I had a busy weekend on call not too long ago....are you ready to hear about it? Here goes...
Friday night was quiet. I had one page from triage around midnight. It was a patient having her first baby. She was initially 2-3cms then 3cms after walking for an hour. She was contracting regularly and uncomfortable with them. I ordered therapuetic rest fro her and sent her home (morphine shot - works by giving momma some rest - when she wakes the prodromal labor will either be gone or will have turned into active labor.) In hindsight, I don't really think it was prodromal labor. I think she was just in very early labor. Why do I think this you ask??? She came back around 6am Saturday morning and was 8cms!
I rush on in. The patient is doing incredibly well.....by the time I get there she's completely dilated and the baby is at a +2 station. I send the resident scurrying off (she was standing by for me) and we get done to business. The patient is doing a beautiful job of pushing her baby out. She is so calm and chats in between the contractions!?! Her boyfriend and family are all present and doing a very nice job of being supportive. I guide her through the delivery of baby #1. She does an amazing job. I repair her tear and off to go check on another patient who I admitted while on my way in.
This new patient was also a primip (first baby) and had come in since her water had broken earlier during the night. This patient was planning an epidural and I had the nurse start pitocin as she wasn't in labor. Her cervix was a fingertip/75% effaced and soft when she arrived. She was also ready to get things going. She was comfortably ensconced in her room with lots of family present. At first I thought the family would be obnoxious but as the day went by, it was the patient who was obnoxious and the family was great! :p I told her I would check on her later.
I then attempted to leave to meet my mother for some Christmas shopping. I was halfway to the mall when I got a page from a personal patient of mine. I had caught her first baby with a student midwife and had spent this pregnancy with her as well. My plan had been to catch this baby even if I wasn't on call. How nice of her to go into labor while I was on call! She's been contracting all night and her water broke a couple hours ago. I suggest she come on in as she says the contractions are now 6 minutes apart and getting stronger. I turn around and head back to the hospital. She arrives a little later and is actively laboring....although you can't tell it by looking at her! She's 5cms and doing beautifully. We get her in the tub where she labors until she's ready to deliver. She moves to the bed and pushes out a gorgeous baby #2 over an intact perineum in six minutes flat. The enitre time, she remained so calm and focused. What a beautiful birth goddess! I aways wish I could take pictures of women when they look like this...But it's so private and intimate. I just want women to see how beautiful they look when they are in the throes of labor. Anyway, she delivered only a couple hours after arriving. Nice.
I check back on my primip who is slowly but surely getting into labor. She's had a couple doses of stadol but isn't quite to the point of being ready for an epidural. She's 3cms now. I tell the nurse if she asks for more stadol again, to go ahead and let her have the epidural. No exam. After all she's been ruptured and if I don't put some specific guidelines down, some of the nurses will check patients frequently even with the water being broke. I decide to head out and try to meet my mom again.
I manage to get lunch and some shopping done with my mother. While at lunch I get a call about a new patient. This patient is also a primip who came in for a labor check. She's 4cms and crying I guess...wants an epidural. Ok, go for it.
I head back to the hospital to check on everyone. The primip on pit has an epidural and is very comfy. I check her and she's 8cms now - woohoo! The family has multiplied...there are about 12 people in the room - no exaggeration! The nurse has told them no more than four people. However, there's not a policy. It's really up to the provider. They want the soon-to-be grandparents to be there along with the FOB, which makes 5 people. I tell them that's no problem. I normally don't put any limitation unless they are interfering with the woman and her labor or if there are complications. She had meconium and so we would also have the neo and nursery nurse there as well, so it was gonna be pretty crowded.
I check on the other primip and she's also comfy with her epidural. She's 6cms and intact bag of water. I leave her be as I am afraid that her fast progress will put me into a situation of trying to be in two places at the same time. I didn't need to worry. The first primip sitch turned into a nightmare and she wasn't gonna deliver anytime soon.
To Be Continued...