Monday, August 11, 2008

Caesar Queen

I'm home after a knackering day at work.

I was the midwife attending the elective CS today (a.k.a. the section queen). You carry a pager and run up and down to the wards and get to meet the women beforehand.

I was as busy as a bee, even though there were only 3 CS booked. I picked up an undergraduate nursing student too, who was meant to be in the day surgery unit, but it was quiet so she hung out with me instead. She wants to be a midwife, so she had a good time (I think).

The first baby was really big. Over 4kg, and it was a bit of a struggle to persuade him to come out! What a whopper, a welcome second son named Angelo. His Mum was unattended in theatre as her husband was minding the 3 y.o. outside. That was a bit sad, but we helped her to have a long cuddle with him before taking him to the ward. He was plump and gorgeous.

The second birth was from pregnancy number 11 for the next woman. She had a long and tragic obstetric history with two miscarriages, two ectopics, a neonatal death at 8 days and two stillbirths plus 3 livebirths, two of these by CS (including one classical section at 26 weeks). All babies but one of the stillbirths had been girls. In this pregnancy her cervix had been supported by a special stitch to help keep the internal door (the os) closed. She and her husband did not know the sex of this last baby, saying "It is up to God, this is our last child even if it is another girl". We were all most delighted to welcome a little boy mid-morning, who seemed vigorous at first, but started to struggle a bit with breathing after 8-10 minutes. Luckily I had hung on to the paediatrician for a bit longer, and she called her registrar to review him. His oxygen levels were only at 80% and he was pushing in his abdominal muscles to exhale and grunting and 'singing'. We took him down to the nursery where he was given CPAP to help keep his lungs from collapsing. Mum and Dad were pretty brave about sending him off so soon, Dad came too, and we were all agreed that God was actually pretty good to give them a son, and for there to be facilities to help him when needed. He was just a bit undercooked at 37 weeks and a few days, and I'm sure he'll be fine in a few days or so.

The student was getting quite an education about the role of the midwife! Today when little Mohammed went off, I had just finished talking with her about how the midwife is essentially in theatre for the emotional support of the mother, and the physical support of the baby, as the theatre staff are there for the clinical support of the Mum. I would in no way consider myself as flash in the neonatal support area, but today I knew a baby with respiratory distress when I saw one. Phew. I was glad I had the paed with me as we put the monitors on him and gave him oxygen, then the registrar took over the oxygen CPAP from me as he arrived.

One of the medical students I had last week mentioned how she saw me keeping tabs on so many things at once- blood loss, neonatal adaptation and respiratory sounds, guiding her hands, noting times and obs mentally while doing other things. I was grateful and slightly surprised to hear her observation, because I realized that she was right. All of a sudden I am doing all those things at once. Multi-tasking - Woo-hoo!

So, back to the day. I ran up and down stairs between theatre and LBS all day, retrieving paperwork, getting ice for blood gases, taking placentas to the fridge, getting changed, seeing women, taking babies to wards, all interspersed with standing for long periods waiting for surgeons to enter and go through adhesions etc, while teaching their own more junior staff the finer points of CS techniques. It makes my back ache to stand in theatre!

Our third baby of the day was another big baby, a near to term girl, who also needed to be squeezed out of the incision! In the end they used forceps. She was snuggled on to her mother's chest for a while before we headed up to the ward. Baby Sairharni weighed just over 4kg too, and joins her big brother in the family. She has the longest eyelashes I have seen for some time.

Back to LBS, paperwork, weighing placentas, showing the student the finer points of placenta examination, entering all the many details in the birth register, sending paperwork all over the hospital and then it was time for home.

It was a lovely day, but I am a bit achey. I've had some panadol, now its time for a cuppa, and a good sit down.

I feel another brooch coming on.....


Natalie said...

I followed you all the way and even felt the sigh of relief when you sat down for your cuppa! You do it all.

Frogdancer said...

They were VERY big babies....

what a day!