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whitewriterI wish I had taken the time to sit down and write this immediately after my shift yesterday, but I chose to train for Oxfam instead. Then there was "couples time" with Pete as we watched more of The Office. I was literally falling asleep during it though I found it entertaining.
Another morning at SSH
The day starts with me driving into the multi-story car park and going up to the yellow level.
During covid, the govt. declared free parking for HCPs because there was backlash when it was found out on FB that we had to pay for parking. Someone was rambling on about how they couldn't take public transport? (not sure why: none of the trains or busses stopped running despite few people on them) -- and having issues with parking.
To all the people out there who don't know what nurses (and midwives) do :
we go to work.
Just like you do.
Sure, we choose a job that could potentially ourselves at risk (for example in regards to infectious diseases -- and or nightshift: working at 2am when your brain is meant to be asleep) - but that's part and parcel of choosing to work here.
But so too is construction work. Or people who work in Garbage and sanitation. Or the military...
Like parking. Driving to work is a choice. Sure because of covid, mass public transport is a bad idea. But thats why everyone else worked from home. The trains kept running anyways just so people who had no other mode of transport to say, get essential groceries - or go to essential jobs --
had a way to do those things.
We always had to pay for parking.
We always had to pay for lunch.
We always had to pay for our own Christmas party.
This is because we are a govt entity (public hospital).
This was a very cheap publicity stunt that allowed the govt to look like they were taking care of their hospital workers in a time of crisis : FREE PARKING FOR ALL HOSPITAL STAFF.
Why don't we get free parking all the time.
Because the car park is not big enough to fit everyone: that's why. Otherwise everyone would probably be driving.
That ended March 2021.
My ID at SSH works to get into the car park (whilst other staff who started at a similar time does not) - don't question how that works - the Security guard who works at all hospital car parks from my experience is usually : a grumpy person. I don't know how much it costs for me to use the car park, and I have no idea if its pro rata or if it's a flat fee I'll get billed since I'm casual...
I should really ask...
The woman
G7P2-1
nothing to note for blood group/serologies/etc. yadda yadda.
This means: That she's had 7 pregnancies. 4 of which were miscarriages (the notes said they had been interspersed between the actual pregnancies- 2 births (both NVB, it turns out) - but 1 of those was of a Stillborn baby. Also known as a butterfly baby. At term, too. It wasn't a late miscarriage -- the notes state, the baby was 39 weeks old when it died. Cause of death is listed as maternal infection. There didn't seem to be anything wrong with the baby on autopsy - or with the placenta. (according to the notes).
This made the pregnancy high risk - Although you'd think the high number of miscarriages would also do it. I didn't know the gestations of when those occured (ran out of time to delve into the notes more) but it did get me thinking.
Is it worse if you have trouble to get pregnant: or if when you do, you keep losing the baby.
Anyway.
So there were 3 support people (we were back to the old days of when I started Midi in 2019 pre-covid).
The hospital visiting policy has all reverted back to pre-covid in this state, actually. It did so since about Jan 2020 except for that Northern Beaches thing and that went backwards for a few weeks - but it's back to normal now.
So the room was rather crowded even though their bigger than what I was used to at MSH.
The woman was the youngest sister out of a family of 8 (don't quote me). Most of the siblings were in Australia (all now grown with their own families, mostly with 1-2 children per family) and there were a few home in Turkey.
Two sisters were here to accompany her today. One that was a few years older (she was rather quiet and didn't speak much at all) and the oldest of all the sisters in Australia- who spoke the "best" English, and she did a lot of the conversation with me today.
The woman herself, had good conversational English but definitely struggled on the finer points. After I'd explain something I'd look for confirmation that she'd understood and she would say yes - but then look at her sister who would re explain it in Turkish.
Hopefully, accurately.
Anyhow. This wasn't her first baby, and the last had been an IOL (Admittedly 4 years ago) so in general, she would have had a good idea of what was going on.
She'd had her last in MSH, actually. This was her first at SSH.
