Sunday Night Dichotomy

Sunday night was the busiest night shift I've worked so far. In addition to our 5 inpatients and their babies (a couple of them needed to be watched closely), we had two women in labor.

The first woman came in at 5 centimeters dilated. She progressed beautifully from 5-10 cm in just a few hours. It was her 2nd baby and I was hoping and praying for just one normal delivery. What a refreshing idea! She did not disappoint. This woman was one of those women that I am in awe of as I watch them labor. She was calm and confident (what a difference confidence makes!).

As I said, she progressed well and quickly. Her husband did a fantastic job providing labor support. It also helps when the partner is confident and not afraid of the whole process like most of our guys. Although, just as his son was born he rushed out to the hallway to vomit. He had to leave until after the placenta was born and out of site. Hee hee. I'm getting ahead of myself though...

So my patient did great. She stayed relaxed and calm and before long she felt the urge to push. It's also nice to get to be hands off for a change. We checked her to see if she was indeed ready and she was fully dilated with the bag of waters still intact. She pushed for about five minutes. And as soon as her water broke her baby was out in the next push. Amazing. All I did was simply catch her six and a half pound baby boy. She didn't bleed abnormally. The amniotic fluid wasn't stained with meconium. There were no abnormal heart tones. The baby didn't need deep suctioning. What a happy and beautiful and refreshingly normal birth! I really needed that. (Never mind the mother, it's all about me right? ha ha) But seriously, it is just so nice to see and experience a normal birth. Most births are in fact normal but I just haven't seen one in a while.
She did tear, however. Which meant I got to suture for 1.5 hours. This month has been great for suturing practice!

Just before this first patient delivered, another woman in labor arrived. A primie at 5cm and having a very difficult time remaining calm. She was the polar opposite of the first patient. Not to begrudge her it's just that most of our primies are very young and immature and not well-prepared. The father of the baby was not in the picture and so she was all alone except for her father who was all she had, I guess and he kept his distance.

To make a long story short, we had to transport her to the public hospital at 5 a.m. We couldn't get her to stop pushing prematurely. Her cervix was almost fully dilated (about 9cm) but was getting swollen. We tried absolutely everything to get her to relax and breathe through contractions until she was "fully" but she just couldn't do it. So our only option was to manage her cervix while she pushed in addition to continuing to do what we could to get her to relax and breathe and she did become fully dilated pretty soon after that. But she couldn't push effectively no matter how much advice and support we gave her. And she refused to try other positions. She was exhausted. She just kept gripping the table, my arms, her legs. She put all her energy into every other part of her body besides where her energy really needed to be focused. The poor girl was in agony. She pushed like this for over an hour and during that time, the baby's head became in view but failed to move beyond a certain point. And her water broke. And it was stained with thick meconium (fetal poop) which is a sign of fetal distress and is very dangerous because the longer the baby is inside, the more likely it is to aspirate the meconium. The fluid was such a color as to indicate that the baby had pooped a long time before.

So even though she was close to delivering we felt it best that she deliver in the hospital where the baby could have better emergency care. So there go the hazard lights on my car again as I drive us to hospital.

We heard later the baby was delivered using fundal pressure and episiotomy (routine at the hospital). Her 5-pound baby needed resuscitation and oxygen and will be held for observation.

Tiring? Yes. I got home and was in bed by 8:30 and slept till almost noon. I've never been so tired after a night shift. Last night I slept for 10 hours. I dreamt I delivered a baby on a bed in someone's home. The shoulder was stuck and I pulled on the baby too hard and hurt it's neck. The baby's body was twisted in a freakish way and I knew I had just damaged it's spine. It was a traumatic experience. When I awoke I sighed with relief that it was only a dream.