2 pushes and then we'll "help you"
Mar. 22nd, 2021 10:33 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterFiled under 'memories from my student days'.
Was this lady who had a cardiac condition she had been born with and always knew about. It didn't change how she lived her life, and was in all other respects healthy and normal.
However when she became pregnant it was a big deal, and she was in the doctors clinic.
They had a plan for her birth. The plan they made was that she was to remain cardiac monitored throughout labour, I think there was a plan for early epidural (and for an induction if she hadn't gone into labour before 39 weeks) and that she would be allowed "two pushes" and then would be "helped" with an instrumental thereafter.
It was a PM shift. I was paired with another midwife.
I remember looking at the cardiac monitor and seeing what was relatively normal looking trace at 70 beats per minute and the midwife saying that she didn't really know too much about what she was seeing on the screen. To which I wondered what was the point of the cardiac monitoring if the person who was there watching didn't really know what they were seeing. I'm sure if it was 150 bpm she'd realise that was well out of range. ectopics she might not notice I suppose, or random rhythms that can occur with an essentially normal heart rate. Junctional rhythms... anyways I digress.
This two pushes thing was a mystery to us.
How can you as a first timer- let alone with an epidural - push a baby out in 2 pushes was beyond us. It seemed like a fake thing. It's like "okay, so your gonna run a marathon today and don't worry you don't need any training and we'll just see how you go. You've got like. 2 hours to run this marathon and we'll give you some pain medications so you don't feel muscle aches. At point X there is a MASSIVE hill for you to climb, and if you don't run up that hill in 2 minutes then we will bring a truck and use the power of the truck to suck you up the hill.
BTW in order to use the truck, we will need to use scissors to cut you open. So that the truck's suction cap can latch onto you.
That's basically asking the impossible.'
It seemed like the woman was happy with that plan.
She got to fully on my shift and we started pushing.
The ECG was fine. We did more than 2 without calling the doctors in.
I think we did passive decent because the CTG was fine from memory.
However it was clear and plain to see she wouldn't push the kid out in 2 pushes. Or let alone 5.
Who knew how many it would take. This is not something we count!
Anyhow the baby came out, and the paed was ?Called? or was there? I remember it being rather of a mess of a vacuum with me as scribe and people yelling out things. The paed was probably phoned because it was an instrumental and they should generally attend those.
The paed thought the kid had RDS and needed NICU admission, so we ended up going with dad and the paed and baby on the resuscitaire.
The woman, had to stay behind and get sutured.
Later on, we wheeled her down to NICU to see the baby.
She seemed so shell shocked.
I bet she had birth trauma.
Or at least, seemed shocked about being separated from her baby at so early a stage.
I think she realised thereafter that 2 pushes was a bullshit.
I don't know what would have been better. Her cardiovascular system seemed like it was coping fine, but how far do you push it? At the expense of her own feelings regarding her own body and her own birth.
I didn't get to talk to her afterwards or at the postnatal ward so I never knew how she felt about how the whole thing went down.
Was this lady who had a cardiac condition she had been born with and always knew about. It didn't change how she lived her life, and was in all other respects healthy and normal.
However when she became pregnant it was a big deal, and she was in the doctors clinic.
They had a plan for her birth. The plan they made was that she was to remain cardiac monitored throughout labour, I think there was a plan for early epidural (and for an induction if she hadn't gone into labour before 39 weeks) and that she would be allowed "two pushes" and then would be "helped" with an instrumental thereafter.
It was a PM shift. I was paired with another midwife.
I remember looking at the cardiac monitor and seeing what was relatively normal looking trace at 70 beats per minute and the midwife saying that she didn't really know too much about what she was seeing on the screen. To which I wondered what was the point of the cardiac monitoring if the person who was there watching didn't really know what they were seeing. I'm sure if it was 150 bpm she'd realise that was well out of range. ectopics she might not notice I suppose, or random rhythms that can occur with an essentially normal heart rate. Junctional rhythms... anyways I digress.
This two pushes thing was a mystery to us.
How can you as a first timer- let alone with an epidural - push a baby out in 2 pushes was beyond us. It seemed like a fake thing. It's like "okay, so your gonna run a marathon today and don't worry you don't need any training and we'll just see how you go. You've got like. 2 hours to run this marathon and we'll give you some pain medications so you don't feel muscle aches. At point X there is a MASSIVE hill for you to climb, and if you don't run up that hill in 2 minutes then we will bring a truck and use the power of the truck to suck you up the hill.
BTW in order to use the truck, we will need to use scissors to cut you open. So that the truck's suction cap can latch onto you.
That's basically asking the impossible.'
It seemed like the woman was happy with that plan.
She got to fully on my shift and we started pushing.
The ECG was fine. We did more than 2 without calling the doctors in.
I think we did passive decent because the CTG was fine from memory.
However it was clear and plain to see she wouldn't push the kid out in 2 pushes. Or let alone 5.
Who knew how many it would take. This is not something we count!
Anyhow the baby came out, and the paed was ?Called? or was there? I remember it being rather of a mess of a vacuum with me as scribe and people yelling out things. The paed was probably phoned because it was an instrumental and they should generally attend those.
The paed thought the kid had RDS and needed NICU admission, so we ended up going with dad and the paed and baby on the resuscitaire.
The woman, had to stay behind and get sutured.
Later on, we wheeled her down to NICU to see the baby.
She seemed so shell shocked.
I bet she had birth trauma.
Or at least, seemed shocked about being separated from her baby at so early a stage.
I think she realised thereafter that 2 pushes was a bullshit.
I don't know what would have been better. Her cardiovascular system seemed like it was coping fine, but how far do you push it? At the expense of her own feelings regarding her own body and her own birth.
I didn't get to talk to her afterwards or at the postnatal ward so I never knew how she felt about how the whole thing went down.
