What a day...
Nov. 11th, 2020 05:02 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterSo I was running an IOL for SGA at 37+1.
Apparently the cervix was super favourable so didn't require a foleys - I found that rather promising.
She palped small and looked tiny so I thought SGA was a valid possibility.
The CTG started off great.
Oxytocin at 15, then 30, then I kept it there for an hour prior to going to 60, then she wanted an epidural.
I thought she only used gas with her first (but it was a spont that got to 8 and then went to OT for C-section for a pathological trace, foetal distress). She sat up so well for the epidural, but then had difficulty staying straight for the procedure.
It seemed like it took forever for the epidural to work. It went in at 12:15, re-started the CTG at 12:36 but wasn't functioning really until 13:15 when she was fully and then we didn't see the point to put up the epidural infusion.
Then we started pushing, and it was slow going.
The head was so low, +1 but still it only budged like 1mm at a time and kept going back, then it made some good progress, but kept going back.
13:40 The AM in charge poked in her head and said I came to look before handover. she said looks fine, which it did. but then : as per usual, as in 2nd stage:
The CTG has a lot of early decels that were starting to widen.
Then before i knew it it was 14:00 and we'd been pushing for an hour. She was a previous c-section so everyone was asking me "how long did they say she could push for " and I was like there wasn't a time limit given.
At 13:50 ish i was like, well if I think she needs an episi can someone please bloody come help me since I haven't cut one on my own before and im not fully confident?
And the PM incharge was like you left your woman pushing on her own>!>!! and I was thinking -- well. I'm meant to leave at 1430 you know.
A student from my group, now midwife, Andrew came to help me out. Because -- PM incharge apparently asked him if he could do an episi and he's like well, I've done a few.. but literally there was no one else. My trace was looking sour, I was thinking vacuum.
Now get this. So he wasn't actually allocated my woman. He was just asked to go help me. What is this crap: I'm morning staff, I need to go home eventually, you need to find me some sort of relief person here.
The peri was starting to sheer.
(and also, when the hell am I gonna find the time to write notes and sort everything out?!)
The PM senior looked at my trace and was like "this needs to be reviewed"
I figured it was cause of repetitve, widening decels
nil cycling in last 60 mins (but also, who sees cycling in 2nd stage active?)
Then Andrew tells me that there was an incident in the observation rooms, something about, a lady at term went to get an ultrasound (I don't know why: there's usually a reason like decreased fetal movements or SGA or diabetes or LGA or some problem with doppler flows or something : most term women don't get ultrasounds routinely). and then in the afternoon came for... some reason to hospital to MAC? and there was no fetal heart rate. And she was begging for a c-section. and they're like, no... its better you don't and she kept begging: and then down the hall bed 4 had a brady during ? I don't know what and they decided they needed to go to a c-section for that one. And of course my lady looks shitty (like if it had been any other day they would have said: you know what its too risky for vbac after pushing for 1 hour due to uterine rupture so we're taking u for a section at fully -- basically stating that they're a crap pusher) but cause its so busy, its sorta left hanging in the breeze.
Then at 14:45 the O&G arrive and a vacuum is done and baby is out at 14:47
Cried super loud. So loud the paed was in the hallway but didn't attend because, well, clearly, kid is ok.
Felt like the longest 1 hour and 47 mins of my life.
Luckily, the O&G had brains to take cord gasses cause I would have forgotten.
For all that worrying about the paperwork and bullshit they want sorted -- I was worrying that no one had actually checked my hartmanns 2nd bag so who the hell would sign it with me (Andrew to the rescue -- and also, he sorta ended up just having my lady. Self allocation? or was it I that allocated?? who knows...)
I had my notes tidied up and my stupid stickers signed and the fluid balance looking somewhat decent (not filled in but signed off) by 15:45 so after a bit of argy bargy I was in the car driving out of the car park by about 16:00 (1.5 hours post supposed end time).
Is this why doing a 06:00 shift is a bullshit, because you end up leaving at the same time as the 07:00 people? I was gonna inform the boss - but I could tell they would be all busy in their meeting with the ADON about the fetal death : and the roster booky thing was nowhere to be found.
PS. the cord gasses looked great. lactate was like 2.7 (normal is 2.6) and that was same for V and A, and the pH was reasonable.
Kid didn't look huge (I was starting to think it was a bigger baby than we thought) but also it wasn't overly small.
People are abandoning the dragon boat club left right and center.
I don't have credit cause Amaysim is being weird and now I want to change companies anyway - so I haven't renewed this month. Therefore Kerry tried to phone me today to say she's joining another team, and yesterday Auntie asked me if I wanted to be club president (tell me she's joking). I haven't yet replied.
Its 17:30 and I'm having real lunch now (I had snacks in the car on the way home). I cancelled running with Bel. All I want to do now is sit on the couch and finish "Truly Madly Deeply" by Jenna Tooms.
I was dubious about her stuff, but actually this is the 3rd thing I've read on her gossamer page: and it's definitely the best of the one's I've read: (Acceptable level of happiness then Shooting Star). Can't wait to finish it so I can review it...
Apparently the cervix was super favourable so didn't require a foleys - I found that rather promising.
She palped small and looked tiny so I thought SGA was a valid possibility.
The CTG started off great.
Oxytocin at 15, then 30, then I kept it there for an hour prior to going to 60, then she wanted an epidural.
I thought she only used gas with her first (but it was a spont that got to 8 and then went to OT for C-section for a pathological trace, foetal distress). She sat up so well for the epidural, but then had difficulty staying straight for the procedure.
