September 9, 2007

Instincts

I think it was about 2 weeks ago, I admitted a 26 week patient with 'gas pain' as she called it. Well, if you have gas bad enough, it can kinda feel like contractions. I've spent a couple nights during my pregnancies thinking, 'ok, I must be having contractions', only to pass a huge amount of gas, followed by a complete bowel evacuation. After assessing her, I found she was contracting every 3 minutes, and I really felt that this was labor and not just preterm contractions. She was acting just like a labor patient, so I checked her cervix without an order (we're suppose to get a MD's order for less than 34 week) and her cervix was closed, but the external part of the cervis was about 3-4 cm and soft...not what a 26 week primip cervix should be. Called the doc, he gave me orders for terbutaline. Gave her the 3 doses, patient reports feeling 100% better, but I still see a lot of irritability on the monitor . Call the doc back explain what I see and that I'm still concerned about her uterine activity, even if she says she feels better. He says to observe and give more terbutaline if she states that contractions are getting stronger, and that he'd be in pretty soon. I tried suggesting Magnesium Sulfate but really, she said she felt good, uterine activity wasn't as bad, so the doc didn't feel it was needed at that time. Plus, she wasn't having contractions like she had on admission; it was just frequent blurbs of 10 seconds. By this time, its about 6:30 a.m. I knew I'd be on my way home before he got in. I found out last night that they actually discharged this patient, only to have her come back a couple hours later, in active labor and they had to deliver her by c/s that afternoon. Now I haven't been a nurse long enough to go on instincts alone, but I just knew she was going to break through the terbutaline and not be stopped. Sucks to be right sometimes.

Last night I had a magnificent delivery. Mom's second baby, 7 years after her first. She presented at 2 cm, and man that baby's head I swear was almost a +2 station it was so low. Maybe an exaggeration, but you get the idea. I'm not sure how she walked around, but I've never had a patient (who wasn't 10cm dilated) have a baby sitting that low in their pelvis. She progressed on her own within 5 hours. Of course, it didn't take much pushing at all and she delivered, without any lacerations. Perineum wasn't even swollen. Only odd thing was the umbilical cord was 35 inches long. Had to measure it because it was so obviously long. Well, I'm off to bed as I'm starting to ramble on a bit.

1 comment:

Sage Femme said...

I once had a cord that long! we did measure it - and it had a true knot in it. I've always learned that the more active the baby, the longer the cord (possibly to allow for the activity).

:)