L&D: Um, do you know what you are doing? Cause I don't.

Alright folks. So last week, I fell in love with Labor & Delivery, so I switched with my buddy Lucas so I could be there again today. I got paired up with the same nurse I was with last week-the Debbie Millward-like one. We ran around inducing women's labors and having a great time. One of our patients was 17 years old at 38 weeks gestation with her boyfriend by her side. I think it was rather startling for me to see her birth year. 1992? That's the year my brother was born. That's so weird. She was being induced because her baby was diagnosed with gastroschisis. (refer to last post on what this is if you care) But if you remember, my patient LAST Tuesday who was 19 years old had a gastroschisis baby. Again, this doesn't have any risk factors and doctors don't know why there is such a prevalence right now.

We started Pitocin drips on the 17 year old and the other patient who was a G4 P3012. (L&D lingo for 4 pregnancies, 2 living children, and 1 spontaneous abortion) She was such a sweet Hispanic woman and I was mostly taking care of her. My nurse went home at about 3:30 and started working with a new nurse, and then...things got crazy.

My new nurse and I go into Amanda's* room and she is contracting every 2 minutes, for about 60 seconds to 100 seconds. No one had checked her dilation recently, and I go and find any doctors at the desk. They all went and scrubbed in on different C sections. The only available medical staff is a 4th year medical student and an intern, who just graduated medical school as well. He is beginning his internship in Family Practice. I notify them of what is going on, and they act very excited about getting to take some independence with this patient. This really bothers me with doctors and medical students. I understand wanting to get a lot of experience, but we should not be rejoicing in the opportunity of delivering a human life completely inexperienced, risking the mother and baby's life, in the hopes of getting experience and looking good in front of your residents. The intern checks her dilation and kind of pathetically asks my nurse to do it and see what she thinks. She confirms that she is ready to start pushing, and the blank stares on the intern and medical student created a surge of anxiety in myself. Intern responds, "Well it will just be a half an hour until our resident is done." My nurse, "Oh we don't have a half an hour boy. Look at this woman. She has had multiple babies, she is unmedicated, and she is clearly pushing right now. That baby will be here in 10 minutes." Holy crap. I gown these kids up in sterile dressings and before I know it, I am holding this woman's legs and reassuring her that everything is going fine. Even though it's not. Even though I fear what is about to happen and how I can't seem to remember ANYTHING from my textbook about delivering a baby. Just push, clamp and cut cord, suction babies mouth, swaddle in blankets, and watch the placenta come out right? Oh crap, I shouldn't have eaten so much at lunch.

But the production begins and my nurse leans over to me and says, "This woman hasn't peed since before she got here, right?" Oh man...I thought she got up on her own, but she confirms she has not peed at all. "Do you know what this means? This women has a full bladder and is the number one cause of postpartum hemorrhage. Let's pray this goes well, ya?" Ummm okay. I look down and there's the giant baby coming out. The baby comes all the way out, and once again my nurse takes the reigns and yells at the students about where they are supposed to clamp the umbilical cord. The intern almost cuts it and I yell "Nooooo!!! The Dad is supposed to cut it!" He does so, and soon enough the baby is suctioned and starts crying. I look back at Amanda* who has tears in her eyes, and not surprisingly, I have tears in my eyes to. "Good job Amanda!! You did so well!! Your baby girl is gorgeous!"

The resident gets in right in time for the rest of the production, which I won't go into great detail about, and after they are done I straight cath (stick a tube up the bladder to drain it) her to decrease the hemorrhaging. Geez I wish I was better at working under pressure. I've done this quite a few times now, but when it's so important to do it fast, keep sterile field, and do it with a bossy nurse yelling at you, "Do you know where you are going with that?" Yes. "Are you sure? Can you actually see where you are going to insert it?" Well yes, at least I'm pretty sure. "Well you better be sure." I am! Just let me do my job! And I did it on the first try, which I have to note is freaking hard on a woman who just delivered for numerous reasons.

It's 5 o'clock and it's time for me to take off from clinical, but before I do, I report back to the med student and intern about the baby and mom's status. The med student was kind of cute because he apologized to me for not knowing anything and if he was rude. I thought that was sweet, especially since the intern just acted like he was high and mighty. But the med student and I high-fived and went on my way to see my clinical instructor to get my final evaluation. I passed with top scores in everything except mileu therapy, which I got a 'supervised' score which is reasonable, since I'm not sure I even know what that is. =) And today I got my Community Health clinical grade and got a 97.8%. And Pediatric clinical I got an A as well. So far so good for the hardest semester in nursing. I will be done in one week...and it can't come fast enough!

And even though I'm not a pro at L&D yet, I really wish I could be there for my older sister's birth that should be sometime this month. Perhaps I would offer no support or knowledge to the situation, but now that I know a lot of what is going on with fetal heart tones, contractions, breathing exercises, and newborn care, it would be really awesome to be apart of that. I guess I will just have to wait for another sister to get prego when I'm geographically closer to them.

*Names have been changed for HIPPA.