Monday, September 1, 2008

Many birthdays later...

Hello world.

It has been 10 days my last confession and I have not been idle.

I have just completed a five day stint where we have alternated between being quiet, and crazy busy, or at least my allocations have been. Some of those shifts I have been scuttling as fast as my feet will carry me, and I pass the various desks where staff gather and I will see a full house of midwives all chatting, unallocated, rooms all checked and ready and cleaning done, waiting for the next woman to come through the door. For an hour or so, some days, that has been me too. Then I will be sent off somewhere, or given a job to do which leads to something else.

If there has been a theme to my 5 days it is meconium stained liquor. I haven't seen a nice birth (myself) for days. They have happened though. To others. Sigh. I've seen some pretty yukky births actually. (Reading back - I just remembered that I supervised a nice normal birth with a resident doctor that was pretty nice on Thursday, that seems so long ago. Oh hang on, that was a fast birth where the baby's face was really bruised, and then she had a PPH.....oh bugger, welcome to my world this week) .

Last Friday (my sister's birthday - hope you're feeling better hon) I was allocated to two rooms with a newish student midwife, almost half way through her course. We had the care of two nulliparous women, one aged 16, and one aged 24. The younger one was quite complex, with many issues that were going to need some tactful handling including a very intrusive mum who had, umm, 'boundary deficits'. The background was quite tricky, but I was a bit relieved when Mum announced she was going home to get some sleep and she was going to leave her daughter to feed herself if she was interested (as opposed to mummy holding the spoon for her). Phew. I left the young couple to go for a walk and do their own thing as she was not in established labour and knew to return if anything interesting happened.

We scooted into the next room to meet an emo-looking couple and their friend. The woman was contracting frequently and quite vocal, growly and frowny with the pain. She was quite funny really, and would say things like 'rrrrr, I hate your dick! Its NEVER going near me again!' Her husband was really shy and quiet, I never heard a voluntary peep out of him, literally not a peep. He just blushed and cringed and slunk away, poor guy, but she would demand his hand with each contraction so he had a role! Their friend was a cheerful and practical young woman, expecting her second child in 2 months time so had some experience and was very encouraging. We introduced ourselves and got the story on the pregnancy and the labour so far. She was 10 days overdue and had presented with reduced fetal movements and a greenish discharge. ? Waters had broken? There was not much fluid around baby so she was offered a gel induction straight away to get things going. The trace was good, baby was apparently in healthy shape, but there was nothing draining in the way of fluid... I left the student midwife with her, to settle in and help her cope with contractions for a while, before she was due for assessment.

I shuttled between rooms for a while, sorting paperwork into piles in case of rapid need, getting more background on each woman. We went to tea, said goodbye to the morning staff and settled in for an evening shift. Would either of them birth before the end of the shift? Would the student midwife get a catch? I was just in seeing Miss 16 when the student midwife came for me at a run, 'come now'.

I sprinted after her, the trace showed a serious dip in heart rate. Over we go sweetheart, onto your side, no? Not improving? Other side then. Ah there we go, its coming back up now. The woman's eyes were bulging in panic, she was praying and urging her son to be all right. She was a big girl and couldn't move fast, and was quite feisty and highly strung. I didn't want to scare her, but we discussed what had just happened, possibly due to there being less fluid around the baby and his cord may/likely have been compressed and caused the drop. The trace had been fantastic, the consultant had just been in to see them and commented how good it all was, and now it was time to reassess her cervix. She asked me to do it rather than the doctor, yep, no problem. There was very little change from 6 hours previously. This was disappointing, but the decision was that the hormone drip should go up for a while, and that we hoped it would help the cervix open. Yes there were plenty of pain relief options, we would discuss those when the time came. She'd coped really beautifully up to now, lets see how she got on. In the meantime I reminded the student to press the assist bell if the heartrate dropped like that again and I wasn't with her. We had a brief but honest discussion about what may happen if the heartrate dropped again, and the possibility of CS was raised if there looked like a serious compromise of the baby. Mostly it doesn't happen too frequently, and hopefully you will tick along nicely and push this baby out in this room, into our hands. That's our plan!

It took a while to get the hormone drip organised. The doctors were having their round, communications were slightly delayed. The hormone drip was eventually started really slow. In the meantime the other young couple were waiting for an assessment, and maybe some pain relief as she was contracting more frequently, and she was due for some antibiotics. Every time I picked up my gloves the phone would ring, or she was in the toilet, or something would crop up. I had the antibiotics made up ready to give Miss 16 and was just inviting her to come over to the chair when the assist bell went for the other room.

I shot across, it was another serious dip, the room was filling up and the woman's eyes were wide with panic again. Hormone drip off. I fought my way to her side and talked /coerced her into cooperating with the docs for a quick internal assessment as we struggled to find the heartbeat again, even with a scalp-clip. Crap! Right- said the doctors - we're going upstairs - call a code! I called the code through, hung up and grabbed Dad by the shoulder and said 'get your shoes hon, we're off to theatre, stick with me'. Within one minute we had left the room, the prepared notes bundled up en masse and we headed for the next floor.

My goodness there were a lot of people in the theatre! It was an unfamiliar theatre to me, and I had trouble finding the fetal heart monitor, but eventually we found it and the FH was still pretty low. The surgeon made a decision for a general anaesthetic (GA). It was an agonising wait, with the student midwife and I focusing on the woman as she went under, promising her that we would look forward to meeting her son soon. When it is a GA dads are not allowed in theatre. The student went out to tell him of the progress, and we would be out again when his son was born.

It was not pretty. The surgery was fairly straightforward, and our hospital has a method for holding up a big girl's gorgeousness to help them get to the CS site without another person being scrubbed to hold it up. The surgeon needed me to apply upward pressure on the head to release it from the pelvis, which is tricky to do while crawling under the sterile drapes. I was apologising to the woman as I did it, but it only helped a little. After a struggle the surgeon finally released the baby from the thick meconium filled uterus. She was white with the effort, and told me later it was the most difficult release she had ever done. Baby was limp and green.

The baby went straight to the crash team, who finally got him breathing after 5 minutes, but his lungs and stomach were pretty full of mec and he was stained with green from head to toe. He headed down to the SCN on a ventilator, but fighting it already. His young Dad went with him, crying quietly, but relieved to see him alive. We went back in to see his Mum again and tell her (even though she was still asleep) that her boy was doing pretty well so far, and then returned to LBS.

The surgeons emerged shortly afterwards, all a bit subdued, and knees knocking from the aftereffects of adrenaline. We all felt it. I hope I don't experience it again for a long time.

I have seen the parents once and baby twice since. Young Zachary had a good evening and even came off the respirator that evening and was in the bath getting the mec scrubbed off him when he slid back into respiratory distress. Both lungs collapsed within a couple of hours and he has been a pretty sick young man, but has improved significantly today, although he will be in the nursery for a few weeks at least. Mum was chirpier than I expected and was recovering quite well in herself, and proud of her son's fighting spirit, and was reassured by each tiny step off the machines again. We had a long debrief chat and rehashed the events, and I filled in some bits of the picture for the two of them. I hadn't slept well since that night, and was so grateful for the chance to see her and give her a hug, and tell the two of them how brave they had been in the emergency. She said she had initially been angry, but as soon as she saw him about 10 hours afterwards she felt it melt away when she saw how sick he was. I think they will be OK, after a very close call.

The student midwife played a really important part in that birth. She hit the assist bell at the right time, and kept her head and stayed focussed on the woman, and has visited them as well. I couldn't have asked for more of her, and made sure she knew she had acted very well in the emergency. She got a lengthy comment in her book detailing her actions.

So, that was a long story about part of Friday's shift. (Sheesh what is it with me and students? They sometimes get more than they bargain for!) We had dinner and then focussed on Miss 16, giving her antibiotics, running her a nice bath for pain relief, eventually assessing her and finding she had cracked on with a bath and hotpacks for comfort, plus two panadol! It was the end of our shift.

The night shift midwife reports it was a beautiful birth on all fours, her Mum arriving loudly just as the head was crowning and being firmly shushed, and not spoiling it too much. Everyone was most pleased with events, and very proud of her. The midwife got a second quick birth that same night, where a woman walked awkwardly in to the LBS and said "I don't think I can get on the bed" and when encouraged to push where she was standing, proceeded to deliver her baby into the midwife's waiting hands 3 minutes later. Aaaahh, how yummy. The midwife was all glowing and teary describing it to me in the morning. Half her luck.

I'll tell you the stories of some other birthdays another time.


Natalie said...

You get me on the edge of my seat!!

Anonymous said...

Your story of the emo couple really had me giggling. I had a tremendous amount of trouble during my son's birth, and your other couples story brought back some rather vivid memories. 11 years on, I can smile, but then? No....

infomidwife said...

Wow, you tell a good story, I was holding my breath! the students working with you get a great experience.

mtnchild said...

Aside from being a wonderful midwife, you are a fantastic story teller. You have so much compassion to help these women that I'm glad there are people in the world like you!

em.s said...

I love reading your blog. You make being apart of a birth sound so amazing. I look forward to the day my partner and I are experiencing it (jan09)

potty mouth mama said...

I love reading your birth stories. I think I'll pop over to your blog for a few minutes, and wind up reading everything.