Thursday at SSH
I had an unremarkable cesarean in the morning. The incharge asked if I felt well enough to go into theater and take on a cesarean by myself, -- as she said, she was concerned if she sent a pregnant midwife to do the case, and they felt dizzy or unwell, or needed to eat or drink; they'd be restricted.
The dizziness was a first trimester issue... which I resolved by working only in ICU where chairs are abundant and u can sneak a snack bag on ur computer. So I took the case.
The elective for previous
The first was an elective cesarian for previous, on a woman who is filipino Catholic but clearly married a muslim man whose name was Mohammed. I asked his name, and when he told me I said I can remember that nice and easy. I wonder what that household does with regards to things like Christmas and Eid. Just have both? Could be fun ... She had no GDM diagnosed in 1st and 2nd pregnancy but in the 3rd there it was. In 1st and 2nd she had LGA babies (well, not strict LGA but for her stature and for Filipino I think it could be classified as LGA: 4.1kg and 4.0 kg -and that being said anything above 4 is considered big (in Australia... but then you hear of women pushing out 5.0 kg babies supposedly just fine and you wonder.. back in the day, they seemed not to be labeled so harshly as LGA.. actually the old cutoff was 4.5kg but still that's 500g bigger than 4kg)and if you didn't have GDM diagnosed then clinicians are sneakily thinking you either had a borderline case or had it but it wasn't picked up.
So this lady had a cesarean for a diagnosed big baby.
And this one, was number 3. So after cesarean number 1, and then number 2, it would be rare for a 35 yr old to then go "I want a vaginal birth" -- plus, this one was thought to be possibly LGA too.
It came out as 3.6kg.
They wanted cord gasses (and I don't know why).
Maybe it was because they thought her diabetes was not well controlled. The HbA1c was a little high I suppose and she did argue with them about taking the metformin - wanting diet controlled instead (but ate custard and other things that were labeled as "dietary excursions"). Her notes sounded really depressing actually.
I thought there was a TOP or a D and C happening in OT prior to this case so I showed up ridiculously late. Usually, I'm supposed to meet the women and her partner prior to the surgery in the wait room, introduce myself, ask about their history face to face, palp their abdomen and do a fetal heart. Write an intro note...
I missed all that -- by the time I got there, they were putting in the spinal and well I can't very well just interrupt an elective cesarean section spinal and say "HOLD IT! MAYBE THE BABY IS DEAD...I NEED TO DO A FETAL HEART JUST TO CHECK" when essentially, in 30 mins, the baby will be out....
Ah well. I figured, if she didn't feel movements she would have said so by now.
I blame baby brain for stuffing up 2x cord gasses by running them as arterial and venous gasses rather than cord arterial and cord venous(yes they're different) -- before all of a sudden on the 3rd test realising my mistake and having to spend time fixing those. Nothing should come of them as the results weren't abnormal but I hate making a mistake like that. Imagine you run a test, but you run it wrong, and say, one number is high - say the lactate is 10 instead of 6. Then based on that one number either the baby has to have more testing (painful heel prick and crying and blood collection) and the test re run only to find its normal. Parents are stressed for no reason... or could go the other way. Something important isn't picked up..
Small mistakes in healthcare can lead to huge (in my opinion) after effects.
The 22 yr old Prinip
so afterwards I had early lunch and was sent to "cover other peoples breaks" which ended up being me, wandering into MAC and taking a phone call-- which led to me helping out instead with a prinip who was 2nd presentation for ?early labour (? because you just don't know until you assess them).
It's always hard assessing a prinip. You don't want to go in too early and declare them 1 cm after they'd been huffing and puffing away in pain for 12 hours- similarly you don't want to decide they're early labour and send them home to then have the baby in the car park either.
But here we were now on the 2nd presentation: which meant, she had early been assessed as "early" and had gone through 12+ hours at home (without sleep, watching law and order SUV to chillax apparently) so clearly, she was here for a reason. I wasn't really keen to send her home without something and we don't give anything and just send people home (anymore) -- we keep them and monitor (incase something bad happens as a consequence of us either missing the fact that they've progressed faster than we thought or; another problem has happened.
I throw on a CTG because we're probably going to give endone, and if the CTG is bad you don't want to give endone and hide a problem. but if the CTG is A+ then you are reassured the baby is fine, all is well, and it's ok for her to ride along the labour journey at her pace.
She had a classic watermelon- stretch mark stripped abdomen, and the hairiest legs (and down there) I'd seen in a long time for a caucasian(?) 22 yr old.
