March 28, 2009

Two deliveries in one night

Once again, this past week had a shift start off with a c-section. This mama was measuring 5 weeks behind in dates, had noticed a decrease in fetal movement over the last week and hadn't felt movement for a few hours before she came in, had very low amniotic fluid, PIH and her 35 week baby was having variable decelerations in the absence of any contractions. They had talked it over with the perinatologist and neonatologist and they decided she needed to be delivered. They were already back in the OR when I came on, so it was a bit awkward to slide my way into a delivery in progress. The baby was pretty darn small for the gestational age, but she was a feisty little one. They had worried she might need transferred to another hospital that has a NICU, but she was doing fabulous. Her placenta was also very small, and looking at it, they noticed that probably only half of that placenta was working due to an old, huge infarct on one side. Scary stuff. After that, I finally had a vaginal delivery. It has been awhile. Like I said, I seem to be the c/s queen lately. Mom came in, 4th baby, wasn't really contracting that frequently, but she said last time she did the same thing, then went from 3 cm to complete in less than an hour. She figured baby #4 would come the same way. She didn't want to deliver in the car on her way to the hospital, nor did dad want to deliver the baby. So she hung out, used the birthing ball, walked, and sat in the rocking chair. And she was right about her labor course. All of a sudden, she was moaning, making all those "birthing noises" that women make in transition, and sure enough, she was 8-9 cm with a huge bulging bag of water. Called her midwife (a former RN colleague) and she had an awesome natural vag delivery. Not only that, but this was the first delivery I had done with this midwife since she finished midwifery school. She was always an awesome labor nurse and she was definitely in her element in the delivery room. I was nice to finally add a labor and vag delivery into the mix of surgical deliveries I've done lately.

7 comments:

Morgan said...

Why do you think you've had so many c-sections lately? Sounds like that last one was necessary- I'm glad her baby is feisty and doing well!

Very cool that you got to work with your friend who is a mid-wife now!

pinky said...

So maybe your streak is over. I had a recent streak of vag births in a row. Quite weird actually in the current climate.

I think a lot of folks mismanage the 2nd stage, that is my working hypothesis these days for the increase in c-sections. It really isn't their fault. If they were never taught how-to push most effectively, then what are we expecting.

Prisca said...

YAY! Gald you got a vag in. Sounds like it was beautiful. Also so happy you had a good outcome w/ the 35 weeker--those are scary!

Joy said...

Wonderful to hear about the vag. delivery! But wow- scary stuff with the c-section. Good thing they delivered that baby or she really might not have made it.

sara said...

I'm so glad your c - section run is coming to a breatk, LOL! Very cool that the mom with the 35 weeker and cruddy placenta did well also. It's great that you get to work with a midwife who you know from the past. Our hospital has 5 midwives (midwifes??) and they are absolutely wonderful. As a CRNA we don't have much interaction with them, but since I was on the floor so long as a patient I got to know them as they cared for me. Wow - what a difference sometimes a midwife vs a resident makes (your OB is still your primary decision maker, they just supplement the care). They actually explained things to me and answered all my questions. I was in awe of how great they were!

sara said...

Forgot to say that the midwife can't do deliveries at our hospitals but I sure wish that they did as they do other places. It would be a true asset to the hospitals. I'm not sure if it's because we live in MI and it's a legal thing and privledges or what. I'll have to investigate :-)

mitchsmom said...

Sounds like one of those cases that c-sections were made for, probably saved a life.
It's so horrible for a patient with a demise to come in and say "baby hasn't moved since yesterday, day before, day before that, etc....