Midwife Mondays 123: Last week on Labour Ward, NIPE Exam Results and my first episiotomy

Week 123 was my last ever week on the high-risk delivery unit before I’m a qualified midwife! How scary is that!

The next time I work on a high-risk delivery unit will be after October, when I’ve got my registration and I’m doing it myself – eek!

So, what did my week have in store? Yet another busy one and even more firsts!

My first shift started by taking over care of a woman who had just delivered. Her baby had been taken to NICU and she was feeling a little overwhelmed by everything. I sat with her and her partner and explained everything that had occurred (after reading her notes tenfold!) and then took her partner through to NICU to see their baby. While he was gone, I helped her hand express some colostrum to take through to NICU for the baby. Their little boy was doing really well and her partner came back to her half an hour later with photos of their little boy having his breakfast!

As this woman was relatively settled and didn’t need one-to-one care we were given another woman to care for. This woman had come over from the antenatal ward for induction of labour. Once she was settled in the room, I examined her and she was 6cm already! She wanted an epidural so we got an anaesthetist and soon she was completely pain free.

Her mum and partner stayed with her for every minute as the day went on and were so wonderfully supportive – so so lovely to see. In just a few hours she was 8cm and then a few hours after that she was fully dilated and it was time to start pushing.

Half an hour into pushing, her baby started to show signs of distress and we brought the doctors in. They assessed her and were happy with progress for the time being so said to carry on and they would watch the monitor at the desk. She carried on pushing for another half hour and was making really good progress, but as the baby was showing more severe signs of distress on the monitor the doctor came back in.

They needed the baby to be delivered so decided on an instrumental delivery – they decided on a forceps delivery and very shortly the baby girl was born and cuddled up with her mummy.

Before I knew it, by shift was over and I was heading home – they say shifts go much quicker when you’re busy and this one absolutely flew by!

My next shift we were handed over the care of a woman who was already pushing. We headed in and the doctors were in the room looking at the trace – the baby was distressed and they had decided to go for a forceps delivery. 20 minutes later, the baby was delivered up onto the mum’s chest and the doctor started suturing while I supported the woman with her new baby.

Shortly it became apparent that the suturing wasn’t going completely to plan. She was bleeding more than would be expected and the doctor sent me to get the emergency drugs. I called in another doctor to help and it started to escalate very quickly from there. Within minutes the Major Obstetric Haemorrhage call had been put out and there were teams of doctors in the room. I weighed the swabs, and the absorbent pads from the floor and the estimated blood loss was already at over 2 litres. We were just starting to prep to move her to theatre when the bleeding started to slow, and then stopped. Thank goodness.

I spent the next few hours sending off more bloods for urgent testing in the lab and supporting the woman and her partner. She was coping really well and thankfully, despite the blood loss, she didn’t need a blood transfusion. We transferred her to close observation for more advanced care and when I headed back just a couple of hours later she looked so much better and had the biggest grin on her face!

I spent the rest of my day caring for another woman in labour, she was having an induction of labour and so we placed the hormone tablet and then monitored the baby. She started contracting really quickly and by the end of my shift she was already at 7cm!

The next day I had a day off, thank goodness, and got a message on our uni class WhatsApp saying that the results for our NIPE exam were out! Eek! Literally never felt my stomach drop so quickly! I logged on to the results site and was absolutely buzzing to see that not only had I passed – I got a first for it! So so thrilled!!! All that work over Christmas and New Year was worth it – yay!!!

My final shift of the week, my final shift on the high-risk unit, we were handed over the care of a woman who was having a really long induction of labour. The poor woman had been going for days and making such minimal progress between each examination. She had an epidural in place and was on a hormone drip to try to boost her contractions but her cervix still wasn’t dilating enough. We took over and she had been 4cm dilated for most of the day, and the doctors had said that if she was still 4cm at her next examination then it might be an anatomical thing and they would take her for a c-section.

When it came to examination the whole room was so tense, but as soon as I started to examine I knew – she was fully dilated! Telling her and her partner was such an exciting moment – she was genuinely expecting a c-section and was almost resigned to the fact that her body wasn’t going to do what it needed to, so she was thrilled to find out that she was there!

She had an hour for descent and then started pushing. Soon the baby started showing signs of distress, so the doctors reviewed and after 40 minutes of pushing they decided that the baby needed to be delivered sooner rather than later. The doctor advised that she should have an episiotomy as the baby was quite low and it might be that an episiotomy would be all that would be needed to help the baby into the world. My mentor told me to get everything ready and then talked me through the whole thing – I felt so brilliantly supported – even though I knew all the theory, doing this in reality was scary and my mentor was so positive and helpful. I talked to the woman an explained what was happening – she consented to the episiotomy, I took a deep breath, and with her next contraction I did it – my first episiotomy!

As the baby didn’t come with the next contraction, the doctor placed a ventouse suction cup on the baby’s head and guided the head out. He then stepped back and let me take over – helping the little baby boy into the world.

It was a scary experience but I’m so glad I got to do it before I finish on this area – I most likely won’t get another opportunity while I’m a student and it was the one remaining skill that I had only carried out in theory. Episiotomy’s are not pleasant but they are sometimes necessary and having carried one out in such a supportive environment was really good.

Within a couple of hours another labourer had come in and we were assigned to look after her. She had started contracting only a couple of hours earlier but when I examined her she was already 8cm dilated. She was doing really really well and when I handed over care to the day staff, she was getting some urges to push, so may well have been approaching full dilatation.

Another good week, with exam results and another first – now, onto study time and dissertation work! eek!

To read my last Midwife Mondays post, click here:

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