Ruby (not her real name)
Apr. 21st, 2021 11:05 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI had "Ruby" on Tuesday morning.
This was how my day began:
"Rita can you go to MAC and do triage" I'm like "sweet! I love MAC" and triage now means, go to mac and help out - your priority is to answer the phone but if the phone ain't ringing then you help a midwife. Put on a CTG/Bloods/obs whatever.
Great.
Get to MAC and its 07:30. It's quiet. We're actually fully staffed despite sick leave (and that got me thinking, was I overbooked?). - I start cleaning, tidying (people are messy!) and asking the staff how things have been in the last few weeks (since I'm only there 1-2 times a week, that's my new main topic of conversation). One of the midwives going on mat leave for her 3rd kid (or was it 4th) had a leaving afternoon tea, but that's about it. Oh and Cathy's last day is tomorrow.
I help fix up a lady to go for her cesarian (for previous). And this reminds me to make a list of to-do's for cesarians:
-sodi bic
-pre op checklist
-change into a gown
-IDC?
-IVC (and fluids if they have to wait longer than 2 hours)
- transfer bed
- arm bands x2
- prepare the cot, the card/armband/?injections - if consented
- read the notes for risk factors
- ?decide if I need to call a paed
-emat
-note for mum
-note for baby
-set of obs for baby
-ensure the paperwork is filled out for mum and baby charts
I think that's it. It's a lot.
I get pulled to run an induction for Ruby
39+4
IOL for LGA (remember when I said that LGA isn't really large...) and decreased FM x3
(although on later conversation Ruby tells me every time she came to the hospital for a "check up" (aka. CTG) the baby started moving heaps.
Was meant to be started 2 days ago (Sunday) after coming in for foleys on Saturday -- but was sent home as she was favourable.
She's been "feeling pain" since 0200 and using a TENs machine to cope and it's been working.
p1
Her first labour was an IOL for fetal welfare concerns because she had a car accident on the M4 (a 110km/hr road) after which she was taken to MSH but was transferred to SSH as she was booked at SSH. It wasn't an emergency IOL but there were concerns about the fetus being okay in there after the trauma (supposedly everything was fine though) so she had the IOL, required an epi to cope with it after about 3 hours of the IOL and then pushed out a girl.
She said she was hoping to go without an IOL this time and also, without an epi - but wasn't against the idea of an epi. She hated the idea of laboring on her back and she feels her Hx of backpain is somewhat related to the epi.
The TENs is working great so she's surprised shes lasted until 10:00 (when I get her into the room).
I try 2x to get an IVC in and I totally blow the vein both times - The CME gets it in for me.
(that buys me an hour to delay the IOL)
then I start the CTG
She's already contracting at least 2-3:10
The med student is hanging about and I invite her into my room to hang out
I do the VE and ARM her with the student watching.
I feel a good water bag but somehow I don't get much liquor.
I determine 5-6 cm and I do a pretty good stretch. I push it away - it's pretty thin in my opinion
The student becomes a great source of support for the woman.
She's coaching her through each contraction, telling her she's amazing and she's doing it and it's almost over
She's well better a midwife than I and she looks about 21 yrs old.
I hate coaching. ..I just don't have the voice and the stamina to go past more than 3x. Unless we are in 2nd stage and it's pushing time I feel odd talking through every contraction.
The woman is loving it.
The student has to leave for a tute and the husband has learnt from the Student and takes over.
I'm avoiding an IOL because I think shes contracting well enough.
Medical staff push me for when I'm gonna do the next VE. I ask if its ok to delay the IOL as she's doing well and I propose a VE in 2 hours (13:00). They agree.
At 13:30 the woman is thinking about an epi - but if she's further enough along she might do without (I had gone through the explanation that you can have an epi at any time even 9 or 10 cm - but that it just might not work as well then. But thats no reason why you can't have it.)
The VE is easy but its definatly painful.
She's on the gas and the cervix is super thin, but there.
I decide she's 8-9cm.
The woman is either in so much pain from the VE or she's so happy that she's not that far off - that she's in tears
She's like "I can do without the epidural!!!" and I'm like if your telling me you can do it without then you totally can!!!!"
I go outside to PM handover and they ask how she's going and I'm like 8-9? (and everyone's like YEAH! GO LADY!' NO IOL FOR YOU!").
I feel the pressure that - what if my result is wrong, or someone goes and does a VE after mine and decide she's 7 or something instead. Will she lose hope, wish she'd gone for an epi earlier? Get disheartened?
I know the're going to put a student in there (midwifery student) meaning my medical student won't catch the kid (even though she's doing such a great job with this lady).
I ask the incharge who gets priority. Midwifery because if the midi students don't catch enough babies : they don't graduate- whilst for a med student it's more of a cherry on top rather than an absolute must.
As I was leaving they were preparing the bath tub for the woman to try out (as this was something she had wanted to try earlier).
I've been thinking about her all day.
Was my VE accurate?
Did she end up having a water birth?
Did she end up having an epidural?
What time was her labour?
Was her baby really an LGA baby (how big was it?)
I hope someone can check the notes for me tomorrow 'cause I'm not back 'til next week.
My day ends with me giving Cathy a hug and me trying to tell her how much she helped me when I was new and she'd be nice to me in the tea room, asking how I was, then listening to me as I'd blab on about how much I hated it [and was dying inside at work].
Cathy has that sort of personality/face whereby you feel like you could tell her anything and she'd sorta just work through it with you and listen to you. And actually want to know how you feel about things.
She's going to some hospital far away up North. She's pretty happy she gets to leave.
