Precip

I can’t believe it, but, last night was my very first precipitous delivery. I mean, I had had very fast labors before but, nothing like this. And once again, I was taught that nothing is what it seems, one birth is nothing like the next. One woman’s symptoms do not necessarily mean the same thing as another’s. I got a call just after 8 from a 39 wk G2P1011 who SROMed to clear fluid at 8pm. No contractions yet. GBS neg. Great. Stay home, touch base with me if anything changes. An hour later I get another call from her saying that her ctx have started but they are irregular, every 10 to 20 minutes, she is walking and talking through them…I am already getting annoyed. It’s close to 10pm, I have no one else in labor, I’m wanting to lie down for at least a little while but have a feeling I’m going to be hearing from this woman all night. I tell her that everything she is reporting are great signs of labor. She should still stay home. “You know I’ve had another baby, right?” she asks. “I just want to make sure you know that.” I knew. She had a 3 day induction after a PPROM at 34 weeks. She didn’t know spontaneous labor. Stay home, I told her again.

The doc bid me farewell for the night, asks if I have anyone on the horizon, I tell him about this patient and we both chuckle and how silly people are for calling us so early in their labors. An hour and a half later the patient calls me back. I had just put my head down in the call room and was, again, annoyed that I was going to have to hear about every single shift in her labor. I could just imagine every call I would get from her…now they’re every 10-12 minutes! Now they are every, like, 8-10 minutes, but they have only been that close for like…20 minutes. I have bloody show! I’m still leaking!! Already I feel like this patient doesn’t trust her body, is too scared, too depended on medical care…

The ctx were coming more frequently now, she thinks every 2 or 3 minutes but has not been timing them, and she is very uncomfortable. I was still not impressed.

“Are you saying you would like to come in and be evaluated?” I asked her.

“yes.” She said.

“okay, well, take your time. Gather your things and really take your time. Also, I just like to manage expectations here.” I tell her. “If you come in and you’re still a centimeter or two…I’m not necessarily going to admit you. I won’t send you home but, you might not get a room right away.”

She seemed extremely disappointed with this bit of information. I’m sure I seemed nasty but when the majority of the patients you see get admitted way too soon, yes, it’s easy to get a chip on your shoulder about making sure a woman is in good active labor before they get to stay.

20 minutes later, I’m lying in a dark call room with my eyes closed and I get a page:

New pt here, pushing, please come immediately.

There was no name on the page. I thought, there is no way this is the patient I had just spoken with. First of all, she was not this active, second, she could have never even made it here in that kind of time! It must be another unannounced patient. Or worse, a patient that isn’t even mine. Even more reason to get annoyed.

I slide my feet into my shoes, put my hand on the door knob and get another page. It simply says: Delivery.

Hm. Well, now, I thought, it HAS to be another practitioner’s patient. I MUST be getting paged incorrectly.

I race upstairs and head to the room I got paged about. I have no idea if it’s my patient, if the baby delivered, if the placenta is delivered…

I walk in and it all becomes clear. It is my patient. She is yelling and crying and thrashing and her husband has his forehead pressed to hers saying that she is going to be ok and the nurse, with one glove on has her hand cupped over the woman’s vagina telling her not to push. I grab some gloves, throw them on, grab my gown and while I am struggling with the sleeves see the head of the baby emerge. I throw the gown down and vaguely remember hearing one of the nurses say something like, “so much for the gown”. The room was way more out of control than it needed to me. My favorite. Somehow, I got the patient to just listen to my voice and told her to slowly push little by little.

“But I wanted the epidural!” she cried.

“No honey.” I said. “There is no time for that. You’re going to have your baby in seconds.”

And about 10 seconds after that, she did. When the head came out she had a moment of clarity:

“Was that it??” She asked, suddenly alert. “Was that my baby?”

“Almost,” I said. She pushed once more and her baby boy was born.

Dad flipped out he was so so happy. I mean flipped and jumped and cried and kissed and told his wide she was a super woman. That she could do anything. And then he told his newborn son that his mother was amazing and that he was so proud of her. The nurses thought he was out of control. I thought he was just being real and honest in a moment of total joy. It was nice.

When he finally calmed down, just 5 minutes after the birth he looked at his wife and said, “Let’s just go home.”

And I really thought he was totally totally right. They were at home for her entire three hour labor, pushed her baby out after being in the hospital for 5 minutes, had no lacerations and a healthy 7lb 7 oz baby. Why stay? I’d go home too.

But it was late and I think the patient herself was still in shock from having gone through such a fast labor. So they stayed.

And even though things went quickly and even though the paper work involved with having to admit someone to labor and delivery and post partum at the same time was frustrating…the whole thing was normal, natural, safe. No IV, no monitoring…no time. Granted, everyone can’t have such a fast and seamless labor but it’s nice to see that babies can be born without inductions, without chorio, without an epidural, without intervention.

“You were gonna make me go walking!” the patient said quoting what I had told her on the phone.

“I know.” I said. “Well, you proved me wrong. You were certainly ready to have this baby. I’m glad you came in.”