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.