I also had to do a vaginal exam. The 23:00 one the night before, had been traumatising. The midwife had been a bit rough (ok vaginal exams are extremely hard to do on a 1st timer prinip: and worst if its the first one they ever experienced: so here I was to do a procedure I don't like on someone that would rather not have it done -- but it needs to be done. She's here for a reason. We need to know if she's progressed (or not) and how fast or far and so forth. The previous result was closed and posterior.
I considered to offer her gas for the exam but theres no exam in the MAC area, which means moving to another area... and that was too much effort. So I chose not to offer it to her, but instead promised to be extremely gentle (and I know me, I am really gentle-- which can be bad cause sometimes, it means I don't get the answer and I'm up there being too gentle to a fault- but I've learnt now: take your time is the answer if your going to be gentle).
I took my time so hard, I swear, my hand smelt like liquor (but I wasn't convinced the waters had broken even though she felt "like she peed herself" and had moist underwear. firstly, the pad wasn't stained but it was damp and secondly, I could feel the waterbag - and it felt intact) for about 3 hours after the exam.
I literally felt like my hands smelled like vagina (but worse, cause it's labouring vagina... actually I don't know what a non-laboring vagina smells like 'cause who goes up a non labouring vagina for 5 mins?! (no-one). I washed my hands to my elbows about 3 times.
ApparentlY-- shaving cream -- is the answer. I learnt that tip at the lights of christmas duty that night when I then did some volunteer work in the City from 1930-2300 (and drastically wondered what I was doing there to be honest considering my volunteer uniform doesn't fit anymore so I wore my work uniform with a hi-vis on top) Ab from F/F division told me when he worked in a nursing home, shaving cream is what they used when some god awful smell had to be gotten rid of.
I left my shift at SSH listening to the girls in the tea room talk about the 19 yr old girl who had 3 children that was an absolute nightmare to deal with in labour (swearing, carrying on, being nasty, aggressive, even in front of her own other children) whose children still remain in her care. I walked back to the car park with the girl who warned me about Monday and Friday shifts being "the worst" (and she's right. it's like all the shit gets dumped on Mon and Fri due to the abnormal concept of "weekend") -- Neelab. I'm going to miss their Christmas party thing because I'll be on a 12 hr at my other job.
My next shifts will be on Dec 19 and 23rd respectively.
I wonder if the 22 yr old prinip delivered vaginally like she had wanted.
The dizziness was a first trimester issue... which I resolved by working only in ICU where chairs are abundant and u can sneak a snack bag on ur computer. So I took the case.
The elective for previous
The first was an elective cesarian for previous, on a woman who is filipino Catholic but clearly married a muslim man whose name was Mohammed. I asked his name, and when he told me I said I can remember that nice and easy. I wonder what that household does with regards to things like Christmas and Eid. Just have both? Could be fun ... She had no GDM diagnosed in 1st and 2nd pregnancy but in the 3rd there it was. In 1st and 2nd she had LGA babies (well, not strict LGA but for her stature and for Filipino I think it could be classified as LGA: 4.1kg and 4.0 kg -and that being said anything above 4 is considered big (in Australia... but then you hear of women pushing out 5.0 kg babies supposedly just fine and you wonder.. back in the day, they seemed not to be labeled so harshly as LGA.. actually the old cutoff was 4.5kg but still that's 500g bigger than 4kg)and if you didn't have GDM diagnosed then clinicians are sneakily thinking you either had a borderline case or had it but it wasn't picked up.
So this lady had a cesarean for a diagnosed big baby.
And this one, was number 3. So after cesarean number 1, and then number 2, it would be rare for a 35 yr old to then go "I want a vaginal birth" -- plus, this one was thought to be possibly LGA too.
It came out as 3.6kg.
They wanted cord gasses (and I don't know why).
Maybe it was because they thought her diabetes was not well controlled. The HbA1c was a little high I suppose and she did argue with them about taking the metformin - wanting diet controlled instead (but ate custard and other things that were labeled as "dietary excursions"). Her notes sounded really depressing actually.
I thought there was a TOP or a D and C happening in OT prior to this case so I showed up ridiculously late. Usually, I'm supposed to meet the women and her partner prior to the surgery in the wait room, introduce myself, ask about their history face to face, palp their abdomen and do a fetal heart. Write an intro note...
I missed all that -- by the time I got there, they were putting in the spinal and well I can't very well just interrupt an elective cesarean section spinal and say "HOLD IT! MAYBE THE BABY IS DEAD...I NEED TO DO A FETAL HEART JUST TO CHECK" when essentially, in 30 mins, the baby will be out....