It seemed like it took forever for the epidural to work. It went in at 12:15, re-started the CTG at 12:36 but wasn't functioning really until 13:15 when she was fully and then we didn't see the point to put up the epidural infusion.
Then we started pushing, and it was slow going.
The head was so low, +1 but still it only budged like 1mm at a time and kept going back, then it made some good progress, but kept going back.
13:40 The AM in charge poked in her head and said I came to look before handover. she said looks fine, which it did. but then : as per usual, as in 2nd stage:
The CTG has a lot of early decels that were starting to widen.
Then before i knew it it was 14:00 and we'd been pushing for an hour. She was a previous c-section so everyone was asking me "how long did they say she could push for " and I was like there wasn't a time limit given.
At 13:50 ish i was like, well if I think she needs an episi can someone please bloody come help me since I haven't cut one on my own before and im not fully confident?
And the PM incharge was like you left your woman pushing on her own>!>!! and I was thinking -- well. I'm meant to leave at 1430 you know.
A student from my group, now midwife, Andrew came to help me out. Because -- PM incharge apparently asked him if he could do an episi and he's like well, I've done a few.. but literally there was no one else. My trace was looking sour, I was thinking vacuum.
Now get this. So he wasn't actually allocated my woman. He was just asked to go help me. What is this crap: I'm morning staff, I need to go home eventually, you need to find me some sort of relief person here.
The peri was starting to sheer.
(and also, when the hell am I gonna find the time to write notes and sort everything out?!)
The PM senior looked at my trace and was like "this needs to be reviewed"
I figured it was cause of repetitve, widening decels
nil cycling in last 60 mins (but also, who sees cycling in 2nd stage active?)
Then Andrew tells me that there was an incident in the observation rooms, something about, a lady at term went to get an ultrasound (I don't know why: there's usually a reason like decreased fetal movements or SGA or diabetes or LGA or some problem with doppler flows or something : most term women don't get ultrasounds routinely). and then in the afternoon came for... some reason to hospital to MAC? and there was no fetal heart rate. And she was begging for a c-section. and they're like, no... its better you don't and she kept begging: and then down the hall bed 4 had a brady during ? I don't know what and they decided they needed to go to a c-section for that one. And of course my lady looks shitty (like if it had been any other day they would have said: you know what its too risky for vbac after pushing for 1 hour due to uterine rupture so we're taking u for a section at fully -- basically stating that they're a crap pusher) but cause its so busy, its sorta left hanging in the breeze.
Then at 14:45 the O&G arrive and a vacuum is done and baby is out at 14:47
Cried super loud. So loud the paed was in the hallway but didn't attend because, well, clearly, kid is ok.
Felt like the longest 1 hour and 47 mins of my life.
Luckily, the O&G had brains to take cord gasses cause I would have forgotten.
For all that worrying about the paperwork and bullshit they want sorted -- I was worrying that no one had actually checked my hartmanns 2nd bag so who the hell would sign it with me (Andrew to the rescue -- and also, he sorta ended up just having my lady. Self allocation? or was it I that allocated?? who knows...)
I had my notes tidied up and my stupid stickers signed and the fluid balance looking somewhat decent (not filled in but signed off) by 15:45 so after a bit of argy bargy I was in the car driving out of the car park by about 16:00 (1.5 hours post supposed end time).
Is this why doing a 06:00 shift is a bullshit, because you end up leaving at the same time as the 07:00 people? I was gonna inform the boss - but I could tell they would be all busy in their meeting with the ADON about the fetal death : and the roster booky thing was nowhere to be found.
PS. the cord gasses looked great. lactate was like 2.7 (normal is 2.6) and that was same for V and A, and the pH was reasonable.
Kid didn't look huge (I was starting to think it was a bigger baby than we thought) but also it wasn't overly small.
People are abandoning the dragon boat club left right and center.
I don't have credit cause Amaysim is being weird and now I want to change companies anyway - so I haven't renewed this month. Therefore Kerry tried to phone me today to say she's joining another team, and yesterday Auntie asked me if I wanted to be club president (tell me she's joking). I haven't yet replied.
Its 17:30 and I'm having real lunch now (I had snacks in the car on the way home). I cancelled running with Bel. All I want to do now is sit on the couch and finish "Truly Madly Deeply" by Jenna Tooms.
I was dubious about her stuff, but actually this is the 3rd thing I've read on her gossamer page: and it's definitely the best of the one's I've read: (Acceptable level of happiness then Shooting Star). Can't wait to finish it so I can review it...
no subject
Date: 2021-11-10 06:38 pm (UTC)Fetal demise is always so upsetting. When I worked gynecology, we'd get the patients post-delivery so the moms wouldn't have to be on the maternity ward.
The pediatrician wasn't at the bedside? WTF?
no subject
Date: 2021-11-10 09:49 pm (UTC)They don't seem to have good "rubber capacity" - I wondered, back then, if that was because the space was so large (so its a 20 bed unit, each bed is single room) but its run at 50% capacity, and staffed probably more for 40%. Midwifery is such that, you could have 10 babies born on one day and the next day just get the one.
So you get 9 midwives on one day madly running around one day
and then the next day - everyone sitting around on their arses.
The area is a very low socioeconomic one so it seems everyone has an issue. Women without problems is rare, if they are not diabetic, they have "social problems" and we are inducing for those, or they have drug issues, and there's concerns for the baby's size. Even when there isn't a problem... someone, somewhere seeks to label them. It's meant to be a hospital for the super low risk... lol. ... no one is low risk at SSH.