My day started off with the pleasant surprise of hearing "we no longer bulb suction babies." It was music to my ears. It has been a real struggle for me to remember to bulb suction babies on the perineum or after delivery, especially when they are already crying.When I arrived on L&D this morning, there was a multip near fully. I and the midwife introduced ourselves and informed her that were going to take care of her because her doctor was in the middle of a c/section. She was happy with that, as she was a VBAC and thought she had a better chance with us. (Even though she was already almost fully, there was still possibility for a c-section because we were worried about shoulder dystocia- her last baby was 8lbs 2oz and born by c/s after she couldn't push it past zero station... I don't know if they tried a vacuum or not... but the point is my EFW was 9lbs for this baby, and the mom agreed that it felt bigger than her last baby... so, in short, we weren't out of the woods yet.) Her doctor popped in after finishing the c/s and stayed to help with the delivery. This was my first time catching a baby with a doc instead of a midwife. Mom and doc joked about how the doc said she wasn't going to get to VBAC, but the patient had insisted all along that she would wait till very close to delivery to come in and that YES, she would be having a VBAC and yes she would be able to push out this baby. She arrived at the hospital at 8cm. :o) She said she was not getting an epidural because she wanted to be able to "push right." I love determined women!
Eventually she gave birth to a 8 pound 12oz baby over an intact perineum, without any sign of a shoulder dystocia. This particular doc did a lot of perineal massage and puckering, which was hard for me to be get into, but it went smoothly. The patient and doc joked some more about mom getting her way, baby latched on soon thereafter, and I cleaned up mom and headed to my other mama.
My other mama also had a "big" baby, and this time the baby did get a little stuck. We ended up having to do McRoberts and suprapubic pressure... but didn't call it a shoulder dystocia. That happens quite a bit it seems... midwives hesitant to call SD... instead saying snug shoulders or mild shoulder, etc. Lately it seems like often women have been completely quitting their pushing efforts after they deliver the baby's head... I have been told to put gentle downward traction on baby's head by the midwife, only for her to try it herself and see that the baby isn't coming- even in the cases where it isn't a shoulder dystocia, the body isn't coming because the mama has quit pushing! We end up practically pulling these babies out. This baby was also over 8 pounds.
My last patient was a woman was a nearly AMA primip I admitted but would not be delivering for a while. She was just getting into active labor when I left: 5-6cm/80%/0 station. She had a questionable pelvic shape, so everyone began watching her closely, I look forward to seeing how it goes for her.
I then had 2 postpartum patients to round on. Both were well and breast-feeding successfully. :o)
I've caught a lot of babies since integration started. I usually average 2 per shift. When I think of the suggested number of catches for competency, I am so shocked that I've surpassed them. There are people who graduate with the number of babies I've caught... how scary!
Today the midwife told me that the goal for my last week before spring break is for her to stop gowning and gloving up. She expects to sit back and watch me do the deliveries... by myself... "postpartum hemorrhage, shoulder, whatever."