Sunday, March 22, 2009

Busy, Busy, Busy

Yesterday (Sunday), T left for an overnight to see the volcano at Tanna, and I left for what was supposed to be a swing-shift at the hospital from 10-6 but wound up being a bit longer.

I arrived to find the ward pretty quiet, a situation which changed dramatically over the next hour as we admitted 4 women, all of them primips and all but one of them hovering around 5cm. They labored into the afternoon; shift change happened at 3, leaving myself, one midwife, and one nurse on staff. At 4 a multip showed up at 5cm. Two of the primips were creeping their way slowly (for here) towards the finish line, and it looked like we were in for a bit of a rush. Another primip showed up fully dilated. Fortuitously, an advanced nursing student showed up at this time as well, and although he required the midwife's continual supervision (something she doesn't think I need...hahahahaha), he was another set of hands. We split up one per bed, with three women in the four-bed labor ward (which they typically like to have only two women in at a time).

The multip's contractions had spaced out to almost 10 minutes, and although she was eager to push, her cervix was a firm 8cm which didn't yield well during a push, so I discouraged it. Someone opened the door and pleaded tearfully for me to come check her relative who was "so much soa now, please you check?" Which I ran out and did between multip-mama's contractions, to find her at 6-7cm, which was only slight progress from her last check 3 hours previous.

The fully-dilated-on-arrival primip delivered first, which I observed while the student nurse and MW Tamanu did a four-handed catch.

The multip delivered next, as I held back a decent sized anterior lip of cervix; this birth I managed completely with the student nurse swooping in to give a shot of pitocin on my request, and MW Tamanu showing up to suction the baby for some random unexplained reason (breathing fine) about two minutes after the birth (ok not so random, since there was moderate mec, but this was a pretty nonsensical time to suction) - both of whom disappeared rapidly because they were still cleaning up from the first birth, while I was occupied with the mom's somewhat-larger-than-average blood loss and they were entirely uninterested in the matter. Her placenta came out fine, her blood loss ceased, her baby looked fine hanging out in the warmer, and another primip began to push.

MW Tamanu proposed that she monitor multip-mom and baby while I managed the next primip's birth. I had feared for this primip's perineum since I had checked her on admission, because of the difficulty admitting my fingers for the VE despite her good attempts to release tension and her apparent calmness about the exam. She had perhaps the best pushing control I have ever seen, and she breathed and slowly pushed her baby past an intact perineum with absolutely no issues whatsoever. Her placenta arrived just 3 minutes later. The entirety of her blood loss, I could have cupped in one hand.

All this she did less than 25 minutes after the first mom had delivered.

We got the babies their shots, registered the births, got the moms and babies sorted out and into their beds, and I left the MW and the student nurse to handle the remaining women, one of whom had been admitted with SROM and no labor and continued to have a non-labor, and the other who I had recently checked at 7cm looking no closer to delivering. I walked back to the room through the usual chorus of "goodnight"s from the village-in-a-city occupying the block adjacent to the hospital, and fell into bed at 10:30.

1 comment:

~L~ said...

that is a HUMONGOUS update! Good to see you-- wondering whether this means you finished your senior paper?

Miss you so much!