My second delivery story. The one where everything nearly went pear-shaped.
Written very clearly on the first page of her assessment sheet was a clear instruction. The message was that because of complications in previous pregnancies this lady must be in theatre for her next delivery.
Oh Great.
At this moment in time she is screaming her head off. She is well due to deliver and she is a long way from Dr So and So's theatre in Cairns.
In Cairns she would have a team of specialist doctors, midwives, neonatal nurses and more fancy equipment than you could poke a stick at. They also have blood. Heaps of it.
We have a bed ( two actually but one doesn't work properly, it goes up but does not go down until a really big person goes on it and then it goes down very quickly). We have some basic delivery equipment, some basic medications, fluids and a security guard and myself. Oh and today we have Lynn.
In the remote areas it is not unusual to work with relief staff. They might fly in for a couple of weeks and then disappear forever. I met Lynn about 5 minutes ago, just before our non-Cairns attending lady arrived.
On hearing the screams Lynn wanders down.
'You're not a midwife are you?' I ask. When I ask this I'm expecting a negative reply. The chances of a positive reply is so remote any bookie would take the bet. The bookie would not even lay the bet off now matter how much was at stake.Do you know how rare it is to have midwife just turn up for a few shifts?
'Yes.' she replies.
For a few seconds this sinks in. I allow myself a little hope we might get through this.
Luckily Lynn is a little more on the ball than me. She is on the telephone talking to people who understand the weird language of obstetrics. The bits I understand is the G 2 P4, massive tears, hemorrhage (the most difficult word in medicine to spell but not of concern right now), and Caesar (not the salad).
She comes off the phone and starts checking things, she does a PV and I tell her the FHR ( little guy's heart rate, which is normal). I'm trying to cannulate. Lynn is straight back to the phone. I'm dying to ask what is going on but it is obvious my questions can wait. She 'll tell me what I need to know.
I get the entonox out and it quietens the poor lady, a little. The chance of getting anything stronger at this stage is remote. Morphine or similar now to the mum might relieve her pain but big chance of a narc'd baby.
Options are to deliver here, fly out or drive out. The chopper is up north but is heading back. Drive out is possible but risk of delivery in the van (ambulance) could be a disaster. We are left with deliver here.
I turn off the air conditioner. Despite the humidity I've found cold babies are hard to warm again and can lead to further problems. We don't have a heater.
Without getting too tied up in the medical talk the ladies previous problems have resulted from trying to deliver a coconut down a straw. Even if there is some give in the straw it is too narrow and something will rip. There is a great probability the child will die if nothing is done. The risk to the mother is significant as well.
The bulging down below is beyond anything I have seen. Even fully stretched it is obvious to me there is no way a normal delivery can occur.
Lynn announces she will perform an episiotomy. Using a pair of special scissors she will cut to make the opening a little wider. By this time the pressure is causing the area to be white. The head of the baby is squashed up against the opening. His scalp is visible. At a guess I would say the diameter of the opening is about 5cm. This is only a guess from memory. It was hardly an ideal time to measure.
Lynn puts her index and 2nd fingers of her left hand between the baby's head and the woman's external organs. She is unable to get the scissors into position. The whole area looks stretched but no tear. She has to pull with the left hand and insert the flat blade of the scissors in between to baby's head and the opening of the vagina. She can not insert the scissors.
Lynn hands me the scissors. They are wet, slippy and suddenly look huge.
'I'll pull, you insert the scissors and cut.' She says, slightly out of breath
I notice she doesn't say 'please' or anything but I decide to let it go this time.
As Lynn pulls up on the labia I pop the scissors in. She strains under the effort.
'Cut, cut, cut.' She implores me. Again I note no 'please'.
I cut. Now before I complete the description I had never done this before. I think I saw it once as a student but that was a long time ago and I was probably hungover anyway. So I cut. Maybe a centimetre
Lynn watches, not quite in horror but she certainly looked surprised. She slowly moved her gaze from my incision and our eyes met. This was our 'Jaws. The Movie' moment. Instead of saying, 'We're going to need a bigger boat,' she said in a calm but very firm voice,
'A little more please Robert.'
A-ha now with the 'please'. I thought one snip would cause a sort of ongoing slice like when cutting fabric that is being held tight.
I literally had to chomp into the muscle. After a few centimetres I could tell that was enough. How could I tell. Well the little guy came flying out like a high-speed train out of a tunnel. I am sure he landed by her ankles.
After the usual clean up Lynn took the lady over to Cairns for suturing and routine check-up. Both mum, baby and midwife did well.
I often think how I would have done if no midwife was available. I like to think I would have done the same but I'm glad I wasn't tested.
Showing posts with label emergency childbirth. Show all posts
Showing posts with label emergency childbirth. Show all posts
Wednesday, March 25, 2009
A Most Unusual Birth
Working in the bush you get to see some unusual things. I took diabetic guy's shoe off once to redress his feet only to find one of his toes left in the dressing. He did not seem too concerned. I once looked after a baby who had a fever, nothing unusual except her mother had a strange squint, still nothing unusual but the squint was new and caused by the beating her husband had given her the night before, she had a fractured skull.
Most things you can get through. All wounds need to be cleaned and either sutured or dressed. All breathing problems tend to need a bit of oxygen and transfer out. All bacterial infections need anti-biotics and viral infections just rest, panadol and fluids. Start with airway and move through breathing , circulation etc etc etc.
The one area I always did feel out of depth was birthing. Generally late in pregnancy mothers to be are transfered to the nearest big hospital. Usually Cairns for Far North Queensland. Of course there was always a few who did not want to go or wanted their children born in the community.