The husband sat in the corner mostly, kept out of the way, went in and out, got drinks and food for everyone and sorta just hung out.
The room had a light feel in the sense that they were obviously cracking jokes in Turkish.
I waited for O&G to do the ARM because the woman had informed me that in the past, with her first pregnancy, she was informed that her cervix was "very back" (i thought she said bad to be honest - but this was re-clarifi ed). and that due to this "very back" nature of her cervix - they told her she should have an epidural prior to ARM (or that's what she needed last time).
Let's unpack this statement. (and I can't believe it's got me reading the textbook)
The cervix is composed of connective tissues covered in a thin layer of smooth muscle. Throughout pregnancy, the cervix changes.
In the 2nd trimester it becomes softer and wider - due to the effect of hormones oestrogens, prostaglandins, progesterone, relaxin, and nitric oxide on the collagen fibers and water content of the cervix.
Memory lane: smooth muscle is an involuntary muscle. It lines the walls of hollow organs such as the stomach, urinary bladder, intestines.
These changes culminate into "cervical ripening"-- when the cervix is "ripe" then it is prepared for labour.
The cervix is protected by a plug of thick mucous - which occurs from the proliferation of the cervical mucosa and glands, which protect the cervix from ascending infection (aka. infection arriving from the vagina).
During pregnancy, the surface area of the cervix increases to 75% more than it's prepregnancy size. It takes approx 4 weeks postpartum to return to a rigid, slit (non-pregnant state). However post pregnancy (to term, I presume) the cervix does not return to its pre-pregnancy state.
When textbooks mention "ecto cervix" this refers to the part of the cervix that can be seen from or exists within the vagina.
This was this woman's 3rd pregnancy to term. So likely, her cervix had changed since that first time that she needed an early epi to do the ARM.
I was handed over that the nightstaff had done a VE and found it very difficult and thought it was 1cm dilated. They also handed over she was GBS negative however on double checking I saw she was gBS positive and therefore under hospital policy was to be given IVABs.
I think the midwife (whom I don't think I'd ever heard before) heard me say under my breath to the medical student -- "always double check your handover..."
Sorry but that was a key feature of my training at MSH -- check all results for yourself.
That includes pre checking the ultrasounds for placental location before going into do a VE to ensure the placenta is well clear of the os. I don't see anyone doing this checking at SSH but at MSH it was a big deal (perhaps MSH had an incident but SSH didn't). It would be rare that a woman who had placenta previa or acreta was not for a planned c-section anyway - or that the woman wouldn't know that there was a problem and would have been informed as such that this (VE) was something to avoid.
So. The med student.
Apparently they have follow throughs also (just like the midwifery students) but theirs sounds slightly more intense. They get 3 for the rotation, and this meant that if they had a follow through they absolutely had to be in the room or around the ward for the entire labour of the woman from start to finish. They can take meal breaks but not for longer than 29 minutes otherwise that means they officially "left" the woman, and it wouldn't count.
If your woman is at the hospital for 20 hours, you need to be there for 20 hours (no time limits imposed, like they are for the GDM students).
I was a GDM student. You had 10 women. You needed to make sure you attended 4 antenatal, and 2 postnatal appointments of all 10. You needed to make 6 of the births. You could just attend the part where the kid comes out if you had to - (like if you had 2 women in a row - or you were far away and it took time for you to get there or whatever -) your supposed to attend the majority of the labour and most women love students who have "earned the right to catch their baby" (seriously, now as a midwife myself I hear the conversations women have about their students so I have more insight than I did as a student). So whilst you can technically skip the labour bit - midi students usually at least attend after the woman is established.
So the med student was there right from the beginning today.
I've given the first dose of IVABs whilst we are waiting for O&G to do the ARM.
One of the seniors whose a little bored offers to do it - but on reading her history declines when she realises the woman is high risk (like, in general).
I just don't like too many hands going up a vagina: if it's that hard, then just the one person whose going to be doing it, should do it.
