Tuesday, April 28, 2009

The 16-year-old

When I got there, my 16-year-old primip was doing very well but also only contracting about every 10-15 minutes. We decided to check her and determine whether to send her back home or augment with AROM. She was 6-7/100/-1 but the cervix was still posterior and a little off center, which made me wonder. She wanted to stay so I broke her water which had light meconium (it was just my weekend I guess, for poop). I asked her to do some walking (which she didn't want to do because she was tired). She ended up in the tub instead.

Fast forward an hour and a half....she's feeling pressure so I check her and she's a solid 7/100/-1...with caput. Something is going on with this baby's head. I couldn't feel sutures to tell position because there was so much caput. She decides she wants an epidural so I agree to that. Afterwards I ask the nurse to change her position every 30 minutes or so (I can't always rely on the nurses to do this!). I go to take a nap (it's something like 12:30am at this point and I have been mildy sleep-deprived all weekend). Oh, before I do this we re-check the patient because I was thinking of putting in an IUPC - her contractions were difficult to trace and appeared to be dysfunctional as they were erratic. She's 9.5/100/0. So I don't put it in.

About 2am the nurse calls me to let me know the patient is feeling 'pushy' so I'm totally ok with that. I have the chills...can't sleep anymore, well dozed a little but between the chills and the fact that the 'doctor's den' is like the arctic.... Wait a minute....wtf? Chills? Not really getting sick, just sometimes get a little temp and general achiness periodically. I think it has to do with my autoimmune issues.

So I go to the room about 3am. She's been pushing for about an hour now. Naturally the nurse had her pushing in the same position the entire time. :p So we get her on her side to push for 15 minutes, then the other side for 15 minutes (the caput is crowning by the time we flip her to the second side!). Then back to semi-fowler's where we had a baby over a small first degree (no repair) vaginal wall tear. The baby was 8-1 and adorable! Unfortunatel;y the baby had a bit of a temp and was grunty so went to the nursery for observation. :pppp

I went home and went to bed - not another call for the last hour and a half of the weekend's call :0

And now I am back on call...


Joy said...

Do you wonder if maybe her young body just didn't know what the heck to do? I guess older women go through the same thing but it makes me wonder!

Glad everyone is doing well!

Ciarin said...

I don't know. A lot of times it's the opposite. These very young girls seem to have faster labors and more do without anything for pain than those that do. I've always thought maybe it was that they had more stamina/energy.