Midwife Mondays 90: More time in theatre & ‘catch’ number 16!

So this week has been another busy one in my little life – though it has got to the point now where “busy” appears to be my norm and I honestly have no idea what to do with myself if I end up with proper time off, even with a to-do list the length of my arm!

So on Tuesday we had a day in uni, spending the day working towards our Skills module. We were focussing on caring for the sick woman and infant so in the morning we worked out specific care plans for women with different conditions; diabetes, pre-eclampsia, sepsis etc. Then in the afternoon we had a lecture from one of the neonatal nurse lecturers, teaching us the theory and skills for placing an NG tube in a neonate – which is perfect timing for my placement on NICU towards the end of this year.

I originally had a couple of days pencilled this week on a non-midwifery placement (we have to do 60 hours of non-midwifery of our choice this year), however they didn’t have any cases that they thought would be relevant so those two days turned into very welcome admin days, which was so useful – the laundry basket was getting to the point where nothing else would fit in it, and I had more unopened emails in my inbox than I could count; sometimes you can’t beat a good admin day to get your head in the game!!

I also had a few more long shifts on the delivery unit.

On the first shift we were looking after a woman with an epidural in labour. She was progressing really nicely and within just a couple of hours she was getting ready to start pushing. It sounds silly, but the thing that has struck me whilst working on the high risk delivery unit this week is that these woman are higher risk. A case that seems initially like a very low risk, normal delivery, turns around in a second and suddenly there is a need to get doctors in the room and a team making decisions for the mother and baby’s wellbeing. In this case, the monitoring on the baby was showing that the baby was starting to struggle, we were keeping an eye on it and knew that the doctors were aware and ready to step in if needed. As she got to fully dilated and, after an hour for descent, started pushing, the baby’s monitoring was getting much worse, with long periods where the baby’s heart rate was dropping after each contraction. After a particularly long one of these decelerations, we had to pull the emergency buzzer and within 20 minutes we were in theatre, and the baby had been delivered using a ventouse suction cap. It just all happens so quickly.

I think I need to try to alter my perspective when working on this higher risk unit, looking at the bigger picture and thinking that things could end up not going quite to plan or heading to theatre, just so I’m prepared, even when things are seemingly going really well, because this week has shown me more than once that you can never second guess what will happen.

My next shift, pretty much the same thing happened again. This woman was fully dilated when we examined her, and she started pushing but the monitoring was showing that the baby was distressed. The doctors came in and the decision was made to go to theatre and try to deliver the baby using forceps. There were a few more long decelerations while we were in theatre and they nearly made the call to go straight to an emergency c-section, but thankfully they managed the forceps delivery safely and the baby came out crying – always a relief!

My final shift of the week was a night shift, last night (so please forgive me if this post doesn’t make sense at points!) We were assigned to look after a woman who was undergoing an induction for reduced fatal movements. She had been on the antenatal ward, but had moved over to the delivery unit for one-to-one care because the trace on the baby had shown a little deceleration. By the time we came on, the trace was completely settled again, so we sat in with her and observed her contractions, which at that point were regular but more tightenings than being painful.

Just before midnight the doctors recommended an examination and to break her waters, which we did. She was 3cm dilated and doing really well, but still not really feeling her contractions. Fast forward an hour and everything had changed and she was feeling really painful contractions and was requesting an epidural. As she was still 3cm dilated, we arranged for the epidural and within an hour it was all sited and done.

At about 2.15 we went on our break, asking the midwife who was taking over for us to come and get us if anything changed. At half past, when I was just putting my head down to try and get a 20 minute nap, the door opened and the midwife was there telling us she was fully dilated!! They do say never turn your back on a multip but that was QUICK!

We headed back into the room, where she had a passive hour to allow the baby to descend, and then she started pushing. Just 4 minutes later she pushed her beautiful baby boy into my waiting hands! So speedy!! I passed him up to the mum’s chest, and give him a bit of a rub down – he was a little shocked by the speed of the delivery but he pinked right up very quickly and was absolutely fine!

So, that’s catch number 16 for me – can’t quite believe I get to do this everyday! It’s such a privilege!

To read last week’s Midwife Mondays post, click here:

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1 Comment

  1. Alastair
    June 12, 2018 / 11:37 am

    Fascinating as always! You may like to confirm that during your third shift the issue was “reduced foetal movement” rather than “reduced fatal movement” (which I’m sure we all realized anyway!)

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