Wednesday, July 8, 2009

The long and short of it!

I had a momma whose birth experience was tough, veered off the track of what she wanted, but then kinda returned back to it :) This was her first baby and she was planning natural childbirth. She a doula and a doula-in-training along with a terrific husband for support. As a side note, I remember talking to this couple as a consult only when they were thinking of transfering care to us. The husband was really leaning towards having a doctor provide care whereas the momma wanted a midwife.

She had been ruptured for about a day and a half with no labor. So it was decided to start pitocin and she eventually got an epidural also. Her labor progressed slowly throughout the evening and night. By the time I took over she was 10cms but very numb. The epidural had been cut off about an hour already. I had to go into the OR to first assist anyway and my student hung out with the patient and also tended to an induction that was there as well. The epidural finally wears off and the lady starts pushing. She makes slow but steady progress. Not all of her pushes were very effective so we tried multiple positions to encourage her progress. Finally, I suggest the toilet (don't know why I didn't think of it sooner). I had told the student that if that didn't bring on some significant progress then we may need to move to the next step (vacuum). Fortunately the toilet was very helpful and she delivered not too much longer after that. All told, she pushed just shy of three hours to deliver her handsome boy of 9-1! So we kinda got her back on track with her desired plan. Her IV was accidenly pulled out during pushing so we didn't restart it or pit :) She had no epidural in place anymore. She got off the monitor for a short time. And she got to push in multiple positions. Course we had some bleeding afterwards but not too bad and not surprising due to the size of the baby and the slogging of the uterus.

The other lady who was there for an induction was past 41 weeks and just ready to be done. She was having her 5th baby. She started at 1/50/-2 :ppppp. Here's her timeline....

10am - pitocin finally started after torture with multple needle sticks.

3:30pm - having mild cramping but no big deal, the nurse wants to increase the pit beyond 20mu/min. Ok. She's still the same exam.

4:15 - she wants an epidural now, and is 3/100/-2...ok, that was her plan anyway.

5pm - we arrive at the hospital from the office, the nurse had just checked her and she was 4/100/-2.

5:10 - she's not getting any relief from the epidural but doing well, her water breaks.

5:14 - she's 10/100/+2

Unfortunately another nurse had this patient and then turned her over to this nurse for the epidural. The other nurse sucks. She's the type who has a very unpleasant, gruff personality (which is surprising since she used to be a midwife in another country) and spends the entire delivery over on the computer charting and not paying attention to whjat we have going on!). She had nothing set up in the table :P Not a huge deal, I threw some gloves at the student and started setting the table.

5:19 - Birth of a beautiful baby :) What fun that was!!!!!!!!!!!!!!!!!!!!!!!!!!


Joy said...

Ugh, what a stupid nurse. I hope I don't end up with incompetent or rude/lazy nurses.

mitchsmom said...

When those multips decide to go, they mean business, huh?

I try to put my stuff in the room on the earlier side, b/c you never know!
I always tell my patients that the only predictable thing about OB is that it's unpredictable.
I especially get stuff in earlier for multips, and even more so an effaced multip. Those are the kinds of things you usually get an intuition for. Although, some nurses have so many precips that you wonder where that intuition is????