Like Moths to a Flame

As I drove in to work yesterday morning, I saw the moon hanging over the horizon.  The full moon.  As it guided and directed the tides of the sea, it guided and directed the tides of women coming in to give birth throughout the next 24 hours... and they gave birth in waves.

After rounds, etc, we went to the L&D ward to find a quickly filling board.  Many women had come in overnight either in labor or to be induced for delivery.  So, in the morning, we had about 6 or 7 women who would be delivering at any time.  No sooner had we started getting settled in than one woman began to deliver.  The seniors covered that delivery because she delivered so fast that the rest of us never even got a chance to get in the room.

I admitted two patients early on who were progressing rapidly.  Given the other women we already had in labor, the concern was that they would all give birth at the same time.  Which mine almost did.  I went in to check on my second admission who'd given birth before. 

She said she was feeling uncomfortable and felt like pushing.  I told her to go ahead and see how it felt.  She did, and I could see the head working its way down the birth canal.  I told the RN to call my senior to come in the room as my patient was ready for delivery.  However, my patient decided that she wanted the baby out and started to push harder.

We told her to stop and wait!  She said, "NO!  It hurts too bad, and I want it over with!"  I barely had time to grab some gloves and run back to the bed as the head popped out.  We told her to stop pushing as I guided the umbilical cord over the baby's head.  She barely stopped to inhale as I did and then pushed again and the rest of the baby was out! 

My senior walked into the room to find me holding onto the baby and trying not to drop him.  I had birth slime and blood on my uncovered arms, and I was trying to keep my shoes somewhat clean since she'd delivered on the bed and everything was dripping everywhere.  I was barely able to get her placenta delivered and the paperwork and orders filled out before my second patient decided she was going to start pushing too.

I walked, luckily, into the next door room, and within about 20 minutes, my second patient delivered.  This time a lot more controlled, and at least I had a gown and shoe protection on.  After getting her settled, I went to change scrubs while I had a chance.  During that time, the baby tunes sounded over the hospital system.  Another one delivered.

I didn't have any more deliveries for a while, but that doesn't mean my colleagues weren't busy.  Soon we were "log jammed" and wondering how we were going to coordinate patients between those in labor, those delivering and those who had delivered.  I was told they'd had to put patients in the hallway, but we had so many coming in with labor that it wouldn't be practical.  Part of the problem was getting patients discharged from the Mother - Infant ward upstairs and rooms cleaned so our delivered mothers could move upstairs.  So there was a bit of stress until things started moving forward again and rooms were cleared on our unit.

Around 1900 I picked up a patient from the intern who was going home for the day.  I wandered in with the senior to introduce myself as he checked her progress.  He decided she was ready to start pushing and working toward delivery.  She did.  We breathed, she pushed and over about 10 minutes she was able to get the baby into position.  My senior walked out of the room to get the chief resident, and I turned around to grab my gloves and gown to get ready.

I heard the nurse say, "Stop pushing" while at the same time saying "Get those gloves on quick!" And barely turned while the nurse pushed the staff button to call in the delivery team.  I quickly grabbed my gloves and rushed back to the bed in time to get a hand on the baby's head to guide him in a more controlled fashion into the world.  The chief walked in the door as I was guiding the shoulders and quickly pulled on gloves to help me with the rest of the delivery.   Another bed delivery.  And, off I was again to change scrubs.

And the women kept coming.

Around midnight, I was in the middle of admitting two patients that I had rechecked after 2 hours and found to be in labor when another 3 patients showed up.  So the other intern and I scrambled to try to get everyone checked and admitted.  I was doing the paperwork for my second admission when the RN for the first admission called that the patient was uncomfortable.  The senior and I went to check her and broke her bag of waters since she was close to being completely dilated (10cm).

We stayed with her for a while while she learned to breath and push.  She was first time delivery, so I walked out of the room to finish my other admission's paperwork, but had to rush back in when the nurse called to say the patient was actively pushing.  Again, my senior checked her and said that it would be soon since the baby had moved down well, and he said the now ill-fated words that he was "leaving to get the chief."

I had my gloves and gown ready, and the nurse was getting things in order to break down the bed (take out the center cushion and put up the foot rests for delivery) when suddenly the patient said, "I really have to push" and did.  Again, barely got gloves on in time to catch yet another baby on the bed.  My fourth of the shift.  Afterward I was teased that I was supposed to be getting some experience since I was an Emergency Medicine resident but that didn't mean more than the OB interns!  It was all in good fun.

I finally was able to sneak in a nap between 4 in the morning and rounds at 0630.  My second admission of the night delivered with the other resident around 0700, which I missed, but somehow didn't really care.  I'd seen more than enough during the shift. 

On my way off the Mother - Infant unit, I stopped to look in the "Baby Aquarium" (my own special name for the large picture window where you can look into the nursery.)  I counted 15 babies.  That didn't include the ones still downstairs, or the ones in their mother's rooms. 

I wonder if the waning moon will lead to waning deliveries as I take my final 24 hour shift tomorrow.  We'll soon see.  
Baby Counter:
Births witnessed:  9
Babies delivered:  13
C-sections witnessed:  3

Tags: Full Moon, precipitous delivery, cervical dilation, meconium, labor and delivery