Busy Week

Man has it been busy in the world of childbirth around here. I know I've said this before but sometimes I wonder where all the pregnant, term moms are coming from! And the surprising thing: most of the patients that have come in have gone into labor on their own (as opposed to an induction) and the inductions actually are medical and are ready! Yeah, can you believe that!?! Women are laboring faster, easier, and we're seeing more 39-42 week moms. So yeah, we've seen more meconium stained fluid, but it's just because the babies are actually coming when they are ready. You see more meconium at term. There has also been a huge increase in the number of moms who are delivering without pain meds or an epidural. Last week, I took a call from a doula who was laboring with a mom at home, a multip, and she called to let me know they were heading in . The mom wanted to labor and deliver in the tub, and with her last baby, she came in at 9cm and went too quickly to do that. She assured me she was in a much earlier stage of labor, and I heard the mom in the background attest to that. Twenty minutes later, I come out of the bathroom after emptying my stomach of it's contents, and the secretary tells me "that patient is here, nurse so and so and whats her name are in with her". Okay, let me explain first that there were 4 labor nurses for 4 patients, 2 of which were delivered. So I figure, I'll go see if they need any help, setting up for delivery, IV access, getting the tub ready, whatever. I open the door and one nurse sees me and pretty much runs out of the room mumbling that she had to do something. The other RN says "Are you ok with this?" I'm wondering WTF? You guys already checked her cervix and found that she was very close to delivery. Why do you want me to take over? She tries to leave and I notice mom is grunting and lookie-there, theres some baby hair. So I put on some sterile gloves and prepare to catch. The midwife was on her way, but there was no way she was going to get there. I tell the other nurse to stay to make sure the baby didn't need resuscitation and this RN and the tech start yelling at the mom "Don't push! Don't push!" Can I just say I HATE when people do this. The baby is crowning, the midwife has no chance of getting there, so lets torture this poor woman. I tell women that if they can refrain from pushing, then their doc/midwife will make it, but if she can't then that's fine with me. If they are moving that quickly that I can't get a doc/MW there(which usually I can), there's not stopping it. So I tell her "You do what you have to do. All we're waiting on is the midwife and if you don't care that she's not here, then I don't care". The mom said "So that's all we're waiting on, F-this!" She pushes and delivers her baby easily into my hands. I gave the screaming baby to mom who does skin to skin and immediately latches onto the breast. Mom was on the unit for less than 5 minutes. No IV access, no monitoring, no nothing. Just good old childbirth. Afterwards, I realized I had had a first: this was the first delivery I caught that I didn't have any apprehension about. In the past, there's always been just a little nervousness about whether the shoulders were going to come out, and that I was the one doing the delivery, not the doc or midwife, etc. Not that time. It was just a mom delivering her baby, and I just had to help the baby onto her chest. I guess I don't know exactly how to explain it, but any other seasoned labor nurse probably knows what I mean. It hasn't become routine, but it is just something that happens and that all I had to do was be there to guide the baby out. I realized then that the other 2 RN's who ran out of the room just didn't want to be the one to "catch". They really are good nurses, but with only 2 years experience, haven't had a 'precip' delivery too often. Not that I'm a seasoned pro, but you know what I mean.

Later that morning, I admitted another patient who was supposed to be coming in at 3AM for antibiotic treatment for positive beta strep and would then have her water broken to induce labor for a macrosomic baby. When she came in, she immediately recognized me as I took care of her with her first baby. Her first was a long labor. I admitted her at the end of my shift and when I came back that night, I did her delivery at about 2AM. She had the most awesome doula that I've ever worked with and mom did fabulous. At that time she had a horrible doctor (who is no longer practicing) who kept badgering her to get an epidural. Mom had gone over her birthplan with her doc, who in the office okay'd it. She wanted to be able to squat to deliver but when the time came, this doc came in, saw mom standing on the bed, using the birthing bar, looked at me and asked "How the hell am I supposed to deliver this baby?" I kinda laughed, which irritated the doc, but I really thought she was joking, I mean, she was the physician! The doula then said "Well, mom is going to push, the baby is going to come out, you'll put your hands between her legs, catch the baby, hand her to mom and we'll have a baby". I about wet myself when she said that! But, in the end, doc made her deliver on her back. This time her labor was only 4 hours. She was 10cm when she came in, she had the same awesome doula, and a much more patient doctor. And she delivered a 10+ baby, squatting, like she had wanted. What was funny is mom, dad and her doula had remembered me and seemed to be thrilled I was there for this one also. As I was leaving at the end of the shift, I went to tell her good-bye and they said the next time they'll have to check to make sure I'm working because now it had to be a tradition that I was there. So it's been a busy week or two, which has been more challenging between my running to the bathroom to pray to the porcelin god, but I'm up for it.