Thursday, January 8, 2009

In which I catch 3 babies in less than an hour.

Didn't think it possible to have so many women decide to have babies within minutes of each other.

Day three, three med students in tow (assigned to me by hospital OB)and instructions to help one of them catch a baby, I arrived to find the admission board with no 8 names on it. Three of them at 8cm, the rest beyond 6, only a couple of them primips. First three hustled into the labor ward. Mama #1 (a G5P4) delivers rapidly, her petite baby (2.4kgs or so) wailed his way into the world. 3 minutes later she pushes out her placenta (I didn't even have to pick up a cord)into my waiting dish, splashes blood on the shoes of med student. Oops. ;) hand off baby to one of the other MW as grunty sounds issue from across the ward. Bolt over, changing gloves en route. Open mid-bundle grab a couple of gauzes as baby crowns. Just barely get mama to slow down a bit, she does, and another baby slides into the world to the sounds of the supervising midwives laughing at me juggling deliveries as they change sheets and threaten to break the waters of the women waiting at 6cm outside the labor ward.

More relaxed second stage to the sounds of Mama #3 fighting an urge to push with an anterior lip.

Young, clearly frightened, and in lots of pain, the three "baby doc's" and I supported her last few minutes of active labor, whispering "it's ok" in her ear, rubbing her calves and hamstrings which were cramping almost constantly. Finally (about 10 minutes later) she was pushing in earnest and we coached her into second stage, tears rolling down her face. I carefully delivered baby's head (she was a primip and respectfully there was no way I was going to let her perineum be a casualty of a 'baby doc's' first catch - aside from the fact that I'd be the one who would then have to repair it!) and then took a first year medical student's hands and helped her catch what wound up being (to me) a shockingly small baby.

For the baby's size (1.8kg's) he was a feisty little thing. Cried quickly, breathed well, and given that I immediately suspected he was either a) pre-term or b)IUGR I handed him off the the RN behind me who bundled him and stuck his tiny head under the ubiquitous plastic box with the O2 tube snaking inside it. I then handed the clamps to the other med student and he delivered her matching tiny, but healthy looking placenta. After I quickly weighed and poked the baby with his mandatory vaccinations I sped him back to his mama (who was lying there sobbing quietly), and quizzed her in my broken French about her pregnancy. "How long was your pregnancy?" "8 months" was her reply. After he went to breast - and sucked, albeit weakly - I rustled up her antenatal chart and sure enough, her babe was a good 6 weeks early. Interestingly, by dates the first mama of the morning was supposed to be less pregnant than this woman, Her baby was 8 weeks early on paper. But certainly wasn't as small or as weak as this little guy.

She called him a lovely French name, somehow appropriate for his delicate little body and he's beautiful. He's in the nursery hanging in there.

My last patient/client for the day presented early on after prodroming for three days, but was sent away with a cervix too posterior to even evaluate. When she returned at about noon, she was 8 cm, and when I broke her bag, as instructed, I found a substantial quantity of moderate, particulate meconium. She was monitored closely, baby's tracing was a bit dodgy (some variable and very occasional lates, all with quick recovery) so the OB instructed me to start some synto, and recheck in an hour in the hope that we could get her baby out sooner, rather than later. Augmentation here consists of 10u of syntocin in 1L of fluid and eyeball 10drops per minute. I started her IV, whacked in the synto and rubbed her back for an hour. At her next check her cervix was found to be the same, and baby was clearly direct OP, with a deflexed head at that. By this stage she was continuing to leak large amounts of increasingly mec stained fluid. "Up the Syntocin." was the instruction from the doc. She has 1 hr and then we get the baby out.

Long story made short: An hour later she was prepped and headed off to the OR where a fat, lovely babe was fished out of a bunch of thick meconium.

Wish I hadn't had to break that bag. But, as small consolation the Doc's parting words to mama this morning at rounds: "You'll be able to have a lovely vaginal birth next time, dear". Wish more docs would say that at home, eh?


Internet access is a bit dodgy all of a sudden... Hope to be back on more frequently soon. Haven't dropped of the face of the planet :)

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