I didn't have time to ask the O&G reg that ended up doing it: if it was as hard as that woman (and the nightstaff) made it out to be. As as soon as they left the room I had turned on the synto (after getting the lines swiftly double checked) and as per hospital policy I was now stuck in that room for the first 30 minutes of the induction.
There was some conversation with the woman about if we should do the epidural prior to the commencement of labour.
I was inclined not to do it that way.
Not unless the woman was set on entirely not feeling any pain.
I discussed this with the medical student too --
the med student pointed out, wouldn't that lead to a super long labour?
And I said well, theoretically yes but also, remember this is an IOL so we could just force the contractions to be harder: as hard as we'd like really, as hard as we deem necessary to get this baby out (one way or the other - depending on the fetus ability to withstand the IOL).
That was the goal today. Baby out.
Turns out it was also the birthday of the middle sister! I wished her a happy birthday.
There was one point about 1hr into the day where the elder sister asked me "so your the midwife today" and I did remember introducing myself as "your midwife for this morning" so. Either I'm not clear enough, or it got missed but i simply reinstated my title and role for the day.
The woman agreed that we could wait for the epi until she started feeling pain.
We talked about how last time the epidural was great and it was fine until the last 45 mins when she was very uncomfortable. I spoke about how epidurals often don't really work at the end because we intend to block pain associated with the contractions but not the pain of the baby moving through the lower parts of the pelvis.
She seemed to be uncomfortable but I deemed that positional. I encouraged her to walk around or move about the room - she went for a walk outside. It's against my own personal policy to restrict a woman to her room, so off she went. (I feel like I never see other people's womens outside their room but mine are always walking about).
The CTG looked amazing. Seriously good.
I was continually looking for the AM incharge.
Seriously. Every hour. I'd go to the desk and look for her for a trace review.
The trace was perfect,
But when we are restricted to only the incharge signing the sticker, this is really hard.
At MSH anyone could sign the sticker.
As long as you were a midwife. I think though, that grads hd to sign with a senior midwife.
There were a few seniors on- so I guess I could have gotten them.
Eventually the IC came and did about 3 stickers in a row.
For the next 4 stickers, I used the CME.
Where was the IC you ask. In meetings.
Meetings about staffing.
The handover meeting.
Some other random meeting.
The MUM wasn't around -
This is bloody ridiculous. What if I didn't have a perfect trace?! [press the buzzer].
That was my beef.
I asked them if women from Turkey had any traditions around birth and the baby. They said not really anything, but that at about 6 months some people did a henna party and did henna on the baby. It wasn't really something done frequently, and they couldn't explain why it was a thing (I asked if it brought luck to the baby or something, apparently not). It was a ritual that celebrated the health of the baby overall.
We talked about Cats.
The eldest saw cats on my socks and asked if I liked cats. I said I did, and i had one but actually the socks were a christmas present from someone who had 8 cats. She spoke about how she had 2 cats at home, one was a stray - that her kids had picked up - but that she was frustrated because the kids did not take care of the cats. She did. And how she once had a vet bill of 4 grand because one of the pets had broken their legs. I'm not sure how that story ended because she said they had to surrender the animal due to the cost; but also told the shelter to phone them if there was no other option and. the animal was to be killed.
I assume the shelter never phoned back.
That doesn't mean the animal was treated, recovered or rehomed.
I left that plot point to meander.
The woman was having a baby girl today, and she had a boy at home.
She found walking around helped her discomfort much more than repositioning in the bed.
She voided in the toilet.
My notes were terrible.
At 11:00 she asked "when can she have an epi" and I said "whenever you tell me you want one".
At 11:50 she said " want an epi"
So I phoned the anesthetist and realised her platelets was 90.
The cut off, apparently, is 80.
90 is rather low. I tried to explain it to the family. I said, your blood is made out of a few things. Red cells. white cells and sticky stuff called platelets. the platelet count is a bit low today, this might effect your epidural but I'll ask the anesthetist and they will explain it.
The risk at low platelets is bleeding.
