Baby!

Just one this time. After two weeks of listening to everyone else in my group talk about the deliveries they've seen and how awesome a c-section is and all that cool stuff that I hadn't had the chance to see, I finally got assigned to a laboring mom.

First the history: This was her first baby and she had been in the hopsital for a very long time for a variety of reasons. Details withheld because of HIPAA, take it up with the government. She was supposed to be induced the following day, but her body decided induction didn't sound like much fun so it went into labor all by itself around 9am. When I showed up and got report she was at 3cm and had not received an pain medication. She had said that she did not want an epidural.

Shortly after I arrived, around 3pm, they did another internal check (that means the doc lubes up their fingers and sticks them in the patient's vagina to feel the cervix and the baby's head) and she was 4.5cm dilated, 90& effaced, and the baby was starting to descend into the pelvis. All good progress. Patient requested some pain meds, got an IV dose, felt much better. You could tell when the pain meds started to wear off again because the moaning got progressively louder and her grip got progressively tighter on the hand of whoever happened to be at the bedside when the contraction started.

The baby was in a posterior position, which means that its back was against the mom's back. Normally, the baby should be in an anterior position, facing mom's back, because that allows for the smallest part of the head to go through the pelvis first. When the baby is posterior, the labor pains tend to be concentrated in the lower back, all the way down to the tailbone. That's exactly what this mom was experiencing, and it didn't look like any fun. She did a really amazing job of concentrating on the breathing and rocking her hips and changing positions to try to keep the pain managable. We also tried a birthing ball, which I though looked great. It's just a regular exercise ball, but they put it in a chair-like frame, so there's a backrest. This mom didn't particularly like it , but I kinda want one for myself.

The nurse and I kept checking on her throughout the afternoon. At one point she and her husband kicked the rest of the family out of the room. Around 6pm they did another internal check and she'd progressed to 7cm dilated, 100% effaced. Fully dilated is 10cm. This was when my nurse told me that if I wanted to eat dinner I should do it now. So I did. Then came more monitoring and encouraging and checking vitals. Lots of encouragement for both the mom and the dad. She was still smiling between contractions, so that was a good sign.

Anoher internal check in a couple of hours showed her still at 7cm. The baby was starting to turn around to a more anterior position though, so something was happening. The mom was feeling more of the contraction toward the front and less in her tailbone. The contractions were also getting stronger and more frequent. Sometime around now the husband asked me if I was going to stay through the end. I told him I would if they were okay with that, and they both said, "Yes, please!" I was very happy to hear that they wanted me there. It was the first time for all of us.

Contractions continued, and the mom was obviously starting to get tired. The nurse mentioned that it was not too late to get an epidural, and discovered that the mom's reason for not wanting one was fear of a needle being put into her spine. But she was tired, and in a lot of pain, and said the anesthesiologist could come talk to her about it. So he did, and she decided that she wanted to go ahead with it. Now, having an epidural put in normally is not a whole lot of fun. Having an epidural put in when you're in labor with contractions every 3-4 minutes is downright miserable. We had her sitting on the edge of the bed propped up on both me and the nurse. The husband had to leave the room because he has a problem with needles. It took them four tries and nearly an hour to get the epidural in place and I think that was by far the worst hour of her entire labor.

When the placed the epidural the also gave her a spinal block for immediate relief. Unfortunately that also completely numbed her from the waist down. So we stuck her back into bed, covered her in warm blankets and left her alone to try to rest. She couldn't feel her contractions at all any more. They were happening, because we could see them with an external monitor, but she felt nothing.

More time passed, she was still numb, but the contractions were still going. Around 10pm, the doc did another internal check. This time she was fully dilated and there was already a head in the birth canal. We asked her if she felt like pushing and she said no, so we just left her alone. Contractions were still coming and we checked on her every 5 minutes or so. In about a half hour she said that she could feel some pressure, although no urge to push. So we had her push anyway. That nurses description of it was to, "Push like you're trying to poop out a watermelon." So she did, and it worked, even though she couldn't feel a thing.

After about 3 contractions worth of pushing I could see the baby's head. That's when we called for the docs to come in. They did, and set up all the stuff for delivery. I pulled out her foley, the docs got themselves ready, the husband was trying not to look, and the nurses were preparing the crib for the baby. It took less than a half hour of pushing for the head to come out and then one more push and the whole body followed. The baby was an adorable little girl (parents didn't know ahead of time), wrinkly and blue until she cried and magically turned bright pink. She was small, only about 5lbs, but she was a few weeks preterm, so it was to be expected.

As soon as she came out there was a flurry of activity. They cut the cord, handed the baby off to the NICU nurses, who did a quick assessment, Apgars, and got her warmed up. In the meantime the docs were massaging the mom's uterus to get the placenta out. It came out in about 5 minutes after the baby. The docs also saved the cord blood and the cord itself for research and the placenta looked a little funky so they saved it to be sent to pathology. It was about 15 minutes from the time of delivery until the mom actually got to see and hold her little girl. Then she got to hold her for only a few minutes before the baby got whisked off to the NICU. There wasn't anything wrong with her, she was just a little bit preterm so she had to go for observation for at least 6 hours. Mom couldn't go with her because she still couldn't move from the epidural.

There were many rounds of congratulations and hugs and then the docs left as quickly as they had arrived (I think they were in the room for less than an hour). I then helped get the mom more comfortable in bed and cleaned up. Both mom and dad thanked me again for staying, and I thanked them for letting me stay. It was quite an amazing experience. I got home about 2 hours later than usual from clinical, but it was well worth staying late.