Sunday, September 17, 2006

Damn, damn and damn!

Instinct is an amazing thing. One should trust it and stick with it!

I am sitting here today feeling really annoyed at myself for not trusting my intuition. Yesterday i was at the birth of my clients, she had admitted herself at around 11 with some light bleeding, which could have been bloody show. I joined her at 11am and she was 3cm but not really feeling many contractions. To cut a v. long story short, she agreed sometime in the afternoon to her water being broken and then her contractions over the next couple of hours really started to kick in. She was coping pretty well, but kept withdrawing and fighting the contractions and I had a hard time keeping her with me and helping her work with them. Eventually she decided she wanted an epidural so they checked her dilation, which was then at 5cm, and she waited for the anaethetist. He took another half hour, during which time she was getting really intense contractions, which seemed to have a plateau to them ie: lasted a while and then subsided to only give her around a minutes grace before the next one. She seemed to me to be really progressing and then even going through transition where she got panicky that the anaethetist wasn't coming, however, it had only been half an hour. It crossed my mind to remind her that she was doing so well and I was really confused how hard these contractions had suddenly become that I even wondered if she couldn't get through without the epidural, so all I said - kick myself now- is "are you sure you want this". I should have maybe been more audible and suggested a re-examination!!!grrr - mad at myself!
He went ahead and put in the epidural and within 10 minutes the baby's heart rate dropped. It did recover, but they decided to then check her again.....guess what!! 10 !

So this went on for a while with her pushing, actually really effectively considering she had had an epdiural, until she had been pushing for 2 hours. She did have a tetanic contraction at one point so they had to give her a shot of terbutaline to relax her uterus. Gradually over this time the baby's heart wasn't recovering as quickly, he had passed meconium and the doc couldn't feel the cord around the neck, so my thoughts were that he was reacting to the epidural, it was a real coincedence! She and her husband were left to discuss c-section eventually as the doc couldn't get the vacuum as the baby was still too high. He was posterior which I had told her he was when she arrived with back ache so we had been working to try to turn him, but obviously it hadn't worked. So with that, the culmination that the ultrasound had said the baby was at least 8lb6 (since when do ultrasounds talk anyway!?) and the dropping FHT, she was prepped for surgery and her hubby and I doned scrubs. Within 10 mins of waiting, the nurse was back to say that she had had the baby, crash c-section! Apparently when the anaethetist put more epidural into her catheter, the baby's heart had dropped again and not recovered.......not jumping to conclusions here, but......coincedence I don't think so! So now I am mad at myself for what might have been, I keep thinking if only I had told her that I felt her dilation might have changed, we could have gotten her checked and she probably would have had the baby (with some vacuum help maybe) vaginally! Oh, and the baby was only 7lb 13, so trusting the "voice" of technology all the while is not always the best way to go.
She and the baby are fine however so the end result was great. Next time, I will trust my thoughts as it would not have hurt to have voiced them a little louder.

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