Have held legs on several vaginal deliveries. Have actually gowned and gloved myself on one, then stood around until the OB let me feel the episiotomy margins and cut sutures while she repaired it. Have seen a few C-sections, and been to clinic, mostly. OB clinic is where you walk in, introduce yourself, ask the big questions - "How are you? How's the baby? Feeling it move? Any contractions? Any discharge, leaking, or bleeding? Any concerns?" - check their dates, check their blood pressures, and then get down to measuring their tummies and listening to the baby. I am the baby heartbeat queen. Or at least I was until TC proved to me that I am nothing more than a rank amateur at baby heartbeats by finding a 10-weeker on a 5', 230-lb lady. This, O Best Beloved, is a hard thing to do. 10 weeks is about the earliest you can expect to find a heartbeat with the little Doppler, and on a large woman it's just outright difficult no matter how old the baby is. But TC (who's a Family Practise resident, and likes me lots) took about 30 seconds. I was so impressed...
Was complimented by staff on my work in the High-Risk clinic, including knowing when to ask a resident. Favourite patient: the Mexican woman who couldn't understand why her blood sugars were out of control. Explained that pregnancy is rough on diabetics, and was she following the diet? Yes, more or less. We got out of her her eating habits, which include a lot of tortillas. Complex carbohydrates are still carbohydrates, and will knock your blood sugar silly. She listened. Should I stop eating bread too? Smart woman. She's 39, and worried about her baby. I love it when people actually listen.
Contrast her to the white girl next door who cheerfully told the dietitian everything she was doing wrong. Her husband works at Papa Johns, brings home pizza. She has watermelon for dessert. And her sugars won't stay controlled. "I'm just a bad girl." Tee friggin' hee. It frustrates me to watch people mess with their babies' lives. Your kid has no freakin' choice at all about what he/she eats. Feed them right.
Otherwise, no deliveries as of yet. I almost had one yesterday, but the first vaginal delivery turned into a circus. First the cord prolapsed. That means the umbilical cord popped out beside the baby's head. You wil please note, O Best Beloved, that the umbilical cord is the only supply of oxygen to the baby's body. And that there really is hardly enough room for the baby's head to fit through the vagina, let alone the cord plus the head. The risk is that the cord will be compressed, cut off oxygen to the baby, and the baby will die. As the baby's heart rate suddenly dropped from a nice brisk 150 bpm to an ominous 70 bpm, we were afraid this was happening. So TC shoved her hand into the patient's vagina to hold the baby's head up off the cord, hopped on the bed, and they ran her down for an emergency C-section. Once things got there, they got the baby straightened out, got the cord back in, and decided to bring the mother back for a vaginal delivery instead. Of course, now she's heavily anaesthetized and doesn't want to push. So after 20 minutes of trying to coax her, we sent her back for an elective C-section. So much for that delivery.
The other one was a woman who was sort of in active labor by an hour before I left. It was going to be a long time. A very long time. So after spending the afternoon getting to know her and her doula and her husband, I turned her over to Brian, who was staying the night on call. Crazy. Told him I'd round on his two C-section patients this morning as he had Gyn patients to round on, and waved goodbye.
Went to Muncie to eat with Angel and get my book. Nearly convinced him to come home with me. Nearly. But he doesn't like the air mattress. I can't win. I wish I had a double bed here or something. I miss my Angel so much.
Today was Ethics Day. We first discussed the case of a baby born prematurely to parents who, when informed that their baby had a 30-50% chance of living to leave the hospital and a 25% of doing so without a major defect secondary to brain bleeding, requested the baby not be resuscitated. The baby was born by C-section Question 1: why do a C-section on such a baby? and appeared purple and limp. The PA NICU atttendant resuscitated the baby anyway. Why? We don't know. The neonatologist who had originally counselled the family came back to the hospital while the baby (now pink, no abnormalities noted at the time) was on a vent and began doing some tests. Dad arrived and was surprised to find his baby was being aggressively resuscitated. Shortly thereafter, the mother arrived from recovery. Parents requested time alone with their baby. It was granted. Dad (a dermatologist) disconnected the vent. Nobody came to reconnect it despite alarms. The baby expired.
Study questions on ethics for the audience:
Could you have left the baby without resuscitating it?
What if the baby had a 50% chance of being normal? Does that change your decision?
What if it was your baby being born, with a 50% survival chance and a 25% chance to be normal? Would you want it resuscitated?
Did the father have the ethical right to pull the baby's ventilator?
More discussion of my thoughts later, after I've seen what you all think. Comments in comments, by all means.
Came home after spending an hour eating lunch and talking with some other students. Be proud of me, O Best Beloved, I could have been a hermit and come home to roleplay with Angel, but I didn't. I stayed out and was social instead. Was still home around 14:30 and have done nothing but relax since. I need to read, as I have Ethics tomorrow morning as well, and that I'm supposed to be prepared for.
Tomorrow night I'll be on call, which means I'll be at the hospital from the time I go in tomorrow (around 6) to the time they let me go Friday (hopefully early). With any luck, I'll get to deliver a baby.
Speaking of delivering babies, I was going to tell you the "covered in blood" story, wasn't I? It's relatively simple; we nicked a uterine artery during a C-section. It bled about a millimetre or two wide, and all the way down to the foot of the bed, flew everywhere while they were trying to ligate it. I had blood all over everywhere, mask, face shield (yay for face shields!), gown...RC had it on her hat. After about four tries they got it ligated and the bleeding stopped. And mother and baby were fine. It was exciting, though.