A nice birth...

I walked in yesterday morning to my patient pushing. I always hate to have shift change in the middle of a delivery. Really, this is the thing that I hate the most out of my job in comparison with my life as a doula. As a doula, I was with my client from the time that she thought that she was in labor until many hours postpartum. But, I will admit that if it is the end of a 12 hour shift for me and I know that I have to come in the next morning, I leave if birth is not imminent.

This patient was a 19yo G1 who was being induced for PIH. After a very long induction (cervadil, followed by another cervadil, followed by a balloon, now on 34{!}mu of pitocin). She was also on magnesium sulfate for her B/P. We use Mag for two things in LAD 1) to lower high B/P in someone with PIH and 2) to stop preterm labor. Mag is a smooth muscle relaxer, the vascular system is made of smooth muscle (thus the lowering of B/P) as is the uterus (thus the stopping of contractions in a pretermer). Induction of someone on Mag for PIH is very difficult. It is a dance between having the Mag at a therapeutic level, watching the fluid ins and outs, and having the pitocin at a high enough level that the contractions are adequate to dilate a cervix which may not be ready. I was relieved though to see this little G1 push the baby to +2 with each push! Baby was sucked right back up in between ctx though. She had come a long way by this point, truly against all odds.

Her night nurse was one of my favorite nurses and her care throughout the night was perfect. I did notice a little laceration just with her pushing effort (without my hand in her vagina at all) and proceeded to lube her up with mineral oil. I kept my hands out of her vagina for pushing as she was pushing in just the right spot. I suggested that she reach down and touch the head, she did! She ASKED me for a mirror to watch the birth! She kept pushing and 46 minutes after shift change delivered a beautiful little boy! `He did great btw. After the NI nurses were done with him, I put him immediately skin to skin with mom. She was still in repair. She ended up with a 3rd degree lac which honestly, I was kind of expecting.

She really impressed me. She was adamant about breastfeeding right away, did not want baby to have a bottle at all in the hospital, initially wanted circumcision, but started to question that decision after I told them that circumcision was not recommended by the AAP. She and the FOB were just so open to suggestions. It isn't very often that I have a patient who is so informed at 19 and so open to the process.

One great thing about a patient with PIH is that I get to keep them after they deliver. They stay on L&D on Mag for 24 hours after delivery, which meant that I had her and her family all day. Even in her "Mag'ed out" state (Mag makes women loopey and out of it, like they have the flu) she was still watching the clock to make sure that she nursed her baby every one and half to two hours. Her family was really helpful with the care of the baby.

I had another delivery in my other room later that afternoon. A lovely multip easy birth, but the one that will stick with me was my little G1.