I worked in birth suite last night, and had a not-so-nice
shift...
This woman was due to be induced on saturday, and came in
for routine CTG monitoring (as she was post dates by about 5 or so days), and
the CTG was very flat... variability 1-5, but a reactive trace.
Eventually the decision was made to induce there and then. She had an
ARM around 3pm, and was 2cm dilated. Clear liquor. Since this was
her second baby, they decided to leave her for an hour to see if she went into
labour 'spontaneously'. She felt some niggles, that's all. So
after SEVEN attempts to get an IV into her (and 2 hours after the ARM)
syntocinon was commenced.
For most of that time after the ARM I was told to leave the
CTG on because they (the doctors) were not happy with it. And, of
course when the syntocinon went up, the CTG was there to stay. Because
the woman was mobilising well, on the ball, on the loo, walking, sitting, etc,
the trace wasn't very clear. So, I sat with her the whole time,
listening to the baby's heart, often getting the maternal pulse showing up on
the monitor (low-lying placenta), but always hearing the baby's heart rate in
the backround, assuring me of the baby's well-being. After about an hour
of sketchy tracing, I told the woman and her husband that the doctor might
want to put a FSE on because they wouldn't be sure of how the baby was from
the printout. I showed them the device, and explained to them everything
that would happen. They asked whether it would hurt the baby. I
can't lie... a wire being screwed into a baby's head would hurt anyone.
I said it would probably hurt the baby, but chances are it won't
harm the baby. They were not happy with that, really, and the
husband said that he has been sitting with me the whole time, listening to the
baby's heart with me, and he was happy that the baby was fine if I was.
Just then, I heard the first decelleration. I watched and heard it
go down to about 80 at the onset of the contraction, then return to the
baseline of about 135 as the contraction was letting up. An early
decelleration. I listened in carefully during the next contraction, and
the same thing happened.
I went out to tell the doctor, and she came in, all stressed
out, saying she had to put a FSE on. The father explained their
concerns, and the woman was getting all stressed out too. I tried
calming her, just whispering, 'just ignore the talking, you've been doing
really well concentrating on your breathing, just keep doing that',
etc... Eventually they agreed to see how dilated the cervix was before
deciding on the FSE. If she was almost fully, they didn't want it.
Unfortunately, it was time for doctor's change of
shift. The new doctor to come on is one I've had altercations with
before: he's rude, unwoman friendly and spiteful. He came in loudly
proclaiming her need for and FSE, so they had to explain all over again to him
why they didn't want one. The woman was contracting, and wanted silence,
and even said, "shut up!" and he just kept talking, explaining why they needed
it. So he did a VE. 4cm. After 3 hours of good contractions on a
multi, who was feeling bowel pressure... 4cm. I had my doubts, but what
can you do? Then she needed to void, before the FSE was applied.
So we got her up to the toilet, and while she was sitting, the midwife in
charge barged in, saying we need her back in bed, on her left side with
oxygen. She's in the toilet... yes, well she needs to get back in bed as
quickly as possible, the baby's in distress. The woman, in desperation, in the
middle of a contraction, said, "don't tell me that!!" She turned to me,
and said, "why are they scaring me like that??" I didn't know what to
say :(
We got her back to bed, on her left side, and applied
oxygen. The FSE was attached, and showed the same early decellerations
with most contractions down to about 80 or so. All the woman wanted to
do was sit up on the ball... oh no, that wasn't allowed. The baby is
distressed, you have to stay there.
Just as a theatre was being prepared for a c/s, she had an
urge to push, and there was head on view. Baby was born within 10 min,
with the heart rate at some points only 50bpm. That was scary.
When the baby came out, she had the cord tightly around her neck 4 times, and
around her body once. She came out screaming, with apgars of
9 and 10.
I just felt like suddenly my evening was out of
control. Sorry it was so long... any comments?
Jo (new midwife)
Babies are Born... Pizzas are
Delivered.