Where I worked there was not always a midwife available. When they were around I always treated them really well.
Anybody can deliver a child when it is all normal and natural. It is when things are not going smoothly when the experienced bush midwife is worth her/his weight in gold.
So to get to the story. Most of my actions were little tricks that by themselves might not make a difference but together can weigh the advantages in your favour.
It was a cold and windswept night. Not really but I've always wanted to write that. It was a typically warm, humid, tropical night. I was on call and it was around midnight. The telephone next to my bed rang. It meant only one thing, a patient.
Usually the security guard will inform you during the call of any of his immediate concerns. Over the years these concerns would only be dramatic stuff, 'Rob, got a bloke here with a knife sticking out of his chest.' "Can you come over got a girl covered in blood.' and ' Pregnant lady.'
Tonight the call was for the pregnant lady. I wandered over and was there within a couple of minutes. I began collecting all the usual history. In essence what I wanted to find out was if she was safe to fly out, drive out or deliver here. She had had plenty of children and with no pregnancy or delivery problems before.
A midwife or suitably trained MO might now do a vaginal exam. Not me. In this case everything is pointing towards an imminent delivery, well most things. The missing factor is lack of fluid.
I try to get as many things together. Delivery equipment and the like, oxygen and suction equipment and a tiny air viva. From the fridge I grab the synto injection. I usually like to put a cannula in mother as well, not that they all need one but it gives me something to do.
Within a few minutes we are at the point of delivery. The top of the head is beginning to pop out. It looks a little pale. Before I can think about anything else out shoots the little guy.
I am astonished. There on the bed is what looks like a pod, fairly clear and inside is a baby. I have no idea what is going on so back to A,B,C. The only way t o check the airway is to remove the 'pod' . Of course, it is the membrane sac. It tears so easily I can't believe it did not rupture on the way out. The little guy is alright. He is soon screaming.
I ring Cairns Base Hospital. The midwife listens to my story. She tells me it is not common but certainly not unusual. For a few minutes I had thought I may be famous.
We go through all the usual post delivery checks. The lady and baby do not warrant a helicopter flight ( they are too well) so it is a long ride in the back of an ambulance for mum, baby and me.
Later on I find out these babies are considered lucky and sailors especially believed they never drown. I think people into astrology and the like also have some belief about them.
Over the next few years before I left the community the little guy did okay. He came for his immunisations, never seemed to be unwell and never had any difficulties in the water. Maybe there is some truth to the beliefs after all. Maybe I will go and check what the astrologists think. Mm mm.
Most things you can get through. All wounds need to be cleaned and either sutured or dressed. All breathing problems tend to need a bit of oxygen and transfer out. All bacterial infections need anti-biotics and viral infections just rest, panadol and fluids. Start with airway and move through breathing , circulation etc etc etc.
The one area I always did feel out of depth was birthing. Generally late in pregnancy mothers to be are transfered to the nearest big hospital. Usually Cairns for Far North Queensland. Of course there was always a few who did not want to go or wanted their children born in the community.
Where I worked there was not always a midwife available. When they were around I always treated them really well.
Anybody can deliver a child when it is all normal and natural. It is when things are not going smoothly when the experienced bush midwife is worth her/his weight in gold.
So to get to the story. Most of my actions were little tricks that by themselves might not make a difference but together can weigh the advantages in your favour.
It was a cold and windswept night. Not really but I've always wanted to write that. It was a typically warm, humid, tropical night. I was on call and it was around midnight. The telephone next to my bed rang. It meant only one thing, a patient.
Usually the security guard will inform you during the call of any of his immediate concerns. Over the years these concerns would only be dramatic stuff, 'Rob, got a bloke here with a knife sticking out of his chest.' "Can you come over got a girl covered in blood.' and ' Pregnant lady.'
Tonight the call was for the pregnant lady. I wandered over and was there within a couple of minutes. I began collecting all the usual history. In essence what I wanted to find out was if she was safe to fly out, drive out or deliver here. She had had plenty of children and with no pregnancy or delivery problems before.
A midwife or suitably trained MO might now do a vaginal exam. Not me. In this case everything is pointing towards an imminent delivery, well most things. The missing factor is lack of fluid.
I try to get as many things together. Delivery equipment and the like, oxygen and suction equipment and a tiny air viva. From the fridge I grab the synto injection. I usually like to put a cannula in mother as well, not that they all need one but it gives me something to do.
Within a few minutes we are at the point of delivery. The top of the head is beginning to pop out. It looks a little pale. Before I can think about anything else out shoots the little guy.
I am astonished. There on the bed is what looks like a pod, fairly clear and inside is a baby. I have no idea what is going on so back to A,B,C. The only way t o check the airway is to remove the 'pod' . Of course, it is the membrane sac. It tears so easily I can't believe it did not rupture on the way out. The little guy is alright. He is soon screaming.
I ring Cairns Base Hospital. The midwife listens to my story. She tells me it is not common but certainly not unusual. For a few minutes I had thought I may be famous.
We go through all the usual post delivery checks. The lady and baby do not warrant a helicopter flight ( they are too well) so it is a long ride in the back of an ambulance for mum, baby and me.
Later on I find out these babies are considered lucky and sailors especially believed they never drown. I think people into astrology and the like also have some belief about them.
Over the next few years before I left the community the little guy did okay. He came for his immunisations, never seemed to be unwell and never had any difficulties in the water. Maybe there is some truth to the beliefs after all. Maybe I will go and check what the astrologists think. Mm mm.
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