Monday, July 6, 2009

Here We Go Again...

And the craziness at work hasn't slowed down over the holiday weekend at all!! Took my labor patient back for a section @ 2000...what a painful section it was. I had all kinds of pain orders from the doc after the section was over. It was going to be that kind of recovery. Then when the patient slept through most of recovery, I didn't want to keep pushing meds on her. Then got a nice chewing out from the postpartum nurse because the patient (who had no pain tolerance) rated her pain 7/10 when she got over to the other side. "Why didn't you start XYZ pain meds in recovery if she hurt so bad?" Well...because she was sleeping through recovery and couldn't keep her eyes open even when I was checking her fundus. Didn't sound like she needed pain meds to me!

Moved that section recovery and took a ROL who walked in 3cm and ruptured. 20 minutes later she was 6cm so I called the doc and said "you better head this way..." and she did. Then as I'm hanging up the phone "the scream" happened. I ran in, patient was easily complete, thank goodness the laborist followed me in. We got her in stirrups. Someone called the doc who was on her way and she said "don't let her deliver, I'm on my way!" Far be it from me to tell a multip who's complete, unblocked and +3 not to push. Doc walked in as the laborist was delivering the placenta. Thank goodness the laborist backed me up 100%.

I'm half way through my vag recovery when one of the breech PPROM (preterm premature rupture of membranes) started having very ugly decels. The laborist who had just walked out of my delivery went down to check her and there was a foot in her entrotis (vaginal canal). Time to head back to a C/S! I was really the only one who could take her, so I (kind of) handed off my recovery and ran down the hall with the new C/S. She was still contracting away so they slept her ( I went from never doing a general anes C/S to 2 in a week!). I went to go put in a foley and when I spread her labia, the ENTIRE foot was sticking out. There is just something all wrong about that. I didn't think I could get the foley in, and the laborist said " just push the foot out of the way..." so I did and somehow got the foley in. Not really sure how that happened, but if I NEVER see a foot hanging out of a vagina again that will be OK with me...

So finished section #2 for the night. There was another ROL that I should probably have taken but another nurse already had her started, so I took the next one. The first patient delivered, mine didn't. I gave the nurse a hard time and said that I should have taken that first ROL because then I could have beat a personal record and had 4 babies in a shift. But looking back, 3 babies is MORE than enough, considering that I didn't admit my vag delivery 'till after she was already over on postpartum. I'm sure I missed something on charting, but everyone was breathing when I left, so I'll fix charting tonight if I need to. I'm getting on a role here, I'm not gonna know what to do if I go a night with less than 2 or 3 deliveries!

Babies today: 1f/2m

Babies total: 56M/61F = 117

Vag:42M/46F = 88

C/S: 14M15F = 29

Babies 'caught' = 2f0.5m

4 comments:

  1. I enjoy reading your blog so much. I am on bedrest at home and I look forward to finding out the happenings of each of your shifts. Very entertaining. They beat TLC's "A baby story" anyday.
    Molly

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  2. Does your hospital not do breech deliveries? That really sucks she was put under general anesthesia. I don't think I'd have signed the consent for that!

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  3. A foot hanging out?!? That does sound like something that you don't see everyday! Sounds like you had a really busy day!

    BTW- I wish I could sleep during recovery from a c-section- that sounds much better than having to sit awake for an hour or two waiting for the numbness to wear off!

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  4. Joy ~ we don't do vaginal breech deliveries routinely at our hostpial. In fact, i've only seen one kid come out breech and that was during a twin delivery, where baby A came out head first and then baby B flipped. The doc had both hands up inside trying to find a foot, head, anything to guide the kiddo out by. Finally it just slipped out butt first, it was cool! The reason I've been told they don't do vaginal breech (espeically on a primip) is because of the risk of the feet, torso and shoulders coming out and then the cervix closing up over the neck and not being able to get the head out. The girl last night was a prime who was also not term, and her cervix would REALLY not have cooperated. Her cervix wasn't completely dialated either, just enough for that blasted foot to come out! When we were rolling her back and she kept saying she felt pressure with her contractions the doctor mentioned that we might have to sleep her and she said "That's fine with me! I've got an IV, and if that's faster then let's do it!"

    Molly~ I'm glad I'm at least entertaining :) Us labor nurses kinda shudder @ "A Baby Story" because they leave so much out! When are you due? I hope your birth experience is EVERYTHING you want it to be!

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