Saturday, April 04, 2009

Newborn Exam Day

I did no fewer than 13 newborn exams today. I did not, of course, catch all of those babies (I caught one and observed two others); there was a baby backlog when I arrived and a steady stream of babies in preparation for discharge. Today, there was a dad that WANTED to be there for the birth, supporting his wife and crying happily once his baby girl was born, following her to the warmer and taking pictures, and then singing along to some R&B type music he had on his phone, appearing to mesmerize his daughter with his swaying. Luckily nobody in the packed-full labor room seemed to mind, one mom in a world of her own across the hall, the other right next to him humming along, his own wife rather engrossed in hating being sutured (not that it was awful, but who in their right mind would LIKE that?).

No drama on the ward today. Two of my favorite people were on day shift, so that's what I did. A nursing student (they are not assigned shifts the same way I am, and I think they just have a number-of-hours requirement) that I'd signed off on one of her first vaginal exams a week or so ago assisted at a birth today; she was too busy standing there crying happily to administer the syntocin that they do routinely around here, which was such a lovely thing that I couldn't get upset. She'll get over that eventually, but hopefully never completely.

I left a little after 3, which left me enough daylight to go get changed and walk into town for some food at the waterfront. Chicken and fries and oversugared soda cafeteria style right next to the water, sharing a table with a woman and her shy 3-year-old granddaughter who were on the island for the weekend from "the next island over that way," which pretty much meant nothing to me. It was good to sit and talk though, and hear about her family. I think I understood most of it.

On the way back to the "resort," walking through the village-in-a-city area, I heard the rather unlikely sounds of a trombone and a trumpet, practicing two different scores simultaneously.

Back now, it's dark outside, and should I decide to leave the TV on I would have a choice between Meerkat Manor and rugby. Maybe I'll try to figure out the rules of rugby (football, as they say here)? It seems to involve short-shorts and jumping atop one another. Beyond that, the rules elude me.

Maybe just some reading time tonight, instead.

Thursday, April 02, 2009


This morning all the women were discharged from the ward.

No, seriously, all of them.

OK, so there were two hang-ons whose babies were under 2k, in the extension ward. But the not-anyone-there-ness of it all in the main ward was pretty astonishing.

By the end of the shift, we'd placed two women and their babies on opposite ends of the ward. One caught by another midwife, one by myself three minutes later. Another birth I managed beginning to end, although I did make a consult call for some decels (the mind-boggling answer I got was to break her Out came a very white looking baby. And by this I do not mean distressed or hypoxic, I mean white; the midwives were looking to see if this woman was married to a white man and even went so far as to ask her the race of the father. I'd gotten so used to dark little black-haired heads that it was quite a surprise to see light-brown-almost-blonde hair and pale skin coming into view. This mom had a history of a prior stillbirth, and in a moment of "something looks wrong here" panic I slapped on the fetal monitor again, to find the heartbeat steady at 140 just as it had been mere minutes previous. I contemplated cutting a cord on the perineum for the first time, as the baby got tied up with a tight nuchal cord and the typical somersault maneuver wasn't working, as there simply wasn't enough slack, and we got a tad-bit stuck at the armpit level. Some breath-holding and cord-stretching and baby-twisting, and everything came out fine. I was of course alone for the ordeal, or the midwives would have been appalled that I didn't just cut the cord (which would have taken at least as long as what I did...).

A teary phone-call with my family this evening. I am ready to go home.

Thanks, T

For leaving the anti-diarrhea meds (...erm...brb...)

Anyway...the woman I was talking about yesterday had her baby overnight and was happily on her way today.

The ward is so full that they are sending women home 12 hours after delivery, sometimes a tad less if they are doing really well. There were 90 more deliveries in March than there were in January.

Nevertheless, today was a very slow day. Sat around doing nothing, or the VCH version of nothing, which involves making beds, folding gauze, making cotton balls, re-reading matron's reports, tallying births for the month, and then finally just.sitting.there.doing.nothing. As I didn't want to kick myself for leaving before something exciting, I stayed for the full shift, and then wound up staying a bit after for someone who had been on the ward for two days and who had finally found herself in labor, a misoprostol (cytotec) induction.

Just after that birth, the reason I am thankful for the anti-diarrhea meds kicked in, and I left the hospital in a hurry.

Feeling much better now, watching some crappy TV. And that pun was unintentional but I'm leaving it.

Wednesday, April 01, 2009

Chugging along

Another shoulder dystocia yesterday; this time I was not alone, but the midwives (two of them!) who were there apparently didn't understand "hip flexion" "legs up" "need more room here, bring her knees up" and about 5 other ways I was attempting to communicate what I wanted them to do (ARGHARGHARGHARGHARGH!!!!!!!!!) until I finally repositioned the woman myself. And a floppy baby. The midwife refused to pass me the bag and mask, told me I had to cut the cord and take the baby to the station. Goodbye good heart rate. Baby came around after a few more minutes, but had no muscle tone even after she was breathing on her own, for a good 20 minutes. The ped's opinion was that she'd suffered hypoxia - the midwife that was with me uselessly stared and didn't inform her of the dystocia or the rescus, so I jumped in with some information. I am not sure what was going on with the midwife, but her mind was not there and I may avoid working with this particular midwife for the rest of my stay here; the others have been varying degrees of acceptable to great at working together at births. Baby looked healthy and active an hour after birth.

