The first was a woman pregnant with her second little girl. She had more protein in her urine than we like, and on top of her chronic hypertension, we called her pre-eclamptic, since she was term at 38+5 weeks, so brought her in for induction. She had a ripening agent called misoprostol overnight, and then the pitocin started around 0700, around the time that my shift began. She was pretty sure she wanted an epidural, and talked about "what a wussy" she'd been during her previous labor. I encouraged her to wait until she was 4-5 cm before getting the epidural, in order to prevent the epidural from slowing things down (hopefully). She relaxed in bed for the better part of the morning, and around 11 AM started getting more uncomfortable. My nurse checked her, and she was 4 cm! She got up and went to the bathroom, reporting some pressure, and a need to poop. SIDE NOTE: I love it when women need to poop in labor! It means that their body is either cleaning itself out because they're having a baby soon, or that the baby's head is actually pushing the poop out. Either way, things are looking good! So, back to the story, she ended up hanging out and laboring on the toilet for a while, pooping, and moaning, and crying. When I went in to see her, she really wanted her epidural NOW. I encouraged her through a few contractions, and calmed her down a bit. She was actually coping quite well, but didn't believe me when I told her that. When our nurse returned and said that anesthesia was on the way, I helped her get up to bed. Her epidural was placed just before noon, and when I checked her, her cervix changed during the contraction I felt from 6 to 7 cm! I ruptured her membranes (broke her water) and then left the room to write a note. Within minutes, I was back in the room, and she was pushing her baby out. We noticed that as the contractions built up, the baby would start pushing herself out, so we let her assist in her own birth. That was very cool! A lovely little girl weighing 8 lbs 13 oz was born at 12:32 pm. She had a tight nuchal cord, so I somersaulted her out, and put her right up on mom's belly. She had an awfully long cord, and I let it pulse for a few minutes before cutting it. Collecting cord blood was very messy - I'm not so practiced at that - but I did it, eventually. Then out came the placenta, complete and quite large, but with some calcifications, which can decrease blood flow to the baby. They may have something to do with the pre-eclampia. She had a midline perineal tear that I sewed up . . . great practice for me, and in the end it did look nice. By the time I left the room, baby was breastfeeding and mom, dad and big sister were all very pleased with the experience.
My second baby was a little boy born to first time parents who came in later that day, maybe around 1800 (6 pm), on their due date. This was a very young, very cute couple very excited to meet their son. Mom was in active labor when she arrived, at 4 cm. She wanted her epidural soon, although she seemed to be handling labor quite beautifully. Her labor continued, but slowed down a bit after the epidural, so I watched it for a few hours. Sometimes, an epidural will slow things down for a bit, but once the body adjusts to the new surroundings (the hospital) and the new physiology (epidural), things kick back in. But her labor was still somewhat spaced out, so we added a "whiff" of pitocin, starting at 1 mU/min and slowly increasing over several hours to 4 mU/min. Her contraction pattern got a little strange - not bad, but strange, with mild contractions one after the other for about 4 minutes, then a 1-2 min break, then a moderate contraction, then repeating that strange sequence. The nurse (one of my favorites!) and I decided to turn the pitocin off, to see if that would reset her contractions. Within about 20 minutes, her contraction pattern looked much better, and we never turned the pitocin back on.
About 2330, I went upstairs to get some shut eye. about 0100, my nurse called and told me she was feeling lots of pressure, so I went back downstairs to check her. She was 6 cm by this point, and the baby was getting lower. I ruptured her membranes, and her cervix changed to 7 almost immediately. I tried to determine what position the baby was in. Earlier, I had thought the baby was in ROA, with the front of his head turned toward her back. But this time, I wasn't so sure. Now that I could feel the head directly, rather than through the bag, I thought I felt the familiar 4 points of the anterior fontanel toward her pubic bone. Uh, oh. But I wasn't convinced, and her labor was progressing nicely. Her awesome nurse had been turning her from side to side, sitting her up, changing her position about every 30-45 minutes throughout the night. That can help baby find their position in the pelvis, and with an epidural, mom can't move around in the same way she would without, so rotating her often can make a difference in helping the baby find its way through the pelvis. This baby was finding his way. When she reported even more pressure at 0330, I checked her again, and the cervix was gone - melted away around the baby's head, which was now quite low. We sat her up and allowed her to labor down, meaning we just let her body push her baby down through her pelvis. Around 0430, it seemed prudent to begin actively pushing, since she was getting even more uncomfortable, and having uncontrollable shakes. But my nursing staff was busy getting someone else ready for a cesarean section, so we waited until just before 0500. That little lady pushed effectively for about 11 minutes before delivering a healthy little boy, born in a direct OP (occiupt posterior) position, or sunnyside up! He turned himself toward his mom's right side, then delivered his own anterior shoulder and right hand! I put him up on his mom's belly, where he took a big breath and cried out, turning pink. Good boy! The placenta delivered itself almost immediately, and it was a good looking placenta, with some minor calcifications. That little guy was 7 lbs 12 oz, and had some swelling on his head just above his forehead from his position in the pelvis. Otherwise, he was quite cute! Mom had a perineal tear, also, a second degree, but barely. Another repair - what good practice for me, and the midwife I was working with had some great coaching/instructions to help me do a neat job. That little guy was eager to breastfeed, and those parents were thrilled to finally meet him! The other fun part about that delivery was how involved the dad was. He had said earlier that he probably wouldn't watch, but he got pretty excited about it, and ended up standing on my left several times, watching the birth of that head. Mom was eager to feel her baby, so from time to time, she'd reach down and feel the head and get so excited to feel her baby so close. They were both so excited and into their birth experience, and it was fun to be a part of that with them.
Lovely!
No comments:
Post a Comment