It certainly feels like a big change this year, like we are suddenly a bit more of a member of the team and a bit less of student. Yes there are still people who are a bit more cautious but most seem to be quite willing to let us carry out the majority of the care and lead the plans etc which is a really nice way to consolidate everything, if a little scary at times!
I started back on delivery with a night shift (brutal right?!) and we were looking after a woman in early labour. On examination she was 1cm dilated at just past midnight, so we were simply keeping her comfortable. She was undergoing induction of labour so still needed support on the labour ward, but not one-to-one care as yet.
We kept checking on her and she was coping well so when we went back into the room to examine her again we were expecting some progression, but definitely not as much as we found – she was fully dilated! In 4 hours she had gone from being 1cm to 10! After an hours rest for a little more descent, she started pushing just before 6am.
Come the end of our shift at 8.15am, she was still pushing. She had made some progress and the baby had moved down, however not enough to think delivery would be soon, so we had got the doctors into the room for a review. Sadly, our shift finished, so we had to leave, but when I checked back she delivered by ventouse (suction cup) an hour an a half after we left and had a happy healthy baby girl.
My second shift was a long day shift and we were handed over the care of another labouring woman, this time in spontaneous labour. At 6am she had been 4cm, so she was officially in active labour and was starting to struggle with the pain. Within the hour she was requesting an epidural and so we got the anaesthetist into the room and an epidural was sited.
We re-examined at about 10.15am and she was 7cm dilated, so making really good progress, and as the epidural was working effectively, she was also pain free, so we had a really lovely chat for a few hours!
After 2pm we examined her again and she was fully dilated, so we decided to rest for an hour before pushing to allow some more descent. Just after 3pm she started pushing. We were getting a bit of loss of contact on the CTG monitor so we decided it would be a good idea to place a Fetal Scalp Electrode on the baby’s head to more effectively monitor the baby heart rate. I’d placed these in uni and in the skills lab, but not on practice, so I was a little bit anxious, but managed to place it first time – Yay!
By about 5pm there was some distress showing on the monitor and we called in the doctors into the room. As the baby was still quite high in the pelvis and was showing distress, the doctors discussed it with the parents and the decision was made to head to theatre and try a forceps delivery.
Within the hour, her baby boy was safely delivered by forceps and was snuggled up into her chest for a cuddle.
We moved her through to recovery and helped her with the first breastfeeding latch and then supported her for the last few hours before the end of our shift.
Yes, delivery is tiring and long, and you don’t always get to be “catching” babies, but this week was rewarding in different ways – and I really felt like I did a good job for both of these women and their families, which is what the job is about after all!
M and I were in Bristol with my parents for the weekend for a “Fake Christmas” before my sister goes away for 6 months up a mountain – full on christmas dinner and champers – winning!
Image by Suhyeon Choi
To read last week’s Midwife Mondays post, click here: