Saturday, November 13, 2004

25 Hour Precipitous Delivery - Part 3

Once we were all assembled in the hospital, things lightened up. The un-laboring mom was glad the doc was there. The grandmother was thrilled we were there. Dad, calm as always, was fine we were there. I was very disappointed, but also very relieved we were there considering the issues at hand. I asked one of the other midwives to come and give report before leaving, so she did and I was grateful. The other midwife left before we left for the hospital.

Our nurse was fantastic. She was kind, respectful, cheerful and wanted my client to have all the things she wanted even as her plans totally shifted from a homebirth.

An anesthesiologist came in to start the IV and had to poke twice before getting it into her antecubital (inner elbow)... (we were vindicated!)... a horrid place since she couldn't bend her arm at all. I asked for an arm board, but they had to order it from the pharmacy. It still hasn't come in 2 weeks later. Mom did her best to not bend the arm, but worried most about nursing.

Once the doc came in, he did a vaginal exam and found her to be about 5-6 cm. Continuing to progress without contractions, he was glad she was there, too. He asked if the pit had been started yet and the nurse laughed and said she was still getting everything together. The client asked if she could have some cranberry juice... said that was the only reason she agreed to come into the hospital... and the kind nurse said she didn't think that would be allowed. The doc, sitting in the rocking chair across the room, said, "she can have as much as she wants!" and the nurse quickly brought one of those pitchers filled with cranberry juice and ice! I expected those little half cup thingies; she did good.

Mom asked if she could get the IV out right after the birth and the doc mentioned her history of bleeding and that perhaps they will leave it in for awhile. The nurse said to the doc that usually the IV is left in until the woman has voided (peed) twice. The doc laughed as he looked up at the nurse and said, "so, you void once and I'll void once and then we'll take it out!" We all laughed. I thought that was indicative of the kindness of this doc.

As we did introductions, the doc got around to me and said, "I remember you," as he shook my hand and I repeated my name. And I had hair 2 years ago!

So, the pit was started and every 20 minutes it was moved up a degree. We ordered food, ate food, including mom inbetween the contractions she was beginning to have about 2 hours into the pit upping.

At one point, I looked at mom and told her that we had spent so much time on the preparations for her birth, I hadn't totally explored how to support her physically/emotionally during contractions. We'd assumed she wouldn't have any and here she was, having them now. She said she would let me know how I could help when it got to that time.

Time passes and our lovely nurse has to go home. We begged for a nice nurse... PLEASE find us THE nurse that is your twin... and she said she would do what she could. Apparently, she couldn't do much. We got a brusque and disrespectful-of-contractions nurse who apparently forgot my client didn't have an epidural. She tried to move the monitor belts during contractions, talked when it was inappropriate, and was just too fast zipping around the room. We gave her about 10 minutes before I told my client that I wasn't so thrilled with her. She said she wasn't either and we strategized about asking for another nurse when the phone rang. I picked it up and it was the nurse who'd just gotten off shift. Puzzled, I listened as she kinda whispered that we might really consider asking for another nurse. I couldn't believe what I was hearing!! Never, in all these years, has a nurse EVER called to say that about the nurse that followed.

I went to the nurse's station and let the nurse sitting there know we wanted to see the charge nurse and re-entered the client's room to hear the grandmother, a charge nurse herself, having a mini-fit about our asking for a new nurse.

Instead of getting a new nurse, labor zoomed into high gear and the client began shaking and sweating... her typical THE BABY IS COMING NOW signs, so she told the nurse to get the doctor. The nurse buzzed the nurse's head on the bed and then reconsidered, saying she needed to do an exam before calling the doctor... that she needed to make sure mom was complete. I told her I was sure she was complete, but the nurse told me to examine her or she would and I wasn't about to knowing the baby was probably right there!

The fuzzy nurse voice over the intercom said, "May I help you?" in that muffled microphone way of hospital's and the nurse said, "never mind" at the exact same time the client SCREAMED: GET THE DOCTOR IN HERE NOW!!!!!! Within seconds, the room filled with nurses who wanted to see what was going on and the mom screamed again to get the doctor because the baby was coming. The nurses left and our nurse was tsk tsking the client and then the nurse looked right at me and said, "glove." I stood looking at her thinking, "she wants me to open her gloves? she wants a glove?" and then she yelled, "glove up!"

Oh my god! She was going to have me catch?!? I washed fast and then gloved and told dad to glove and I grabbed a washcloth because mom blew her bottom out last time and we were going to work to go nice and slow this time. She had another contraction and the head began showing and then the doc walked in.

As he gloved, I removed mine and moved to the side of the bed, near mom's head. She was stirrup'd, draped, and then the baby, coming out without a contraction, continued progressing outward. The stupid nurse was to my left and was exhorting this mom to PUSH, PUSH, HOLD YOUR BREATH! And I glanced at her and wondered what the hell she was looking at when she seemed to be looking at the client's vagina. I whispered in mom's ear, "slow, slow, you don't need to push, the baby is coming nice and slow... good, good... that is perfect..." blah blah blah. It was all overlaid with the family exclaiming how much of the baby was showing and mom not pushing as the baby slid out.

I'd missed a hospital catch by about 60 seconds.

Pitocin was pumped into her IV and an IM methergine was injected. There was no bleeding. Her placenta was born within a couple of moments, but still no bleeding. I was so relieved and firmly believe that having the IV in place with the meds kept her safe. There was no tear this time and mom was thrilled!

Despite the stupid IV placement, mom began nursing her 4th daughter and we talked and shared thoughts and after about 90 minutes, it was time for me to go. The rest of the family had already gone.

The next day, I talked to mom who told me the IV was still in. She'd hemorrhaged 4 hours after the birth!

I felt weak as I imagined that happening if she'd delivered at home. Even if we had had the IV in... even if we had kept her from bleeding initially... if she bled 4 hours postpartum, she would have been alone and had to be transported - alone. Our decision to transfer was the right one.

Mom, 2 weeks later, is doing well. There are sad moments of not having her so-hoped-for homebirth and we'll keep talking about it and working through it.

4 beautiful girls.

An alive mom whose bleeding was controlled with meds.

How blessed to live in these times.

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