Sunday, January 10, 2010

Back in Wonderland

I had an absolutely awesome birth recently. The only negative was that Nurse Crappy volunteered to take the patient. Seriously Nurse haven't figured out that I can't stand you?

She called me from triage to let me know the patient was there and was 6cms, her first baby. She had done the Bradley method but I had gotten the sense that she might not be committed when it comes done to it, when I had seen her in the office. I thought she would end up getting an epidural. Here's the convo with Nurse Crappy over the phone...

Nurse Crappy: Can she have an epidural?

Me: Did she ask for one?

Nurse Crappy: Well, no, but she asked a couple questions about epidurals.

Me: No order for an epidural then.

Nurse Crappy: Well can she have IV pain meds?

Me: No, she's going natural, studied Bradley, no pain med orders. They can call me from the back if she really wants them.

Nurse Crappy: Do you want a an IV?

Me: (while banging my head against the wall) No. Take her to the back, get her in the tub, and tell her I'm on my way.

Nurse Crappy: So no orders then?

I swear that's how the triage call went.

I arrived to find the patient in the tub. She's breathing perfect through her contractions, very calm and relaxed. She does ask me about an epidural. I tell her that she's doing so well and that I don't think she needs it. I tell her that I will do whatever she wants but don't want her to regret it afterwards. She doesn't mention it again. She does ask a little while later about IV pain meds. I talk about that option with her but again tell her that I really think she's doing a wonderful job and that she can do without if she chooses to do so. She doesn't mention it again. By this time she was lying on her side as that is where she felt most comfortable.

Fortunately, she was the only patient I had so I was able to focus all my attention on her. I did nursing care as well as labor support with her husband. I decided that Nurse Crappy wins, in this situation. She once told me that she loved midwife patients because she doesn't have to do anything....grrr. So, she didn't do anything but stick her head in the door twice...and that was too much. I've just gotten to the point where she is like fingernails on a chalkboard. I also got a much better nurse, one I very much enjoy working with, a little later.

About three hours went by and the patient wanted to be checked as she was starting to bear down a little bit, so I did. Surprise! She was supposed to be ruptured according to Nurse Crappy (and it's possible she had a leak or something). There was a large bulging bag of waters (BBOW)! And I mean bulging! She was 9cms with a very buttery cervix (meaning very soft and stretchy and very likely to melt away with a little more pressure). I asked if she wanted her water broke and she promptly said no. Not a problem. We continued to do what we were all doing.

A bit later she was really feeling more pushy so I rechecked her and she was the same. I accidently (yes, really) broke her water. She started having a contraction while I was doing the exam and my finger went through the membranes. It was a geyser. She immediately felt even more pushy. I told her to do some small grunty pushes as I anticipated that cervix would go away very quickly. A few minutes later I re-checked and she had a small lip which I easily reduced with one contraction. The baby had come down from -2 station to 0 and she began to push in earnest.

She pushed for about an hour, still lying on her side. She did try upright for a couple contractions but felt like the urge to push was less so went back to her side. She was a fantastic pusher, worked hard. She had been really worried about the 'ring of fire' or burning sensation that comes shortly before birth. She wanted to try cold compresses when the time came so I had that ready at the bedside. I asked the nurse to apply perineal support with the cold compresses while I just watched the head deliver on its own. It was so cool to be able to involve one of my fav nurses like that in the birth. She delivered an adorable baby with only a couple small periurethral tears. The baby was almost 8 pounds! And this was a petite women...very impressive.

Afterwards I told her that she was made to have babies and I hoped that she and her husband would have many. That baby came out with a perfectly round molding what so ever. She was beautiful to watch laboring and birthing!

I've had a couple other births, one which required the doc's assistance with vacuum. The patient needing the vacuum was a total princess. Some of the midwives and my BFF call me a Princess but I'm totally not like this chick. She had an epidural and was asking the nurse to scratch her nose! And the nurse did! She was snapping out commands at her family left and right. I kept waiting for her to start cracking a whip!


AtYourCervix said...

(Not another princess! Noooo!!!)

I love your Bradley birth story - that was awesome! That's what women really need - a good labor support team, people who will remind her of how well she is doing, when she starts talking about pain medications. Too often, we (nurses) are too busy with too many tasks and too many patients at one time, to be able to sit at the bedside and give those reassurances. Also, I talk and listen more with mom in between her contractions - sometimes she asks for drugs during the contraction, but doesn't really want drugs, and will state as such in between. Sometimes she really does just need that "you're doing great!"

Yehudit said...

Must be hard working with Nurse Crappy.

Can I ask you about those VEs.

VE 1. She was 6cm
VE 2. (3 hours later?) She was 9 cm
VE 3. She was ?still 9cm and broke her waters
VE 4. She was 9.5 cm (lip) which was reduced.

Just trying to figure out the indication for VE 3 and 4 - unless there was some delay at end of second stage - was there a reason to expedite delivery in this case?

Ciarin said...

It sucks to work with Nurse Crappy.

Indications...VE#3 Pt was feeling a great deal more pressure and urge to push - wanted to be checked. Broke water by accident as bag of waters was so taunt.

VE #4 Pt was actively pushing and couldn't stop.

No need to expedite second stage - don't believe I mentioned anything about 2nd stage??? Or did you mean first stage :)

Yehudit said...

Sorry, yes - I meant to type first stage. Was there a concern about progress?

Ciarin said...

Nope Yehudit...

sara said...

My first baby was born in Jan. very quickly after a 4 hour labor and about 30 mins of pushing (15 mins at home and 15 at the hossy) and her head was also perfectly round :) The ped noticed it when she came to check on her a few hours after she was born- "her head looks really good for one that just came through", she said. I couldn't agree more; it was like a dream! I can't wait to have another one.