Four more bundles of joy were born into my hands this week...a girl and three boys! In the process, I found out how great God's grace is and how He can keep a body marching on when it's wa-a-a-y past bedtime!
I got up at 7:45AM to prepare to go to work with two of my mentors in the office. I saw 4 clients with one midwife, 3 of whom I had attended when they gave birth about two weeks ago, and another whom I hope to attend in the coming weeks. Two of them even brought their babies with them; they're all growing and thriving! I saw several others with another of the midwives; one who had given birth 6 weeks ago, and others that will deliver months after I move on from here. After completing my paperwork, I went back to my room, where I took care of bills, exercised, and ate dinner.
While I was making my dinner, I missed a phone call from the midwife on call that night, so I paged her to find out what was happening. She said one of our patients who had planned to have a Cesarean on Thursday was coming in and said she was in labor. This patient had wanted to avoid a Cesarean this time, but on Tuesday had decided that she would go ahead and have surgery after all. However, when labor started and she was progressing, she decided to give it a good try and continue on with labor. I left my room about 10:30PM to collect that patient's history and physical exam.
In the meantime, another patient came in who had been scheduled for labor induction on Thursday, but unbeknownst to us, had arranged to come in the night before to begin the induction early. After the department found her orders and prenatal records, they began the labor induction about 11PM.
Then a couple of others came into the department, one of them due soon thinking she was in labor (but wasn't yet), and the other having lots of contractions, but who had only completed 27 weeks of her pregnancy. The one who wasn't yet in labor was treated and released; the other (early) one ultimately went home after we ran lots of tests, confirmed she didn't have an infection that might have started preterm labor, and stopped her contractions with medicine. The challenge was in thinking about the possible causation of her preterm labor long after my brain had decided it was time for bed when my mentor quizzed me.
However, the midwife on call and I had this continuous circuit between low-risk labor, high-risk labor, and triage all night long. (Our two laboring patients were both low-risk, but the one being induced was transferred from antepartum to the high-risk side when the other side of the unit filled up.) Thoroughly confused yet??? (Me too....sigh!)
I saw my mentor jog out of the low-risk side toward the high-risk side, and I knew I'd better go find out what was going on, because when people run in the hospital, it's never something to be ignored. The one who was being induced progressed rapidly, and she gave birth to a baby girl just before 2AM; the mom only needed 2 stitches. After we finished our paperwork for that birth, we moved on to the triage unit and discharged the two patients there.
After that, we were able to turn our attention to the remaining patient in labor. We had to keep a close eye on the baby's heartbeat, because he kept doing funny business. Finally, with oxygen and IV fluids, the baby decided he would behave himself, and a sweet little boy was born around 5:30AM. His parents and midwives have already decided that he looks like his brother. One of the neatest things ever was when his mom, right after birth, said three beautiful words -- "I did it"! She said then that she had decided to schedule the repeat Cesarean thinking she couldn't give birth any other way; it was evident from the way she worked with her labor that she really had not wanted to proceed with surgery, but she didn't see any other way. In some ways, I think that for her, avoiding a Cesarean provided a bit of emotional healing from her previous experience, and I was so happy that I could help her fulfill her heart's desire. She only had to have 3 stitches...this recovery period should be comparatively a breeze, and I told her so!
By the time the paperwork for that birth was done, my primary mentor arrived for our regular 10-hour day on the unit, and I had already been up 23 hours! On our regular day on the unit, we not only care for the midwifery patients; we care for the patients who have been seeing the residents and med students in the clinic. There was one that was almost ready to push about that time, so we went in to help her get ready. After a little more time, she began to push; even with an epidural, she pushed very nicely, but it still took a long time since she was a first-time mom. Ingredients for woozy feelings for a midwifery student...1) Sleepiness; 2) Dim lights; 3) Baby's heartbeat...oh so rhythmic; and 4) No food and very little water since the night before...yep, it's a set-up! I could feel myself getting dizzy and started weaving. Quietly, I looked up and prayed for God's help, because I couldn't leave. I decided to try something, and I closed my eyes between the contractions, and just that tiny bit of rest seemed to help just enough to get me through each of the remaining contractions. It was exactly what the mom-to-be was doing, and it worked perfectly for me too. A baby boy with lots of dark hair was born just after 10:30AM. (First-time mom...no stitches needed!)
I'm sure my primary mentor saw my closed eyes and knew what was going on, because after we came out of the room, she asked me if I needed to go to bed, and though I did, I learned that the mom isn't the only one who gets a burst of energy when the baby is born...so does the midwife! So I told her I was fine...just needed something to nibble on. It really wouldn't have taken me longer than about 5 minutes to get to the room where I was staying to get something to eat, but we had another mom in labor who had already had 2 children, and I know better than to trust them not to deliver quickly. So my mentor dug through her lunch bag and produced a cheese stick; I grabbed some saltines from the unit stock. It's amazing what a feast cheese, crackers, and water can be!
I actually figured this mom would deliver faster than she did, but this baby boy wasn't born until around 2PM. Again...another mom who needed no stitches! After she and her family spent some time with the baby, I went in to do a newborn exam on the baby, as I had done on 2 of the others. When I came out, my mentor wanted to know if I'd examined the baby yet, and when I told her I had, she said, "Go to bed"! It was 2 hours before I was expecting to be off that day, but she didn't have to tell me twice! I went back to my room, ate almost anything that didn't eat me first, and finally gave in to sleep a little after 5PM...33 1/2 hours after I had gotten up!
Except for one very brief awakening at 8:15 PM when I wondered if I had overslept (and missed rounds at 6:30AM) and it was actually 8:15AM, I slept until the alarm woke me at 5:45AM. I was dreaming I had missed rounds...OK, there's a theme here, so I dragged my body out of bed and joined my mentor (who had been up during the night catching yet another baby) to go and see our two midwifery moms who delivered during my long stretch. They both wanted to go home and we discharged them so they would be ready to go when the pediatrician discharged the babies. Moms and babies were doing well!
When I returned to my room this time, it was tempting to climb back into bed for another nap, but I stayed up, had breakfast, packed up, and drove back 2 hours to my friend's house in Broken Arrow. I'm still a little tired, but I'm almost back up to par. Thanks be to God for His grace and keeping power!
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