As I write, she has started to doze. Maybe we'll have 15 minutes together?
So, back in the birth room, things are hopping. Yesterday's day shift started prematurely for me. Shift starts at 6 am, but the wee one woke me up around 3:30 am wanting to eat while I wanted to sleep. So I got up, fed her, changed her and she decided not to go back to sleep but rather flail her arms and legs around in glee. What to do? I got up, got dressed for work, pumped the boobs and headed to the clinic...an hour early.
They didn't seem to mind my presence...I just started working and when endorsements came along, I was given a labor. Teresa had only been at Mercy for an hour or so. She was in active labor, but this was her first pregnancy, so I was banking on it being a long shift. At 5 cm, she was clearly tired and in quite a bit of pain. Her precious mother was right beside her and was so fantastic catering to her every need and whim. She had already thrown up twice, so I was monitoring her hydration status very closely. She wanted to sleep....
I checked her every 20-30 minutes. Everything was normal and healthy. Her pulse was borderline, but her baseline was high, so it was nothing to worry about. She progressed quickly and was BEGGING to push around 7:45 am. She looked quite ready to go....Thankfully I had just pumped so I knew my boobs wouldn't explode mid-delivery...seriously, I have nightmares about that occurring in the birth room!
As Teresa began to push, her amniotic sac burst spewing thick meconium stained fluid everywhere. Not a good sign. But heart tones were still good, so we continued knowing that we would need to deep suction with the suction catheter as soon as the baby arrived.
She pushed for 45 minutes....the baby's head came down slowly and with each contraction, it would come and then retract back deep inside after a contraction. This is fairly normal, but Jenn, my assist, noticed that the heart tones were beginning to drop. I noticed that this paralleled the visibility of the head with heart tones returning to normal levels upon retraction. Not a good sign. The baby wasn't getting enough oxygen. I stimulated the baby's head in order to make her take deeper breaths and Teresa continued to push...now more urgently.
The baby's head was coming, but it was a slow process and her perineum was just too tight...the baby's heart tones continued to drop, so we became a bit more encouraging to Teresa to push with all her might to get her baby out. She was doing so great.
The baby's head began to crown, with my supervisor and Jenn close by, the baby's head came out, white as a ghost stained with meconium and a very tight umbilical cord wrapped around her neck...no wonder she was having trouble breathing! Teresa gave a good strong push and we got the baby unravelled from the noose of the umbilical cord and Jenn proceeded to deep suction while I tended to Teresa's excessive bleeding. She was beginning to hemorrhage.
We needed to transport the baby, as this tiny new baby girl was just not breathing too well. She cried a shrill, weak cry and was so limp. Jes, my fellow midwife prepared to transport the baby while my supervisor, Ate Susan, Jenn, and me began to handle Teresa's bleeding. IV inserted, fundal massage followed by placenta out, more blood, and trailing membranes. Portions of the amniotic sac were still stuck inside. This can add to the bleeding. After my supervisor went inside her uterus to get any placental fragments out, it was decided that we needed to transport her, too. Manual exploration of the uterus is extremely painful and without anesthesia, it can be almost impossible for the patient to endure it. Besides the retained placenta portions, Teresa was sporting a 3rd degree tear. We quickly transported her praying that she would not endure much more pain and that she would heal properly.
The rest of the shift was filled with baby checks and newborn screenings.
After my shift, I headed to DMC to check on Teresa...She was quietly resting in the crowded postpartum area. She had a slight fever, but looked well. She had been poked and prodded, but she was sutured and on the mend. She named her baby girl Krizte at the request of her father. I was able to pass on some beautiful baby clothes many of you gave me at which Teresa got teary-eyed and excited. She had only seen her baby once, but was determined to get to the third floor to breastfeed her as soon as she was mobile. What a trooper! She said that Krizte was breathing better but would have to be on antibiotics for some time due to aspirating the meconium. We prayed for a safe and complete recovery and she promised to text me when she got out of the hospital.
I came home feeling so grateful for my healthy Promise and my intact perineum and uterus...sorry to be so frank, but for those of you that understand this junk, I know you are thinking the same thing!
Sooo, that was my third birth shift back....nothing like severe complications to get you back into the swing of things! I was so grateful for my supervisor, Jenn, and Jes...they ran around like chickens to ensure the safety of my patient and her baby. Well, back to the homework....
Thanks for your prayers and encouragements!
PS. I've no pictures as Tim took the camera far, far away. Next post, I promise. :)