Clinic day #34

I saw the next mum that I have due and her cervix is ripe and ready to go and the baby's head is nice and low... anytime now (or of course, it could be two weeks!)!

Clinic day #33

A pretty straightforward clinic day...

One of my client's unborn baby is growing very slowly. On ultrasound she is below the 10th percentile and is now being followed by an Obstetrician, though she is close to term and it is my opinion (I'm not an OB, mind you) that the size is due partly to genetics and partly to smoking, she will probably simply need close observation. So far the doppler flow studies and amniotic fluid volume is normal and the baby is growing symmetrically.... fingers crossed, it will remain that way and she'll be transferred back into my care for delivery.

The kid is just messin' with ya

Interestingly enough, I have a first-time mum with a transverse baby: the baby instead of being head down like they are supposed to, is lying side to side! This is quite unusual because usually there is not a lot of room in the uterus for that much turning that late in the pregnancy! At 34 weeks, it was head down, and then at the 36week visit it was back to lying sideways again! So, I sent her for an ultrasound to confirm that fact, then tried to arrange an OB consult for a possible external cephalic version (where they try to manually turn the baby from the outside of the belly). I was having trouble arranging a consult - so many OBs taking vacations, etc. I faxed off the consult to the third OB and went to do the mum's home visit. Wouldn't you know, the kid was head down again! So, I'll be seeing her twice weekly to confirm head down, since the kid is so mobile! It will be interesting to see how it turns out...

Clinic day #31 & #32

There were a bunch of births last week for me, so most of my clinic was rescheduled to Monday this week, and then of course my regular clinic for Tuesday.

I checked into some prices for my clients who don't have health care coverage and found out that a hospital stay overnight (which includes a labour room for 24 hours) is $1700. If they want an epidural, they have to bring cash to pay the anaesthetist and it is about $500. Expensive, but not as expensive as some places in the States: I heard that a normal vaginal delivery and associated costs can run $10,000!! [I don't know if this is actually true]

Other than that, nothing really interesting to report...

A race for the lucky day

As you are all aware, yesterday was the 7th of July, making the numeral date 07.07.07.

Apparantly everywhere was booked solid for weddings, and several of my clients thought it would be neat to have their babies that day.

At noon I was paged with a mom in early labour. We talked and determined that it wasn't quite time for me to come yet. Shortly after 15:00 she paged again and I went out to see her. She was 2 cm and about 60% effaced with the head at -2. Her contractions were only 30-40 seconds long and she was talking through them no problem. I told her that it wasn't quite time for me to stay yet, and to call me when the contractions were longer (45-60 seconds) and stronger.

She repaged at 19:45 and when I went to her place and checked her at 20:10 she was a generous 3 cm and 95% effaced with the head lower at -1. Since she was GBS positive I started up her IV and she continued to labour. She walked around for a while, with contractions gradually getting closer.

She had a tub set up as she wanted a waterbirth, but with her contractions still only 5 minutes apart and 45 seconds long, I didn't think it was quite time to get in, I wanted labour to really get going first. So she walked around for a while and they got closer together, then she sat on the birth ball for about an hour and they spaced out to every 4-5 minutes again. So I recommended she get up and walk her stairs. That really got them going - every 2-3 minutes, and she was starting to have extra rectal pressure. "I feel like I have to poop and can't!" As I normally do, I said "That feeling is the baby moving down and pressing on your rectum - that poop has arms and legs!" Most mums aren't too amused with this humour (maybe I should reconsider my wording...), but she laughed, which left me wondering if she was indeed entering transition. This was around 2300. But, with strong contractions and rectal pressure, I recommended the tub. She climbed in, and between contractions continued to watch the Live Earth concert that was on TV. Her contractions briefly spaced out but gradually got close and then midnight passed, rats! About 10 minutes later, she started making grunting noises... her water broke, and she had her baby beautifully at 0020!

It was a beautiful birth and the mom coped just wonderfully! Baby girl, 8#13oz.

[Sidebar: this birth was the second in my career where my backup midwife didn't make it for the delivery because the pushing went too fast!]

Preemies

Lately I have had a spell of premature babies.

About 2.5 weeks ago a mum called with leaking water at 34 weeks. So I transferred her care to University Hospital with instructions to keep me posted on the plan and I would attend the delivery as supportive care.

On Monday I was called to check on a first-time mum who was in early labour at 32 weeks. I also transferred her care to University Hospital with the same instructions.

I returned on call to discover that both of these women had delivered - the first one before I went off call, and she didn't let me know to come and support her! The second one delivered while I was off call, and since she knew that I was off call, she decided she was fine without a midwife she didn't know supporting her - she had good support with her mom and partner.

Both babies are doing well - baby #1 is home and gaining very well. Baby #2 will be in hospital for at least a few more weeks, but I talked to the mum today and she is doing very well. I haven't had a premature baby in a long time, then two in a row!

People's attitudes are often interesting to observe and occasionally they are mildly incomprehensible.

I have a client that has an interesting history: a history of alcohol and drug abuse (she tried to abort the pregnancy with these early on, which didn't work), and the relationship that produced this pregnancy was very new. Because of the drug use I was obligated to make a report to the Children's Aid Society (CAS). They usually want a simple drug test for the baby and if that is fine, then there is no further involvement needed. My plan for this client was to bring it up at her last appointment, when she was 31 weeks. By that point we would have established a relationship of trust, but it was still far enough away from the birth that we would have time to deal with CAS in a reasonable manner. She came into the office for her appointment in a rather unstable mood, and we had a talk about depression and I referred her to the clinic that has a depression treatment program. I decided to hold off on letting her know about the need for CAS involvement until the next appointment two weeks later.

A week later, I got a page from her: she was having contractions, every 10 minutes, lasting a minute. So off I go to check her at home. Most of these calls are false alarms: Braxton-Hicks contractions or ligament pain. I arrived at her home, and palpated a pretty good contraction. So I check her, and lo and behold, she is 2cm dilated and 75% effaced, with the head nice and low! So, I called the obstetrician at University hospital and she requested I send her in by ambulance. I let the client and her partner know that she was in labour and that we were going to send her in by ambulance. Her reaction was atypical to say the least. Most moms at 32 weeks would be super-worried: the baby isn't ready to be born yet! She and her partner were very excited and happy that she was in labour! Strange indeed...

Anyway, after starting the IV I explained that CAS would need to be involved, and she was okay with that plan. She was 3cm by the time she got to the hospital, but then her labour quit and now we are waiting to see what will happen...