Now that I've been a midwife for about a year, I'm precepting students, both student nurse-midwives, and professional midwifery students. In preparing some things for them, I came across this delivery note from one of my early births. It's fun to read, and then realize how far I've come in merely 2 years. The other fun thing is that 7/7/11 is the date I got certified/passed my boards. This was exactly one year to the day before that. Fun!
7/7/10
Delivery note:
G2P1001 at 39 weeks 4 days.
T labored well, changing positions often, first on her bed, then upright, then into the tub at approximately 0900. Active phase of labor was approximately 4.5 hours. SROM occurred at 0930, with leading membranes. Mom pushed gently and spontaneously, allowing for a very controlled, gentle descent and time for perineal stretching. The small room was nice & warm due to the “first day of summer.”
Throughout, FHTs were stable, ranging in 120s to 140s, with accelerations over 150 heard during contractions on several occasions.
After a 23 minute second stage, the head was delivered at 0952, followed by spontaneous rotation to LOP. Mom raised her hips above the water, no nuchal cord, delivered the anterior shoulder with mild traction and then the posterior shoulder and body. A viable female neonate was placed immediately on the mother’s abdomen where she was noted to be centrally pink with spontaneous cry. Care was taken to keep infant’s head above the water line. Apgars 9 & 9. Weight 7# 14 oz, 21 inches long.
Placenta delivered Schultz at 1002 with third contraction after NSVD with mom standing, mild traction. Appears complete with three vessel cord.
Mom then got out of the tub, and laid down for 3rd stage management. Hemostasis was easily achieved with fundal massage. Blood loss approximated at 300 mL.
A first degree laceration of the right labia was repaired with 2 interrupted stitches using 3.0 vicryl and 1% lidocaine. Bilateral, periurethral tears were also noted, but required no repair.
Baby was back in mom’s arms at 1015, and began breastfeeding almost immediately. RR=72, HR = 132, T=99.1 (axillary)
Mom was stable postpartum, with BP=127/65, T=99.2.
Big sister and grandparents met the new baby at 1020.
At 1030, Mom walked to bathroom, voided, and then got into her bed. 600 mg ibuprofen and ice bag put on perineum taken at 1045 after reports of discomfort.
Baby breastfed on both sides, and then fell asleep. Newborn exam completed at noon with no abnormal findings.
Postpartum teaching done, including danger signs, when to call CNM. Family fed and resting when we departed at 1230.
Here is the journal entry I made (for school) regarding this birth:
• I caught a baby all by myself. It was a lovely homebirth, with a waterbirth. Sally just stood there and let me catch. It was awesome. The whole experience was quite lovely, with a nice labor that I felt good supporting, managing. I had just met the couple in an AP visit two days before, and it was good to know the concerns the Dad had about the homebirth so that I could be sure to address them during the actual labor. Checking in with him during and after the labor, it seems that he felt good about the experience.
• I delivered the placenta well – impressed Sally because I followed the curve of carus even though our client was standing up!
• I did at least one suture all by myself. :-) And there were only 2.
• Did another newborn exam. Still feeling somewhat awkward about the routine.
