First Blog Post

First time I've written a blog.... I'm too boring for this really!

Anyway, thought I'd write about my most recent night shift, to give you all a taste of what you're in for.

I'm currently on the ante/post natal ward rotation - where I work, we do three months stints on labour ward, interspersed with three month ward placements. I've just started my ward rotation, following a delivery suite placement which was a veritable tangle of caesars, PPH's and instrumentals, I usually seem to be allocated to the women who already have the alluring combination of nulliparity,syntocinon, epidural and a chunky baby in a helpful OP position at the start of the shift so I guess I can't take credit for it all

Anyway, I went in to handover on the ward, quite a lots of women in but not many complications, so we allocated who was looking after who, put the kettle on, and made a start. I was working with a colleague I hadn't seen in ages so was looking forward to a good gossip later on, I went round and introduced myself to 'my' women for the night, and started prioritising my work. About an hour later I took a call from labour ward, they wanted to borrow a midwife to come round and admit someone, 'should only be for an hour or so'

I went round and was sent to see K and her hubby J. K had come into labour ward to be checked over as she'd been contracting all day on and off, in early labour with her 5th child. I made them a cuppa, did admission obs and listened in, good sized term baby, ROP position, 'coupling' contractions which were moderate on palpation, all obs NAD. She had had an uncomplicated pregnancy and was feeling pressure at the height of her contractions. I just pootled around a bit, and within half an hour K was no longer able to talk through her contractions and was asking me to break her Waters as this had been done in most of her previous labours. I explained that I would do it if she insisted, but that I would prefer to leave them alone as leaving the bag of Waters intact would make it easier for her baby to rotate to a better position, and as her contractions were picking up anyway, let's just wait and see. I made her a hot chocolate which sealed the deal! Soon after she requested analgesia, I did another abdominal palpation and found the baby to now be ROL and the head to be 2/5 palpable, fetal heart rate reassuring, and gave her Entonox. A few minutes later she stood up, SROM'ed, and baby was born about five minutes later in fab condition, OA position at birth, intact perineum. This was less than an hour after I took her care. As labour ward was reasonably steady, I then got my long awaited cuppa, while K and J had some quiet time in their room with their new baby, low lights and the all important tea and toast, baby latched on and fed beautifully. I got the paperwork and computing finished up, and K got up for a shower prior to going to the ward for a rest - she had another 4 kids at home to deal with the next day as well as the new one!

I transferred K to the ward, and came back to give the MCA a hand with cleaning the room, during which the doorbell went and a young woman arrived unannounced. Her Waters had broken so she had come in to be checked over, she was not contracting when she left home but was now starting to niggle. B was having her second baby, and had a complicated social history mostly centering around her ex partner. She was accompanied by her new partner D, who was a very quiet and nervous presence in the room! I did a CTG as she had SROMed pre labour, but decided not to do a speculum and HVS as we are advised to do at our unit - her history was very good, she was still draining copious amounts of Liquor, and her contractions although irregular were getting stronger. BAby was a good size and, you guessed it, OP. I discontinued the CTG, and B mobilised around the room, She was instinctively adopting the positions we would advise for an OP labour, so I just provided the bits and pieces she wanted and stayed in the background, with the lights low. She used the pelvic ball for a bit, floor mats and beanbag, spent a lot of time kneeling on a floor mat at the end of the bed leaning on the bed, sat on the loo a lot, rocked, walked etc etc - she had had Meconium Liquor from the early stages of her first labour and had been told she had to stay still on the bed to be monitored, so was making the most of the opportunity to remain mobile this time. As she slipped into active labour, she became more and more distressed, talking about her previous partner and her previous labour - she pretty much cried all the way through labour. I couldn't take the hurt away, but I stayed in the room constantly, passed the tissues, made drinks, and just pretty much held her hand. She was getting urges to push as soon as her contractions became regular, and I discussed the way the OP positions cause early pushing sensations, but after a couple of hours of regular contractions (and tears) she was getting to the limit of what she could cope with and requested an examination - I found her to be 6cm dilated with quite a thick cervix, the presenting part at the ischial spines and the saggital suture in the oblique diameter. She requested some pethidine so I gave it, thinking that she was so wound up mentally that perhaps if the pethidine helped her to relax, her labour would progress. Her contractions had also started to 'go off' a bit - but questioning revealed that she hadn't eaten for over 12 hours. She didn't feel that she could eat anything, so I gave her some fresh orange juice on crushed ice to try and raise her blood sugar level a bit. About half an hour after giving the pethidine, D came out and called me back to the room (it was about the only time he spoke to me), I went in to find B on the bed, pushing in all fours. I gloved up and caught the baby (literally - didn't get my pack open!), she was a good size, with her elbow up above her head and her hand over her face. Mum had a physiological 3rd stage, mainly because by the time I had taken the baby to the resus for a whiff of oxygen and a reminder to breathe, the placenta was on the bed! Mum was lucky to have only a small first degree tear which did not require sutures, bearing in mind the size and position of the baby.

By now it was after 5am, I dimmed the lights and left B and D with their new daughter - D sobbing over his baby. I had my second cuppa of the shift while I did the paperwork and computing, then went in and made breakfast for the family before I handed over to the day staff.

I drove home in a daze - you know those drives where you find yourself sitting at a junction with no recollection of how you got there . Mr Dory was still at home as the kids were off school. He got ready to go off to work - the plan was for me to get a couple of hours' sleep while the kids watched a DVD and put the computer on (bad parent!) and get up at lunchtime. By the time Mr Dory made me a cuppa I was asleep on the bed in my uniform, so he woke me up, to get in! The next thing I knew it was 2pm, the kids had baked cakes, and brought me a coffee. I'm glad I only went over to labour ward for an hour....