Another fairly standard day.
Oct. 2nd, 2020 11:29 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterJerked around by senior staff.
That was the theme for today.
They allocate me a twins lady who was trying to decide mode of delivery (MOD). C-section v. vaginal birth. I was bored, I had one antenate to myself, she was contracting but it was still early labour. And the plans had not yet been set. So I reminisc'ed with the ward clark about how in my 20s I would judge my friends who had children and then complained to me about issues regarding pregnancy/or their kids. My rational at that point was like -- you made your decision to have children, why are you complaining about something you chose to do -- flipped to, Ratty you chose to do midwifery and now that you don't like it and your still there.... why are you complaining about it (to be fair, at least I've got plans to leave) ANYHOW. so with this twins lady, the way things were headed I felt like they shouldn't have given her a choice in the first place re: MOD, but then again; initially she had always been c-section all the way; and it was only now when she was experiencing TPL that she started to say "perhaps I should at least try for an NVB...."
As far as twins go she was the most low risk type of twin delivery. I tried to explain to the clerk why some twins are DCDA and others are MCMA and I reach towards cell division (at which point the twin was formed being the choice between MCMA v MCDA). It turns out wikipedia says I'm right -- depends if the cell or embryo split before or after the formation of the amniotic sac which is at about 9-13 days after fertilisation) https://en.wikipedia.org/wiki/Monoamniotic_twins
I wish i chose embryology in 3rd year B Sci. It would have been helpful as a midwife!
So we are about to go to c-section and the incharge changes my allocation.
Oh actually, If i send you to the section I need to send someone with you to support you so how about I change you with someone else, so that I don't lose two midwives off the floor...
I agree instantly, because well. I'm not the incharge.
So instead I get a standard induction with a student instead, which was great because this student was well better than I was when I was a student. She only started in July and basically did everything ! I don't think I was like that.
So I stood back. We chatted, we pushed up the synto. I explained why I didn't think midi was for me.
Bloody hell this woman was hard to palp contractions on, if I was being polite I would say it was due to body habitus and if I was not polite I'd say she's fat. oh hell is brought down on me for calling a pregnant person fat. When will I grow out of my prejudices .... (this became a topic at dinner at the sister in law's tonight).
I tried to figure out why this woman wasn't in pain. I talked to the AM incharge. She's like hum. She goes to do a second ARM and VE declares the woman a 2cm and not effaced (when she started the day at 3-4cm and fully effaced). so I don't know how those two examinations done 4 hours apart could have yielded such different results. I have to explain to this woman, why she's actually technically gone backwards according to the progressive VE. I chalk it up to the subjective reality of an examination by people with different sized hands. She seems to accept my answer. Right here is an example of where a progressive VE undertaken by 2 different people, has failed a woman.
Her cervix hasn't really changed. So clearly the contractions haven't done anything there. To also be fair I didn't think she was anywhere near established anyways.
So we push the synto to 150. her SBP also goes up to 150 (she was an induction for essential HTN, which I think is a reasonable reason to induce. I guess. However her blood pressure was well controlled on meds, the baby wasn't SGA and she didn't test positive for PET. Her cervix scored a 3 and favorable not requiring a foleys the day prior so, in essence i thought she would be an easy induction).
We fluid restricted and pushed the synto to what was essentially 210mls/hr at 10U in 1L but was 70mls/hr in a 3x strength bag. When we changed the bag to the 3x strength one I made, the woman started showing she had pain. I swear on the previous bag, she was chatting, breathing a little but was like, so. Is this labour? And we are like ... no.... I don't think so....
It was the weirdest thing ever.
It made me question if there was even synto in the bag!
And then 30 mins post us starting the 3x bag, she asked for an epidural/ or possibly the doctors suggested it since her blood pressure was borderline. She wasn't keen on the gas,
Then immediately after the epidural was in and appeared to be somewhat effective there's a large brady.
I turn her on the side. I consider to turn off the synto.
I turn off the synto.
I turn her to the other side, the trace starts to recover.
The student goes to get the incharge
The incharge comes in and barks don't just stand there staring at it call the registrar! And I'm thinking right, well there's half my biggest fear realised....
Anyhow. Synto's off, we wait for review. Trace looks good.
Post epidural brady?
Anyhow. The incharge somewhat apologised for snapping at me.
The consultant reviewed the trace.
Recommended recommencing the synto. And then it became time for me to leave. I wished the woman luck (and myself and the PM student I was leaving behind in that room by herself) were already thinking LSCS.
And I thought about it. On orientation they told us always to escalate things to the access. But was this a case where I should have gone straight to the registrar? I didn't realise until after we called the incharge that she had been busy with some sort of preterm emergency.