Midi is a small world- might see her again some day.
This was how my day began:
"Rita can you go to MAC and do triage" I'm like "sweet! I love MAC" and triage now means, go to mac and help out - your priority is to answer the phone but if the phone ain't ringing then you help a midwife. Put on a CTG/Bloods/obs whatever.
Great.
Get to MAC and its 07:30. It's quiet. We're actually fully staffed despite sick leave (and that got me thinking, was I overbooked?). - I start cleaning, tidying (people are messy!) and asking the staff how things have been in the last few weeks (since I'm only there 1-2 times a week, that's my new main topic of conversation). One of the midwives going on mat leave for her 3rd kid (or was it 4th) had a leaving afternoon tea, but that's about it. Oh and Cathy's last day is tomorrow.
I help fix up a lady to go for her cesarian (for previous). And this reminds me to make a list of to-do's for cesarians:
-sodi bic
-pre op checklist
-change into a gown
-IDC?
-IVC (and fluids if they have to wait longer than 2 hours)
- transfer bed
- arm bands x2
- prepare the cot, the card/armband/?injections - if consented
- read the notes for risk factors
- ?decide if I need to call a paed
-emat
-note for mum
-note for baby
-set of obs for baby
-ensure the paperwork is filled out for mum and baby charts
I think that's it. It's a lot.
I get pulled to run an induction for Ruby
39+4
IOL for LGA (remember when I said that LGA isn't really large...) and decreased FM x3
(although on later conversation Ruby tells me every time she came to the hospital for a "check up" (aka. CTG) the baby started moving heaps.
Was meant to be started 2 days ago (Sunday) after coming in for foleys on Saturday -- but was sent home as she was favourable.
She's been "feeling pain" since 0200 and using a TENs machine to cope and it's been working.
p1
Her first labour was an IOL for fetal welfare concerns because she had a car accident on the M4 (a 110km/hr road) after which she was taken to MSH but was transferred to SSH as she was booked at SSH. It wasn't an emergency IOL but there were concerns about the fetus being okay in there after the trauma (supposedly everything was fine though) so she had the IOL, required an epi to cope with it after about 3 hours of the IOL and then pushed out a girl.
She said she was hoping to go without an IOL this time and also, without an epi - but wasn't against the idea of an epi. She hated the idea of laboring on her back and she feels her Hx of backpain is somewhat related to the epi.
The TENs is working great so she's surprised shes lasted until 10:00 (when I get her into the room).
I try 2x to get an IVC in and I totally blow the vein both times - The CME gets it in for me.
(that buys me an hour to delay the IOL)
then I start the CTG
She's already contracting at least 2-3:10
The med student is hanging about and I invite her into my room to hang out
I do the VE and ARM her with the student watching.
I feel a good water bag but somehow I don't get much liquor.
I determine 5-6 cm and I do a pretty good stretch. I push it away - it's pretty thin in my opinion
The student becomes a great source of support for the woman.
She's coaching her through each contraction, telling her she's amazing and she's doing it and it's almost over
She's well better a midwife than I and she looks about 21 yrs old.
I hate coaching. ..I just don't have the voice and the stamina to go past more than 3x. Unless we are in 2nd stage and it's pushing time I feel odd talking through every contraction.
The woman is loving it.
The student has to leave for a tute and the husband has learnt from the Student and takes over.
I'm avoiding an IOL because I think shes contracting well enough.
Medical staff push me for when I'm gonna do the next VE. I ask if its ok to delay the IOL as she's doing well and I propose a VE in 2 hours (13:00). They agree.
At 13:30 the woman is thinking about an epi - but if she's further enough along she might do without (I had gone through the explanation that you can have an epi at any time even 9 or 10 cm - but that it just might not work as well then. But thats no reason why you can't have it.)
The VE is easy but its definatly painful.
She's on the gas and the cervix is super thin, but there.
I decide she's 8-9cm.
The woman is either in so much pain from the VE or she's so happy that she's not that far off - that she's in tears
She's like "I can do without the epidural!!!" and I'm like if your telling me you can do it without then you totally can!!!!"
I go outside to PM handover and they ask how she's going and I'm like 8-9? (and everyone's like YEAH! GO LADY!' NO IOL FOR YOU!").
I feel the pressure that - what if my result is wrong, or someone goes and does a VE after mine and decide she's 7 or something instead. Will she lose hope, wish she'd gone for an epi earlier? Get disheartened?
I know the're going to put a student in there (midwifery student) meaning my medical student won't catch the kid (even though she's doing such a great job with this lady).
I ask the incharge who gets priority. Midwifery because if the midi students don't catch enough babies : they don't graduate- whilst for a med student it's more of a cherry on top rather than an absolute must.
As I was leaving they were preparing the bath tub for the woman to try out (as this was something she had wanted to try earlier).
I've been thinking about her all day.
Was my VE accurate?
Did she end up having a water birth?
Did she end up having an epidural?
What time was her labour?
Was her baby really an LGA baby (how big was it?)
I hope someone can check the notes for me tomorrow 'cause I'm not back 'til next week.
My day ends with me giving Cathy a hug and me trying to tell her how much she helped me when I was new and she'd be nice to me in the tea room, asking how I was, then listening to me as I'd blab on about how much I hated it [and was dying inside at work].
Cathy has that sort of personality/face whereby you feel like you could tell her anything and she'd sorta just work through it with you and listen to you. And actually want to know how you feel about things.
She's going to some hospital far away up North. She's pretty happy she gets to leave.
Midi is a small world- might see her again some day.
