Wednesday, December 12, 2007

In at the deep end - paddling like mad.

Hmm, well it seems I can swim!

My second day on LBS I was to be oriented/refreshed again with the plan to leave me be with someone to back me up at page or a push of the bell. I started at 0700 and entered the room to a young woman having her second baby, who was entering transition and restless. Spontaneous labour, all good, intermittent listening to bub, gone off the boil a bit?. Encouraging her to move to apply gravity and to help cope with contractions.

By 0735 there was strong involuntary pushing so I pushed the bell anticipating an imminent birth, a different midwife arrived and it was clear there was a babe on the way, with head on view. 0745 birth of a lovely floppy-ish baby boy. My preceptor took him over for a bit of resus (I was still a bit slow with clamping) but he was fine. Gave the oxytocic (just remembered) and all was good. Placenta came out followed by a gush, hmm. Fundus firm, trickle stopped? Perineum is intact - another gush, where from? Higher up? Can see the cervix and push it back - but does it have a tear? Gush, not happy, fundus firm again - or did it twitch beneath my hand? The room was filling up - thank God.

The short version was that she lost a little over 1500mls of blood, but the drama was over in 25 mins. By 0822 she had her baby in her arms (for the first time) and he got to work on her breast straight away, where he essentially remained, with only short breaks, for 2 hours. All 3650g of him (8lbs 1oz). She was so full of oxytocics that the intermittent uterine atony was under control, and she made it up to the ward OK, didn't have to go to Adult Special Care.

Before she left LBS I was assigned care of a another woman having number 3, her second planned vaginal birth after a CS. She had had a small bleed, and had maybe ruptured her membranes, but was contracting a bit. Her spontaneous labour built up over the morning to having 3 contraction in each 10 mins by 1230. Getting really painful, thinking about an epidural. Went to the loo, opened her bowels and came back to bed at 1300 draining meconium stained liquor and proceeded to a spontaneous vaginal birth (with no epidural, we sent the anaesthetist away at 1310 when we realised she had involuntary pushing and was fully dilated - she cried!) at 1322 of a 3960g boy (8lbs 12oz). Unfortunately she pushed quite vigorously and blasted his head out quite suddenly, thereby sustaining a partial 3rd degree tear (torn a little into her anal sphincter :( ). She had to go up to theatre for it to be repaired very thoroughly, as this type of birth injury is a nasty one, and frequently has long-term consequences for the woman with continence, and sexual comfort. Rats. The woman was very happy with her quick spontaneous birth in the end though, and wanted the tear fixed as best as humanly possible. Midwives always feel bad when 3rd degree tears happen, and she had had an episiotomy and forceps for her previous vaginal birth. I felt it go, but it often tears from the inside first, and this was in a different place from her previous epis. You have little control over these injuries sometimes. I had another midwife with me and she was very kind and practical, and fairly philosophical about the tear. She also finished the paperwork for me as it was time to go home! I had done a very full day's work!

A big day all around. So much for orientation! See if I can have a drama free day tomorrow. I swam OK - in fact it was quite exhilarating and I remembered more than I thought I would! Thank heavens I had had a chance to check a room yesterday and knew where things were in an emergency (for both births)

Welcome to the world little Shane and Felix. You are in my birth journal as babies number 28 and 29 of my midwifery career, with hopefully many more to follow.

1 comment:

Lesley (El Zed) said...

Wonderful stories, Laura. But I'm so glad I've finished having babies!
Lucky mums to have you with them .