Midwife Mondays 122: Emergencies, Complicated cases & a very speedy baby catch!

So, week 122 in this incredible adventure was another busy one – as usual! And it really was a case of hitting the ground running from the first second!

At the start of my first shift of the week myself and my mentor were told that a lady had just arrived in the hospital, contracting regularly, and we were assigned to look after her.
I headed in to the room and started to check her over, doing her observations, palpating the baby to assess the position, and finally listening in to the baby’s heart rate. It was at this point that it all became a little less “routine”.

I found the baby’s heart beat with the doppler, and it was significantly slower than it should be, and it wasn’t recovering. An average fetal heart rate is generally between 110 and 160 beats per minute. This baby’s heart rate was staying around 86bpm and had been for the whole time I’d been listening. I put on the CTG monitor and asked the lady to roll to her left hand side, as this can sometimes help in these cases, but not with this baby – there was no change.

I told the parents what I was hearing and said that I would like to examine her in case she was fully dilated, as this can also be a reason for these decelerations. I also pulled the buzzer to get a few extra people in the room to help. I examined her and she was 8cm dilated, so it wasn’t that she was fully dilated. When to doctors got into the room, I told them what was going on and they immediately made the decision to head to theatre as the baby’s heart rate had been below 100 beats per minute for over 5 minutes now. We sped down the corridor and into theatre, and in less than 10 minutes the baby was delivered by caesarean section – and thankfully was nice and pink and cleared by the paediatricians within a few minutes.

The parents dealt with the whole thing really well – It is so stressful for the parents when things like this happen and so communication is so important. I had tried to keep them informed throughout and once the baby was with the paediatricians, I checked the gender and headed back to the parents to ask how they wanted to find out. Did the dad want to go over and check, did they want me to tell them, or did they have something else they wanted – and the said they wanted me to say. So I had the pleasure of telling them that they were parents of a beautiful baby girl! That moment is always so special but it was particularly moving given how stressful everything had been in the run up to it – and being able to bring the baby over to them just minutes later and let them have their first cuddle was just wonderful!

After they were settled in recovery, we headed back to the labour ward and were handed over the care of another woman – a particular complicated case.

This woman had a very high BMI and was due for induction of labour. We needed to monitor the baby for a while before placing the induction tablet behind the cervix, however this presented its own issues as the monitor really struggled picking up the baby. Once the waters are broken, we can monitor the baby with a scalp electrode, but as her cervix was closed, we needed to monitor through the skin, which is often quite tricky in women with a higher BMI. In the end myself and my mentor had to take it in turns to hold the monitor in place, holding her tummy in a certain way to get the right angle, but we got there!

To place the tablet, we thought it would be best to put her legs in stirrups and in the end had to get one of the doctors to help placing it as it was very tricky to examine her. Once the tablet was in, and we had monitored the baby again to ensure it wasn’t distressed by the hormone tablet, she went for a walk for a couple of hours to try to bring on labour. Gravity is a wonderful thing when it comes to labour, so she wanted to get up and about as much as possible. We even tried her on a birthing ball, which, we realised when we went to get one for her, don’t have any weight ranges on them so we had to have a tricky discussion with her about liability etc in case it wasn’t strong enough.

Obesity is only increasing and it is something we deal with more and more in maternity care – but this case has really highlighted to me that some of the equipment we have is just not appropriate for these women. It makes it difficult for us and uncomfortable for them, and it definitely needs looking at as time goes on. I’m glad I had the experience though; now I will have a much better idea of how to deal with these cases moving forwards.

On my next shift we took over care of a woman who was already pushing. She was doing so so well but the baby was really starting to struggle and so the doctors decided to rush her to theatre for an instrumental delivery – the baby just needed to come out as quickly as possible. Thankfully, the baby was delivered quickly and easily with forceps, and it was perfectly pink and crying. It was definitely a rushed start to the shift but a positive outcome and thats all that matters!

We then took a lady from the antenatal ward who was having an induction of labour. We started the induction process and then she went for a walk and had a sleep. Around 3am, I broke her waters, and then she went back to sleep for a little bit. By the time our shift finished, she was contracting regularly and was 4cm dilated already. Apparently she went on to deliver around lunchtime the next day – and had a healthy baby boy!

My final shift of the week was another night shift and we started in theatre – they were just finished a caesarean section and so we took over for the postnatal care and transfer to recovery. Once she was settled in recovery and all sorted, with the baby nicely latched and feeding, we headed back to the labour ward.

When we got there I took a phone call from a woman who was 36 weeks and 4 days, and was feeling some tightenings, irregularly – it sounded a lot like Braxton Hicks so I checked with my mentor, who agreed with me and so I advised her to take some paracetamol and try to get some sleep and call back if it got any worse – it could be early labour but most likely Braxton Hicks Contractions.

20 minutes later the phone rang again and one of the other midwives answered it. I wasn’t really aware of it until she said the lady’s name, so I went over and took over the call. Things had definitely changed and she was definitely in labour now – I asked her to come in and started setting up a room for her. Within 40 minutes she had arrived and it became very clear that she was progressing very very quickly. She was squatting on the floor so I helped her out of her underwear and onto the bed. I examined her and she was 5cm already  – and definitely progressing quickly.

Within a 20 minutes she was starting to push involuntarily so I examined her again and she had advanced to fully dilated – in 20 minutes!!!

She started pushing and following her instincts and less than 40 minutes later, her baby was born. I passed the baby up onto her chest, and tried to help her get her head around the very quick labour – it was still only 2 hours from her first call to me when she was only feeling mild, irregular, pretty much painless cramps, and now her baby was here!

She was definitely shocked, but really pleased too. I got her and her partner a cup of tea and a stack of toast, and helped her to start breastfeeding. Then I did all my paperwork and before I knew it, a fresh day midwife was walking through the door and taking over care!

It was another busy busy week, and I definitely learnt a lot – and had baby catch number 26 too!

Image by Megan Menegay

To read my last Midwife Mondays post, click here:

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