Some medical conditions lead to what is called "expectant management." You're expecting that something is eventually going to happen. In our case, it's a birth. And, while you "expect" for something to happen, you wait....
We get to the hospital relatively early, at 0530, to round on all the patients. We then have the morning meeting at 0700 where all the patients are presented and discussed. Maybe a student presentation on a pertinent topic. We then end about 0800 and report for our various duties. In my case, I present to L&D (Labor and Delivery Unit), where I wait for something to happen. Yesterday morning, I didn't have to wait long.
My first delivery of the day happened at 0820. We had been signed out about 4 or 5 patients from the night before, three of which were still waiting to give birth. I got the first one. Again, push, push, out comes the head, turn, lift up, pull down and catch the baby! A little girl in this case. DH. Her mother let me take her first photos since she was alone and family hadn't yet arrived.
Then it was back to waiting...
There are many reasons people come to Women & Children's Hospital of Buffalo, and one of them is the expertise of the Maternal & Fetal Medicine (MFM) team. They handle all of the complications and high risk pregnancies that present to the hospital. As an intern, and especially an Emergency Medicine intern, I'm expected to see non-emergent pregnant patients, like the one I had with an upper respiratory infection, pregnant patients that we "rule out" as being not in or in labor, and to help where I can. Any high risk or possible premature birth is handled by the 2nd year OB/Gyn resident and yesterday she had her hands full as she is also expected to attend all of the C-sections.
So, much of my day was spent watching her run around admitting patient after patient with various textbook complications of pregnancy such as placenta previa, where the placenta lies across the cervical opening or close to the opening. Most often they will have bleeding and spotting throughout the pregnancy and have to be delivered by C-section. We had three of them come yesterday for admission.
We had two women with pre-eclampsia which is a combination of high blood pressures, protein loss in the urine and to some extent edema. If not treated, the condition can lead to seizures and possible coma. The only real treatment is delivery of the baby. Usually it occurs in the last trimester which is good in terms of fetal development and in this case every week or sometimes day can make a difference.
Both of our patients were in their early 30th week. One was able to be controlled, the other, unfortunately was not and was taken for a C-section where she was found to have another complication of pregnancy, placenta accreta, which is an abnormal attachment of the placenta into the uterine wall. She, unfortunately, ended up with a hysterectomy since the placenta had invaded into the musculature of the uterus. These are just some of the reasons to have an MFM team on site. You just never know what might happen.
As you can see, I wasn't very busy yesterday in terms of my duties. All of the less than 36 weekers had to be seen by the second year. So I just helped out where I could. I finally got my own admission around 8 p.m., but she was coming to be induced so she wouldn't be delivering for another 12 hours. But, I admitted her, got her comfortable and waited. Luckily, the other intern had been managing a few other laboring patients, so I saw another delivery with her - this baby literally flew out of the birth canal before my colleague could even get a towel around him. She managed to catch the baby and hang on long enough for the pass to the waiting nurse. And, my colleague let me deliver one of her other patients who delivered very rapidly as well. So I got in a second delivery yesterday.
We did have an emergency on the floor I was sent to see since the seniors were tied up with all the complicated pregnancies that seemed to be coming in. A 15 year old pregnant with her second child suddenly became hypoxic (dropped her O2 saturations) and tachycardic (had an increased HR > 100). In most cases, you have to think about a blood clot to the lungs as pregnant women are at higher risk for developing them. She turned out, in the end, to have pneumonia, but we spent about an hour getting her tests and labs coordinated so that occupied a part of my evening.
Things seemed to slow down in general even more close to midnight, and I got about 4 hours' sleep before getting up for rounds this morning. After rounds home, a nap, a few odd and ends things in my office watching the skies open and snow fall like crazy. Close to two feet is supposed to fall over the next 48 hours, and it will be no fun digging out in the morning. I have a garage, my Jeep and 4 wheel drive. Give me heated seats and I can go anywhere.
Back to the hospital in the morning for another 24 hours on-call. Well, maybe 23 since it's changing to Daylight Saving Time (no 's') on Saturday night. We'll see how much we can pack into this shift.
Baby Counter:
Births witnessed: 4
Babies delivered: 3
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2 comments:
15 years old pregnant with her second child...............................wow!!
like I said before, I hope you are in Labor and Delivery for a long time; these are fascinating reads
betty
My first born was my son, born to me by ceasarian whilst I had Hong Kong Flu. I remember how ill I was and how fortunate too at having such a fantastic team looking after me. My son was 9lb 150z and I am only 5' 1" It was a bit of a time. Like your young mum above I had no visitors, apart from granddad, as hubby and everyone else was down with flu too. They thought granddad was the father....lol!
I bless anyone who takes up a profession in medicine. You have helped bring back fond memories today Veronica. You and others like you deserve all the praise in the world for being there for others. Thank you!
Love
Jeanie xx
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