Midwife Mondays 96: NICU placement & more riding in an ambulance!

This past week has been a seriously busy one. I had recovered a bit from the complete and utter exhaustion of a couple of weeks ago after a few recoup days off last week, but I can now firmly say that it is back with a vengeance! I am COMPLETELY shattered – and it’s not really surprising; from Monday to yesterday (7 days) I have worked over 51 hours and my goodness can I feel it!

I’ve been mostly working on NICU this week; part of the course is that we need to work 60 hours on the neonatal unit, something which I’ve been really looking forward to this year.

My first day on NICU started with a bit of a tour of the unit, with a refresher of my newborn life support (just in case!) and then I was taken into the room and introduced to my mentor. She gave me a bit of an overview of the baby we were caring for – we were in the intensive care part of the neonatal unit so these babies generally have one nurse to each baby. This particular baby boy had been born at term, and diagnosed with downs syndrome and suspected cardiac abnormalities and had needed 3 days of medically induced hypothermia to try to preserve brain function after the brain was deprived of oxygen at birth (the baby wasn’t breathing at delivery and needed full neonatal resuscitation and intubation). At a week old, he was still sedated and intubated, with all sorts of infusions and monitors attached – it seems like a very difficult case and they still aren’t really sure what the outcome will be for this baby. This must be a really difficult part of working on NICU; caring for these babies and not knowing what the future will hold for them or what to tell the parents. This baby will most likely have some form of brain damage and developmental problems and may well need long-term health support.

As this was a very tricky case, which I couldn’t really get hugely involved in care-wise, one of the other nurses asked me to feed one of the other babies in the room. This baby girl was born at 26 weeks and was now 2 weeks old so still really really tiny. She was on hourly tube feeds so I got the chance to feed her a few times over the day; and definitely felt myself getting more confident with such a tiny baby as the day went on.

My second day on NICU I was back in the same room, initially with the same baby boy, however very early on in the day we were told that there was going to be a new admission. They didn’t know exactly what was wrong with this baby, but there were several things on the antenatal scans which had led them to think there might be some kind of condition or syndrome affecting this baby. As such, the decision had been made for a caesarean section and so when the surgery started, the NICU staff were called and myself and my mentor headed to theatre to be there for the delivery.

When the baby was born, it was obvious that there was something wrong. The baby was really struggling to breathe and needed a full resuscitation and a CPAP (continuous positive airway pressure) machine to help him breathe once his condition had been stabilised. We put him in the transport incubator and transferred him to our room in NICU. The rest of the day was spent with various doctors, radiographers and geneticists, all trying to establish what was wrong with him. They actually now think that it might be a quite a rare syndrome, so they are sending off samples for genetic testing – hopefully that means they will get to the bottom of it and be able to treat him appropriately.

My third shift on NICU was a night shift and this time I was given my own baby to look after – eek! Granted, she wasn’t particularly high-risk and was more of a Special Care baby than an Intensive Care baby, but she was my responsibility for the night (overseen by my mentor, obviously!) This baby was born at 30 weeks and was now nearly 8 weeks old – and so so cute!

She was on two-hourly tube feeds as well as two different infusions, the rates and doses of which needed checking and documenting every hour, and I had to keep a close eye on her observations too, documenting them every hour as well. It certainly made the night go by quickly – as soon as you were done with the feed for 22.30, there was about 20 mins of downtime to watch the baby and then it was nearly time to start noting everything down for 23.30 (perfect for sending a few emails and also getting a little bit of blog work done too – I’ve been really behind on getting my posts written ahead of time recently so it was nice to be able to write up some recipes and foodie posts that are now all ready to go for a few weeks time!) Luckily, she stayed stable all night and so when my shift ended I went home knowing that all was fine and I’d done my job right – thank goodness!

This week I also had a shift with the Paramedics as part of my non-midwifery hours (we need to do 60 hours of non-midwifery as part of our second year). I headed in for my 8am start and met the team I would be with for the day. Unusually, there was not a lot going on for the first couple of hours so we headed to a standby point and waited for a call. Finally the call came in and we were off. Seemingly this was going to be a bit of a ‘mental health day’ as the first and second cases we attended were both Panic Attacks of varying severity.

Our third case of the day, again, was a mental health case. As he had no support locally that he felt he could call on, we arranged for him to see the crisis team as a matter of urgency at the hospital. It was very difficult seeing this man break down in tears and beg for help, but hopefully the crisis team will be able to give him the support and help he needs.

Our last case of the day was a woman with a suspected kidney infection who was now dizzy and confused. By the time we got her into the back of the ambulance, she was ticking some of the red-flag boxes for sepsis so we blue-lighted her into the hospital where they started the sepsis-six protocol. Sepsis is such a scary condition and relies solely on the quick recognition and responces of the medical professionals so it was very impressive and interesting to see the paramedics recognise the signs and make the necessary decisions to get her the help she needed. It was a long day, and we ended up finishing late, but when you end the day knowing you’ve done your job right and that people are getting the help they need, you don’t mind!

My final shift of the week, yesterday, I was back on NICU again. By this point I was completely pooped and it did feel a little bit like part of my brain wasn’t there…but I was determined to make the most of my time there!
Like my night shift, I was given a baby to look after, this time a little boy. He had been born at 28 weeks and was now just over a month old. Impressively he was actually only needing a little bit of oxygen and tube feeding so my job for the day was pretty easy. He needed 2-hourly feeds as well as observations every hour – quite a gentle day really, which is exactly what I needed after the mad week I’d had!

It’s been a good week actually – so incredibly busy and very full on, but I’ve enjoyed it! Definitely looking forward to working a few fewer hours next week though – my body is falling apart at the seams!

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

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