Saturday, July 12, 2008

It was.......a good night

So last night I worked at the big house.
I came in and picked up a patient who had arrived the evening before for decreased fetal movement. She is being cared for by a CNM I work with frequently at the LDRP hospital.
The baby is reactive but measuring small so the midwife decides to go ahead and induce the next morning. Through the night the mom was having sporadic contractions and occasionally the baby would have a spontaneous deceleration in the heart rate but would recover and look fine. So, they attempted pitocin augmentation. They got the pit started and within fifteen minutes the baby had a seven minute deceleration, so off the pit goes. The mom continued to contract and by about 1:30 yesterday afternoon had made it to three centimeters so the CNM breaks her water and they place internal monitors on baby and the uterus. The continued all day with the spontaneous decelerations lasting anywhere from 3-8 minutes, but in between the baby was beautifully reactive. At 6:15pm the CNM checks mom and she had not changed her cervix so they decide to call in the doc and proceed with c/section since the baby won't tolerate pitocin. The doc is hung up at the LDRP hospital doing a c/section and this one wasn't emergent so we were just going to hang out until he could arrive.
Here's where I come in. Got report and headed in to assess the patient and make sure we were all on the same page and things were in-line to head to the OR once the doc arrives. I am in the room assessing the patient and chatting with the family and having a good time when the baby decides to have another deceleration, down into the 60's......so flip the mommy to her far left side, place O2 by facemask, increase IV fluids.....baby still down but coming up slowly.....vaginal check......9.5cm, just an anterior lip. The CNM comes in (she had been in the lounge on the phone with the doc), baby recovers nicely and we start pushing. Baby handles pushing wondefully and and hour and 20 minutes later we have a girl!!! Oh, I just love it when those kinds of things happen. Baby had a nuchal cord, not tight, but short! BTW, for all you L&D RN's......she had IUPC and MVU's were NEVER adequate......not once!!!!! Women's bodies are simply amazing.
So, I got her recovered and sent to postpartum and was able to sit down and have a nice relaxing dinner and then picked up a triage that had come in with her water broke.
This couple was absolutely wonderful. The mom was undecided on whether or not to go natural so I told her we would just play it by ear...We spent the night walking the halls, sitting on the birth ball and by 0330 she was 3cm and baby had moved down to 0 station (when she came in @MN she was 1cm and baby was high at -3). She spent some time in the shower, which she LOVED! and just did amazingly well. I really spent 95% of my time in that room providing labor support and just enjoying this couple, they were soooo great. At 0700 this am, I did not want to go home.....I wanted to stay with this couple and support them...I wanted to see their sweet little girl be born......I felt like she was really in a groove and I didn't want that disturbed by a new, strange face coming into the room. I feel like it is such an honor and privilege to be allowed to form such an intimate bond with someone and to witness their transformation into parenthood. I just didn't want to leave them......I feel like continuity in care is sooooo important and makes women feel secure and relaxed.
Situations like this keep me motivated to continue with my school work and become a nurse-midwife. If I had been her midwife I could have provided all that support and then stay with her and provide that continuity of care that I feel every woman deserves.

Now, I am off for a week! Woo! Hoo! Headed to camp with the church youth group. My oldest is now old enough to be part of the youth group and attend camp. Me, being the protective mother I am.....totally not ready for my kid to be so independent of me! I am going along as a camp cook. He will do his thing while we are there and I will be hanging out in the kitchen, so I am not going to be hovering or bugging him :) I just wanted to be available.....you know, in case he needed a hug from mommy or something. He hasn't ever spent more than a night or two away from home and this is for a whole week, so I wanted to be a little closer than 2.5 hrs away........just in case :)

2 comments:

I am a Monkey's Mama said...

What an awesome story...too bad that doesn't happen more often, maybe the cesarean rate wouldn't be so high!

Anonymous said...

Nice fill someone in on and this fill someone in on helped me alot in my college assignement. Gratefulness you for your information.