Saturday, December 4, 2010

a day in the life #2....

So, if you were able to read the previous post, I said that I would be writing about two different shifts. For both of these shifts, I was basically at the center for 24 hours. However, they were both very different in how they played out.

Phone call at midwife sister has been at the center for a couple few hours and caught one baby, another Mama will be having her baby soon. Additionally, another one of my midwife sisters is ill and, if possible, I need to cover her clinic schedule. Oh, and we had a Mama whose water broke the afternoon before and I'll need to check in with her and hopefully be with her in labor...sounds like a busy day....

While I was on my way in, my phone rang and it was the midwife who had called me earlier. Apparently, she had 'pocket dialed' me and I was able to hear her and a Mama in what sounded like the bathroom, having a baby! I listened for a little bit and then hung up the phone. A while later, the midwife called me back and we laughed about it. We decided that I should stop at Starbucks...since I had time now...and get some treats. With the type day of I had ahead of me, a little morning treat seemed in order.

When I arrived at the center, there were two lovely Mama's and their two new little boys all snuggled up and warm. I checked in with both of them and the nurse who was helping to care for them. Then, I went over to the clinic to prepare the charts of the clients that I would need to try and see for our sick colleague. It was a full day, with a lot of clients who all needed some sort of lab work...gearing up for a busy day.

At 8 o'clock, I got a call from Sue, the Mama whose water had broken the afternoon before. She was doing well, having some contractions but not really in active labor. We had given her some instructions for trying to get her labor started which she had tried. Our policy at the center, is that if a woman's water breaks, and the fluid is clear, she needs to be in active labor within 24 hours. Sue's time would be up at 2pm. Since it was now 8am and not much was happening, I decided that she needed to come in. We decided that she would arrive at around 9:30. I would not be able to cover the clinic day.....I saw the first three clients and then we had some serious shuffling to do. Which, thankfully, because we have amazing staff, we were able to do.

Sue and her husband arrived right at 9:30. She was having contractions but they were pretty short and pretty far apart. Her little one sounded great, the fluid was clear and her vital signs were perfect....we just needed some labor! I checked her cervix and it was only opened a slight little bit. We did a lot of talking about the chances of her being in active labor by 2pm and the probability of needing to go to the hospital. Clearly, this was not a fun conversation and we all had frustration and disappointment to work through. We decided that we would still try some tricks and hope for the best. We did some herbal tinctures, some walking, and used the breast pump. We were able to get some more contractions going, but they weren't enough to change her cervix. Finally, we made the tough decision to head over to the hospital. Luckily, I was able to call the midwifery group who works there an they were able to accept her.

Sue and her husband decided to use one of our on-call doula's to come over to the hospital to help support them. While I was there with them waiting for the doula to arrive. I got a call from the center to let me know that another Mama had been sent over from the clinic! She had come in for her 40 week appointment and been found to have extremely high blood pressure and was transferred to a physician. I spent several hours at the hospital going between the two families, answering questions and offering support.

Eventually, I made it back to the center. (Both of the hospital mama's had been settled in.) I very quickly ate some food, as my last food had been that long ago Starbucks treat! Then I went over to the clinic to help with the end of the day. Very glamorous stuff like taking out trash, doing laundry and cleaning speculum's. I started getting phone calls from two other Mama's, both having their first babes. They would be coming in sometime, but not quite yet. I decided to try and leave the center for a bit. A friend of mine was having a "journal club", which means a bunch of nurses getting together and reviewing an article from a medical journal. I really wanted to go and visit with friends I haven't seen in I went for it. It was a nice break and I was able to stay for a little while before heading back to the center.....

Kelly, was one of the first time Mama's who had been in early labor and talking with me over the phone. It was time for her to come in. She arrived with her husband and doula around 9pm. She was doing good, her baby sounded great...but her blood pressure was a touch high. Low enough to stay at the center, but high enough for me to need to monitor it closely. Her cervix was 5cm and we all got ready to work this baby out. Kelly worked very hard, spent time in the pool, in the bed and walking the hall. A few hours later she was 7cm, but her blood pressure had gone up just a touch more. I decided that we would need to re-check her blood pressure in 2 hours. Over those 2 hours, Kelly worked hard, she had some difficult stretches but we were able to talk her through them. Unfortunately, when we re-checked her blood pressure the third time it was very high and it warranted a transfer to the hospital. Now we had 3 Mama's over there! Argh!

Just before Kelly had to go to the hospital, the other first time Mama I had been talking with had come in! Nicole came in did not appear to be in labor, she was so calm. Initially, I felt bad for having them come in when it looked like they would need to go back home. However, as birth is so humbling, I was proven very wrong. Nicole was 7cm dilated! After I checked her cervix she literally, rolled over on to her side, in bed, pulled the covers up and went to sleep! About an hour later, she opened her eyes and asked if she could get in the pool. I said "yes" and asked if she was still having contractions, to which she replied "sure". She stepped into the pool, rested her head on her arms on the pool side and.....feel asleep! Again, some time later she opened her eyes and said she needed to go to the bathroom and that she was hot in the pool and wanted to lay down again. Sure thing! Once again, curled up on her side, appearing to be asleep....Nicole started grunting every couple minutes. I asked her if I could check her cervix and she was 9cm! I asked her to wait just a bit to really start pushing and she said "ok" and went back to sleep. Then, 15 minutes later, she opened her eyes and said, "I really want to start pushing and do you have a birth stool?" Wow! We set up the birth stool and 14 minutes later Nicole had a pink little baby boy in her arms! Amazing, amazing!......

Then it was 6am and time for me to go home. What a strange, hectic, wonderful shift! Of the many things that pregnancy and labor teaches me, one is to never, ever take anything for granted or to make assumptions. It seems that the more I learn...the less I know....

P.S. The 3 Mama's at the hospital all had vaginal births and healthy babes....


  1. Just found your blog! I'm in my first year (first term, actually) of nurse midwifery school, and am enjoying reading about whats waiting for me when I graduate....
    Thanks for sharing!

  2. 'in the making'....thanks for reading my rants and I wish you luck and perseverence on your journey!

  3. For women presenting with high BP at the bc -- are they still hypertensive after relaxing in the tub for awhile? And of course, be sure it's an appropriately sized BP cuff. I'll also try Cal-mag q hour. But yes, sometimes you just gotta go, and it can be so hard!

  4. It depends on what the BP is...if it is borderline, then yea we'll try the pool. In this case, she had spent a couple hours in the pool and the last BP, the one that finally made the call necesary, was 158/100!