My three ladies: the almost intrapartum, a postnate and an antenate.

[whitewriter]

The almost intrapartum
40+0
Apparently, we IOL any lady whose still pregnant at 40+0.
It's either that or they have a c-section.

Her previous pregnancy was a c-section.

The foleys catheter insertion itself was considered "traumatic" according to the lady.

And they barely could get in to do a VE only to find her cervix still unfavourable.

What kind of discussions were they having down in the antenatal clinic? This woman was never suitable for a vaginal birth from what I could see. Every risk factor present, she's 43 (AMA- advanced maternal age), last baby was like, 6 years ago, she's unlikely to have another - so why not just cesar the lady and call it a day?

You'd think I'm not a midwife with those words.

Now she's on a green sheet which means "emergency wait list" which really means "fit her in when they can" which at 12 noon was decided to mean : not today, which means "probably tomorrow" and if I was to guess at the % chance of it happening tomorrow I'd still say 50/50 depending. The husband refused to have her go home (lady was fine with anything) but you know what, I agree with him. He cited safety reasons (ok I didn't agree with that) but I do agree that if she's taking up a bed in the hospital it'll speed management along to prioritise her c-section because she's taking up a bed. Just for that reason alone.

It's not great when we're busy to be filling beds with pointless women when this could all have been resolved if at 36+0 someone thought about this picture and was like "you know what, a c-section is best here" and just booked the damn thing in properly.





The Antenate

Young lady G4-P1 comes in for back pain and abdomen pain, gets assess in MAC, according to the chart: she didn't get any medications - but she's still here. She didn't initially come in for decreased fetal movements but on assessment she says they're "much reduced". So they book her a fetal welfare scan in house. The scan says the baby is LGA 88% centile. Big baby. And she already had 1x traumatic birth with the first which she described to me as thus:

She came in for an IOL, because of suspected big baby, they told her to have an epidural because if they needed to go for a c-section for said big baby, then she'd already have the line in and all - but she says it didn't work because she could still feel everything: but she wasn't in pain. The birth was fine (pain-wise didn't feel anything), but then on the CTG the baby's heart dropped so they got out the forceps and not waited for a contraction or anything just put it inside her, yes she could feel it, and pulled the baby out.

So that's why she wasn't keen on having another big baby: but rather, was wanting an early IOL. The first doctor that talked to her said "no way" (aka. wait until 39 weeks as 37 weeks is too early to call it) so she wanted to talk to another one.

There were so many things wrong with this picture that I didn't want to probe. I just arranged for another review. This seems like a mess on so many levels.

Firstly: declaring someone's baby is a big baby is already setting up a woman for failure.

Secondly: epidural is a risk factor for instrumental delivery. Would she have had an instrumental if she had not had an epidural? maybe not. Clearly, she had space for so called big baby. Who supposedly got stuck (I didn't have time to read through her notes properly to see if she was a genuine shoulder dystocia).

Thirdly: she says the epidural wasn't effective but she also says that she didn't feel any pain in the childbirth (huh) that her legs can move any everything: so actually - -the epidural was effective then. We're not here to numb your whole body. I tried to tell her, some people do feel numbness, but that's not the goal of epidurals - not our ones anyways. So was education on epidurals not provided effectively?

So I didn't know what to do with that. I didn't get a handover for her, and I had no idea where her yellow card or paper notes were either-- and despite searching for them actively: at the end of my shift I still had no idea where they were.



The third was a simple postnate that just needed a paed check; and a proper postnatal check and her papers.


Bed 9

I also helped out in bed 9 with a larger lady who, after being in +++ distress, was given an epidural, to then very shortly be fully. She was so much work that the poor midwife who actually had her (Alyssa) who is like, 29 weeks pregnant herself, hadn't had a chance for a break or toilet or to even write her notes. So I sorta took the lady for a bit. It was funny. It was like she was using the time of passive decent to catch up - like we couldn't start pushing until all the paperwork was in order (and let me tell you, there's a lot).

I know how she feels. You can't just jump into the paperwork from where your at currently, you literally have to go back to wherever you last wrote : if you ever did, and do everything methodically or you'll just get confused. The trace looked dodgy (rising baseline for no reason, an hour of passive decent had been given) so I started guided pushing: after my meager efforts to encourage the lady - and then being asked to go back to my 3 ladies, I heard it became an instrumental delivery.

Risk factors: she was a really big lady. I had trouble palping her contractions, I had trouble seeing her peri, I did some guided pushing. It was hard to position her because she couldn't get her knees quite up high to hold them back. We tried all 4's -- but for instrumental she would have had to have been turned again. In any case, when I left, the baby was out. 36 +2 days, on the Panda and Andrew was monitoring her.


There was a debrief re: the death yesterday but considering I haven't had lunch 2 days in a row and I was starting to think starting 1 hr early so you can go home 1hr early is a farce, I didn't bother going. I wasn't directly involved anyhow.