January 25, 2010

Back to busy

We are finally starting to get busy again after such a long spell of not as many births. Last night was one of those hopping nights where you don't have time to do much but run room to room, but not so horrible you couldn't provide good care. We started the night with just two moms in labor, but by the end of the night we were full and had had 4 deliveries. And get this: they were all vaginal! Yeah! First delivery happened right after we came on shift. I wasn't the labor nurse, but I did "baby care". A first time mom who was induced fro pre-eclampsia, a true medical induction. She had an epidural, and had no problems delivering while on pitocin and Mag sulfate to control her risk of seizure. She will be on Mag for 12-24 hours post-partum, just to make sure she is covered when there is still a high risk of her BP spiking. But she was doing well. Second delivery was a quick one. Grand multip, never had an epidural, had thought she would get one with her first delivery, but she was one of those women who just went too fast - even with her first. She didn't look to be uncomfortable as she rolled by with her 2 teenage daughters following behind her, but she knew it was time. She gets changed, and sure enough, she's 9cm. Midwife is called and makes it there in record time. If this mama's water had broken, there would have been no way her midwife could have made it. Her daughters were there for the birth, and at first, I didn't think they really wanted to be there and they looked scared to death. That is until the baby started to crown and these to girls watched with mouths agape, mesmerized by the birth. You could see the awe in their eyes after they watched their mother deliver their new baby sister. The third delivery was about midway through the shift and it was a couple whose second child died of a fatal metabolic disorder after 29 days in the NICU. It was a genetic problem and because their first child was just fine, they never thought to have anything checked. This time, they had CVS to see if this baby would have the same problem - and he was fine. They said they felt some relief to know that - that is until at about 20 weeks, the baby developed heart block and fetal bradycardia, which resolved on its own by 30 weeks. Last night, she came in with contractions, and was only 1 cm. But in 2 hours time, her water had broken and she delivered. Doc was called when she was 7-8 cm dilated, but there just was no stopping her labor. She delivered 5 minutes after her doc was called. Beautiful, healthy little boy. Both mom and dad cried, thankful their new son was healthy and relieved that the stressful, anxiety-filled pregnancy had a great outcome. The last delivery of the shift was at shift change. Mom had been laboring for a very long time. She had a PROM. She was only 1cm dilated and wasn't contracting, but was 39+ weeks. After about 8 hours, she started contracting on her own. She started making slow, very slow progress, but baby remained happy and she didn't have any signs of infections. At about 2200, she stalled at 8cm. And stayed at 8cm until 0200. Doc order pitocin to try to help things along, she had opted for an epidural earlier at about 5-6 cm, and finally at 0200 she was 9. She was complete by 0330 and started pushing after 'laboring down' for about an hour. At about 0615, I was able to call her doc in and she delivered a beautiful baby - 30 long hours after her water broke. Some of the docs wouldn't have been quite so patient. They would have started pit right away when she wasn't contracting, and would have done a c/s after 2 hours of no change at 8cm. Just goes to show that with a little patience and trust, the body will usually do it in it's own time. It was just kind of a fun night. The 3 of us nurses working labor last night work well together and can function pretty independently. Most times, we call a nurse from the nursery or the charge nurse to do "baby care". But the 3 of us will do baby care for each others deliveries if we are in a position to do so. We work like a well-oiled machine, so even when it's busy, we have a lot of fun.

5 comments:

Kat Clark said...

Thanks for posting this - it was awesome to read about a good night at work. Especially when it involves healthy moms and babes!

Lct4j said...

What great deliveries! I especially love how patient you and the doctor were with the 30 hour labor. I'm so glad that woman had an experienced nurse like you to let her labor down and not start pit until much later in her labor. Good for you and her!I'm also thrilled the baby is healthy and Mom and Dad are relieved and ecstatic.

Lindsey said...

I love to read your birth stories. More and more you sound like a nurse midwife with your trust and faith in a woman's body's wisdom. It suits you, I think.

I wish I'd have known more of L & D nursing in college. I'm sure if I'd been exposed to it, I would have become one myself. Such hard but beautiful work.

Joy said...

Wow, those are some inspiring and unique stories! I love reading the birth stories!!!

Che said...

I've been lurking for a while - I love reading your stories :) I'm excited for you to become a midwife if that is where you end up - I dropped out of medical school after a year and a half to become a CNM.

So exciting for those teenagers! And, yes, it's wonderful that the doc (and nurses!) could be patient with the long labor :)