Busy Night

Last night I worked a shift at the clinic for the first time since we got back. It was a busy one. I had the privilege of catching two baby boys. How fun! And I got to suture again. Not fun for the mom but good practice for me.

When I arrived at 7:30 pm there was a woman in labor who had been admitted 2 hours prior and was found to be 7 centimeters dilated. She progressed quickly and gave birth to her first child just before 9 o'clock. Unfortunately for the mom, her son's hand was pressed against his face as he was exiting her body. That was the likely reason why she ended up with a second degree tear. Not fun for her but it did mean I got to get more suturing practice. I think I'm starting to get the swing of it.

Ten minutes after our first patient delivered, another woman in labor arrived. She was about 6 centimeters dilated. Clearly we were busy with all of our post-birth duties so it was good that the second patient didn't require a lot of attention. Our nurse on staff was able to attend to her while we focused on suturing and monitoring the health of both mom and the new baby while they got to know each other upstairs. By 11, the mom and new baby were settled in their bed and the labor room was cleaned and ready to go so we brought our newest patient upstairs. She too was a first-time mom. To be honest, she did not appear to be in active labor so we doubted whether she was actually progressing. She barely grimaced or made a sound during contractions. She whimpered a little and reached for her lower back with each set of pain. She kept saying she wanted to push so we explained to her why it's not a good idea to do that until she is at least dilated to 10 centimeters. Over the next hour she labored beautifully while we did what we could to support and encourage her. Despite her calm disposition it became clear that her contractions were indeed quite strong. I love watching a pregnant belly contract. You can see it change shape as it tightens and does its work at sending the baby on its way. It's amazing to watch.

In response to her increasing discomfort and desire to push we checked her progress. It was now midnight. I was pleased to find she had progressed to 9+ centimeters, with only a small portion of the cervix remaining. We broke her water and by the end of the next contraction she was fully dilated and ready to push. She was relieved to finally be given the green light to do so. (On a side note: we aren't trying to be mean when we don't let a woman push as soon as she says she's ready without checking her progress. An exception to this would be a woman who clearly has an unavoidable urge to push. We have numerous women who are accustomed to pushing well before it is time. Doing this can cause a lot of problems, from cervical swelling to maternal exhaustion, to malpresentation so we find it best to avoid this.)

It took our mom some time to find a way of pushing that was effective. She alternated between a semi-sitting position and a full squat. She ended up pushing for about 45 minutes, which is perfectly normal for a first time mom. The baby descended little by little until finally it was crowning. We encouraged the mom to breath and let the baby's head ease out slowly. She was a trooper at responding to our directions.

The baby's head was born, then with the next contraction the entire body was delivered. And would you believe that this baby ALSO had his hand up close to the top of his head so that his elbow was at shoulder level. This too caused quite a bad tear. Probably the worst I've seen yet. Hilary had to do the suturing as it was very close to being a 4th degree tear. Poor mommy. That's going to take some time to heal.

After another suturing job, getting another mom and baby settled, and checking vital signs on the other four mother & baby pairs we were able to sleep for a couple of hours. That was at 4 this morning. With that, I'll sign off. I'm going to try and get some more rest.