Saturday, August 22, 2009

So I thought...

...my last call was crazy. Wrong! My most recent call was absolutely stunning in terms of craziness! And it was only twelve hours...

I had to catch a fetal demise :( That was the start of my day.

Then I had another patient who was on mag for preeclampsia and on pitocin as well. She had to push for about an hour and a half but delivered a cute little baby over an intact perineum (with some asynclitic molding - no surprise because the baby was not that big and should have come a lot easier than it did).

Then I had a lady doing natural childbirth. She came in smiling at 7-8 cms. Her first two babies came really fast, especially once her water broke. So we broke her water and anticipated a baby really soon. Noooooo.....she delivered four hours later! I finally convinced her to try the tub and that's all it took!

Then I had taken over the doctor's primip that had been laboring all day naturally. As I took over, she was getting an epidural. I asked the nurse why she didn't try the tub when she was talking about how tense the patient was. She looked surprised and kinda stumbled over her answer. *sigh* It's a shame when women who want natural childbirth see the docs....unless they get lucky and get one of the nurses who are really supportive of that, they get no labor support. Anyway, the patient was kinda stuck at 8cms from what I had gathered so we put her on her side and put the peanut between her legs. The peanut looks really ridiculous but works everytime. It's just one of those tried and true tricks, like the tub. I re-check her and she's complete and feeling pressure. She pushes for twenty minutes and pops out this adorable 8 pound little girl over a few skidmarks! Pretty darn impressive for a first-timer :)

And I did all this while not feeling good :p Nothing like birth though to cheer a girl up.

8 comments:

Paula said...

What is a peanut?

Ciarin said...

It's like a birth ball only shaped like a peanut. It's about the size of a birth ball so it really opens up the pelvis beautifully. It is wonderful for women who have limited mobility...whether due to an epidural or for some other reason.

Holly said...

I don't mean to be antagonistic, but what about the pelvis does it open? You know the bi-ischial diameter actually gets narrower the further your legs are apart (unless we're talking deep squat).

Ciarin said...

When the woman is on her side with this between her legs, babies seem to rotate into appropriate positioning as opposed to the standard side-lying. It doesn't necessarily allow a baby to descend further, just more room to rotate. Make sense?

For example, women who are having slow labors or seem to be 'stuck' at a certain dilatation often have a baby that is malpositioned (you have to think about the power, the passage, and the passenger). This woman had progressed normally up until about 8cms...then just seemed to get 'stuck'. I couldn't be sure about malpositioning with her, just did the peanut on a hunch. I took over the care of this woman from the doctor so had never checked her prior to the time I checked her after using the peanut (where she was 10cms).

pinky said...

Sh1t back in the day we used to have really crappy epidurals so all the L&D nurses did really good labor support. We had to! We had a tub in every room. We would even get a reactive strip. Medicate the woman with nubain and phenergan then put her in the tub. Worked really well for non epidural pain relief. Nowadays folks will say, "but she will drown." NO, you stay with the patient. "but she will fall" That is why the spouse is there to help you steady her.

Holly said...

Thanks for the explanation re: the peanut. I'll put that idea into my back pocket. A lot of the hospitals my clients birth at have those peanuts (and lots of them have flat balls). Love new tools!

Joy said...

Wow, love the sounds of the peanut! I'll have to remember that if I need it.

Paula said...

thanks for the scoop ciarin!