November 23rd, 2003

White Coat

Her name is Ella...

For my dear feathered: Babies I have seen delivered (mostly C-sections): Sterling, another Taylor, and Cantata.

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).
  • Current Mood
    ecstatic amazed
White Coat

Well, he didn't exactly fall out...

Went back. She'd gone from 5 cm dilated to 9 cm dilated. Went in and started coaching pushing. Dr. W looks at me. "Go ahead and get ready." Gowned and gloved. Baby's head came out a little harder this time, a little first-degree tear, nothing major. I caught him, suctioned him (not expertly, but I did), handed him off. I don't know what his name is, Mom hadn't decided.
Dr. W, wonder of wonders, let me suture the laceration. I suck at knot tying, O Best Beloved, suck something awful. So this afternoon I will be practising knot tying, I think. As it is a skill I intend to master eventually. Why am I never ready to when I'm supposed to tie?

Had Panera for lunch, very delicious French Onion Soup. It was cold by the time I got to it after the delivery, or at least only lukewarm. But it didn't matter. I have my requisite 3 childbirths; I will be able now to sit back and enjoy the rest of the potential babies to pop out. I can concentrate on doing it well instead of just praying nobody has to step in.

I think I will have Frank sign off on some of my stuff tonight, as he will be willing to do so once he has seen me deliver a baby or so. And I will deliver another baby, I know it.

As far as babies falling out, I was on the labor board on Thursday, and all was going well. I was helping a woman push, we waited a while for her to get feeling back after we upped the epidural, and then suddenly we realised she hadn't been cathed in a while. Drained 700 cc of urine from the bladder and suddenly - push, push, nykki-go-tell-them-we-need-Dr-C-now! I turned around, yelled "We need Dr. C" out the door, and turned back to the bed. There was the baby. Pow.
This was the same delivery in which I learned I had a cousin-in-law at the hospital. Labor Nurse Carrie is the wife of my second cousin Drew, who has a unique last name. It was most amusing.

Now the board is less full, I am less stressed, and Angel will be here shortly with a handful of paperwork and pills for me. Life is good, O Best Beloved, and Thursday is Thanksgiving.
  • Current Mood
    accomplished accomplished
White Coat

Pee when you have the chance...

Got paged. C-section on one of the two remaining labouring patients. Ran back. Dr. W. didn't want me to miss what might be the only thing to happen all night...

When we got out of the OR, there were two new patients here for induction (probably won't deliver before morning) and a new one in triage. Triage-lady's baby has gastroschisis. She's a terrible historian, doesn't know what's going on, and we have no records and no information on her, except that now she's having contractions.
And I had to pee before the C-section, but I haven't had a chance to until just now. It's a good thing you left when you did, Angel. It got crazy. Wonder what dinner will be, if anything...I wonder if the cafeteria closes soon.
H&P's to write up, and a baby with gastroschisis to hope is born before morning. I won't get to do it, but O, Best Beloved, I want to see.

Edit: O, did I forget to mention that the lady with quads was contracting? It's all working out to be nothing, though.
  • Current Mood
    nervous wound-up