The two ladies of SSH
Oct. 6th, 2024 07:47 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
whitewriterI went back to SSH on Friday for my first shift since having Elizabeth.
It's a bit earlier than when I had Wendy but I think I need the mental stimulation. Midwifery is much more cerebral for me than ICU I think, somehow. But in both jobs, since going part time I really do need to think a lot more, need to consider everything a lot more. Things take me forever. and I'm always learning something.
Like Mifeprostone is $130 and misoprostal is $1.50.
People call Mifeprostone "Miffie".
It's a MTOP drug.
Medical termination of pregnancy.
LADY NO. 1
Friday was the first time I ever gave that to someone, let alone, the first time seeing a fetal heart beat on a monitor and giving that drug, knowing what it'll do to that tiny 21 weeker.
You don't allocate those types of patients to the religious or the pregnant for the most part.
Like, even though its totally our job, and like I fully agree with and understand why we're doing it and it's just going to go downhill anyway- it's still a sad as day for everyone.
Firstly it was a 21 weeker. So the kid was probably half a kg (that's pretty big). Both big and small, somehow. Too small to survive, too big that once in labour, would still feel like something pretty big was coming through.
Its birth just the same as with a 37+ weeker really I think. The youngest gestation I saw delivered was about 26+5 with borderline viability in play the woman had a say and chose for it not to live. The baby was 600g post birth when we weighed it, and, the midwife at the time turned to me and said "damminit, it could have lived".
Facts of the trade that suck.
Almost no one seemed to know how to give the drug.
No one had read the policy -- so I scoured the whole thing looking for useful information. Thats where I read that Miffy was $130 bucks and Misoprostal was $1.50 (so not useful) but that Miffy worked better at further gestations comparatively.
Your not supposed to eat for 2 hours before and after.
The doctor we consulted said it didn't matter but the policy said there was a 30-40% chance of vomiting so I figured on one of the worst days of your life, having anti nausea premedications charted and given at a significant time, and at least waiting an hour or so post lunch was really reasonable.
The thermometer I was using showed she was spiking a temp.
I was then told all the thermometers in the unit were unreliable and broken (even though I changed the battery) its like. We're a major public hospital with funding, why are midwives having to bring their own $20 thermometers to work (which we're supposed to use to check the baby's temperature because its hard using the adult ones) -- when the exxy Welsh allen thermometers are apparently "not working".
So we made clinical decisions based on her "rising temp" (speeding up the induction being the main decision) and putting her on a proper sepsis pathway rather than a probable sepsis pathway. This reminds me, i did fill in the paperwork for a yellow zone clinical review but I didn't start the sepsis pathway paperwork.
There's too much paperowrk.
The poor lady was afraid of pain. It was her second child, her first was a c-section at 6cm. I think she is a 3 year old who might have thought a brother or sister was coming.
It's like how do you explain that to your child.
Maybe they hadn't told her yet. The lady looked fattish so could probably have gotten away with it.
I keep seeing that heartbeat in my minds eye. Poor baby. May it's soul rest in peace. It was likely living in an infection ridden world which was getting smaller and smaller by the hour as the amniotic fluid had broken and there was hardly any left. Sorta like a fish in a tank but say only 10% of the volume remained.
She will likely remain in my memory bank of memorable patients for quite some time.
At one point in the day, she seemed quite surprised when I mentioned I hadn't given this drug (the miffey) to anyone before so I was reading up and double checking all the things I had to do in regards to it.
Breastfeeding Hx. She fed her first child for approx 3-4 days she said and then sorta it didn't work out so she gave up.
At that time I didn't bring up more information which in hindsight I should have, which was that we should give her a medication to surpress lactation as that would complicate an already stressful time.
Lady no 2.
Heavy smoker.
40+
with a very young looking husband considering.
4th baby,
many previous miscarriages (10?)
muslim.
Nice lady
36+0
kept having irratable uterus/tightenings/contractions on and off since 3am.
Cervix remained long and closed.
When the endone settled her pain, then you could see what her uterus was doing on the CTG more clearly and it made her contractions seem worse But actually it was because she would stop withering around so it could monitor them more effectively and clearly -
rather than them actually being "Worse" (I think, anyway).
I barely had time for a palp (where does time go...).
I had to transfer her to u/s for a scan because her previous scan was really bad (polyhydramnios and macrosomia) but then subsequent scan said normal liquor volume and normal sized head (lols) so they just wanted to check that because they'd already convinced her to a c-section based on issues 1 and 2. So was the bad scan right or the good scan right.
The inhouse scan was there to decide.
Apparently the good scan was right.
As I left the contractions/etc, hadn't fully settled and she was still there on the worlds longest CTG that I have to admit I was doing a piss poor job of monitoring.
Also they were planning not to intervene in stopping the birth should it continue as 36+ weeks is good enough, really, in the scheme of things.
Memorable moments of the day
So I'm in ultrasound with lady no2. and we're talking about why would we have more children (like you know, conversational) and the sonographer guy comes to me and shows me a name on a paper and says "is she coming for a scan" and I say no, I have her too and they've cancelled her scan. And he says "so what do I record"? And I say I don't know, she doesn't need it anymore because they've decided ...
...
..
and then I think hum. Maybe I shouldn't say too much. In anycase, the scan is no longer needed.
Lady no.2 about to have baby no 4. doesn't need to know that Lady no1. is having a bad day next door.
Does she now.
Count your blessings cause it ain't easy for everyone.
The social worker coming in and doing a whole speil and show with Lady no1. She looked quite young. But it made me also think about the types of people she has to see in the hospital and what she has to do all day. Talk to people basically having the worst time of their lives. When is the happy patient?
