Maybe it's because I hadn't worked for 8 days...but this weekend was an adventure! I loved having 8 days off, but I'm afraid it may have been a little too long, cuz all of a sudden 3 in a row seemed like a LOT!
Thursday night we did a cervidil that did nothing and ended up being cut Friday afternoon, and I also had a ROL that was a G7 who came in banging out contractions every 2 minutes that were off the chart. We watched her for the last 4 hours of the shift and she never changed, but was still contracting pretty regularly after fluids, vistaril, terb, and a morphine/phergan combo IM. But nobody wanted to send a term G7 home still contracting that often. I think they sent her home mid-morning on Friday.
Friday night was when it got interesting. I think every L&D unit has "codename patients" who are frequent fliers for a very LONG 9 months and everyone celebrates after they deliver :) It seems like some docs specialize in these kinds of patients too. Anyway, we have one doc in particular who is a WONDERFUL OB, but really seems to attract the "interesting" patients to his practice and they come in with all kinds of crazy histories and backgrounds. So this particular patient of his has been frequenting our unit for the last several months, very non-compliant with everything, tells the nurses how to run the show, asks for meds by name for symptoms (Can I have some zofran for my nausea? Seriously, what patient asks for zofran by name?) and is quite dramatic. Everyone on the unit knows her name. Non-compliant diabetic, multiple other health problems, on both oxycodone and oxycotin at home for pain, multiple positive drug screens, the works. She had a complicated history with several miscarriages and had lost several babies near-term. She had started dilating early on so she had a cerclage in but would still come in "in-labor" every few weeks. Anyway, the doc had checked her in the office and she was about 2cm around her cerclage so he sent her over to the hospital. He sat there and waited for 4 hrs and she never showed up, so he went to his Christmas party. Then she showed up...and we got her!
She screamed and moaned and had the worst looking strip I've ever seen. Seriously, a flat line. Flat, flat, flat, flat, flat. I looked at it again last night and it's one of the strips that makes you nauseous to look at. It looked like she was contracting a little, but a little difficult to monitor so not really sure. The doc said to give her morphine. We second-guessed that, but his comment was "if that kid's already flat, what's morphine going to do to it? It can't get flatter..." Did the morphine touch her, nope. Interesting that the urine screen came back positive for everything! Doc came back and checked her after his party and she was actually 6cm with her cerclage! He broke her water and it was the most disgusting mec I have ever seen. It didn't even look like mec fluid, just like pure meconium. All that at 35wks. Poor kid was super stressed out! So section and kid was in the NICU, had a .7 shift to the left by the time it was down to the unit and sugar dropped from 50 to 25 in a matter of minutes. Ouch.
I was pooped at 7am Saturday morning! Then got 5 hrs of sleep and went back last night. I had a delightful couple from out-of-states and did a really nice delivery about 0100. First vag delivery I've done in what seems like a very long time! Toss in a triage and I was ready to come home and SLEEP!
One more night of orientation this week then watch out out pregnant people, I'm on my own! I guess if I look at it, I've been flying almost solo for the last couple weeks anyway, but still, that last snip of the cord seems a little scary. One of the nurses told me something really good a few nights ago though, "you still have the same resources after you're off orientation. We're all still here, we'll still answer questions, you can still ask for help. Nothing really changes that much." That's a good thing to remember :)
Babies today: 1f/1m
Babies total: 28M/23F = 51 (50 is my first big milestone! Yea!)
Vag:21M/20F = 41
C/S: 7M3F = 10