Busy times, clinic #9
Births on Monday, Tuesday and Wednesday.
I had two moms, both second timers that I was expecting to go rather quickly.
Monday's homebirth dallied around until we took her in. We gave her an epidural, and then finally to section (she did end up progressing to 10 cm, but with the very slow progress and no descent as well as an increase in the baseline uterine pressure [the OB put an intrauterine pressure catheter in] causing pretty much tetanic contractions, the decision was made to go to caesarean section). The baby apgared at 9 and 10, but 30 minutes later he stopped breathing and turned a very dusky grey. I thought he was choking, so stimulated him and suctioned him. I also noticed that he was shaking his arm kind of funny, and I called the Head Midwife over to see if she thought it was a seizure, which she didn't, but he was pretty much stopped by then. She said we would observe and do a paed consult if he did it again. After 2 hours of observation, he didn't do it again, so we discharged him to the nursery. After I got home the nursery nurse paged saying that he was having grunting, flaring, and retractions, so I did a paed consult. While they were examining him, he started a full blown seizure, and shortly after that had another one. So off to NICU... and rounds and rounds of tests. Turns out that it was caused by high intracranial pressure, and as that wore off, so did the seizures, and he will not likely have any lasting effects. The thing was that he had moulding, but not a lot - I have seen plenty worse with no issues. Anyway, I'm glad that it is resolved. It was quite the learning experience - I now know what a neonatal seizure looks like: much milder than adult seizures.
Tuesday's birth was a 'butter' birth - at home, quick, and beautiful.
Wednesday's birth I assisted at. A lovely birth, the mom was so calm and peaceful through it all, and there were lots of tears throughout the room as she delivered, especially from the 10(?) year old son, happy tears... I had tears come to my eyes too, as there was a lot of love present, and it was palpable. There was also something at this birth that I've never seen - trouble delivering the posterior (or bottom) shoulder. Her perineum was very tight, and finally it tore pretty badly when the posterior shoulder delivered. The midwife at first thought that it tore into the anal sphincter and that we'd have to get an OB to repair it, but after a thorough inspection, we could see the sphincter intact. It did take some time to repair it.
And of course, the rest of the week was taken up with doing home visits for these moms and clinic, which was relatively uneventful.
I did get a page from a mom who works with animals, and she had been exposed to leptospirosis. My internal response was: lepto-what?! But of course I maintained a professional demeanor (I hope!), and said that I'd investigate what to do for that. So I consulted with Maternal-Foetal-Medicine and they consulted with Infectious Diseases. Turns out that the incubation period for this infection is up to three weeks, so if she feels anything, even a vague sense of not feeling perfectly well, she will be treated with antibiotics. There is not an extended amount reported in the literature, but apparantly it can cause abortions. So there was a bit of back and forth for that too.
Ever learning, and ever serving. I love weeks like this!
I had two moms, both second timers that I was expecting to go rather quickly.
Monday's homebirth dallied around until we took her in. We gave her an epidural, and then finally to section (she did end up progressing to 10 cm, but with the very slow progress and no descent as well as an increase in the baseline uterine pressure [the OB put an intrauterine pressure catheter in] causing pretty much tetanic contractions, the decision was made to go to caesarean section). The baby apgared at 9 and 10, but 30 minutes later he stopped breathing and turned a very dusky grey. I thought he was choking, so stimulated him and suctioned him. I also noticed that he was shaking his arm kind of funny, and I called the Head Midwife over to see if she thought it was a seizure, which she didn't, but he was pretty much stopped by then. She said we would observe and do a paed consult if he did it again. After 2 hours of observation, he didn't do it again, so we discharged him to the nursery. After I got home the nursery nurse paged saying that he was having grunting, flaring, and retractions, so I did a paed consult. While they were examining him, he started a full blown seizure, and shortly after that had another one. So off to NICU... and rounds and rounds of tests. Turns out that it was caused by high intracranial pressure, and as that wore off, so did the seizures, and he will not likely have any lasting effects. The thing was that he had moulding, but not a lot - I have seen plenty worse with no issues. Anyway, I'm glad that it is resolved. It was quite the learning experience - I now know what a neonatal seizure looks like: much milder than adult seizures.
Tuesday's birth was a 'butter' birth - at home, quick, and beautiful.
Wednesday's birth I assisted at. A lovely birth, the mom was so calm and peaceful through it all, and there were lots of tears throughout the room as she delivered, especially from the 10(?) year old son, happy tears... I had tears come to my eyes too, as there was a lot of love present, and it was palpable. There was also something at this birth that I've never seen - trouble delivering the posterior (or bottom) shoulder. Her perineum was very tight, and finally it tore pretty badly when the posterior shoulder delivered. The midwife at first thought that it tore into the anal sphincter and that we'd have to get an OB to repair it, but after a thorough inspection, we could see the sphincter intact. It did take some time to repair it.
And of course, the rest of the week was taken up with doing home visits for these moms and clinic, which was relatively uneventful.
I did get a page from a mom who works with animals, and she had been exposed to leptospirosis. My internal response was: lepto-what?! But of course I maintained a professional demeanor (I hope!), and said that I'd investigate what to do for that. So I consulted with Maternal-Foetal-Medicine and they consulted with Infectious Diseases. Turns out that the incubation period for this infection is up to three weeks, so if she feels anything, even a vague sense of not feeling perfectly well, she will be treated with antibiotics. There is not an extended amount reported in the literature, but apparantly it can cause abortions. So there was a bit of back and forth for that too.
Ever learning, and ever serving. I love weeks like this!
posted by Stork at 5:34 PM
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