Birthing in covid.
Sep. 11th, 2021 10:44 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriter10/9/21
So I had a lady, whom halfway through the day, I realised I'd met her before: at MSH, as a student in October of 2019. I'm so sure... But I will have to ask a ward clerk to find me her MSH medical record number (MRN) and then back check it with my student notes.
P1
VBAC (vaginal birth post cesarian)
previous c-section for high head
1st Labour complicated by ?requiring an IOL, then wanting an epidural and the anesthetist of the day refusing unless she had an MRI, then by the time that was done, she was only 3cm and high head and when offered a c-section she just took it.
Why did she need an MRI? Past medical Hx of "HANDL syndrome" or aseptic meningitis, causing headaches and she was taking panadeine forte for this (through pregnancy also, but only PRN or as needed).
It was this story, that rang bells.
At first, I thought it happened at SSH. But I also don't think SSH has an MRI machine.
Her first VE: was my 2 fingers, which I think I should have done the traditional and minused 1 from my VE but, it was such an easy 2 : like it wasn't at all posterior - anyone, even a student, could have found that cervix - that I generously classified her as 3cm .
So she wasn't established quite yet. Hospital policy regarding VBAC is that if they're contracting 2:10 then they need to be in the hospital, even mild contractions, and monitored.
Once they're established, they can be admitted- but they're now on a time clock. If they don't birth fast enough, they'll end up with an IOL (if they've been permitted) or a cesarian for "failure to progress".
Midwives have a trick to reduce diagnosis like "failure to progress" which is, to delay stating progression.
So for example, instead of saying 3cm they'd say 2cm. -- cause previous VE was 1.5cm, it's classed as progression but if the next VE is say, 4cm, going from 2 to 4 is much better than 3 to 4.
The difference between 2 and 3 and 4 are almost arbitrary as the size of our hands aren't even equal.
Then there's the classification of what is "established labour" Old textbooks say 4.
Newer ones say 6 if its a prinip and 4 if its a multip.
She isn't a multip only on a technicality - because the 1st birth was a cesarean.
She was stuck in this dark windowless room with no visitor to support her (traditionally the partner) because that's the dumb rule in covid) - until she is established, and therefore, admitted to birthing unit and gets put into a much nicer lovelier room with windows (which have blinds if they wish to close them) and a huge bathtub that looks really Instagrammable.
Dumb covid rules.
I get them but then again I don't get them.
If we're assuming the partner's covid status based on the woman's status, and considering they're one unit. And mostly, their presence is a comfort to the woman. Even if they're an asshole, they're her asshole and generally she wants them there. Just the presence. How many times I've had to wet a washcloth or give a woman water when the man was sleeping in the corner (lol), but they're still important.
Not allowing a partner in, really goes against everything we've ever been taught so keeping them out is really quite painful.
So having her always ask me when can he come in, and me not having quite an answer because the answer is : when your established.
That could be, say. 4 hours. Or 1 hour. ...
So at the next check I felt pressured to give her another higher reading. I got, 4-5cm. Bulging forewaters.
After an hour of dicking around post that VE, I managed to get her that nice room I had previously described. And her husband came too. He was an ochre bloke. And it was when I was saying "last birth was at MSH right?" that the nail hit the head and I had this massive de ja vu feeling she was in bed 6 or 7- the large corner room, and I had met her right after she had had the MRI, and we'd had morning handover.
I did an awesome ARM, even if I do say so myself. I always feel like I take forever up a woman's vagina feeling as best I can, NOT to accidentally scratch something I'm not meant to during the ARM -- and not to have a freaking cord come down. I reckon, what probably is 3 mins feels to me like 10 mins. But the pain of having an adverse outcome from an ARM is worth the 3 mins it takes me to do it over a super pro that can do it in 1 min.
Or maybe I do take a minute, but it just feels like 3. Never timed how long it takes.
When I left, she was in the bathtub enjoying the water. Next VE was due at 16:00.
