January 12, 2009
You saw me standing alone, without a dream in my heart, without...okay, sorry for the tangent, but I've had that damn song in my head all weekend. Anyway,this weekend was a full moon weekend and as I've come to expect on a full moon weekend, labor and delivery was hoppin'. Every call from ER was "We've got a ruptured 38 weeker here, here's another mom who thinks her water broke". Multiple phone calls from people wanting to know if they should come in or not because they were leaking fluid but not having contractions, etc. But, everything that happened was manageable. Saturday, I took over a patient that had been ruptured for 19 hours, stuck at 3 cm. It was her 3rd baby and her last labor was a quick 4 hours. So she was very frustrated. I go in, introduce myself and she asks me how long this could go on, when will they decide to do a c-section, etc. I told her I figured since it was her 3rd baby that all of a sudden, the baby would drop into the pelvis and she would go from 3 to complete just like that. I did my assessment and decided to check her and found her to be 8 cm. Yeah! I turn around to wash my hands and as I turn the water on, she says "Um, I feel a lot of pressure". Sure enough, she was complete and ready to deliver. A nice smooth delivery within my first 20 minutes at work. After that, I had a couple people coming in for possible labor that ended up going home after the contractions spaced out. Then I admitted another mom, 4th baby with SROM. With her last 2 babies, by the time she realized she was in labor, she had just enough time to get to the hospital before a nurse caught her baby. This time she wasn't feeling contractions at all, but was contracting about every 8 -10 minutes. Baby hadn't descended yet, and she hoped to be able to have an epidural this time. After talking with her, we decided that if she waited until she was in a lot of pain to get her epidural, she wouldn't get one, so I called the anesthesiologist to place it. She was contracting and had changed her cervix from 4 cm to 5 cm by the time he got there, so I didn't feel quite so guilty. After the epidural was in place, her contractions started spacing out a bit. Crap. But, after about an hour, they started picking up again and all at once, I look up at the monitor and see the FHR dip down. Go in, FHR in the 40-50's (read by a fetal scalp electrode) and she's complete and ready to deliver. Now with a FHR in the 40-50's, you have to add about 100 to that to get my heart rate! We get her flipped onto a side the baby liked and got the doc on his way. I figure at the time the heart rate dipped, she went from 5 cm with a baby way up there to 10cm and the baby just slammed down into the birth canal. Doc got there, she pushed through 1 contractions, delivered a healthy baby without any lacerations, and the Doctor was done before the 5 minute APGAR score could be given! It was the easiest delivery I've ever seen. Sunday wasn't quite so busy but was steady. Steady is good. It was a weekend where it was busy, but not so busy where you didn't have time to chart, eat, or use the bathroom. Hopefully, it continues that way and doesn't get too crazy. 12 hours is a long time to go without a bathroom break!