Monday, March 23, 2009

Crappy Day (sensitive readers skip this post please)

Mid-week last week, a 16-almost-17 year old primip had gone for an ultrasound to evaluate size greater than expected for dates at 21 weeks, and was found to be carrying conjoined twins. Because the twins shared a heart, termination was recommended. After a not-very-informed discussion (this based not on being there, but on what the doctor told me about the plan), the family agreed that the pregnancy be terminated as soon as possible, which translated into misoprostol induction on Monday.

The misoprostol caught up to her finally this morning, and T and I were present when her babies delivered vaginally without issue, completely unresponsive and unmoving although with a heart beat. The babies made no attempt to survive. Their mother was relieved it was over. The family is taking the babies home to bury.

Not too much later in the day, we began the admissions process for a woman in labor at term with her third baby, and were unable to find heart tones. She reported last feeling movement early this morning. The ultrasonographer was on lunch and unreachable, so every person on the ward tried again, and again, for almost an hour, unsuccessfully. The mom reacted very little to this. By the time the ultrasound happened, the expected conclusion was fetal demise. The ultrasound confirmed a non-beating heart. The mom was still not reacting much to this news at all when we left, even laughing with the hospital billing person. This baby will be almost a pound larger than her other two, and as she was already in labor (although just 2cm), she will likely deliver her dead baby some time tonight.

Perhaps the only good part of our day was greeting the postpartum women whose babies we had caught yesterday and the day before.

I was amazed yet again at how much the women on the ward seem to enjoy having each other around. When the labor ward was full the other day, two of the immediate-postpartum moms wanted us to remove the separating curtains so that they could chat, which I found amusing. In the overheated, overcrowded "extension" room, where moms and babies stay if they need a bit longer for whatever reason - usually low birth weight - I've walked past to see groupings of moms talking, playing cards, nursing babies in a circle. I won't say it is ideal, just that the sharing of space doesn't feel as bad as I imagined it would.

We've seen a fair amount of the hospital and are concluding that the maternity ward is the highest volume spot but is in a state of furthest disrepair. It is also the hottest spot in the hospital, and this is not our imagining. It is shameful. The doctor that is the most motivated to make changes seems oddly focussed on crazy little things like the boards that are used for bandages maybe carrying staph bacteria (not a problem that has been encountered...) instead of things that are actually making people sick, like the inappropriate reuse of suctioning equipment. We are not here to fix anything, we are here to participate and to provide good care the way we know how. But it is hard to see things proceed in such a mal-coordinated fashion.

T and I both left early; T because she felt unwell, myself because it was just an hour until the end of shift and I was very hot and very done, and there were more people there than things to do already. I had taken to sanitizing all the surfaces in the delivery rooms (um, is this ever done? oh the disgusting things I found), but once all the handles, knobs, and cabinetry were done, I was about finished with scrubbing things with gauze.

We are back, in air conditioning (oh lovely air conditioning), being overheated and exhausted in our room.


~L~ said...

I am sorry you had such a rough day!

Wendy said...

I had a couple of fetal demises when I was there too, and upon reviewing the stats for the prior 5 years or so, it appeared that they had something like a 2% stillbirth rate. One of the women I attended had been sent off to ultrasound after the MW was unable to find heart tones upon admission -- but the MW hadn't told her why she was going. The woman came back with a slip of paper in her hand, which she was told to give to the doctor. She still had no idea that her baby had died. The doc was nowhere to be found, and the head MW did not want to be the one to tell the woman, lest she get in trouble by the doc. Ugh. She was eventually told, and was heartbroken. I attended the birth and cried with her when the baby was gently born. Crappy day, indeed. I hope you girls are taking good care of each other.