A Thank You Card

When I got to work for my last shift there was a card for me, from a woman I looked after a few weeks ago. I had met V a couple of times before the shift she had her baby, as she had been admitted to the ward overnight a couple of times, so I knew her as quite a quiet women with a wickedly dark sense of humour. She was a petite woman and growing a well sized child, the plan was to induce her labour at term due to the size of her baby.

When I took over V's care she had an epidural on board, syntocinon running, and had been pushing for an hour, fully dilated for two hours. Her baby was still OP on palpation, and although she was pushing with everything she had the baby was not descending particularly well. I went into the room and turned the lights down (I don't like blaringly bright labour rooms esp in the second stage) and watched what she was doing. V was pushing well, with gentle and consistent encouragement from her husband, who was being shouted over by the student midwife who was in the room. The student had decided to go home rather than staying a bit longer for the birth, as it looked unlikely that V would be able to give birth without some obstetric assistance, and to be brutally honest (sorry!) I felt that she wasn't helping the situation very much. I stepped back, to enable V's husband to take the lead in encouraging his wife - they made a great team, and I felt that she was responding well to his familiar, soothing voice. Over the next 40 minute he supported her unwaveringly, mopped her brow and encouraged her to sip water, I just gave the occasional pointer and reminded them both how well they were doing. But the (normal) second stage early decelerations in the baby's heartrate were taking longer and longer to recover to the baseline, and there were no external signs of progress. With consent I examined V to find that although her baby's head was rotating there hadn't been much descent, and V couldn't have tried any harder with her pushing. I talked to V and her husband about getting the doctor in to review the situation as I felt that there may be the chance of an instrumental delivery if we acted while V still had some 'oomph' left. The doctor came in to review, and the decision was made to move to theatre for a 'trial of instrumental delivery', but with V prepared and consented for a caesarean just in case it was not successful.

I showed V's husband where to get changed while I got V ready for theatre, and quickly talked her through what to expect once we got in. She was, as you'd expect, scared and excited at the same time, scared of the unknown, and excited as she was soon going to become a mum, and find out whether she was carrying a boy or a girl. Once we got into theatre, V was in fits of giggles to see her very tall husband almost wearing a set of scrubs. I made sure she was covered, and the doctor reexamined V prior to starting, The baby had, by now, rotated into an occipito anterior position, and was delivered by forceps relatively easily. I helped V put her chunky baby girl skin to skin, while the doctor repaired the Episiotomy she had performed prior to the birth.

After a short time in recovery, I decided to take V and her family back to the labour room for a bit of bonding time - I was questioned by the midwife in charge as to where I was going, I replied that V had had a long day, the ward was busy busy but labour ward wasn't, so I was taking her back to the room for a while - not usual practice for the unit I work on unless there have been complications in theatre. I made V and her family comfortable, (the baby was breastfeeding like a pro by now) and brought them in a tray of tea, toast, fruit and yogurt (ill gotten gains of a ward fridge raid!) as V had not eaten much at all since breakfast, and left them for some quiet time while I did the paperwork.

V's baby was not far short of ten pounds, and gorgeous (I love chunky babes...). V got up once her epidural wore off and had a shower, after which I transferred her to the ward - her husband went home for a well earned rest.

The card V and her husband sent included a photo of V, me, and her naked baby in the labour ward room just after I weighed her - V looked tired but radiant. She wrote to thank me for the difference I had made to their experience that night, and to thank me for being there. Things like this mean so much more to me than flowers and chocolate - someone who has taken the time to write at a time when she will be very busy with a few weeks' old baby - and show that, where things end up in a 'not ideal' situation and a birth that is not the 'perfect textbook' experience, you can still make a difference.