It's a bit earlier than when I had Wendy but I think I need the mental stimulation. Midwifery is much more cerebral for me than ICU I think, somehow. But in both jobs, since going part time I really do need to think a lot more, need to consider everything a lot more. Things take me forever. and I'm always learning something.
Like Mifeprostone is $130 and misoprostal is $1.50.
People call Mifeprostone "Miffie".
It's a MTOP drug.
Medical termination of pregnancy.
LADY NO. 1
Friday was the first time I ever gave that to someone, let alone, the first time seeing a fetal heart beat on a monitor and giving that drug, knowing what it'll do to that tiny 21 weeker.
You don't allocate those types of patients to the religious or the pregnant for the most part.
Like, even though its totally our job, and like I fully agree with and understand why we're doing it and it's just going to go downhill anyway- it's still a sad as day for everyone.
Firstly it was a 21 weeker. So the kid was probably half a kg (that's pretty big). Both big and small, somehow. Too small to survive, too big that once in labour, would still feel like something pretty big was coming through.
Its birth just the same as with a 37+ weeker really I think. The youngest gestation I saw delivered was about 26+5 with borderline viability in play the woman had a say and chose for it not to live. The baby was 600g post birth when we weighed it, and, the midwife at the time turned to me and said "damminit, it could have lived".
Facts of the trade that suck.
Almost no one seemed to know how to give the drug.
No one had read the policy -- so I scoured the whole thing looking for useful information. Thats where I read that Miffy was $130 bucks and Misoprostal was $1.50 (so not useful) but that Miffy worked better at further gestations comparatively.
Your not supposed to eat for 2 hours before and after.
The doctor we consulted said it didn't matter but the policy said there was a 30-40% chance of vomiting so I figured on one of the worst days of your life, having anti nausea premedications charted and given at a significant time, and at least waiting an hour or so post lunch was really reasonable.
The thermometer I was using showed she was spiking a temp.
I was then told all the thermometers in the unit were unreliable and broken (even though I changed the battery) its like. We're a major public hospital with funding, why are midwives having to bring their own $20 thermometers to work (which we're supposed to use to check the baby's temperature because its hard using the adult ones) -- when the exxy Welsh allen thermometers are apparently "not working".
So we made clinical decisions based on her "rising temp" (speeding up the induction being the main decision) and putting her on a proper sepsis pathway rather than a probable sepsis pathway. This reminds me, i did fill in the paperwork for a yellow zone clinical review but I didn't start the sepsis pathway paperwork.
There's too much paperowrk.
The poor lady was afraid of pain. It was her second child, her first was a c-section at 6cm. I think she is a 3 year old who might have thought a brother or sister was coming.
It's like how do you explain that to your child.
Maybe they hadn't told her yet. The lady looked fattish so could probably have gotten away with it.
I keep seeing that heartbeat in my minds eye. Poor baby. May it's soul rest in peace. It was likely living in an infection ridden world which was getting smaller and smaller by the hour as the amniotic fluid had broken and there was hardly any left. Sorta like a fish in a tank but say only 10% of the volume remained.
She will likely remain in my memory bank of memorable patients for quite some time.
At one point in the day, she seemed quite surprised when I mentioned I hadn't given this drug (the miffey) to anyone before so I was reading up and double checking all the things I had to do in regards to it.
Breastfeeding Hx. She fed her first child for approx 3-4 days she said and then sorta it didn't work out so she gave up.
At that time I didn't bring up more information which in hindsight I should have, which was that we should give her a medication to surpress lactation as that would complicate an already stressful time.
Lady no 2.
Heavy smoker.
40+
with a very young looking husband considering.
4th baby,
many previous miscarriages (10?)
muslim.
Nice lady
36+0
kept having irratable uterus/tightenings/contractions on and off since 3am.
Cervix remained long and closed.
When the endone settled her pain, then you could see what her uterus was doing on the CTG more clearly and it made her contractions seem worse But actually it was because she would stop withering around so it could monitor them more effectively and clearly -
rather than them actually being "Worse" (I think, anyway).
I barely had time for a palp (where does time go...).
I had to transfer her to u/s for a scan because her previous scan was really bad (polyhydramnios and macrosomia) but then subsequent scan said normal liquor volume and normal sized head (lols) so they just wanted to check that because they'd already convinced her to a c-section based on issues 1 and 2. So was the bad scan right or the good scan right.
The inhouse scan was there to decide.
Apparently the good scan was right.
As I left the contractions/etc, hadn't fully settled and she was still there on the worlds longest CTG that I have to admit I was doing a piss poor job of monitoring.
Also they were planning not to intervene in stopping the birth should it continue as 36+ weeks is good enough, really, in the scheme of things.
Memorable moments of the day
So I'm in ultrasound with lady no2. and we're talking about why would we have more children (like you know, conversational) and the sonographer guy comes to me and shows me a name on a paper and says "is she coming for a scan" and I say no, I have her too and they've cancelled her scan. And he says "so what do I record"? And I say I don't know, she doesn't need it anymore because they've decided ...
...
..
and then I think hum. Maybe I shouldn't say too much. In anycase, the scan is no longer needed.
Lady no.2 about to have baby no 4. doesn't need to know that Lady no1. is having a bad day next door.
Does she now.
Count your blessings cause it ain't easy for everyone.
The social worker coming in and doing a whole speil and show with Lady no1. She looked quite young. But it made me also think about the types of people she has to see in the hospital and what she has to do all day. Talk to people basically having the worst time of their lives. When is the happy patient?
