Friday, March 27, 2009

Another work day

Arrived at the hospital around 9:30am, and found a woman having recently been started on pitocin for augmentation (after spending all night at 4cm, and inexplicably having her water broken around midnight). We discovered that her second child had been a stillbirth after a cord prolapse, something that hung somewhat over this birth.

A female OB came in, did a very ungentle exam, and T may have talked her into giving this woman another few hours to let the pitocin work; we don't know whether that is true, because she didn't ever really talk to us despite us talking to her.

Meanwhile, T had managed to bring up the reused suctioning tubes at precisely the right time, which led to a review of appropriate indications for suctioning AND *hallelujah* the ordering of many disposable tubes so that the reuse would end.

Anyway, by a bit after 11am she was pushy, and by 11:42 she was "complete"...ok, actually, she was 9cm, but she had a strong urge to push, I thought the cervix would go away, and I lied to the other midwives there so that they wouldn't stop her pushing. Her cervix did indeed go away, she took a bit longer than expected to push out her baby, but eventually out came a very GDM-looking baby. Not just big - this baby was big by Ni-Van standards at 3.98kg, but was not technically macrosomic - it was about the proportions. Pull as I would, I could not get this darned kid's chest out. Poor kid was starting to cry less than halfway out, his mom had lost her pushing steam, and I pulled, then another midwife pulled (same results as when I pulled, so she stopped) and then T finally piped up with a "you HAVE to push your baby out now," and out he came.

Her postpartum went smoothly.

Boredom and cleaning.

In the waning half-hour of shift, a woman who had a c-section for twins 10 days before came in reporting bleeding and fainting. This woman's English is excellent, and we had a much easier than normal triage conversation, which revealed that she was indeed bleeding too much. The OB was called - a different one, but again, a very ungentle exam. He admitted her for observation overnight.

As I attempted to leave (seriously, I was picking up my backpack), a dad flagged me down for help with breastfeeding.

Still, we left only a little late.

To the market and back, ate in our room, watching and hating-but-not-enough-to-turn-it-off Australian TV.

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