They asked me if you could eat something to fix it. I explained no, a transfusion would occur if required but 90 isn't low enough for a transfusion. So how would a transfusion worked: if say for example, she was actively bleeding: then she would likely get a set of pooled platelets along with the red cells, provided her Hb was also low (it wasn't it was 123-- thats why I remember it, because it was 123 lol).
90 wasn't a dealbreaker. The Anesthetist came. Wasn't worried and popped an epi in right in time for the 13:00 VE.
Have I mentioned how much I hated VEs? at the desk this morning I got raked over the coles for suggesting that I leave my 13:00 VE to the PM staff who start at 13:45.
45 minutes people, is that really gonna make much of a difference as to whether she has progressed or not? Should not the same person be doing the VEs as much as possible? I'm not. gonna be around for the 1600 (or 1645 VE).
Sighs. This woman has a working epi. And I need practice (bah humbug).
I decided at 13:15 it was 4cm -2
on the basis that the previous at 09:05 was 2-3cm and -3
and before that at 06:30 it was a -1
Before you know it I was signing the med student's sign off sheet and handing over to the PM staff.
The med student asked if she could work with me next week since I seemed to not mind teaching a few things.
I said sure -cept I have no idea when, or if (even) I was working at SSH next week because I only remember my roster 1 week at a time.
The goldfish approach.
After lunch I attended the inservice on the new Fetal CERS criteria about when to call a fetal code blue. Which was interesting to an extent as one of the seniors was like "do you know how hard it is to review every single room per hour when you have 6 inductions running?".
Yup. Uhuh. And it was mentioned how sometimes, a midwife could have 9 stickers awaiting to be signed (um be proactive and look for them).
I wonder if in the powerchart I should have documented. CTG classified as normal. Awaiting T/L to be available to sign sticker. Unavailable.
Next hour
previous sticker not signed however CTG remains within normal limits.
Attempted to find T/L
etc.
I left feeling bad that I didn't get around to even checking to see if anyone touched the emat (I certainly hadn't) and also that my notes were terrible. But my stickers were signed and the CTG was textbook perfect.
3 hours it took me to write this!
Another morning at SSH
The day starts with me driving into the multi-story car park and going up to the yellow level.
During covid, the govt. declared free parking for HCPs because there was backlash when it was found out on FB that we had to pay for parking. Someone was rambling on about how they couldn't take public transport? (not sure why: none of the trains or busses stopped running despite few people on them) -- and having issues with parking.
To all the people out there who don't know what nurses (and midwives) do :
we go to work.
Just like you do.
Sure, we choose a job that could potentially ourselves at risk (for example in regards to infectious diseases -- and or nightshift: working at 2am when your brain is meant to be asleep) - but that's part and parcel of choosing to work here.
But so too is construction work. Or people who work in Garbage and sanitation. Or the military...
Like parking. Driving to work is a choice. Sure because of covid, mass public transport is a bad idea. But thats why everyone else worked from home. The trains kept running anyways just so people who had no other mode of transport to say, get essential groceries - or go to essential jobs --
had a way to do those things.
We always had to pay for parking.
We always had to pay for lunch.
We always had to pay for our own Christmas party.
This is because we are a govt entity (public hospital).
This was a very cheap publicity stunt that allowed the govt to look like they were taking care of their hospital workers in a time of crisis : FREE PARKING FOR ALL HOSPITAL STAFF.
Why don't we get free parking all the time.
Because the car park is not big enough to fit everyone: that's why. Otherwise everyone would probably be driving.
That ended March 2021.
My ID at SSH works to get into the car park (whilst other staff who started at a similar time does not) - don't question how that works - the Security guard who works at all hospital car parks from my experience is usually : a grumpy person. I don't know how much it costs for me to use the car park, and I have no idea if its pro rata or if it's a flat fee I'll get billed since I'm casual...
I should really ask...
The woman
G7P2-1
nothing to note for blood group/serologies/etc. yadda yadda.
