Monday, March 23, 2009


Yesterday (Monday), T went in to the hospital a couple hours before I did, while I stayed behind and did some business-plan writing and blog-catching-upping. She admitted three women, and when I arrived, one had delivered, she was coaching the second - a primip who had been pushing for an hour already - to push in a variety of positions, and another woman was writhing in looks-like-ready-to-push condition across the way with nobody in attendance. I went out, found her chart, and did an exam; she was complete, and relieved to be "allowed" to push. She pushed for about 15 minutes, and then we had a 5 minute shoulder dystocia that I was completely alone for, with T across the hall just having caught the other baby, which began to cry as I began to move through maneuvers. What ran through my mind? A passage from Gabbe - "you must not pull desperately on the head." I find that somewhat random and not entirely helpful, but the maneuvers are so entrenched in my mind at this point that they were pretty automatic. Hip flexion, Rubins, posterior shoulder, sweeping for an arm...Woods Screw maneuver - pushing both shoulders simultaneously, in this case counter-clockwise, to find the spot where they would come through - worked, and out came a floppy baby with a blessedly acceptable heart rate. T came across the hall just as the baby was beginning to respond to my stimulation, to let me know she was available - I told her the baby was coming around, thanks, I'd call if I needed another pair of hands, since she was all of 15 feet away. Baby cried vigorously at 2 minutes after suctioning and further stim - at which point I lunged back at the bed to catch a placenta - and by 5 minutes was happily snuggling with her mom, who had uncharacteristically requested her baby be handed to her.

This episode was then followed by 6 hours of utter boredom. Two primips arrived, one at 3cm who was still at 3cm when I left, and another at 4cm who was at 5cm when I left, both of them laboring quietly and with the help of relatives. I sat and read, watched the midwife and nurse play computer games, chatted, and was in many similar ways completely sleepy and bored out of my mind.

10 minutes before the shift completed, we got an interesting phone call...they were sending someone down in labor. The catch here is that this woman hadn't known she was pregnant.

Apparently, after having her fourth child, she had begun depo provera and had been getting regular shots for 10 years, including during this pregnancy, uninterrupted. She continued to have monthly "cycling" with light spotting, which happened even during this pregnancy. At some point a few weeks previous, she had become suspicious of pregnancy because she had felt strong movement, but then her monthly bleeding occurred on time, and she concluded that something else must be wrong. She came in to the hospital in labor, still not totally sure what was going on and entirely unprepared to give birth or have a baby. We felt her belly and concluded that she was somewhere around 38 weeks, we couldn't know really but it seemed reasonable that she was at term.

She apologized to me throughout. For what, I'm not sure; maybe for not having prior care, maybe for not having her things with her, maybe for having another baby at all, maybe she was apologizing to herself and her baby by apologizing to me.

Her baby came quickly. Fifth baby, after all. Vigorous boy in a sludge of mec, looking 40-ish weeks old. Mom had through the swift (half an hour from admission and being told that yes, she was pregnant to having a baby) labor apparently managed to come to terms with the fact that she was having a baby. "Wun smol boy!" she repeated after us. After she'd delivered her placenta, she sat up in her bed, nursing and staring at her baby. "Gonna have a STORY to tell when I get home," she said.

I wandered home through the ever-so-dangerous (insert eye-rolling here) alley, through the usual chorus of "good night"s from the people living there, a bit past midnight, and sleep was not far behind.


~L~ said...

wun smol boy will have a story indeed!

Wendy said...

WAY TO GO, NIKI!! You had an opportunity to use your shoulder dystocia skills in a real situation, and you did it! Awesome! Congrats!