My Midwifery days
Learning curve
Posted 20-Jun-2008 at 18:38 by midwifemissy
I took over the care of a lovely lady this morning with my midwife when I went on shift.
She was a primip, and already fully dilated and pushing really well. As the morning progressed I could tell that she wasn't making the progress expected for the effort she was making.
The Doctor was called in to asess her as she had been pushing for a while, and making very little progress. He wanted synto starting, and said he would assess her again in 45 minutes to see how things were. He also said that the baby was 'transverse'
Synto was started, and the lady was pushing for all she was worth with each contraction. Still very little visible progress. The doctor returned and again assesed the lady, and it was decided to go to theatre for a trial instrumental, and if that wasn't successful, then for a section.
Once in theatre the lady was given a spinal and the doctor tried to deliver the baby using a ventouse suction cup, this wasn't working, so forceps were then tried, after much effort a beautiful baby boy was born, he needed a few rescue breaths, but soon recovered and was fine.
Mum however had a retained placenta, and had to have a manual removal, this is the first time I had seen this, and it didn't look very nice, but Mum was fine as she couldn't feel anything thankfully.
When my midwife and I had settled Mum and baby back into their room, and helped Mum to start breastfeeding, we went for a much needed drink.
Wheile we were having a break I asked the midwife why they had tried an instrumental when the baby was in the transverse position?
She explained that it was the baby's head that was transverse, and instead of his head being flexed and resting on his chest, he was looking to the side, not as I had thought the way he was lying. She said it is called Occipito Transverse presentation.
This really fascinated me, as I had never heard of it before. It has been a really good learning curve for me, I have seen a forceps delivery, learnt about a new presentation, and seen a manual removal of a placenta.
After all that, I was relieved to see that Mum & baby were both fine, and the last time I saw them, baby was feeding like a dream.
She was a primip, and already fully dilated and pushing really well. As the morning progressed I could tell that she wasn't making the progress expected for the effort she was making.
The Doctor was called in to asess her as she had been pushing for a while, and making very little progress. He wanted synto starting, and said he would assess her again in 45 minutes to see how things were. He also said that the baby was 'transverse'
Synto was started, and the lady was pushing for all she was worth with each contraction. Still very little visible progress. The doctor returned and again assesed the lady, and it was decided to go to theatre for a trial instrumental, and if that wasn't successful, then for a section.
Once in theatre the lady was given a spinal and the doctor tried to deliver the baby using a ventouse suction cup, this wasn't working, so forceps were then tried, after much effort a beautiful baby boy was born, he needed a few rescue breaths, but soon recovered and was fine.
Mum however had a retained placenta, and had to have a manual removal, this is the first time I had seen this, and it didn't look very nice, but Mum was fine as she couldn't feel anything thankfully.
When my midwife and I had settled Mum and baby back into their room, and helped Mum to start breastfeeding, we went for a much needed drink.
Wheile we were having a break I asked the midwife why they had tried an instrumental when the baby was in the transverse position?
She explained that it was the baby's head that was transverse, and instead of his head being flexed and resting on his chest, he was looking to the side, not as I had thought the way he was lying. She said it is called Occipito Transverse presentation.
This really fascinated me, as I had never heard of it before. It has been a really good learning curve for me, I have seen a forceps delivery, learnt about a new presentation, and seen a manual removal of a placenta.
After all that, I was relieved to see that Mum & baby were both fine, and the last time I saw them, baby was feeding like a dream.
Total Comments 3
Comments
 |  oh  what a day missy! its good that you've learnt so much out of it- you certainly sound like you coped better than i did- i think instrumentals are barbaric and manual removals just gruesome- but i suppose they both lead to something being 'extracted' which isn't going to get out any other way. It's brill to know they were both fine- what a happy ending  xxxxx |
  Updated 20-Jun-2008 at 19:16 by Butterfly (typos!! grr) |
| |  Hi Missy Wow, i bet those days just feel like a mad blur of learning, well done! May i ask, if it doesn't take up too much of your time how a manual is performed? My fiend had a retained placenta a month ago and they managed to pull it out in the end. Thanks x |
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| |  Hey Missy - wow - sounds like you have learned a lot even if it was a little gruesome!! I had a ventouse with my 2nd - not pleasant but hey I got a gorgeous little boy at the end of it I'd never heard about that type of presentation...when I first starting reading your blog post I automatically wondered why they hadn't just done a section for a transverse presentation - DOH!Glad it's all going well for you - long may that continue!! xxx |
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