The Beauty of Birth

I am coming to the end of my OB experience and I must say it has touched me in a way I never thought it would.  I was able to witness two births this week during my labor and delivery rotation and it was indescribable, but I'll do my best to try.  It started at 8 am when this lovely couple came in for an induction for their second child.  We got them settled and acquainted to the room.  Mom was really nervous about labor and delivery because she vividly recalled her first delivery where she was in stage 2 labor (10 cm dilated and 100% effaced to delivery of baby) for three hours which ended in a forceps vaginal delivery with lesions to the perineum and the epidural wearing off.  She came in and we started her on a slow pitocin drip.  She had been 3 cm dilated for 3 weeks now and after a few hours on pitocin she had only dilated another cm but contractions where now 3 minutes apart.  The doctor was notified and because he was busy with another surgery he said decrease the pitocin because he didn't want her delivering until 4 or 5 that night.  It was a little disheartening to turn things down when the couple a) had a horrible first labor experience and wanted to get it over with asap and b) had told their little preschooler that she could come see her sister after school.  These are the things we never tell the patients, we just make the best of situation and see where things go.  I told her that the pitocin jump started the process, but we wanted to see what her body would do and hopefully their daughter will have a sister by the time she got out of school.  She had a hunch we were working on the doctors schedule and when she mentioned it, I just kinda smiled at her.  Since we were slowing things down and she was still only 4 cm dilated I went to lunch.  No kidding, 30 minutes later, my instructor was rushing into the cafeteria saying your patient is about to give birth.  I rushed up stairs and when I got into the room, the babies head was already out.  It literally took 3 more pushes and she was out.  Total time in stage 2 labor.... 15 minutes!  Her doctor wasn't going to make it in time so they had to use the "doc in a box" or better known as the on-call doctor.  After getting APGAR scores and vitals we wrapped the baby up and handed her over.  The couple was still teetering on two names and asked me, of all people, what I thought she should be named.  I had to plead the fifth.  That is no decision for a student nurse to make.

After that my clinical partner's patient had a sudden decrease in fetal HR. She went from 120 to 60 bpm for six minutes.  Everyone was rushing into the room, the pediatric recover team was called for resuscitation and the NICU was notified that they'd be getting a new patient.  There was an army in the room already so I just stood at the nurses station staring at the monitor hoping either that the HR would increase or the baby would deliver so they could start reviving him.

FHR Monitor Strip

(Teachable Moment: a fetal heart rate monitor will tell you the baby's heart rate (the top graph on the monitor strip) and when the mother is having a contraction (the bottom graph on the monitor strip), but it doesn't show the intensity of the contraction.  You need to feel the mothers stomach during a contraction to know how strong it is.  If it feels similar to what it feels like when you press on the cartilage at the tip of your nose it's weak, like your chin it's medium and like your forehead it's considered a strong contraction.)  Now back to the story.... The baby came out floppy and not making any sounds, but everyone was there to start interventions and within five minutes of delivery things were looking promising.  Still the baby was brought to the NICU for close watch.

Later that day I saw a c-section.  The baby had a heart condition where the doctors felt he wouldn't handle the stress of a vaginal delivery.  Rather than taking the chances they scheduled a cesarean section.  I was able to talk to mom in the OR as everyone else set up and did counts.  She looked petrified, so I thought small chat would mask some of those emotions.  Now one might think a c-section is the easy way out.  You cut, you pull out the baby and voila!  Oh no.  You cut a little bit and then you pull and tear and stretch the abdominal muscles.  Pulling allows for a quicker recovery than cutting.  Then after getting through the  fat and muscle and fascia they finally reach the uterine muscle.  With one little slice from the scalpel fluid comes gushing out.  The residents forearm literally disappeared into the incision and fished around for a while.  Then a leg came out.  It was just one leg out for a while and they tugged and pulled on that leg a lot.  I thought babies just slipped out with c-sections, but I was wrong.  It reminded me of the dairy farm video Aunt Gam has where the calf was stuck in the cow.  After a couple more twists and tugs, the baby was out.  It was a crazy day, but Im glad to have this experience with me forever. However, I still can mark this off my list... OB nursing is a no go!