That was the theme for today.
They allocate me a twins lady who was trying to decide mode of delivery (MOD). C-section v. vaginal birth. I was bored, I had one antenate to myself, she was contracting but it was still early labour. And the plans had not yet been set. So I reminisc'ed with the ward clark about how in my 20s I would judge my friends who had children and then complained to me about issues regarding pregnancy/or their kids. My rational at that point was like -- you made your decision to have children, why are you complaining about something you chose to do -- flipped to, Ratty you chose to do midwifery and now that you don't like it and your still there.... why are you complaining about it (to be fair, at least I've got plans to leave) ANYHOW. so with this twins lady, the way things were headed I felt like they shouldn't have given her a choice in the first place re: MOD, but then again; initially she had always been c-section all the way; and it was only now when she was experiencing TPL that she started to say "perhaps I should at least try for an NVB...."
As far as twins go she was the most low risk type of twin delivery. I tried to explain to the clerk why some twins are DCDA and others are MCMA and I reach towards cell division (at which point the twin was formed being the choice between MCMA v MCDA). It turns out wikipedia says I'm right -- depends if the cell or embryo split before or after the formation of the amniotic sac which is at about 9-13 days after fertilisation) https://en.wikipedia.org/wiki/Monoamniotic_twins
I wish i chose embryology in 3rd year B Sci. It would have been helpful as a midwife!
So we are about to go to c-section and the incharge changes my allocation.
Oh actually, If i send you to the section I need to send someone with you to support you so how about I change you with someone else, so that I don't lose two midwives off the floor...
I agree instantly, because well. I'm not the incharge.
So instead I get a standard induction with a student instead, which was great because this student was well better than I was when I was a student. She only started in July and basically did everything ! I don't think I was like that.
So I stood back. We chatted, we pushed up the synto. I explained why I didn't think midi was for me.
Bloody hell this woman was hard to palp contractions on, if I was being polite I would say it was due to body habitus and if I was not polite I'd say she's fat. oh hell is brought down on me for calling a pregnant person fat. When will I grow out of my prejudices .... (this became a topic at dinner at the sister in law's tonight).
I tried to figure out why this woman wasn't in pain. I talked to the AM incharge. She's like hum. She goes to do a second ARM and VE declares the woman a 2cm and not effaced (when she started the day at 3-4cm and fully effaced). so I don't know how those two examinations done 4 hours apart could have yielded such different results. I have to explain to this woman, why she's actually technically gone backwards according to the progressive VE. I chalk it up to the subjective reality of an examination by people with different sized hands. She seems to accept my answer. Right here is an example of where a progressive VE undertaken by 2 different people, has failed a woman.
Her cervix hasn't really changed. So clearly the contractions haven't done anything there. To also be fair I didn't think she was anywhere near established anyways.
So we push the synto to 150. her SBP also goes up to 150 (she was an induction for essential HTN, which I think is a reasonable reason to induce. I guess. However her blood pressure was well controlled on meds, the baby wasn't SGA and she didn't test positive for PET. Her cervix scored a 3 and favorable not requiring a foleys the day prior so, in essence i thought she would be an easy induction).
We fluid restricted and pushed the synto to what was essentially 210mls/hr at 10U in 1L but was 70mls/hr in a 3x strength bag. When we changed the bag to the 3x strength one I made, the woman started showing she had pain. I swear on the previous bag, she was chatting, breathing a little but was like, so. Is this labour? And we are like ... no.... I don't think so....
It was the weirdest thing ever.
It made me question if there was even synto in the bag!
And then 30 mins post us starting the 3x bag, she asked for an epidural/ or possibly the doctors suggested it since her blood pressure was borderline. She wasn't keen on the gas,
Then immediately after the epidural was in and appeared to be somewhat effective there's a large brady.
I turn her on the side. I consider to turn off the synto.
I turn off the synto.
I turn her to the other side, the trace starts to recover.
The student goes to get the incharge
The incharge comes in and barks don't just stand there staring at it call the registrar! And I'm thinking right, well there's half my biggest fear realised....
Anyhow. Synto's off, we wait for review. Trace looks good.
Post epidural brady?
Anyhow. The incharge somewhat apologised for snapping at me.
The consultant reviewed the trace.
Recommended recommencing the synto. And then it became time for me to leave. I wished the woman luck (and myself and the PM student I was leaving behind in that room by herself) were already thinking LSCS.
And I thought about it. On orientation they told us always to escalate things to the access. But was this a case where I should have gone straight to the registrar? I didn't realise until after we called the incharge that she had been busy with some sort of preterm emergency.