This means: That she's had 7 pregnancies. 4 of which were miscarriages (the notes said they had been interspersed between the actual pregnancies- 2 births (both NVB, it turns out) - but 1 of those was of a Stillborn baby. Also known as a butterfly baby. At term, too. It wasn't a late miscarriage -- the notes state, the baby was 39 weeks old when it died. Cause of death is listed as maternal infection. There didn't seem to be anything wrong with the baby on autopsy - or with the placenta. (according to the notes).
This made the pregnancy high risk - Although you'd think the high number of miscarriages would also do it. I didn't know the gestations of when those occured (ran out of time to delve into the notes more) but it did get me thinking.
Is it worse if you have trouble to get pregnant: or if when you do, you keep losing the baby.
Anyway.
So there were 3 support people (we were back to the old days of when I started Midi in 2019 pre-covid).
The hospital visiting policy has all reverted back to pre-covid in this state, actually. It did so since about Jan 2020 except for that Northern Beaches thing and that went backwards for a few weeks - but it's back to normal now.
So the room was rather crowded even though their bigger than what I was used to at MSH.
The woman was the youngest sister out of a family of 8 (don't quote me). Most of the siblings were in Australia (all now grown with their own families, mostly with 1-2 children per family) and there were a few home in Turkey.
Two sisters were here to accompany her today. One that was a few years older (she was rather quiet and didn't speak much at all) and the oldest of all the sisters in Australia- who spoke the "best" English, and she did a lot of the conversation with me today.
The woman herself, had good conversational English but definitely struggled on the finer points. After I'd explain something I'd look for confirmation that she'd understood and she would say yes - but then look at her sister who would re explain it in Turkish.
Hopefully, accurately.
Anyhow. This wasn't her first baby, and the last had been an IOL (Admittedly 4 years ago) so in general, she would have had a good idea of what was going on.
She'd had her last in MSH, actually. This was her first at SSH.
The husband sat in the corner mostly, kept out of the way, went in and out, got drinks and food for everyone and sorta just hung out.
The room had a light feel in the sense that they were obviously cracking jokes in Turkish.
I waited for O&G to do the ARM because the woman had informed me that in the past, with her first pregnancy, she was informed that her cervix was "very back" (i thought she said bad to be honest - but this was re-clarifi ed). and that due to this "very back" nature of her cervix - they told her she should have an epidural prior to ARM (or that's what she needed last time).
Let's unpack this statement. (and I can't believe it's got me reading the textbook)
The cervix is composed of connective tissues covered in a thin layer of smooth muscle. Throughout pregnancy, the cervix changes.
In the 2nd trimester it becomes softer and wider - due to the effect of hormones oestrogens, prostaglandins, progesterone, relaxin, and nitric oxide on the collagen fibers and water content of the cervix.
Memory lane: smooth muscle is an involuntary muscle. It lines the walls of hollow organs such as the stomach, urinary bladder, intestines.
These changes culminate into "cervical ripening"-- when the cervix is "ripe" then it is prepared for labour.
The cervix is protected by a plug of thick mucous - which occurs from the proliferation of the cervical mucosa and glands, which protect the cervix from ascending infection (aka. infection arriving from the vagina).
During pregnancy, the surface area of the cervix increases to 75% more than it's prepregnancy size. It takes approx 4 weeks postpartum to return to a rigid, slit (non-pregnant state). However post pregnancy (to term, I presume) the cervix does not return to its pre-pregnancy state.
When textbooks mention "ecto cervix" this refers to the part of the cervix that can be seen from or exists within the vagina.
This was this woman's 3rd pregnancy to term. So likely, her cervix had changed since that first time that she needed an early epi to do the ARM.
I was handed over that the nightstaff had done a VE and found it very difficult and thought it was 1cm dilated. They also handed over she was GBS negative however on double checking I saw she was gBS positive and therefore under hospital policy was to be given IVABs.
I think the midwife (whom I don't think I'd ever heard before) heard me say under my breath to the medical student -- "always double check your handover..."
