For everyone: Presenting Ella :)
Came in this morning and looked at the board. Two likely candidates, one 80%/8/-1 and the other 90%/7-8/-1.
(For those of you playing Medical School: The Home Game, the numbers are: Cervical effacement [how thinned-out the cervix is, a judgment call if ever I saw one] ranging from "long" to "complete" and anything in between/Cervical dilation [in centimetres; 10 is complete. 4 marks the beginning of active labour]/station [how close the baby's head is to the perineum; 0 is at the ischial spines, -3 is waaaay up in there, +3 is practically out])
Kept up on them. 7-8 was stalled at 7-8, nothing doing. Watching and waiting. Watching and waiting. 8 was comfortable and pleasant. Was told "we'll probably wait a few hours and see if the pitocin works." Went to study for an hour or so. Came back, and 7-8 was marked "DEL" on the board. Apparently, the baby fell out onto the bed, again. Dangit.
Went to check on 8, because hell, now I only had one patient. Was talking to her and looking at her fetal strip when Dr. G came in. He checked her. "Do you want to try pushing?" For once, O Best Beloved, I was in the right place at the right time.
She pushed. Baby descended. She pushed. Baby descended. She pushed. Dr. G looked at me. Why don't you go get your gown on? Yes, sir. Gowned and gloved, took up a point station as the baby's head was peaking. He put my hand on its head (we didn't know, boy or girl), and talked me through it. "Keep it slow..." One hand on the top of the head, so I can see. The other hand behind the rectum, with a gauze square, under the baby's chin. Guide it out...slowly...slowly...now thumb on the perineum, support it so it doesn't tear...slowly...can you see the head coming? Move your hand so you can see...slowly...
And then it was there, with an almost-audible pop as the forehead slid out, but I was controlling it and nothing tore. And more pressure and support to get her nose out, then her jaw, and then I was taking the suction bulb and cleaning out her mouth and nose. "Check for a cord around the neck." No cord. If there is one, you pop it over the baby's head and get it off. And it was back to guiding. I check for the top shoulder, out below the pelvic bone already, then pull practically straight up, on the baby's head while getting my hand in position to support the neck. Shoulder on the bottom out, shoulder on the top out, baby comes sliding out. I caught, he clamped, Dad cut, we handed her off. A girl, 6#8oz, Apgar scores 8 and 9. Her name is Ella.
Got cord blood and delivered the placenta, too, which is a lot of slow traction and tugging as it comes loose, letting Mom expel it naturally. And then did the check for lacerations. All clear. She had a tiny little rug burn up by her urethra, no other tears, no stitches, nothing. Beautiful.
And I did it myself, O Best Beloved...all by myself.
More about the babies who fall out on the bed in a bit; I have to go back and check on the board. There's a woman who's on her fourth baby who may be a very fast delivery (and a perfect one for me).