pushing for maybe ten minutes at this point. I shook my head no...I'm not cutting! That's an absolute last resort - not for a patient who has been pushing for ten minutes with great progress and a baby looking fine on the monitor. But I couldn't explain all that to them unfortunately.

So, she continues to crown but then hits She had this tight band that just wouldn't stretch anymore, nor would it just tear. It was literally holding the baby's head back. The women surrounding me are looking at each other then me, then speaking rapidly in another language. I know what's going on. I'm thinking, this band is like steel...maybe I will have to cut after all....but baby looks ok....I decide to continue with massaging it and her pushing a little longer. I am glad I did - she delivered over an almost completely intact perineum.....barely a tiny little first degree vaginal floor (where the band was) that required no stitches. Perineum was intact! Woohoo! Afterwards, lots of hugs and kisses from the women :)

Next, was another scheduled section that went smoothly with me doing the skin incision again.

Then I hunkered down to watch the final two ladies laboring. The induction lady with pelvic pain, was plodding along slowly still so I broke her water and put internals in at 5/70/-2. Baby was looking great! The patient had just gotten her epidural.

The other, was doing her thing and just wanted to be checked. At my suggestion. After all, she had been there now for something like 6-7 hours with no apparent signs of a baby coming. She was 6/100/-1 with a bulging bag, which was a surprise as we had thought her water had broke about a little bit ago (which is what I hoped for so I wouldn't have to have the whole 'break your water' talk). So I have the whole "break your water to get your labor moving before you wear out" talk, seeing as how she had been laboring since 9pm the previous night with no sleep. No go. Ok....2cm in 7 hours is not exactly normal labor progress. But there are some weird dynamics going on so I don't know if that was contributing or what. I just stayed the heck out of it. I guess mom was tryning to run the show, appeared to not know what she was doing as she was making strange statements i.e. "Oh, maybe this will be the last one (contraction I guess)" or "soon, the baby is coming soon". I believe in encouragement but let's keep it real ok. Later I found out that the mother was snapping at the husband (who was doing really good support) and giving contradictory advice to the patient (for example - when the patient reached 2nd stage, "don't push too hard, just a little push then breathe through the rest of the contraction" - umm ok, we'll have a baby five hours later at that rate!). Anyhow, it was just odd all around.

So another patient comes in labor. She had been a doctor patient during her prenatal care but claims she is a midwife patient. Ok, whatever. She had ruptured her bag spontaneous earlier that afternoon and was 4/100/-2. She was wanting an epidural once she started to really hurt so we sent her out to walk in the meantime.

Meanwhile, my induction lady is moving along a little better.

By this time it is well into the evening...ninish or so.

The lady with her mom as a doula, wants me to check her again. She's 9/100/-1, and finally consents for me to break her water. She wants me to do it while she lays on her side...ok...we get her all settled...then she has to get back up to go to the bathroom. *sigh* I know she was scared, I totally get that. But it's gonna hurt more at some point. Anyway, we finally get it done and she is pushing about 45 minutes or so later. I leave her be to do her thing, as another patient has come in for a labor check.

This one is a personal patient of mine so am very happy to see her although I am not wondering if all of the March babies are trying to get born on my call or what!? She's 4-5/100/-1 and looking active. About this time I send her to the tub as my induction lady is now approaching a section :( So the CRNA will be tied up for a bit and this patient has planned on an epidural.

My induction lady finally made it to 10/100/-1 after two hours of struggling with a persistent anterior lip. Now she's getting hot on me and my baby is tanking. She pushes decently but would have a lot of work to do and I just am concerned that the baby won't hang in there long enough. I call it ....and the patient is ready at this point. Naturally my doc is unhappy about coming in for his fourth section of the day (another midwife had a personal patient of hers who was being induced - normally we don't have many inductions- for being almost 42 weeks and ended up needing a section). He tries to give me a bit of a hard time about 'all these inductions' - I quickly point out that the other three women were all spontaneous labors.

Shortly before this, weird vibe patient had delivered very nicely. I did some perineal massage with the saffron oil she had brought and she brought her baby out over a small first degree requiring no stitches. But guess what happens? The placenta decides it like sit in her. She wants no intervention. I give her hour goes by. Bleeding is absolutely fine so I can afford to be patient and try to get her what she wants. However, eventually, I gotta make things happen. I basically give her the "ok I tried to do this your way, now we are doing it my way" chat. And we finally had a placenta another hour after that without me having to get my doc to intervene. Whew...I was happy it was over with. Later I heard from another midwife who rounded on her the next day, that she was very happy with her experience and thrilled with my care. Good, after all, it matters most what her perception of the experience was. I am glad it was good :)

During this time, previous doc patient, not midwife patient screamed her baby out....yes, screamed. That was the longest, loudest ten mintues of my life I think! A conversation we had at one point during this screaming...

"Pull the baby out!" (her first baby was operative vag delivery)

"Midwives don't pull babies out"

"Then get me the doctor!!!!!"

"He's in the OR, so you are on your own my dear"

"You're mean!!!!!!!!"

We all tried hard not too laugh but it was funny! She did great though, nice delivery, screaming aside.

My induction lady had an adorable baby that was doing pretty good, aside from coming out with a temp.

So my personal patient was left. She had also progressed to complete at the same time as the screamer. She pushed for a bit and delivered a beautiful little girl over just a couple skidmarks!

I charted for an hour then went home to bed at 5am.

My pager went off at 5:30am. I vaguely recall admitting another laboring patient. It was her fourth baby and she was 6-7cms. However the nurse told me she looked quite comfortable. I took that as a sign to go back to sleep, which I did. I'm not sure if I could have driven safely back to the hospital as I was trying not to fall asleep on the way home. Fortunately, this lady didn't have a baby until tennish.

And there you have it!

No comments: