Tuesday, November 4, 2008

Back to night shift

Just a quick check-in before I start night shift again tonight.

I worked last weekend and had two very different days!

On Saturday I met a young couple having their first child. In spontaneous labour, not wanting any pain relief, very private, from a non-English speaking country but they spoke very good English, which is always a help because my Arabic sucks (I have three words). She declined the opportunity to have her baby caught by a male resident doctor, so I was actually in with a chance at catching this baby myself!

She laboured really well, steadily and stoically. It was such a breath of fresh air to see her. No drips, no CTG, no drugs, just massage and movement. Gripping our hands and calling to God to help her. Membranes intact, walking well. I offered the shower, or a bath for pain relief, she chose the shower, but she didn't seem to want to be away from me for too long. So I stayed, and talked soothingly to her, encouraging her, applying counter-pressure to her back with the pains. The room was fairly quiet, the day drifted away.

Earlier we had talked about the usual progress of labour, how she was smiling now at 3-4 cms dilation, contracting 3-4:10, but things would heat up and get intense and she may feel desperate and out of control and restless. That was all normal, I would welcome those signs and she should trust her body and allow it to function in this way. She looked a bit nervous but secretly determined, and a bit excited at the prospect. Sometimes I will explain that the intensity feels a bit sexual, and this is when they can reach for their partner and focus together, as they complete the activity that started 9 months ago. It is really intimate, and often noisy in a similar way. My job is to hold that space for them, and help establish their confidence to get through that intensity together.

And so it unfolded. She did so well. He did so well. In the last 2 hours or so I barely left the room, as she entered transition, trying a bit of gas briefly, then throwing up and getting back in the shower. She was just beautiful, unveiled, naked at times, breathing hard, reaching for us and accepting our assurance that this was exactly right, prevailing, pushing through, napping between contractions then rousing to focus again.

At 8pm her waters broke in a gush. Could she feel a baby in there? Have a feel! No, she wouldn't but I could if I wanted to. I could feel him quite close. I guided Dad's finger gently in, he gasped in delight, his jaw dropped! Go ahead and push. By 8.10pm there was suddenly a head well on view, and I laughed and scrambled to another pair of gloves. Their son was born at 8.16pm, with one hand tucked up under his chin, and a full head of hair, and an intact perineum for Mum. What a triumph for her, what a delight all round. All 3kg of him. Just beautiful. So clever. Baby Mohammed tucked in for a feed quite quickly, Mum lying on her side and resting after her efforts, both of them relaxed and sleepy after a big day. What a natural she was, she should definitely do that again!

Noting his birth later at home I realised that he was the first baby I had caught all by myself (no midwifery or medical student, doctors, intruments by docs, or gone to CS) since 12th August. There was a second midwife present, but I was the only one to lay hands on him to birth him. I am quite fussy about calling a baby 'mine'. I must be the primary accoucheur. There are many, many babies that I suppose I could call half mine, where I was gloved up and guided hands, then someone else 'got the catch', with me as secondary accoucheur. Even for the babies I have seen through to CS lately after long labours, where I am listed as witness to the birth and I have signed the birth certificate forms. But there is something pretty special about seeing and feeling their wrinkled scalp appear, watching the face emerge and blowing bubbles or mewing a bit on the perineum. I love that bit the best I think, when they are just head out - poised between worlds, a soul hovering in transit. Then to guide a baby's shoulders out after waiting for their dear little head to turn, then placing them in their mother's arms, or helping Mum or Dad to bring them the rest of the way out that is, oh, just sooooooo amazing. There were 3 people in the room, and now there's 4 people in the room. Yay!

So full of the joys of Spring I waltzed into work on Sunday morning. It looked like I was going to get another one, a young primip at 8cm, labouring all night, but no. Her progress was really slow, really slow, and she was unwell, febrile, tricky epidural, offensive smelling liquor. She was a big girl, and quite immobile, a bit passive. She ended up having a CS mid-morning, baby a bit flat, needed some resus, really whiffy, probably with sepsis, but not doing too badly really. Poor love. Lovely family, that little baby boy P, will be well loved and cared for. He was a big'un too! When we took him down to SCN he weighed 4.220kg (9lbs 5oz). I saw his Mum in recovery and she was just relieved it was all over, and couldn't wait to get down to see her son.

I returned to LBS gasping for a cuppa (11am) but no - I was sent straight back to theatre with another woman who was opting for a CS due to a big baby. She was another really big girl, we used special lifting equipment to move her safely onto the table. There were delays for one reason or another and by the time the baby was born at 1301 I was getting really cranky for some nourishment! Further delays in the ward receiving the baby, and I finally took baby S to the ward where she weighed in at 4530g - (10 lbs) with an enormous head - 40cm (av. = 34-36) - the biggest I have ever seen on a baby - her head looked like a bowling ball. Good decision on the CS! No wonder that head hadn't entered the pelvis!

By this time I was feeling quite vague and trying not to cry (I really ache when I'm standing in theatre, and being hungry and thirsty too, boo hoo, woe is me). I got back to LBS at 1355. I fell on the nearest spare meal from the patient trays and wolfed it down, with my feet up on a chair. I couldn't even talk, but after 20 mins rest I was feeling more human. I finished my paperwork as quickly as I could, weighing the smelly placenta with a student to show her the probable chorioamnioitis, and tracking down small details from the two births I had witnessed that day, plus a form from the previous day that the ward had lost (I found it, they had been having a 'boy's look' It was there all the time). By 3.25 I was off home, I actually walked home after my earlier exhaustion! The exercise will do me good.

So now I am starting 4 nights tonight. I have a social weekend planned in between sleeping, and hope to catch up with the girls for a pseudo-camp weekend. It should be great.

I look forward to hearing about an Obama win in the USA elections - the alternative is just unthinkable!


Lesley said...

I have my Obama earrings on! I'll post about 'em tomorrow — don't want to jinx anything ...

Frogdancer said...

Well done, you baby catcher you!

Karen said...

What an amazing post - I thorougly enjoyed it - love this Net-travel.

Madre Adoptiva said...

I'm in love with your blog! I am reading everything I have time for (clicked on the midwifery category pretty much immediately). Keep up all the fabulous work you do!!!

Karen said...

Hi Laura,

Just want to tell you how much I love your posts about delivering babies - they ALWAYS make me tear up!


Anonymous said...

I so love your 'birthstories', I always get so caught up in the emotion. Fantastic writing, I so love visiting you!

Jennifer said...

So wonderful, as always, to read about the deliveries, about your impressions and experiences. Hope the new schedule feels manageable for you--

potty mouth mama said...

I love these stories - amazing.. Makes me want to have more and more babies.. Hmmm.