Saturday, March 28, 2009

Won't Come Out

I arrived at the hospital today and was handed a chart. "8cm, you want to do this one?" OK, I shrugged. A couple of hours later she was fully dilated, and then she refused to push. She didn't say "no" or stomp her feet, she just...didn't do it. We cajoled and talked and changed positions and threatened and finally she settled in to heavily guided pushing. At the 2 hour mark, with contractions 7 minutes apart, we began pitocin augmentation. No progress. At 3 hours, we informed on-call obstetrician, the same woman that paid us little attention yesterday. We fared slightly better today, although she still did a shitty job of informing the woman of her plans. Baby was high, not managing to make his way past the pubic bone, despite the now-effective pushing efforts. We suspected acynclitism and so did the OB. She made the odd decision to try a vacuum (too high! ack!) and then, after three failed attempts, the forceps...I'm not sure what she thought she was doing, but any idiot could see she was doing it wrong. The blades were positioned incorrectly, the handles wouldn't lock, and she kept asking the male midwife on staff to help her pull in an uncoordinated fashion. To do all of this, she cut a truly nasty episiotomy.

As this was going on, across the room, a woman delivered her stillborn baby. Her baby had been alive during the night shift; late decels were recorded, no response was made, and her baby was dead when the morning shift came on and checked in with her. It isn't certain that this baby's death was preventable, particularly with the long response time for the OR staff, but it is a definite possibility.

Back to the woman I'd been with most of the day. After all this traumatizing predictably-ineffective intervention, the decision for c-section was made. The episiotomy was repaired, which the OB accomplished skillfully (finally). The far-flung team was called and drivers were sent.

This poor woman also had a very strong urge to push, which she could not stop. She bore down despite the heavy swelling and the stitches. We monitored her baby intermittently, and he didn't seem to mind the pushing, so we encouraged her not to push but didn't go to any great lengths to stop her. We prepped her for her c-section, and waited. For over an hour. Her baby moved no lower during this time.

Her c-section, once begun, was fine. Her baby had a massively molded head and I truly don't think he was going to come out her vagina - there was no more molding to be done, his head now sweeping back from his face in dramatic form.

Despite the large number of women walking around the ward in various states of labor, we left after the c-section. We'd run right on through shift change and were feeling like we'd had quite enough for one day, thanks.

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