My first night of call off of orientation was Monday. Thankfully, it was a quiet night. (The Saturday before had been an almost perfect dry run. I was still on orientation but the midwife I was on with went to bed at 10 and didn’t wake up until I paged her at 7:15 the next morning. Though I felt terribly alone and though every time I sat down to close my eyes I was kept awake by anxiety that something would go wrong, I made it through. The MD and the other CNM had no idea that I had triaged, admitted and delivered the baby of a G2P1 at 2:45am. She arrived at 4 cm after having regular ctx for at least 3 hours at home, got her epidural finally (it only took two hours), and was tucked in for some rest. I spoke with the pt’s 2 friends during the placement. One friend was very annoyed that the baby would probably not be born until November 30th since they had arrived just after 11pm on the 29th. Why do you care so much? I asked. Well, she explained, “My ex husband’s birthday is November 30th and my boyfriend’s ex wife’s birthday is November 30th so…it’s just a bad day.”
I told them all to try to get some sleep, to turn out the lights and not to talk. But an hour later I was called to the room by the nurse for what she called “dipsy doodles”.
(“You should have told her that ‘dipsy doodles’ are not in the NICHD criteria” said a friend of mine. But I’m gonna choose to live with a dipsy doodle strip until I am certain of the nurses’ respect)
I will say though that when I saw these so-called dipsy doodles I was not impressed at all. There were three variable decels to the 100s. Three.
“These dipsy doodles just started so we figured either something’s wrong or she’s fully”. Said the nurse.
Right, I thought. First of all, what would be wrong with 3 dipsy doodles in 15 minutes? And secondly, she was 4 like 2 hours ago. But whatever. I checked her.
And I stood corrected. Fully and +3. She pushed her baby out in 2 contractions. I considered attempting to deliver in the caul since her water hadn’t broken yet but the nurse stuck her head between my patient’s legs when she saw membranes bulging out of the introitus, squinted her eyes and systematically handed me an amnihook. It would have probably gotten in my mouth anyway.)
So Monday, I was certain to get slammed. But I prayed to whatever god you want to believe in and they came through for me. I had two triage situations at the beginning of the night: one woman with decreased FM who had never heard of kick counts and who felt the baby move before, during and after a reactive NST and then a call from a term pt who was c/o flu like sx, afebrile, vomited x2, +FM, no bleeding…turned out when her husband came home he reported having the same sx all day. And the relatives they were both with all weekend for the holiday had been puking too. I told her to push fluids, brat diet, call back if she spiked a temp. And then, I babysat a cervadil pt all night long. She was a P0 being induced of course. For repeated episodes of decreased FM, a BPP of 6/10 and an AFI of 6. Now, none of these things on their own would necessarily be a good enough reason to induce but together they seemed to be enough evidence of…the clinician feeling uncomfortable? In any case, the pt was feeling the baby move the entire time she was in the hospital and her strip looked great from the moment she walked in the door. Her cervix was so closed I would actually call it sealed. The cervadil went in at 8:45pm and every time I came to the floor to write a note on her, I was sure to give the nurses some face time. I watched them look at each other’s pages on facebook and listened as they talked about their boyfriends’ bad habits. The rest of the time I let myself lie in bed and sleep. It was so quiet the rest of the night that I woke up with a start at least two or three times convinced the beeper was broken. I’d grab it, press the button that lights up the screen to see if the battery had died and even though a little skepticism remained I thought…I’m just not going to investigate. If they need me, they’ll find me.
I pulled the cervadil at 7am because the pt was contracting every minute and writhing around in a tremendous amount of pain with each one. Her exam was unchanged. I mean like a bishop’s score of 1, with 1 as a handicap because I felt bad for her. Like, sealed so tight that my fingertip barely, barely got in the external os. At that point though, the next midwife was coming on. If the tables had been turned and I was coming onto the floor with the same situation, I thought to myself, I’m actually not sure exactly what I would do. I asked the doc on call with me. Well, she said, you could just let her contract on her own, or you could start pit. Really? Start pit? Isn’t that just asking for a bad outcome? I thought.
The midwife coming on wanted to send her home. And the doc coming on agreed.
I checked her chart today. Turns out the patient was sent to c-section for FTP after 2cm and a maternal temp of 202 at midnight. It also looks like though her epidural was adequate enough to control the pain on her skin during the section, it was not enough to cover the pain of the surgery on her insides and she had to receive IV sedation for the 2nd half of her surgery. She is 21. It was her first baby. And I just can’t help but wonder if the outcome of her labor could have looked different…
I’m back on Friday. I keep praying to all the same gods I prayed to before but I sort of have this feeling that I am due for a busy shift. And the anxiety will begin…now.
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