Ah well. I figured, if she didn't feel movements she would have said so by now.
I blame baby brain for stuffing up 2x cord gasses by running them as arterial and venous gasses rather than cord arterial and cord venous(yes they're different) -- before all of a sudden on the 3rd test realising my mistake and having to spend time fixing those. Nothing should come of them as the results weren't abnormal but I hate making a mistake like that. Imagine you run a test, but you run it wrong, and say, one number is high - say the lactate is 10 instead of 6. Then based on that one number either the baby has to have more testing (painful heel prick and crying and blood collection) and the test re run only to find its normal. Parents are stressed for no reason... or could go the other way. Something important isn't picked up..
Small mistakes in healthcare can lead to huge (in my opinion) after effects.
The 22 yr old Prinip
so afterwards I had early lunch and was sent to "cover other peoples breaks" which ended up being me, wandering into MAC and taking a phone call-- which led to me helping out instead with a prinip who was 2nd presentation for ?early labour (? because you just don't know until you assess them).
It's always hard assessing a prinip. You don't want to go in too early and declare them 1 cm after they'd been huffing and puffing away in pain for 12 hours- similarly you don't want to decide they're early labour and send them home to then have the baby in the car park either.
But here we were now on the 2nd presentation: which meant, she had early been assessed as "early" and had gone through 12+ hours at home (without sleep, watching law and order SUV to chillax apparently) so clearly, she was here for a reason. I wasn't really keen to send her home without something and we don't give anything and just send people home (anymore) -- we keep them and monitor (incase something bad happens as a consequence of us either missing the fact that they've progressed faster than we thought or; another problem has happened.
I throw on a CTG because we're probably going to give endone, and if the CTG is bad you don't want to give endone and hide a problem. but if the CTG is A+ then you are reassured the baby is fine, all is well, and it's ok for her to ride along the labour journey at her pace.
She had a classic watermelon- stretch mark stripped abdomen, and the hairiest legs (and down there) I'd seen in a long time for a caucasian(?) 22 yr old.
I also had to do a vaginal exam. The 23:00 one the night before, had been traumatising. The midwife had been a bit rough (ok vaginal exams are extremely hard to do on a 1st timer prinip: and worst if its the first one they ever experienced: so here I was to do a procedure I don't like on someone that would rather not have it done -- but it needs to be done. She's here for a reason. We need to know if she's progressed (or not) and how fast or far and so forth. The previous result was closed and posterior.
I considered to offer her gas for the exam but theres no exam in the MAC area, which means moving to another area... and that was too much effort. So I chose not to offer it to her, but instead promised to be extremely gentle (and I know me, I am really gentle-- which can be bad cause sometimes, it means I don't get the answer and I'm up there being too gentle to a fault- but I've learnt now: take your time is the answer if your going to be gentle).
I took my time so hard, I swear, my hand smelt like liquor (but I wasn't convinced the waters had broken even though she felt "like she peed herself" and had moist underwear. firstly, the pad wasn't stained but it was damp and secondly, I could feel the waterbag - and it felt intact) for about 3 hours after the exam.
I literally felt like my hands smelled like vagina (but worse, cause it's labouring vagina... actually I don't know what a non-laboring vagina smells like 'cause who goes up a non labouring vagina for 5 mins?! (no-one). I washed my hands to my elbows about 3 times.
ApparentlY-- shaving cream -- is the answer. I learnt that tip at the lights of christmas duty that night when I then did some volunteer work in the City from 1930-2300 (and drastically wondered what I was doing there to be honest considering my volunteer uniform doesn't fit anymore so I wore my work uniform with a hi-vis on top) Ab from F/F division told me when he worked in a nursing home, shaving cream is what they used when some god awful smell had to be gotten rid of.
I left my shift at SSH listening to the girls in the tea room talk about the 19 yr old girl who had 3 children that was an absolute nightmare to deal with in labour (swearing, carrying on, being nasty, aggressive, even in front of her own other children) whose children still remain in her care. I walked back to the car park with the girl who warned me about Monday and Friday shifts being "the worst" (and she's right. it's like all the shit gets dumped on Mon and Fri due to the abnormal concept of "weekend") -- Neelab. I'm going to miss their Christmas party thing because I'll be on a 12 hr at my other job.
My next shifts will be on Dec 19 and 23rd respectively.
I wonder if the 22 yr old prinip delivered vaginally like she had wanted.