Nurses here in Honduras share a superstition with nurses in the US. When it comes to pregnant ladies, they say there is never one alone; the laboring patients always come in multiples. (Disclaimer: this is going to be a heavily medical post)
The peace of this evening belies the craziness of the day. My day started with a call at 7:15 which I heard crackle on the radio while I was getting out of the shower. I ran to the base station across the house in my trousers and towel, hoping none of the neighbors were up yet. Pediatric patient waiting in the ER- there goes my quiet coffee, breakfast, and devotions hour.
One pediatric patient turned into two pediatric patients and clinic was starting before I knew it. Only I didn't actually see many clinic patients today, because...
Woman #1- young first time mom, brought in by a midwife because something strange had happened when she got to 10 cm dilation and started to push. We didn't worry about any of that because the baby was crowning and someone had to catch it. As the nurses took care of the baby and we started getting the woman back to the post-partum room, I ran to my consulta and grabbed the next chart which was....
Woman #2- young second time mom, there for induction of labor. She'd been having "occasional" contractions, but when I did her first cervical exam she was already 5 cm dilated! I broke her water, hoping this would get labor started. I turned to fill out paperwork and as I did, the baby's heart rate started declining, down, down, down, until it was in the 50s. Quick exam- no cord hanging out. Suddenly mom is vomiting and her blood pressure is 60s/40s. There was a huge amount of fluid coming out, but no blood or other scary signs. I called the OB from the next room who went to check on the status of an OR in case we needed to get the baby out NOW. By the time he returned, mom and baby had both stabilized. He said he's seen that kind of thing before when there's a huge volume shift after breaking the bag of water. Before she could progress much further, there was a frantic call on the radio for doctors to come to the inpatient ward for....
Woman #1 who was convulsing. Her blood pressure was now 200s/110s. The midwife must have been describing an ecclamptic seizure, and we'd already delivered the baby (treatment #1) but there is still a risk after delivery. The OB rustled up the magnesium we needed to start and she stabilized after scaring the pants off everyone.
Woman #2 may have delivered before Woman #3 came in; truly I can't remember the sequence of events after that.
Woman #3- G9P8, poor prenatal records, probably around term given fundal height measurements and best estimate at 18 weeks of her LMP. She'd been leaking some fluid for a couple of days, then started bleeding as well so decided to come in. One reason she hadn't been to any prenatal appointments in the last few months was she had been bitten by a snake (!)....I haven't had a chance to unpack that one yet. We decided to induce labor and are waiting for her now to sneeze and deliver the baby.
There were a couple of other pregnant women in today, and a crazy story of a home birth bringing the baby to the ER at 5am before my shift started. The nurses are starting to blame me for the streak of deliveries. Who knows?
Update: Woman #3 did not sneeze out the baby as I was hoping/expecting. Instead, she got to 10cm, pushed for an hour, and made absolutely no progress. I called a C-section and scrubbed in with a family medicine resident assisting me and the OB-Gyn working as our circulating nurse :) It was my first one without a more experienced doctor scrubbed in with me and went alright! Mom and baby both did well.
One pediatric patient turned into two pediatric patients and clinic was starting before I knew it. Only I didn't actually see many clinic patients today, because...
Woman #1- young first time mom, brought in by a midwife because something strange had happened when she got to 10 cm dilation and started to push. We didn't worry about any of that because the baby was crowning and someone had to catch it. As the nurses took care of the baby and we started getting the woman back to the post-partum room, I ran to my consulta and grabbed the next chart which was....
Woman #2- young second time mom, there for induction of labor. She'd been having "occasional" contractions, but when I did her first cervical exam she was already 5 cm dilated! I broke her water, hoping this would get labor started. I turned to fill out paperwork and as I did, the baby's heart rate started declining, down, down, down, until it was in the 50s. Quick exam- no cord hanging out. Suddenly mom is vomiting and her blood pressure is 60s/40s. There was a huge amount of fluid coming out, but no blood or other scary signs. I called the OB from the next room who went to check on the status of an OR in case we needed to get the baby out NOW. By the time he returned, mom and baby had both stabilized. He said he's seen that kind of thing before when there's a huge volume shift after breaking the bag of water. Before she could progress much further, there was a frantic call on the radio for doctors to come to the inpatient ward for....
Woman #1 who was convulsing. Her blood pressure was now 200s/110s. The midwife must have been describing an ecclamptic seizure, and we'd already delivered the baby (treatment #1) but there is still a risk after delivery. The OB rustled up the magnesium we needed to start and she stabilized after scaring the pants off everyone.
Woman #2 may have delivered before Woman #3 came in; truly I can't remember the sequence of events after that.
Woman #3- G9P8, poor prenatal records, probably around term given fundal height measurements and best estimate at 18 weeks of her LMP. She'd been leaking some fluid for a couple of days, then started bleeding as well so decided to come in. One reason she hadn't been to any prenatal appointments in the last few months was she had been bitten by a snake (!)....I haven't had a chance to unpack that one yet. We decided to induce labor and are waiting for her now to sneeze and deliver the baby.
There were a couple of other pregnant women in today, and a crazy story of a home birth bringing the baby to the ER at 5am before my shift started. The nurses are starting to blame me for the streak of deliveries. Who knows?
Update: Woman #3 did not sneeze out the baby as I was hoping/expecting. Instead, she got to 10cm, pushed for an hour, and made absolutely no progress. I called a C-section and scrubbed in with a family medicine resident assisting me and the OB-Gyn working as our circulating nurse :) It was my first one without a more experienced doctor scrubbed in with me and went alright! Mom and baby both did well.