I wonder how she went.
So I had a lady, whom halfway through the day, I realised I'd met her before: at MSH, as a student in October of 2019. I'm so sure... But I will have to ask a ward clerk to find me her MSH medical record number (MRN) and then back check it with my student notes.
P1
VBAC (vaginal birth post cesarian)
previous c-section for high head
1st Labour complicated by ?requiring an IOL, then wanting an epidural and the anesthetist of the day refusing unless she had an MRI, then by the time that was done, she was only 3cm and high head and when offered a c-section she just took it.
Why did she need an MRI? Past medical Hx of "HANDL syndrome" or aseptic meningitis, causing headaches and she was taking panadeine forte for this (through pregnancy also, but only PRN or as needed).
It was this story, that rang bells.
At first, I thought it happened at SSH. But I also don't think SSH has an MRI machine.
Her first VE: was my 2 fingers, which I think I should have done the traditional and minused 1 from my VE but, it was such an easy 2 : like it wasn't at all posterior - anyone, even a student, could have found that cervix - that I generously classified her as 3cm .
So she wasn't established quite yet. Hospital policy regarding VBAC is that if they're contracting 2:10 then they need to be in the hospital, even mild contractions, and monitored.
Once they're established, they can be admitted- but they're now on a time clock. If they don't birth fast enough, they'll end up with an IOL (if they've been permitted) or a cesarian for "failure to progress".
Midwives have a trick to reduce diagnosis like "failure to progress" which is, to delay stating progression.
So for example, instead of saying 3cm they'd say 2cm. -- cause previous VE was 1.5cm, it's classed as progression but if the next VE is say, 4cm, going from 2 to 4 is much better than 3 to 4.
The difference between 2 and 3 and 4 are almost arbitrary as the size of our hands aren't even equal.
Then there's the classification of what is "established labour" Old textbooks say 4.
Newer ones say 6 if its a prinip and 4 if its a multip.
She isn't a multip only on a technicality - because the 1st birth was a cesarean.
She was stuck in this dark windowless room with no visitor to support her (traditionally the partner) because that's the dumb rule in covid) - until she is established, and therefore, admitted to birthing unit and gets put into a much nicer lovelier room with windows (which have blinds if they wish to close them) and a huge bathtub that looks really Instagrammable.
Dumb covid rules.
I get them but then again I don't get them.
If we're assuming the partner's covid status based on the woman's status, and considering they're one unit. And mostly, their presence is a comfort to the woman. Even if they're an asshole, they're her asshole and generally she wants them there. Just the presence. How many times I've had to wet a washcloth or give a woman water when the man was sleeping in the corner (lol), but they're still important.
Not allowing a partner in, really goes against everything we've ever been taught so keeping them out is really quite painful.
So having her always ask me when can he come in, and me not having quite an answer because the answer is : when your established.
That could be, say. 4 hours. Or 1 hour. ...
So at the next check I felt pressured to give her another higher reading. I got, 4-5cm. Bulging forewaters.
After an hour of dicking around post that VE, I managed to get her that nice room I had previously described. And her husband came too. He was an ochre bloke. And it was when I was saying "last birth was at MSH right?" that the nail hit the head and I had this massive de ja vu feeling she was in bed 6 or 7- the large corner room, and I had met her right after she had had the MRI, and we'd had morning handover.
I did an awesome ARM, even if I do say so myself. I always feel like I take forever up a woman's vagina feeling as best I can, NOT to accidentally scratch something I'm not meant to during the ARM -- and not to have a freaking cord come down. I reckon, what probably is 3 mins feels to me like 10 mins. But the pain of having an adverse outcome from an ARM is worth the 3 mins it takes me to do it over a super pro that can do it in 1 min.
Or maybe I do take a minute, but it just feels like 3. Never timed how long it takes.
When I left, she was in the bathtub enjoying the water. Next VE was due at 16:00.
I wonder how she went.