Two more births, without issues.

At the end of the day, I checked a primip that had been in the hospital all day and working really hard. I couldn't figure out what language she spoke, and she was off in labor-land. Not Bislama, but English, it turned out. She was only 3cm. I was not prepared to stay and do a lot of labor support, but did take time to provide her and her partner some information and some coping techniques, kind of an impromptu 30 minutes of childbirth ed. She was very tired. "There is only one muscle in your body that needs to do the work right now," she finally woke up and understood, "think about letting all the rest of your muscles sink down into the bed and rest."

I hope that she delivered without incident last night. If she is still there when I go in (in a few minutes), I'll be glad to provide support and receive information back with full fluency, but unhappy that she hasn't delivered.

Tuesday, March 31, 2009

Babies, babies everywhere!

T came in to the hospital today with me, and stayed until 1.

She missed the first birth of the day by about 20 minutes, a multip that came in at "8cm" someone said...6-7 was more like it when I checked, but whatever, her fourth baby came out 30 minutes later, a girl. The messiest birth here so far; pee and amniotic fluid everywhere.

I won't go through all the births today. Four catches, three observes (two of those vacuum deliveries - in case you're wondering, T, Dr. B is substantially better with that particular apparatus than Dr. D was). Two vastly different repairs: one a skin-level repair that came with a big 'ole baby; the other a dramatically deep 2nd degree that came with a little bitty baby. Lots of cleaning. Only a few moments here and there to catch my breath, 11 hours at the hospital.

Monday, March 30, 2009

Never look too bored around a doctor

Especially one that loooooves to chat about horrible things.

You might get chatted at and invited to a c-section "we anticipate to be really difficult, you'll see us sweat, that will be good eh?" This woman had a previous stillbirth after undiagnosed partial previa --> full abruption --> distressed baby --> c-section --> dead baby --> couvelaire's + massive hemorrhage. She'd elected a vbac attempt, and after hanging out at 4-5 for 12 hours, with good strong contractions for 6 of those, she was talked into (offered, whatever) a c-section. After quite a lot of difficulty placing the spinal, the operation went off without issue. Mom lost a fairly small amount of blood, her uterus and intestines cooperated and returned to her abdomen (ick), baby was happy and healthy and vigorous.

I got back to the maternity ward after the time I'd decided to leave.

Rewind a bit.

When I got in yesterday, a couple of mothers had delivered and pregnant bellies were all over the ward. I helped move people around, settle people in, and then the boring bits start. All those pregnant bellies were in various states of not-really-labor, including one that just needed to listen to her baby and go home and a few that thought they had ruptured membranes, but probably didn't.

The family from the stillbirth the day before came to pick up their baby. Another hour of wailing and mourning and sadness.

Cycled women through their "CTG" (amounts to an NST), checked early-laboring cervixes for non-ruptured moms, and settled into the boredom.

About an hour before I was intending to leave, the above-mentioned doctor caught me rolling cotton balls and dunking them in alcohol with a rather resigned and bored posture about me.

When we got back from the c-section, there were several suddenly active-labor-looking moms on the ward. One I'd checked and found at a 4 just before tackling the alcohol swabs, and she wanted to know if she could go in and lie down. She didn't have to push, she said, she just wanted to lie down. She looked like she was going to push, so I told her to go ahead, ran to eat something, and was fetched by her husband not 45 seconds later. I found her 9cm, broke her water, her cervix almost-dissappeared (could feel the tiniest edge of it) and told her she could push. She had a lovely girl of substantial-for-here size just a few minutes later, intact perineum, happy mom-baby.

As I was getting the instruments cleaned up, another mom I'd checked earlier and found at a 2 walked into the labor ward (usually if they do this themselves, they're pushing already). She was 6-7cm and in hard labor, and her relatives briskly escaped the room (why?!). I ran about looking for them so that I wasn't stuck doing labor support, and found her husband instead, who gamely entered the room and rubbed his wife's back, looking only mildly horrified. Just half an hour later, a spontaneous push, and when I checked she was complete. 20 minutes later, another substantial-sized baby, her second girl, this time with dad as a witness for the first time since I've come here. Sure, he was plastered to the wall beside his wife's head looking apprehensive for most of the pushing, but his face lit up when his daughter cried. Mom, alas, had a substantial second degree tear that took a good long time to repair, and no matter how much lidocaine I injected (nor how little she seemed to notice the needle while I was injecting the lidocaine), she was in pain during the repair. I'm rather sure she detests me now, but I'm also rather sure that I did a good job putting her vagina and perineum back together, and I did as well as I could to get her pain relief in the process. "Don't worry," said the midwife to the dad (who appeared not at all worried), "next time you have a boy, it will be easier too..."

I cleaned, rearranged, prepared spaces, and left. As I left, the midwives predicted a line into the admissions room and through the labor ward all night. I predicted a solid sleep after over 12 hours at the hospital (preceded by 3+ hours of doing school work). It turned out I had to battle a monster cockroach before settling in, but I did sleep.