Back from Night 2

Posted Fri, 16/04/2010 - 09:41. ctd3exw's blog. 1 comments

Hi Guys,

Just come back from my night shift and have house full of kids. Im waiting for baby sitter to come and take one to Sports camp and look after the other- and the eldest is going into school to do ICT coursework as he is taking his GCSES next month.

I'm pretty tired (as usual!) Last night I had a student with me- lovely gentle African Nurse called Olivia who had never seen a baby being born and was new.

We took a VBAC lady (vaginal birth after caesarean section). She was previously an EMCS (emergency c section) for fetal distress, grade III meconium and brow presentation

General

And this time she was very keen to try and have a baby vaginally. She had laboured up to 3cm last time and had attended NCT classes and was an intelligent lady with very very sensitive skin.

She was continuously monitored and was previously 3 cm when we took over care. Four hours later- the CTG was looking abit suspicious and the lady could not get comfortable with her very sensitive skin and the CTG pads so I asked her if I could put a clip on the baby's head to listen in.

She said " I'm not sure about this- the NCT lady told me that they can hurt the babies head" I was astounded by this remark and talked about the benefits outweighing the risks and concluded that the NCT lady was either being misquoted here because I could not understand why someone would make such a remark.

Anyhow, I broke her waters (as she was 4 cm) and needed to in order to get the clip on and there was Grade II meconium. So I knew the paeds would be at the delivery now. I asked the Reg to look at the trace and she would just observe but recommended an epidural as well. Mum wasnt keen on the epidural but understood that if we ended up in Theatres- it is quicker to convert an epidural to a spinal if needed, and also that she may need some extra pain relief to get her up to fully as this may be a longer labour than she was anticipating. She decided on the epidural.

The anaesthetist never got to put the needle in since the Regs outside watching the trace decided that the trace was now pathological and wanted to section her.

So off we went to theatres and she hollered her head off and the anaesthetist was getting irritated -bless him. The Reg and the SHO were staying in the scrub room since they thought they would not be able to stop grinning their heads off at what they were watching.

This lady was howling and shreeking- "I can feel the needles! I can feel it all down my spine! The needles! The pain- this is hurting me"

Well the anaesthetist was doing no such thing and he was sitting behind her waving his hands in the air- "Look Im not even touching you!" and this carried on for a good few minutes. I crept in inbetween the husband and the ODP guy and got eye contact and tried to calm her down which worked for a short while and then it would start again. Eventually we managed to get her spinal done and she was operated on. The baby was a boy who wee-ed and poo-ed for England and was in good condition.

The paperwork took ages in recovery since I had had to focus soley on her from the time the eipdural had been suggested and it took a while to get sorted out. However we transferred up to the ward and about 330am and came downstairs to see if anyone else had come in.

At 0600, I met a Traveller woman of Irish descent who was expecting her 5th baby. She was 36 weeks and 4 days and contracting mildly about 2 times every 10 minutes. She came in in a dressing gown and a pair of high heels- bless! I really like the Traveller women.

She showed me her pad which looked like it was also meconium stained liquor so I popped another pad on her and put her on the CTG to monitor how the baby was doing. I shouldnt have examined her but seeing as I had not worked out she was 36 weeks and though she was term- I did. In retrospect I shouldnt have but it was a genuine mistake and something for me to reflect on. She had a typical stretchy cervix which still needed to do more work and the baby's head wasnt terribly well applied to it. I could clearly feel the suture lines on the the babies head.I took a swab as well.

She was very sensitive about being touched. She couldnt read or write. She was 37 and the eldest child was 19. She was a heavy smoker. She had had 4 babies before and was a late booker but had been scanned. She had mental health problems- quite serious ones and there was domestic violence issues from the husband who called the ambulance to come and bring her in because he had drunk too much to drive. He didnt smell of booze but his language was very very inapproprite really telling me he hadnt hit her for months! and how she liked pain and was kinky! Lets just say I didnt warm to him much. He left and went to find some breakfast. We dont usually get the men around alot- they like to keep it as womens business. He sucked on the gas and air and I was pleased when he disavanished.

I left her in the care of lovely Sister called Lynne who no doubt will take great care of her. I said I'd meet her later this evening when I go back to say hello to her or possibly care for her again. Im not sure what the outcome will be for her. I think they'd like to confirm more liquor and see more meconium staining before leaping in and starting her off since she is only 36 weeks. She had thought she was 38 weeks! So she could possibly be in the antenatal ward on antibiotics instead- alot depends on how the contractions progress as well. She was contracting- they were palpable but not long or particularly strong.

Traveller group have one of the highest cot death rates in the UK- and have a much shorter life expectancy than other groups in the UK- 12 years less for women. They have problems accessing the health services and particularly services to help them with domestic violence issues becasue they are just not geared up to cater for a different type of culture such as theirs. She had been referred to Social Services which she would have known about but I couldnt see what the plan was to protect her unborn baby from the DV issues at home. I left the lovely Lynne to sort all that out since it was 0800 and time for me to go.

A Traveller woman at the door to her caravan