Sorry but that was a key feature of my training at MSH -- check all results for yourself.
That includes pre checking the ultrasounds for placental location before going into do a VE to ensure the placenta is well clear of the os. I don't see anyone doing this checking at SSH but at MSH it was a big deal (perhaps MSH had an incident but SSH didn't). It would be rare that a woman who had placenta previa or acreta was not for a planned c-section anyway - or that the woman wouldn't know that there was a problem and would have been informed as such that this (VE) was something to avoid.
So. The med student.
Apparently they have follow throughs also (just like the midwifery students) but theirs sounds slightly more intense. They get 3 for the rotation, and this meant that if they had a follow through they absolutely had to be in the room or around the ward for the entire labour of the woman from start to finish. They can take meal breaks but not for longer than 29 minutes otherwise that means they officially "left" the woman, and it wouldn't count.
If your woman is at the hospital for 20 hours, you need to be there for 20 hours (no time limits imposed, like they are for the GDM students).
I was a GDM student. You had 10 women. You needed to make sure you attended 4 antenatal, and 2 postnatal appointments of all 10. You needed to make 6 of the births. You could just attend the part where the kid comes out if you had to - (like if you had 2 women in a row - or you were far away and it took time for you to get there or whatever -) your supposed to attend the majority of the labour and most women love students who have "earned the right to catch their baby" (seriously, now as a midwife myself I hear the conversations women have about their students so I have more insight than I did as a student). So whilst you can technically skip the labour bit - midi students usually at least attend after the woman is established.
So the med student was there right from the beginning today.
I've given the first dose of IVABs whilst we are waiting for O&G to do the ARM.
One of the seniors whose a little bored offers to do it - but on reading her history declines when she realises the woman is high risk (like, in general).
I just don't like too many hands going up a vagina: if it's that hard, then just the one person whose going to be doing it, should do it.
I didn't have time to ask the O&G reg that ended up doing it: if it was as hard as that woman (and the nightstaff) made it out to be. As as soon as they left the room I had turned on the synto (after getting the lines swiftly double checked) and as per hospital policy I was now stuck in that room for the first 30 minutes of the induction.
There was some conversation with the woman about if we should do the epidural prior to the commencement of labour.
I was inclined not to do it that way.
Not unless the woman was set on entirely not feeling any pain.
I discussed this with the medical student too --
the med student pointed out, wouldn't that lead to a super long labour?
And I said well, theoretically yes but also, remember this is an IOL so we could just force the contractions to be harder: as hard as we'd like really, as hard as we deem necessary to get this baby out (one way or the other - depending on the fetus ability to withstand the IOL).
That was the goal today. Baby out.
Turns out it was also the birthday of the middle sister! I wished her a happy birthday.
There was one point about 1hr into the day where the elder sister asked me "so your the midwife today" and I did remember introducing myself as "your midwife for this morning" so. Either I'm not clear enough, or it got missed but i simply reinstated my title and role for the day.
The woman agreed that we could wait for the epi until she started feeling pain.
We talked about how last time the epidural was great and it was fine until the last 45 mins when she was very uncomfortable. I spoke about how epidurals often don't really work at the end because we intend to block pain associated with the contractions but not the pain of the baby moving through the lower parts of the pelvis.
She seemed to be uncomfortable but I deemed that positional. I encouraged her to walk around or move about the room - she went for a walk outside. It's against my own personal policy to restrict a woman to her room, so off she went. (I feel like I never see other people's womens outside their room but mine are always walking about).
The CTG looked amazing. Seriously good.
I was continually looking for the AM incharge.
Seriously. Every hour. I'd go to the desk and look for her for a trace review.
The trace was perfect,
But when we are restricted to only the incharge signing the sticker, this is really hard.
At MSH anyone could sign the sticker.
As long as you were a midwife. I think though, that grads hd to sign with a senior midwife.
There were a few seniors on- so I guess I could have gotten them.
Eventually the IC came and did about 3 stickers in a row.
For the next 4 stickers, I used the CME.
