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whitewriterI'm struggling to keep names straight. Between SSH/MSH and MICH --You try keeping straight midwives in two hospitals, and RNs in one of the biggest ICUs in the state (if not the country).
I take handover from a senior who only works night shift. I was told to take handover from "Mel" so I was looking for the flat affect educator Mel and not nightshift Mel.-- who was sitting in front of me the whole time.
My bad.
Nightshift Mel thought the woman would be for a cesar so bad she put on an hourly bag after the epidural went in because why waste a regular urine bag when your feelings are strong.
The doctors are running scared of litigation and they are traumatised from the bad stuff that happened last year.
39+5
IOL for decreased FM x3 (I kid you not)
no diabetes.
no HTN
no risk factors
she's 38 and she's South-East Asian
p0.
When I see that someone is undergoing an IOL for decreased FM x3 I read this:
IOL for anxious woman who could not be soothed or comforted by medical staff.
There was nothing wrong on any scan.
There wasn't anything odd or concerning on any test.
But she's worried, and anxious -- so lets just put this woman and her baby through the risks of an IOL and end this pregnancy.
It's almost like an IOL for social reasons.
It's literally a highway to a cesarean.
So Anyways I get there and she's got an epidural before they even start the pain medications because the night staff felt sorry for her that she was feeling contractions ( read: discomfort) from the prostin that they put up her cervix because the foleys catheter didn't work.
They've been trying to induce this lady since Sunday.
It's now Monday morning.
1x foleys and 2 prostin's later - a hand presentation (where the hand is next to the head during a VE when they are about to do the ARM : the official start to any induction is the ARM as it means - no going back = so they turned her over. hoped the hand would go away - it did - and then at 07:00 finally, they redo the VE hoping the hand isn't there anymore: they manage a controlled ARM on a high head (this was an ARM for doctors not midwives) --
and it's synto time.
so I start.
They gave me a student today.
I must have acted so unsure - when I said to the midwife, wow this is my first student.
That the student asked me if I was a student.
That cracked me up a little inside.
To be fair, we wear the same uniform as RN students. And I said point blankly to her, no because that would be the blind leading the blind. -- and I'm blind enough as it is I couldn't imagine being a student paired with a student.
Has that ever happened? Because if so that should be reported as negligent.
Anyhow.
so here we are. Anxious +++ lady and the synto.
We get to 10:00 and we have a fetal CERs for rising baseline and early decelerations.
That's my first time ever calling a fetal CERs and I was glad the T/L was in the room the whole time to do it with me. I got shown where the paperwork was (rather than having to muddle through the powerpoint sent to us all via email) and now I feel confident if I ever had to call one again, that I could.
The synto got turned off for an hour to "give the baby a break" and let it "return to baseline".
Jebus, give the baby a break.
What is this woman going to be like once the kid is out, I wonder.
I wonder how the stress of all this will affect it's own future.
Maybe it won't. Dad seemed pretty chill.
I tried to keep a light room.
I did a VE at 11:00 without flinching --Cept it was a really ODD VE.
It was like. really thick on the maternal right.
but really thin on the maternal left.
So thin I couldn't feel it at all.
I had to get it redone.
Apparently: it's a 5.
The head was really freaking high though.
I stayed up until the VE at 15:40
The midwife was a grad also (but from the Bmid stream) and she said she could feel the thick cervix on the maternal right also (dang it that turning her on her right didn't seem to work)
But honestly this entire labour was with the woman basically laying in bed. or sitting up in bed.
what a horrid position to be in when your trying to bring a baby's head down. With what shall we bring it down with?! brute force? (synto). This baby did not like synto (what Baby does?)
When will I get a natural birth I wonder.
I left the grad and her student (a medical student) with the woman after the VE.
It also had to be repeated again because the grad had the same result as me : thick on one side (like how do you call a dilation if you can only feel one side?!)
That means she would have had at least 6 different hands up her vagina from midnight to 16:00.
Welcome to childbirth in the West.
We have problems because we create problems.
Side note
I spent large swathes of time it seemed, chasing the T/L this shift. So much so that at one occasion I made the mistake of answering her phone (she left it in my room) and it was a MGP midwife from the ward asking for a bed for her 36+5 woman whose waters were breaking and was supposedly laboring.
I heard MGP later asking another midwife for some good juju vibes to help her woman.
She came up and I apologies for so rapidly giving her a half ready room (it was cleaned but not stocked, and had some dirty items in there - because I spent too much time trying to find the T/L that I didn't look at the room properly.
Positive note: it was a really nice and large room with beautiful views of the surrounding area of SSH.
Honestly, SSH doesn't know how good they have it with views.
Ok granted MICH has amazing views from floor 5 upwards. And I'm probably just pissed cause ICU is down in the dungeon and all we get are buildings, and maybe the ood tree.
I come to SSH and make sure I take a good look out of the windows at least three times every shift.
I also warned MGP that I still hadn't found the T/L so not to be surprised if the T/L is ... surprised (potentially angry), that she's here already.
PS. the LGA baby from last week (mexican/colombian baby) came out in the c-section at 3850g
According to the centile charts that's at the 90% centile.
It wouldn't get special treatment for "LARGE BABY" though (thats a thing) in SCN-- babies that are considered "too big" (>4.5kg) are taken to special care. Their sugars are monitored 3rd hourly and feeds are given to ensure they don't become hypoglycemic being out of the womb.
3.8kg is LGA but it's not something that needs treatment.
