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.