Friday, September 18, 2009

2 Little Boys

No babies this week, but last week I went OOT (out of town) before I got to talk about the 2 nice deliveries I had one of the nights I went in extra. The first was a C/S that was walking to the back as I came on. I almost feel guilty "claiming" that baby because I hardly even got to say "Hi I'm BDay Nurse" to the mom before the drape goes up and the baby comes out. Then in recovery they are usually so out of it, and after laboring all day, all they want to do is sleep. Doesn't leave much time for the "bonding" time. But nice, quick section. We were actually in the OR from in time to out time less than an hour. That's pretty impressive! It was a one of my favorite CRNA's on too, so that always lends some humor to the situation.

I was ready to go home after my section recovery was over and I probably could have, but there were 2 patients who were almost complete so I told them I would stay until both of them delivered so that then they would have 2 more nurses open. The 1st delivered pretty quick but the second one was an un-blocked primip and she took several hours to get from 9cm to complete. She was about 9.5cm and it was almost 1am when a SROM came in that I went ahead and took all the time thinking "I kinda wish I had just gone ahead and gone home already!" But I took her down to her room, she was 4-5cm, ruptured, multip who had gone natural with her 1st baby (all 28hrs of labor) and wanted to go natural again. Ok, that's all cool. Until she'd been on the monitor for 5min and I was doing the "interview" and she had a contraction...and I had a nice variable decel. (I thought this article on interperting a fetal heart rate tracing was really good. It's a decently short overview, and does a good job of covering the basics of what takes lots of time and experience to understad and apply!)

So after watching a few contractions there were several things that became apparent...these variables weren't going away with position changes, mom was NOT going to get off the monitors on my watch (or license) and she needed to make cervical change QUICK or she was gonna get a section. The doc for that group is known for NOT watching ugly strips for very long, and the last "questionable" strip I had with her I got my head bit off for not calling her sooner, so within 15mins of Mom showing up, I had someone start my IV while I called the doc. I told her right up front that I was having decent variables with each contraction, and that mom wanted to go natural. Surprisingly, she came in to the hospital without me even asking!

When she got there mom was a good 5-6cm, and in GREAT control. The doc came down to the room, checked her and looked at the strip. Then proceded to tell me that baby was "fine" and that what I was hearing was the monitor moving during a contraction and picking up mom's heart rate. Then she left and went back down to the Dr's lounge. I don't usually argue with doc's but I KNEW that wasn't mom's heart rate, so I slapped a pulse ox on mom's finger (to monitor mom's pulse), had another nurse come down and listen and when she agreed with me that it wasn't mom's heart rate I put a scalp lead on baby'shead. The more of those I put on the better I'm getting at them!! Anyway, by this time mom was a good 7-8cm and my variables weren't getting any better. Variables into the 60's and 50's (dropping from a baseline between 130 and 140bpm) sound horrible to a labor nurse and you find yourself holding your breath between beats just willing it to beat again. I finally called the Doc again and said "just FYI I put a scalp on and now my variables are in the 50s lasting throughout the contraction." She came down and thankfully mom was complete. She pushed twice and had a baby with a tight nuchal...but came out screaming!! Thank heaven she was a multip and went fast!

She delivered 2hrs to the minute from walking in the door. And about 15min before the previous patient that I had been waiting on to deliver before I left! Mom was in SUPER control of herself and I would do an unblocked (or blocked!) delivery like that anytime. She was fantastic. I told her before I left that doing deliveries like that remind me 1) why I love my job and 2) why I don't mind coming in extra :)

Nothing like a little excitement at 2 or 3am to liven things up and get your heart racing!!

Babies today: 2m
Babies total: 61M/72F = 133
Vag:45M/54F = 99
C/S: 16M18F = 34
Babies 'caught' = 2f0.5m

2 comments:

  1. I love reading your stories. I am glad you got a couple of good easy deliveries!!!

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  2. What lovely births! The last one sounded a bit scary so I'm glad it turned out well. I hope to labor at home longer this time than I did with my previous labors so hoping my birth goes as swiftly and quickly!

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