Where was the IC you ask. In meetings.
Meetings about staffing.
The handover meeting.
Some other random meeting.
The MUM wasn't around -
This is bloody ridiculous. What if I didn't have a perfect trace?! [press the buzzer].
That was my beef.
I asked them if women from Turkey had any traditions around birth and the baby. They said not really anything, but that at about 6 months some people did a henna party and did henna on the baby. It wasn't really something done frequently, and they couldn't explain why it was a thing (I asked if it brought luck to the baby or something, apparently not). It was a ritual that celebrated the health of the baby overall.
We talked about Cats.
The eldest saw cats on my socks and asked if I liked cats. I said I did, and i had one but actually the socks were a christmas present from someone who had 8 cats. She spoke about how she had 2 cats at home, one was a stray - that her kids had picked up - but that she was frustrated because the kids did not take care of the cats. She did. And how she once had a vet bill of 4 grand because one of the pets had broken their legs. I'm not sure how that story ended because she said they had to surrender the animal due to the cost; but also told the shelter to phone them if there was no other option and. the animal was to be killed.
I assume the shelter never phoned back.
That doesn't mean the animal was treated, recovered or rehomed.
I left that plot point to meander.
The woman was having a baby girl today, and she had a boy at home.
She found walking around helped her discomfort much more than repositioning in the bed.
She voided in the toilet.
My notes were terrible.
At 11:00 she asked "when can she have an epi" and I said "whenever you tell me you want one".
At 11:50 she said " want an epi"
So I phoned the anesthetist and realised her platelets was 90.
The cut off, apparently, is 80.
90 is rather low. I tried to explain it to the family. I said, your blood is made out of a few things. Red cells. white cells and sticky stuff called platelets. the platelet count is a bit low today, this might effect your epidural but I'll ask the anesthetist and they will explain it.
The risk at low platelets is bleeding.
They asked me if you could eat something to fix it. I explained no, a transfusion would occur if required but 90 isn't low enough for a transfusion. So how would a transfusion worked: if say for example, she was actively bleeding: then she would likely get a set of pooled platelets along with the red cells, provided her Hb was also low (it wasn't it was 123-- thats why I remember it, because it was 123 lol).
90 wasn't a dealbreaker. The Anesthetist came. Wasn't worried and popped an epi in right in time for the 13:00 VE.
Have I mentioned how much I hated VEs? at the desk this morning I got raked over the coles for suggesting that I leave my 13:00 VE to the PM staff who start at 13:45.
45 minutes people, is that really gonna make much of a difference as to whether she has progressed or not? Should not the same person be doing the VEs as much as possible? I'm not. gonna be around for the 1600 (or 1645 VE).
Sighs. This woman has a working epi. And I need practice (bah humbug).
I decided at 13:15 it was 4cm -2
on the basis that the previous at 09:05 was 2-3cm and -3
and before that at 06:30 it was a -1
Before you know it I was signing the med student's sign off sheet and handing over to the PM staff.
The med student asked if she could work with me next week since I seemed to not mind teaching a few things.
I said sure -cept I have no idea when, or if (even) I was working at SSH next week because I only remember my roster 1 week at a time.
The goldfish approach.
After lunch I attended the inservice on the new Fetal CERS criteria about when to call a fetal code blue. Which was interesting to an extent as one of the seniors was like "do you know how hard it is to review every single room per hour when you have 6 inductions running?".
Yup. Uhuh. And it was mentioned how sometimes, a midwife could have 9 stickers awaiting to be signed (um be proactive and look for them).
I wonder if in the powerchart I should have documented. CTG classified as normal. Awaiting T/L to be available to sign sticker. Unavailable.
Next hour
previous sticker not signed however CTG remains within normal limits.
Attempted to find T/L
etc.
I left feeling bad that I didn't get around to even checking to see if anyone touched the emat (I certainly hadn't) and also that my notes were terrible. But my stickers were signed and the CTG was textbook perfect.
3 hours it took me to write this!
