Thursday, 15 September 2011

Midnight madness in maternity

Midnight madness in maternity

12.09.11: Went back to hospital this evening planning on heading to labour room to see if anything was going on, computer room was open so we went on internet for a bit, AJ headed to maternity once she was done and was going to phone me if there was anything exciting happening while I stayed on internet (putting up one of blogs!) Unfortunately hadn’t banked on it being so busy that she wouldn’t even be able to call!

When I arrived 15 mins later AJ had already delivered one baby. She had walked into the delivery room to find no midwives about and just one nurse who was faffing about doing something else despite the fact a lady was literally giving birth. However it was not the baby’s head that was protruding from the vagina but its bottom. Uh oh! Breech presentation! Aj managed to deliver half the baby but was struggling to get its arms into the right position when fortunately a midwife arrived and did the rest of the delivery. The baby unfortunately was seriously pale, not breathing and slow heart beat and so in need of major resuscitation. Aj assisted with this (and was able to ensure the right CPR ratio was being done at least initially). When I arrived the baby was crying…sort of. It was the weirdest cry I have heard, definitely not a healthy one so hope the baby recovers ok.

Unfortunately in all the commotion no one had been available to deliver the placenta and now the uterus had contracted too much and it was impossible to get the placenta out safely in the normal manner (we all tried!). In addition there were 2 other ladies in the labour ward, 1 whose baby was going into fetal distress (the heart rate had dropped very low) but was not close enough to normal vaginal delivery and the other who was fully dilated and almost ready to give birth. One doctor had arrived by this time but there were now 2 patients she needed to deal with – 1 requiring manual removal of the placenta and 1 requiring a c section due to fetal distress. She did try to suggest that AJ could do either the c section or the removal whilst she did the other (and I’m not sure she was joking :S) but AJ sensibly declined and told her to phone another doctor regardless of the time!

I went to see the c section (mostly because I was worried that if the baby was in distress then it might need CPR and I wanted to ensure it was done right this time!) while AJ stayed to watch the manual removal. During the caesarean section the surgeon got literally covered in meconium filled amniotic fluid. It’s a good thing she was wearing both goggles and a mask (a scary amount of the doctors here don’t bother with goggles) because if the mum was HIV positive (common here) then amniotic fluid in the eye could infect the doctor although it is quite unlikely. When the baby came out he was fortunately very healthily crying away so I was glad both that he was fine and that I would not to have to say anything about CPR ratios!

As soon as I arrived back in maternity I just had enough time to wash hand and change gloves (note to self, dry hands before trying to shove gloves on!) before helping with the third women’s labour as she was starting to deliver as I walked in. That baby was another boy and also healthy :D.

The placenta from the 1st woman was eventually successfully removed but the lady did lose quite a lot of blood. She was allowed to stay in labour room so she could be carefully monitored – glad to see this done for once as quite often here even very sick patients are left quite far from the medical staffs view!

One of the babies being weighed. The hospitals scales are pretty basic and you have to move a pin along until the scales look balanced.

So yeah, quite a manic few hours, especially for AJ. I think we were both in need of a long sleep when we got home. Kept for a bit longer though because we had just discovered not only were our taps magically working but they were letting out cleanish water! Massive excitement and cue filling as many buckets as possible while it lasted! And then finally sleep :D.

Halfadoc x

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