Last Night

Yesterday afternoon I showed up on Labor and Delivery without my roller skates, a big mistake, come to find out. From 4pm until 5:30am, there was little rest for the weary CNM (my preceptor) and student nurse midwife (me). We admitted a woman (J.H.) who was 4-5cm dilated right when we got there. I had not even finished her admission paperwork before I had to see another woman (C.B.) who thought her bag of water might have broken the day before. Sure enough, she was ruptured, and since it had been more than 24 hours and her risk for infection rising with every hour before delivery, we also admitted her to induce her labor with Pitocin. No sooner than both these women were settled but another comes in, this time in extreme pain with her contractions. When we go to asses her, her baby's heart rate slowed down to half its normal rate for about a minute, causing us all to go into emergency mode and buying the woman a repeat C-section (she had had one previous c-section).

My preceptor went "back" to the OR to assist the doctor with the section while I kept an eye on the 2 other women who were laboring. Before long another woman comes to triage, reporting that she is being evaluated for preeclampsia (a dangerous disorder associated with high blood pressure during pregnancy), and might need to be induced. The nure and I looked at each other, and when the patient was out of earshot said: "Get in line, honey! There's already a few ahead of you." (We only have 2 true labor rooms at PIMC, and one other that can be used for labor in a pinch.)

Well, we ended up sending the lady with preeclampsia to another hospital to be induced, while we continued to try to coax some babies out of the women we already had. Both of them decided to progress very slowly though, and it wasn't until about midnight that we saw some significant progress. J.H. all of a sudden went from 5cm-7cm, and then from 7cm to 8cm to 9cm to complete rather quickly (probably the epidural she got between 8 and 9cm helped her a lot as she really needed to be able to relax). We knew to expect a big baby as J. had been measuring big the last couple of weeks, and sure enough, baby's shoulders got stuck on her way out. My preceptor and I had to pull and stretch and push in all sorts of different ways before this little one finally emerged into the world at 2:15am , giving us a bit of a scare at first by the looks of her, but perking up rather quickly and letting us know with her lusty cry that she had had enough of the discomforts of being pushed through the birth canal.

Meanwhile, C.B. had been measuring 3cm since she came in, but by the time we got to checking her after J.H.'s birth, she had made it to 5cm. Her body really kicked into high gear then, taking her through the last 5 cm dilation at the speed of lightening. Her chunky baby boy was born around 4:30am, emerging from the birth canal en caul (with what remained of the bag of waters still encasing his head).

My preceptor and I crashed (literally) into bed at 5:30am...eager for the couple hours of sleep we hoped to get before we had to wake up and give report to the oncoming midwife.