Archive for October, 2009

Birth story#4

Friday, October 30th, 2009

My 114th birth handled (293rd birth present) 4/28/00

My patient Rosario O., 26 y.o, 40 3/7 weeks AOG, G1P0, came in with her husband Rodnie at 8:26 am, I did an IE she was only 1-2 cm, 70% effeaced, +1-+2 station. I advised her to walk around and a great time.

At 12:45pm, she wanted to have another IE so I did one. She was only 3 cm but very stretchy cervix, I tried to spread my fingers to somehow help it stretch more, she dilated to 6cm. I did manual dilation of the cervix. It is only possible if the cervix is very stretchy and making sure the cervix will not lacerate.
At 1:29pm, she was already 9cm, I let her to her left and right side lying alternately as it will help the cervix to open and at the same time it will help her not to focus on pushing before the perfect time to push.

She wanted to push. There was no progress. I did an AROM (artificial rupture of membranes) to help her progress with thick meconium stain which is not good. It signifies that the baby was already very distressed inside. Of course before doing it, I made sure that the presenting part was already +1 or more station to prevent cord prolapsed.

After knowing that there was a meconium stain, the suction machine was prepared to suction the baby’s nose and mouth when the head is out before the baby cries to prevent the baby from aspirating the meconium to his lungs. When the head was out we suctioned the baby and continued suctioning after the baby was out at 2:01pm. We got a lot of meconium visible in the suction tube and in the suction bottle. The baby was so cute. Her name is Nathalie Jhelan, with apgar score 9/10, weighed 2987 grm./6.9 lbs. Praise God everything went well.

The placenta was out at 2:04pm with a gush of blood. We massaged and injected 10”U” pitocin to stop the bleeding. She lost 450cc of blood. She had a 2nd degree laceration on perineum and labia and I sutured her. It felt so great to be a part of the birth. Present at birth: me, Carla Snyder, Ana Tipan
P.S. I also deliver’s second baby on 4/25/01.
1st stage – 14 hrs 56 mins
2nd stage – 5 mins
3rd stage – 3 mins
Admitted – 4 hrs 54 mins

Birth story #3

Tuesday, October 27th, 2009

M113th birth handled 4/25/00

My patient Helen T. 29 y.o, 39 weeks AOG, G5P4, came in the clinic with her husband Jose at around 10:25 pm. I checked her in and did an IE, she was only 2cm, 60% effaced, no bag of water felt. The fetal heart tones heard most loudly in the LUQ (left upper quadrant). I was so sure thought that when I did an IE I felt the baby’s head. The patient was so very sweet. She was always smiling at me even she has contractions.

At 2:00am she wanted to have another IE, so I did one and was 4cm, 80% effaced. She was doing fundal pressure every contractions with herself even I told her not to as it can hurt the baby. After a while she felt her legs shaking and I though she was already fully but to my dismay she was only 6cm.

So I take a nap on the couch for a while then after 12 minutes Ate Toinnette shouted my name and I wake up suddenly as if my heart was displaced out of my body. I jumped off from the couch my pens, keys, and thermometers in my pocket were all scattered on the floor. It was good that Grace came to the patient’s cubicle first and saw that the head was already coming so she supported it with her bare hand. When I arrived the baby’s head was already out so I suddenly put on my gloves. There was a single loose nuchal cord so I slipped in on the baby’s shoulder. Then the baby was out very fast at 3:02 am, a very cute baby boy named Jessie, with apgar score 9/9, weighed 2700 grms/6 lbs.

The placenta was out at 3:08am, with only 50cc estimated blood loss. No laceration. Everything was normal no problems. Praise God. After they were settled, I felt tired because you know what happen after the adrenaline rush. I tried not to think that I was kind of a negligent nurse/midwife but it was good that we had a good team.
Present at birth : me, Tionnette R, Grace E.
1st stage – 5 hrs
2nd stage – 2 mins
3rd stage – 6 mins
Admitted – 3 hrs 08 mins

Bith story #1

Tuesday, October 20th, 2009

My 112th birth handled 4/30/00

I was on Day shift. I was the first up supposed to be I will receive the patient Noralie came to our clinic on at 4:45 am, 25 y.o, G1P0, 6cm. She was Carla S’s patient to stay so we handled this patient together. The patient extreme reacting to labor pains but was able to control it and deep breathed.

At around 8:15 am, she had the urge to push so I did and IE and she was 8cm, with very stretchy cervix 90% effaced, +1 station, membranes felt so we let her breath.
After few minutes, she really wanted to push. When I checked her she’s 9+cm, so lifted up the cervical lip 5-11, then she pushed hard while I was lifting the lip above the baby’s head. She really did great pushing. After 2 minutes, she was already fully. I let CS take over, then baby’s head was visible, the after another push the head was out with single nuchal cord (umbilical wrapped on baby’s neck) loose, so it was slid on the baby’s shoulders.

During the delivery of the baby’s head the patient was bleeding) from the laceration. Then finally the baby was out at 8:43am, a healthy baby boy “Michael Dave”, apgar score 9/9, weighed 3100 grms/ 6.13 lbs.

After the birth the patient was bleeding a lot. CS put pressure on the laceration with sterile gauze, but still she continued bleeding and her cervical prolapsed. So I supported the cervix while doing CS was doing cord traction to let the placenta be out but still the placenta still attached.

The patient was on the birth stool, so I let the patient lie on bed. Then the placenta was out at 8:48am, the cervix was still visible, so CS massaged the fundus upwardly. I gave the patient a 10 “U” pitocin to help the uterus contract and stop the bleeding. When I examine the placenta, I thought there was one cotyledon missing but thanks God there was none. The patient has a big fat second degree laceration that I sutured. She lost 650 cc estimated blood loss. What a birth to start with my day. It was hard but thankful that everything went well with the patient and the baby.

Present at birth: me, Carla S, Lynn J, Julie T
1st stage – 4 hrs 32 mins
2nd stage – 11 mins
3rd stage – 5 mins
Admitted – 3 hrs 58