Sunday, May 3, 2009

Delivery suite

This is going to be a relatively short post as I am pretty tired. Anyway, this Sunday I was rostered for a 12 hour shift at RHW delivery suite from 7pm-7am. I already anticipated beforehand that there will be a lot of waiting and there will be times when complete boredom takes over. The entire process of labour is a very slow but gradual process and it can take up to 20 hours for nulliparous women (women who have never given birth to a child)in just the latent phase of labour. And the fact that each birth is very unpredictable eg: a woman who appears to be commencing well initally may suddenly develop an arrest of fetal descent due to poor maternal pushing, fetopelvic disproprotion, abnormal fetal position etc. In Sydney, a midwife is assigned to every pregnant lady that is going into labour and the actual delivery is performed by the midwife and another person (eg: nurse, medical student) with the obstetrician only intervening when the labour is not progressing efficiently. Basically she is in charge to make sure that the whole labour process is going smoothly by doing regularly hourly checks on the mother and fetal monitoring, performing vaginal examinations to check that the mother is fully dilated and the fetal head is engaged and provide advice and support to the mother, husband and other family members once labour begins. She also assists in the actual delivery of the baby and the removal of the placenta as well as suturing up the vaginal and genital tract lacerations afterwards. The newborn baby will be assessed by her eg: the baby's weight, height, Apgar scores etc and she will educate the mother on the proper techniques of breastfeeding. It is her duty to contact the obstetrician registrar if she encounters any problem during the labour eg: sudden onset of fetal distress show on the cardiotocograph, maternal compromise or if a particular stage of labour is prolonged.

Tonight I witnessed one live birth and the seoond lady who was supposed to go for a spontaneous vaginal delivery finally ended up with a Ceaseran section as her cervix was not dilating. I was quite disappointed as I hoped that I could observe at minimum two deliveries but then again, it is all very unpredictable and you might not even get the chance to see a vaginal delivery if you are extremely unlucky. The first lady's labour went exceptionally well and progressed at a very fast pace considering the fact that she is a nulliparous woman. Her entire family was there (mum, dad, sis, husband) to provide her with encouragement and emotional support which I believed to have helped in speeding things up quickly. I oould see the tensed looks on the family members faces as they eagerly waited to see whether the baby's head will emerge as this signalled the completion of birth (it only takes one more contraction for the entire body to be delivered). And when finally the baby is born (it was a girl), I could see the overwhelmed and joyful expressions on their faces especially the mother who broke down in tears of happiness. I guess every birth is a miracle but not without the suffering, pain and turmoil. It does make me a bit frightened as I can't imagine myself going through the physical and mental exhaustion and torture of a normal delivery. I can expect that any woman's first delivery will be an unforgettable one which makes her child even more special. The first moment of bonding between mother, father and baby is a magical moment as it is the stepping stone in the long and tedious process of nurturing, caring and providing love and affection.

The second lady was not so simple and straightforward. Although her membranes ruptured at 3:30pm earlier today, she had a prolonged latent phase and poor progress in the active phase of labour i.e. a cervix dilation of 1cm/hr. She had a previous caeseran section before due to a breech baby so she has to be monitored more closely as she is predisposed to more maternal and fetal complications eg: postpartum haemorrhage and uterine rupture. She was practically moaning in pain everytime a contraction started and was urgently requesting that an epidural analgesia be administered. She was finally given one and was assessed 4 hours later to check whether she had made any progress. I was instructed by the midwife to take her vitals (blood pressure, pulse, temperature) and general observations every half hourly, plot my observed findings and results on the partogram (labour curve), write in the progress notes and assist the midwife when she examines the woman. It gets a bit monotonous and boring after awhile especially in this case scenario where the woman is hardly making any progress at all. Four hours later, the decision was made by te obstetrician registar to do an elective Caesearan section due to obstructed labour.

I luckily managed to finish my shift by 2am as the last lady had to go for a C-section (I am supposed to just observe and assist in vaginal deliveries) and there were no other women in the delivery suite going into labour until tomorrow afternoon. I still have two more delivery suite shifts so hopefully they'll be a bit more eventful than this one. Then again, I am much relieved to have ended earlier than expected as I don't think I would have survived until 7am in the morning. And thank goodness I don't have to go for clinic tomorrow, either. Now I can truly appreciate the amount of sacrifice interns, residents, registrars, nurses and midwives have to go through during their night shifts as it is very physically and psychologically draining.

No comments:

Post a Comment