I Like It Like That

    

This is the first baby I delivered.  DJ.  The second picture I wish I'd had during the "Love" photo challenge.  The family didn't have a camera other than a cell phone, and since I always carry my digital camera I offered to take a few shots and email it to them.  I took the first picture soon after the birth. 

After all the craziness following the delivery, I was coming back in the room to grab my white coat from the rack and caught the father sitting looking down at his new son.  I grabbed my camera, and he looked up.  I told him to go back to looking at his son and caught the image.  So beautiful.

I wish the best for them.  Both 15.  Still in high school.  From the hours I spent with them (more on that later) it seemed they both had supportive families.  But, I know it will be a long hard road for them.  I am glad I was able to capture this simple moment.

Anyway, back to the meat of things:

I started OB/Gyn yesterday, and I found out that I am assigned to the Labor and Delivery Service.  In essence, pregnant women come in and are triaged (sorted according to priority).  One of my jobs is going to be to decide who stays, who goes home, who needs other services.

After morning rounds, I presented myself to the senior resident who showed me around the 10 bed unit which has 3 triage beds and is connected to an OR with another 6 holding beds.  The OB intern took me in with her on the first few patients as they started coming en masse that morning.  Then, I was pretty much on my own.

We triaged about 20 patients from 8 a.m. to noon.  It's not the E.D. where you see someone, make a decision and move on.  Some of the women coming in have to be "ruled out" as being in labor.  Which means they need to be monitored for contractions and examined several times to see if they are "progressing."  Yes, that's right, I am doing MULTIPLE vaginal exams.  Ugh.

For all of my patients yesterday, I did the exam with one of the OB residents due to the fact that there is a lot of difference between the pregnant and about to deliver woman versus what I am used to seeing in the E.D.  Yes, I admit, I was lost.  Didn't know what I was feeling.  Couldn't tell you if someone was 1 cm or 5 cm.  All I can say is that on the first exam, I checked and went "Whoa, there's a head there!"  I need more practice, and I am assured I will get plenty.  Great.  Love those pelvics.... :P

I admitted my 15 year old around 10 in the morning.  She went from 2 cm to 4 cm in about 2 hours, so she was "ruled in" as being in labor.  She got sent to a room to await her delivery.

We were in the midst of the morning deluge of women when one of the nurses pulled the call bell, and all we heard over the intercom was, "I need some help in here.  And, a resident!" followed with a loud cry in the background.  We ran in to find the RN saying that the patient had begun to want to push and when the sheet was pulled back she had seen a head.

The patient was yelling, "I want my epidural!"  We tried to explain to her that it was a little to late for that, and she started saying, "No, I can't do this without something for the pain."  Meanwhile the staff quickly got out the delivery kit and started setting up the room.  Within about 2 minutes the bed was broken down, the patient was pushing, and boom, out popped the baby.

The baby was quickly taken to the warmer and cleaned, mom was taken care of, the room was restored to order, and we were back at the desk continuing to triage.  It's funny.  A lot of places now play some sort of Lullaby or "Twinkle Twinkle Little Star" when a baby is born.  So soon the chimes were playing throughout the unit.

Just around noon, we had sorted through most of the women and were settling down into "sit and wait for the next check" mode when the phone rang, and we were told by the charge nurse that a woman was coming up from the E.D. "crowning."  That means that the head was visible at the vaginal opening.

The staff quickly started to mobilize.  They decided to take her into the O.R. room, and we quickly grabbed hats and masks.  The ambulance crew rolled her in, someone dressed dad and we got her transferred to the bed.  The senior did a quick exam and said she was at 9 cm (10 cm is a wide open cervix) so we had some time to get the stirrups and get everything in the birthing kit open.

She delivered a little girl and word quickly spread to the pediatricians standing by that the mom had smoked crack cocaine 2 days prior.  We later found out that this mom had had 8 other children and didn't have custody of them because of her drug habits.  So, at some point Social Services will be called, and this newborn will end up with another family.  Studies are pointing to cognitive developmental delays which become apparent around the age of 2.  Again, only time will tell what's in store for this little one.

The rest of the afternoon was a little more laid back.  There were a couple of C sections which the medical students attended, and meanwhile we just checked and either admitted or discharged our group of triaged patients.  I also found that I was able to use my ultrasound skills as we checked head placement and amount of amniotic fluid on the women we checked.  I, also, went in several times to check on my 15 year old, and she progressed slowly.

Finally, around 2000 (8 p.m.) we were told by the RN that the 15 year old was feeling like pushing.  My senior checked and found that she was at 10 cm.  We started getting ready.  I got gloved and gowned since she was my admission, and I had first dibs on the delivery.  My senior guided the head and showed me how to do so.  Out came the head, you pull down and release a shoulder, you pull up and out pops the baby.  And, the most important thing, you hold on tight and don't drop it!!

We cleaned and suctioned, the cord was cut, and the baby was passed off to the awaiting nurse and pediatrician.  The other senior showed me how to repair a laceration that my patient had sustained during the birth.  We got everything cleaned up.  And, then, back to work.

The rest of the night was actually anti-climactic.  I got another admission around 2200, but she was an induction (we promote labor) and would probably not even be ready to give birth for about 12 hours.  I went to bed around midnight and was woken once at 0200 for a triage.  She ended up being sent home since she wasn't in labor although she was having contractions.

Back to bed around 0300 and up at 0530 to round on patients.  I saw my 15 year old.  She looked fresh and rested and anxious to see her son.  We talked about birth control plans and breastfeeding.  Then rounds at 0700 and out the door at 0800. Not too shabby.  Hopefully, the rest of this month will go as well.

Wednesday Grand Rounds and no babies for me tomorrow.

Baby Counter:
Births witnessed:  3
Babies delivered:  1

Tags: OB/Gyn, labor, contractions, cervix, AFI

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