whitewriter | Things that happened today

So I took handover today, from 3 different people whose women birthed in the evening or late at night; for which there were no beds, and so were needing to stay a bit longer in birth unit prior to moving on to the next stage (the ward, home or another section of birthing if we needed the actual birth beds). We handed over. A midwifery handover is very structured and focuses mainly on oral delivery and utilises the yellow card or the partogram as guides.

(Whilst in ICU its all chart driven, and we ain't paper lite, at MISH its 100% computer -- one of the few ICU's in the state to be 100% intranet charting if you can believe it, and it was so well before I got there in 2013).

They're structured like this
Womans name.
Gestation.
Antenatally well or unwell or complicated by GDM or HTN or PV bleeding or whatever
Blood group
Serology NAD or positive this or that
Had an IOL/was a spot laborer - NVB or
Was the above but we had non reassuring CTG and it became a C-SECTION
Labor complications were: PPH/vasovagal/HTN/whatever and we treated it with blah.

Birthed at blah blah time.
Live infant male or female, apgars whatever and whatever.
Breastfeeding or formula feeding.
Last feed at blah
Has passed or not passed mec or urine
The plan is they're going home/ward/staying here for now .

I made the mistake of not checking the fluid balance chart for any of the handovers and when I came to update that I ended a bag (which is a new thing, in the last 5 years in intranet charting) it hadn't been signed for as started and as I hadn't started it, I couldn't end it. My little ICU heart sank. I hate having an unclean and non updated FBC. Look it wasn't the first time this happened, and it's a common occurrence. So I just didn't say anything but the seniors were checking charts and they were like who had "so and so" and I was like uh-oh.

And well yeah. I got a bit chewed out. I agree, it was my fault too because - I should have checked it on handover. It should be a habit. But when half the info is in paper format and half of it in intranet format, I can see how it's easy to focus on one at the exclusion of the other.

Another moment from today.

I was standing at the nurses' station (or is it midwifery station?) and the doctors were crowded into room 3 to look at a trace and they were saying to the midwives "what is it classified as, like whats the sticker say? What does the sticker say?" and the midwife is like "it's normal"...

That doctor isn't known for being very nice (or very woman centered) but it made me realise that this sticker thing is getting bigger and bigger, and I guess maybe they are trying to take it more seriously, that the root cause of the problem regarding what happened with the FDIU was the misuse of stickers as a tool to "save the baby" (whilst I had dismissed that and blamed things like staffing and lack of decision making in a timely manner: like, waiting for something to get better - when it wasn't - and just sitting on it).

The brady in MAC.
So I was hiding in MAC after lunch (I took the 3rd postnate up at 13:00 and did some quickie notes, then sat in the tea room from 13:15 to 14:30 I kid you not that's an illegal length of break. I was reading fic, of course.

Then felt guilty and wondered what was happening in MAC. So I went in there. It was basically empty. But the senior was alone. So I inquired sorta half asking if I could sit around in there and she's like - did someone ask you to come here? and I was like well no.[and she was like I'm alone in here so okay]. Two AM seniors on their way home were like : Why are you here? Then I was like, did I do something wrong? (the people questioning me were seniors on their way home, 30 mins early.... an 8 hour shift is basically the same as a 6 hour, with perks. You handover at 1:30 and then its lunch and then its whatever til piss-off o'clock. I'm a junior and I can't act that way... I get it, there's days when its quiet and you can go early -- cause there will be days you stay back up to 2 hrs unpaid... but I'm still here to learn, not just play.)

Anyhow somehow I ended up helping out. Getting a lady from outside and bringing her in (interesting story to come) and then the PM junior came in, and takes over that lady I bring brought in -- P0 so first baby. Didn't look at all like she was in labour. Young mum, about 20. some safe start Hx involved with the partner? -- listed under a female name, so not sure what's the go there. Saw that she was told to come in because it was her 3rd phone call about the same thing over the last 3 days (early labour pains?) term baby 38 and 2 days. Anyhow. They put her on a CTG for ?not sure why (routine admission? but actually when we dug into her notes she had poor antenatal care and skipped like 7 appointments out of the 10 they're supposed to have so actually, with that history a CTG is a solid idea. Shes got criteria for high risk of Stillbirth: antenate, poor antenatal care, probably poor education. They get a brady. The baby's heart rate goes down to 105. The doc was just around the corner, but then Dr not-very-nice walks in to find out about the brady and he's like so why wasn't the alarm pressed to alert us of the issue?