Except intrapartum. Apparently.
I'm going to have to mule over that one for a while.
I take handover from a senior who only works night shift. I was told to take handover from "Mel" so I was looking for the flat affect educator Mel and not nightshift Mel.-- who was sitting in front of me the whole time.
My bad.
Nightshift Mel thought the woman would be for a cesar so bad she put on an hourly bag after the epidural went in because why waste a regular urine bag when your feelings are strong.
The doctors are running scared of litigation and they are traumatised from the bad stuff that happened last year.
39+5
IOL for decreased FM x3 (I kid you not)
no diabetes.
no HTN
no risk factors
she's 38 and she's South-East Asian
p0.
When I see that someone is undergoing an IOL for decreased FM x3 I read this:
IOL for anxious woman who could not be soothed or comforted by medical staff.
There was nothing wrong on any scan.
There wasn't anything odd or concerning on any test.
But she's worried, and anxious -- so lets just put this woman and her baby through the risks of an IOL and end this pregnancy.
It's almost like an IOL for social reasons.
It's literally a highway to a cesarean.
So Anyways I get there and she's got an epidural before they even start the pain medications because the night staff felt sorry for her that she was feeling contractions ( read: discomfort) from the prostin that they put up her cervix because the foleys catheter didn't work.
They've been trying to induce this lady since Sunday.
It's now Monday morning.
1x foleys and 2 prostin's later - a hand presentation (where the hand is next to the head during a VE when they are about to do the ARM : the official start to any induction is the ARM as it means - no going back = so they turned her over. hoped the hand would go away - it did - and then at 07:00 finally, they redo the VE hoping the hand isn't there anymore: they manage a controlled ARM on a high head (this was an ARM for doctors not midwives) --
and it's synto time.
so I start.
They gave me a student today.
I must have acted so unsure - when I said to the midwife, wow this is my first student.
That the student asked me if I was a student.
That cracked me up a little inside.
To be fair, we wear the same uniform as RN students. And I said point blankly to her, no because that would be the blind leading the blind. -- and I'm blind enough as it is I couldn't imagine being a student paired with a student.
Has that ever happened? Because if so that should be reported as negligent.
Anyhow.
so here we are. Anxious +++ lady and the synto.
We get to 10:00 and we have a fetal CERs for rising baseline and early decelerations.
That's my first time ever calling a fetal CERs and I was glad the T/L was in the room the whole time to do it with me. I got shown where the paperwork was (rather than having to muddle through the powerpoint sent to us all via email) and now I feel confident if I ever had to call one again, that I could.
The synto got turned off for an hour to "give the baby a break" and let it "return to baseline".
Jebus, give the baby a break.
What is this woman going to be like once the kid is out, I wonder.
I wonder how the stress of all this will affect it's own future.
Maybe it won't. Dad seemed pretty chill.
I tried to keep a light room.
I did a VE at 11:00 without flinching --Cept it was a really ODD VE.
It was like. really thick on the maternal right.
but really thin on the maternal left.
So thin I couldn't feel it at all.
I had to get it redone.
Apparently: it's a 5.
The head was really freaking high though.
I stayed up until the VE at 15:40
The midwife was a grad also (but from the Bmid stream) and she said she could feel the thick cervix on the maternal right also (dang it that turning her on her right didn't seem to work)
But honestly this entire labour was with the woman basically laying in bed. or sitting up in bed.
what a horrid position to be in when your trying to bring a baby's head down. With what shall we bring it down with?! brute force? (synto). This baby did not like synto (what Baby does?)
When will I get a natural birth I wonder.
I left the grad and her student (a medical student) with the woman after the VE.
It also had to be repeated again because the grad had the same result as me : thick on one side (like how do you call a dilation if you can only feel one side?!)
That means she would have had at least 6 different hands up her vagina from midnight to 16:00.
Welcome to childbirth in the West.
We have problems because we create problems.
Side note
I spent large swathes of time it seemed, chasing the T/L this shift. So much so that at one occasion I made the mistake of answering her phone (she left it in my room) and it was a MGP midwife from the ward asking for a bed for her 36+5 woman whose waters were breaking and was supposedly laboring.
I heard MGP later asking another midwife for some good juju vibes to help her woman.
She came up and I apologies for so rapidly giving her a half ready room (it was cleaned but not stocked, and had some dirty items in there - because I spent too much time trying to find the T/L that I didn't look at the room properly.
Positive note: it was a really nice and large room with beautiful views of the surrounding area of SSH.
Honestly, SSH doesn't know how good they have it with views.
Ok granted MICH has amazing views from floor 5 upwards. And I'm probably just pissed cause ICU is down in the dungeon and all we get are buildings, and maybe the ood tree.
I come to SSH and make sure I take a good look out of the windows at least three times every shift.
I also warned MGP that I still hadn't found the T/L so not to be surprised if the T/L is ... surprised (potentially angry), that she's here already.
PS. the LGA baby from last week (mexican/colombian baby) came out in the c-section at 3850g
According to the centile charts that's at the 90% centile.
It wouldn't get special treatment for "LARGE BABY" though (thats a thing) in SCN-- babies that are considered "too big" (>4.5kg) are taken to special care. Their sugars are monitored 3rd hourly and feeds are given to ensure they don't become hypoglycemic being out of the womb.
3.8kg is LGA but it's not something that needs treatment.
Except intrapartum. Apparently.
I'm going to have to mule over that one for a while.
