COTW SMNET Catch of the week 16/1/12

For anyone who's not sure - these are real situations designed to help you get an idea of what other people would do in this situation, to help you evaluate the care you'd provide, to get other ideas if you are in the situation in the future - and to make you realise just how much there is to learn in midwifery and just when you think you have it sussed something will happen to make you realise that nature has ways of taking us all by surprise, no matter how experienced you are. The women and their families have very kindly agreed for their experiences to be shared online and in accordance with the NMC all are completely anonymous.

Some of these situations will be lovely normal births, others will end up in theatre or have a nice birth with complications afterwards, as in real life not all pregnancies will have a happy ending. There are various settings so don’t forget where you are (can’t transfer to theatre from a homebirth without ringing an ambulance etc). Intermixed with the intrapartum cases there will be antenatal or postnatal scenarios thrown in as midwifery is not all about the birth.

Each event will last for 1 week, with me setting the scenario on the Monday and unfolding a bit more each day until Sunday when I conclude it, ready for the next. However if I am around and basic questions are asked (such as why I did something or what something means) then I’ll answer them earlier.

Join in, make comments - be they practical suggestions of what could have been done, a 'OMG I'd never have done that', a 'why did that happen?', 'similar thing happened to me', or a 'I haven't got a clue - hope mum and baby were ok'. The more people and comments who are part of this the more fun and interactive

10.00 You are working on a busy labour ward and are told you will be taking a term, labouring primigravid woman with raised blood pressure who is being sent in via ambulance by the community midwife.

Was she planning a homebirth? Wouldn't be much to do at my unit until she arrives however I believe you can access her records before she comes in, so do that and have a look at her history. Has this otherwise been a normal pregnancy would seem so if transferring from homebirth but want to check myself not assume. Check placenta site and rh and rubella status. I'd probably double check protocol for raised bp too, just to be sure I wasn't missing anything. Make sure I have a sphyg or dynamap in room.

Do we know exactly what the bp is? Also how long she has been labouring, findings of last ve (if had one) and when it was performed? Do women with high bp labour have a tendency to labour quickly? I thinlk I've heard that but anecdotally rather than evidence based.

She was admitted from antenatal clinic where she went for a check up

These are all the details the coordinator has. Prepare the room with CTG straps ready, and check the resusitaire and get water ready.

11.00 Woman and midwife arrives. Start CTG On a/p fundus=39cm, Long, cephalic lie 3/5th palpable FHHR 140bpm
Community midwives handover
Fern is a primigravid woman at 38weeks and 5 days gestation who attended for her routine antenatal appointment this morning but was tightening every 3 minutes so she examined and found Fern to be 3cm dilated, with a cephalic presentation. There was a trace of protein in her urine as well as blood.
Ambulance observation sheet gives Obs as follows, Temp 36.5, BP 115/81, P 86, resps 16
Midwife leaves almost immediately.