June 22, 2009
Wow, it's been over a week since my last post. Things have been kinda busy, at home and at work. This past weekend at work was kinda crazy. Saturday night was pretty slow. I was in charge, we only had a few patients on postpartum and besides one delivery at 11pm, labor only had a couple people come in for labor checks. That is until 6:15 a.m. I get a call that we have a 30 weeker in ER. Most of the time, the pretermers don't need much more than some terbutaline, IV fluids or antibiotics for a UTI. Not the case that morning. When she rounded the corner in the wheelchair, she had a contraction and made that grunty-I'm-pushing noise. Immediately she was checked and oh, crap, she's completely dilated wita huge bulging bag of water you could see pushing into her vagina. We dont' have a NICU and we try to ship people out to a hospital that does have one if they are less than 34 weeks. But this wasn't an option. We did manage to get the doctor there for delivery because somehow, her water didn't break on it's own. Once the doc and pediatrician were there, the OB broke her water, that baby's head came down and with one push, she pushed that baby out with so much force, the OB caught the baby like a football! It's just amazing how powerful the uterus is together with mom's pushing. The baby did remarkably well for being early. After it was stabilize, it was transferred to a high level facility and was doing quite well. Yesterday morning, I had a change of shift c-section after pushing with a mom for 2 hours. Baby just wasn't coming down and all, but she gave it everything she had. She pushed in a variety of positions, used the towel to play tug of war to help with pushing, birthing bar, squatting, everything. He just wasn't going to fit and never got any lower than maybe a 0 station. So we go back to the OR and because she had pushed so hard for 2 hours, his head was wedged down against her pelvis and I ended up having to push up on his head from under the drapes to the doc could get him out. There is nothing like pushing up on a baby's head and feeling the doctors hand touch yours as the pull the baby out. It gave me a chill. You may think "well, if you had to go under the drape and push up through the vagina, surely he would have fit eventually". Really, he was never coming out that way. You could see his scalp molding on his head from where it was trying to fit, but he didn't have a cone head. I know that may not make sense but basically his skull bones never started shifting to maneuver the birth canal. And he was a big baby for a small woman. Anyway, after it was all done, mom, dad and baby were absolutely thrilled with their baby and he latched on and nursed right away in the recovery room. It was change of shift, so I passed her off to the dayshift, and spent the next 1 1/2 charting.