Friday, July 5, 2013

Busy baby hour! Scope of the hospital...

Yesterday was a mellow morning and afternoon, I spent most of my time cleaning, stocking, helping the staff  and hearing about their lives, admitting a couple preterm SROM mommas, spending some time in the prenatal clinic, and labor sitting with a 43 week momma that had been having late decels for hours. Around evening time she started feeling like she needed to push, so we moved to the delivery room, baby was OP and she had a cervical lip that kept coming down, it took her awhile to get him to move (eventually he turned). We had her cycle through running start position and mcroberts, and kept a close eye on baby, who at some point had sustained very low heart rate...  well, eventually baby was born completely limp, no respiratory effort, and pale, skinny as heck with a large head (very obviously IUGR for 43 weeks). His cord was pulsing strong so he stayed attached to mommy for 10minutes, we ended up giving him some breaths on mom, and some oxygen breaths when cord stopped pulsing.  We gave him apgars of 1m- 3, 5m- 5, 10m- 6, 20m- 8. Eventually he came around and about an hour and half after birth he started nursing! Hooray!

Because they are a hospital, their scope of practice is much further than what I will practice back home, the experiences are educational, but still with some of these I would have transferred awhile prior.. Such as when she had an ultrasound and was found to be severely IUGR, or when she hit 43 weeks... long before birth, but even if it was during birth, the late decels would have clued me off to transfer.... We consulted with the Dr on staff so many times with her, and each time we were told to keep going. On the positive side of it, he got to stay on mom and get all his blood, and oxygen from mom while we did breaths on her chest, and only for a few minutes did he go to the warmer for oxygen and breaths and vitals assessment... that is the benefit of having midwives in hospital (and also some rare special OBs do this...but so few), baby is going to have a much better chance because neccesary resuscitation was done with cord attached.

Since they do ultrasounds so minimally here, and their ultrasounds are very, very basic, I'm not even sure they would have done anything different for baby, such as inducing when they realized he stopped growing... Ultimately it turned out ok this time, but that won't always happen....

Then, a little bit of time went by and bam! 4 babies in an hour!! We ran from one room to the other! Very, very fun! And each were quick, easy, normal deliveries, the babies cried right away, and the perineums were intact! I think Elias and I needed a run of healthy, easy births to restore our faith after the 2 prior (the cord prolapse and the 43 wk limp baby).

So off we go to another full and crazy day!!

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