Thursday, December 10, 2009

6 Babies Part II

So the first primip very slowly made her way to 10cms....this was after numerous position changes and using the peanut. She was also experiencing a lot of pressure and was very umcomfortable with that. She began to whine a lot. For those that know me, my tolerance for whining is minimal. I stayed out of the room as much as possible initially because none of the pep talks or support seemed to be helping her. Her family was clustered around her, offering encouragement and support. She just wasn't havin' it.

Meanwhile, the other primip was 8cms and feeling some pain. We got her epidural dosed and I broker her water. We got her settled again so I went back to dealing with the whiny primip.

The whiny primip had been pushing for awhile - some of her pushes were great and others not so much. The baby had a good bit of caput and momma had protruding ischial spines which were holding baby up a bit. I was a little concerned that she might not be able to get the baby out, especially if she continued to fight the process. After an hour and a half of pushing and slow but steady progress, we got her epidural dosed up again. I also kicked out the family except for the FOB. They were very understanding, and I kept them updated. I talked to the doc on call with me...he basically said to tell her she had 30 minutes to do something or he would come in and section her. Not the response I was wanting. She was potentially vacuumable at this point but he really needed to be the one to make that decision. I was so ticked off that he wouldn't come and evaluate. I went back to the room, where the patient was a little more settled after getting her epidural redosed, and told the patient what he had said. I could see that the caput was starting to crown. I then proceeded to talk to her as if she was my child. I told her she didn't need a section and if she would just suck it up and do the work, she could do this. I told her I wasn't letting her have a section....she was only gonna do this one way. And we got to work.

Forty minutes later, she delivered an adorable baby with a huge conehead after a 90second shoulder dystocia. Apgars were 1 min - 2, 5 min - 6, 10 min - 8, 15 min - 10. I thought I would have to change my underwear after the whole thing was said and done. It was nervewracking! The next day, I went to see her and the baby and both were doing great! Oh, and this was over an intact perieum - and the baby was close to 8 pounds!

The second primip by this time was complete and ready to push. She did a great job. We had a baby crowning fairly quickly. She also had an adorable baby after a 2 minute shoulder/body dystocia. The baby had apgars of 5-6-8. The baby weighed in at almost 9 pounds and momma just had a single periurthral tear that I threw a few stitches in. Change my pants again. Both doing very well the next day.

So two beautiful natural birthes. Then karma had to strike....and I get two shoulder dystocias.....geez.

I went home and got some rest. It's a good thing cause I was destined to be up all night on the Sunday night.

A woman came in who I had seen a few times in the office. She was 4cms in the office and was planning a trial of labor after having a c/s with her first baby. Her first baby was 9+ pounds and OP (posterior position) along with some chorio (infection in the uterus) - unfortunately a failed homebirth. She's tiny as well. Maybe 5 foot at best. I knew this baby was smaller - I estimated between 8 and 8 and a half. She was coming up on 41 weeks so was really hoping she would go into labor over the weekend. Otherwise we would be breaking her water on the following Monday.

She called me and let me know she was contracting and getting more uncomfortable. I suggested coming in. Two hours later, she finally showed up - just I am really starting to worry! Her water was broke as well, which she failed to mention to me. She was 4-5cms. So I had her walk for awhile alternating with rest. The plan was to wait until she was a little more uncomfortable then have her get in the tub. But then the baby was acting up a little - nothing major but enough that I wanted to keep an eye on the baby. Once I was happy with the baby again, we just never made it to the tub....the waterproof doppler couldn't be found so she would have to get out every 15-20 minutes for a quick listen. We decided not to bother with it. She did many position changes, with her husband on one side and me on the other. I did some massage of her back and later had her husband do some effluerage, whcih she liked. Like the other two women who birthed naturally, she was gorgeous to watch. So calm and relaxed. She was about 5-6cms, when I checked her 4 hours after the first exam. I was a little concerned about the slow progress but just tried to remind myself that labor doesn't always follow Friedman's curve.

In the meantime I caught a baby for the doc on call. This patient had a history of a precipitous labor with her first baby. She went from 5cms to 8 after walking. I broke her water, then got her in the tub. She was the type of person who never seems to be happy with anything but who knows...she was in labor after all. I found it difficult to establish a rapport with her (which is something that doesn't happen often for me) but the nurse was actually doing labor support! What a pleasant change. So I left them to it. She ended up delivering about an hour and a half after I broke her water. I was surprised as I didn't think it would take that long. So that was baby #5.

In the meantime, my other lady is continuing to do very well....seems to be getting more transitiony so I start getting a little more excited. Soon, she wants to push. I check her and she just has a small anterior lip which easily reduces with the next contraction. I tell her she can push when she feels ready. When I look at her pushing and her big belly I start worrying. I so want her to be successful. But her belly looks huge in comparison to her. But she very quickly crowns up and we have a baby! She pushed for 23 minutes. She had small periurethral tears. WOOHOO! She was so happy afterwards. I was so happy for her! Her labor from admission to delivery was about 8 hours....but anytime one has to stay awake all night labor seems long.

I left at 7am, when I went off call.

1 comment:

Joy (When Does Daddy Come Home?!) said...

And did you sleep for the next three days?!?! Makes me tired just reading about how busy you were!