And the midwife was like. literally it happened 2 mins ago, I was here the whole time, the other doc was just outside and I called her in - and then she phoned you and you came. And that was at these time points on the CTG. It was a genuine brady but you guys were right here the whole time.

I get his point. We need to be activating systems, to prove that there is a problem. But I also know that their buzzer system is slightly not straightforward as westmead as the first level of buzzer can mean woman or midwife needs help and the 2nd level is ALL HANDS ON DEC.
When it really should be : woman. then midwife needs help (so senior knows to go) and the last is emergency everyone come.

So now I know. Problem on the CTG, press the buzzer and if I get in trouble for that I'll say well on Tuesday I heard a midwife get chewed out by Dr not-very-nice for not pressing it for a brady.

So I had 3 postnates and this was the one that probably impacted me the most.
I was reviewing her emat since on handover I was told she had complex social Hx with her now separated from husband, who was present at the birth. (and I knew the midwife that had her initially, and I asked him how the husband was, and he said he was just on his phone the entire time... and paid no attention to the lady). That she had her first child with her husband, then separated, then they tried to get back together for their family's sake: but she didn't want a sexual relationship. So they were living together, and then he forced her to have sex with him-- to get her pregnant and also -- to prove to his "girlfriend" that he could have "any woman".

So then she did actually get pregnant, and decided she'd had enough of his DV-ing and moved out. But apparently didn't have any proof of the DV (hello, the pregnancy?!) and therefore technically didn't qualify for social housing. So she was living in her parents living room; feeling homeless; because she was trying to find a suitable commercial accomodation for her, now 3 yr old son and her soon to be and now is daughter right up until she went into labor (which was yesterday). And I had to ask her "if she would like to go home today"....

Because we were so bedblocked.

She said no (good on her) because she didn't feel like going to the living room just yet.

I offered social worker but she's declined because she already has a caseworker and is in contact with all those so, supports had been sorted.

But what a horrid story to come out during the booking in appointment which would have happened in feb! The things midwives have to support women with.

Then I met another woman, P2 here for a CTG "because they told me I had to have one today". Hx. decreased fetal movements, ongoing, not happy with how they are. Say's they're still reduced - I didn't question if she was comparing it to her first pregnancy - that part of the discussion "ship" has already sailed as they were planning an foleys at 38+0 and to IOL on 38+1 And today she was stressing over the foleys and how it works and why the IOL is on the Saturday and how come she doesn't have a time and aren't foleys only meant to be in for 12 hours, and what if she wanted the IOL earlier cause shes fearing the pain and -

Take a breath.

So she's in the doctors clinic because her anxiety causes her bulimia, which is a problem in pregnancy, especially if the pregnancy itself causes more anxiety. The doctors were recommending an IOL to end the pregnancy sooner rather than later. Well that and since she's stating the baby isn't moving well and etc. that's all the more reason to IOL (technically yes- but once again, each pregnancy is different and is she comparing?) .

But here she was stressing about the IOL that she felt like she will just go into labour before Friday anyway (and I'm like won't that be good) -- I just felt like this whole IOL was causing her more stress than just utilising mechanisms to cope with waiting until postdates to start the IOL. Even with the FM concerns. She seems to be the type of lady that would never be happy with any FM pattern.

So are we actually inducing her to help her, (but is it actually?)
or because we are actually concerned for the baby? (the CTG looked good when I did it). Moral dilemma and I wasn't there for key points in the antenatal discussion of all this so I'm just walking into a bushfire without water or knowledge of which the fire came from.

She begged me if she could just have it earlier so she could stop stressing over it. I told her we were waiting for an RMO r/v. If that's the reason we're doing the IOL in the first place (anxiety) it seemed like a good reason to do it early.

She reminded me of my dad. When my dad knew he had a drs appointment in a week, 3 days before he would start telling me about how the doctors are no good, they're killing him, etc. Sometimes he woke me at 2am to rail at me about this. Then I got wise. I stopped telling him until the morning of. Wake up early, tell him to get up there's an appointment today. Appointment goes swimmingly. Get home. No winging. I sleep peacefully.