Diary of a student midwife!
http://20six.co.uk/maddison
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Farewell, for now!
Thank you for all the 'where are you' messages I have received! I'm still around, and still a midwife! I havnt posted for aaages cos my computer died and I have limited internet access.
I am still loving labour ward and have learnt a lot. I have nearly got my IV drugs certificate- have given loads, just need to do the dreaded work book and have 'the talk' with the training midwife to ensure i'm competent. The same with my epidural top ups- just need to chat with the anaesthetist. Still havnt sutured! Had a good teaching session though and feel confident to give it a go now, when the opportunity arises. Still not signed off for cannulas!- can do them but get scared and dont attempt it!
My social life is finally getting back to normal, after 4 years! There are a group of us that go out on the beer fairly regularly so i'm feeling a little less like a hermit!
So, as of next month, I have been qualified for a year, therefore I dont feel 'Diary of a student midwife' is appropriate anymore! The 1st year after qualifying is a HUGE learning curve and has been fabulous, but at work i'm not a classed as 'newly qualified' anymore, and certainly not a student. That is why i've decided to lay this blog to rest. When I sort out my internet, i will give birth to a new blog about life as a real life midwife (if I can figure out how too- and can have 2 blogs!), and will post on here its new title!
Thanks to all the potential midwives, real midwives, pregnant ladies and new mums that have followed my blog! See you all in a maternity unit soon!
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A fabulous end!
After the twins were sorted I did a few odds and ends (early labourers, post sections etc) then was asked to look after a primip who'd come in this morning with SROM.
P and her husband were 17 and childhood sweethearts. At her last ve (10 mins previously) she was 7cm with head at -1. She was coping amazingly with entonox and hardly looking like she was in labour. We discussed syntometrine and I put it to her in a way that it was a 'consent for it if its needed' rather than 'consented given so definately give it'. She was quite happy for a physiological 3rd stage and preferred no injections.
An hour and a half later she was making small grunty noises so I thought 'ill just ignore that- la la laa' (i like to deny 2nd stage as long as possible!). Dad went out to move the car. I listened to the FH and heard an early deceleration. Almost at the same time I noticed her bearing down a bit more so I had a peek- and saw vertex! 
I told her the news and she was so shocked bless her! I encouraged her to push, and the head was descending quickly. I was going to get her to breathe through so dad didnt miss anything, but the FH was dropping to 70bpm and taking longer to pick up each time. I brought a resuscitaire into the room just incase. She pushed amazingly and dad walked in the room 5 minutes before we had a little boy! (30 min 2nd stage!). He was a bit shocked and making a feeble effort to cry so I let dad cut the cord then brought him to the resuscitaire. He needed a good 5 mins of facial O2 but came around fairly quickly (apgars 7 @1 and 10@5) when he went to dad for a cuddle- who was amazed!
I took cord blood for electrophoresis then took the cord clamps off and 'bled' the cord (helps with detachment with physiological 3rd stage- and almost impossible to get cord blood afterwards!). She sat on the loo with a bed pan and we had a placenta 15 minutes later. She also had an intact perineum.
I went home absolutely elated. It was one of the most fabulous births i've had the pleasure of being the midwife for! (and if I could do as well as her- i might consider doing it..... ok not really!)
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Busy day- part 1!
Ok- went home last night leaving a primip with twins and her doula ready to fight for normality. The doula was very pro-active. She wanted to use the pool and wanted to speak to the consultant if she couldnt. She was refusing monitoring, had the room in darkness and refused a cannula! It was very difficult though, cos i got the impression that the doula was fighting for what she thought the mum should want, rather than what she did. I could be wrong, they could have decided extensively beforehand, but it didnt seem that way. She was aggressively assertive which was difficult.
I came on this morning and mum had been in the pool ALL night- draining meconium! She was found to have an anterior lip so came out (she had agreed to deliver in theatre). The night registrar stayed on and was fantastic- very up for letting her get on with it. We had her bed in theatre and she was on all fours and standing/ squatting. I dont think I have ever sat on the floor in theatres before- it was brilliant! Mum however was so so shattered and had no strength to push, though was doing brilliantely. The reg discussed ventouse in a 'this is an option if you wish' rather than a 'you must do this' way, and mum was thinking about it. The doula piped up saying 'WELL, I think you're ALL being very negative'.  We wern't- we were being unbelievably positive cos we knew there was no way she'd have the strength to push anymore- even she said that, but were still telling her how well she was doing and how she could do it.
She then made the choice to have a ventouse (kiwi cup) but no epis. We reassured her that she was still birthing her baby cos she still had to push to help. The head was still -2 (high). Shortly afterwards we had a gorgeous girl followed by a boy. We waited and waited for the boy and mum still pushed well but he started getting unhappy and was helped out with forceps. The blood gases were on the low side so he was definately ready to come out.
All in all- not the perfect normal delivery mum planned, but far far from the obstetric lead twin births we're used to. She was still elated and knew she'd been the primary force in birthing her babies.
This was only 11am... 
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The clock has gone!
Ok- have had several requests to get rid of the annoying clock so I have! I too hated it but couldnt be bothered figuring out how to take it off! It wont be back!
Day off today- just waiting for my mum to drive down, then we're off shopping!
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Update!
Ok update! I have decided that the best way to get on in this job is just to throw yourself into the deep end! I didnt say in my 1st post but mum lost 2.5 litres at delivery, needed misoprostal and haemobate and a Rusch balloon (*see bottom for explanation). When I came on today she was officially 'high dependency'. 'shit' I thought cos have only ever done HD as a student with a mentor but really got on well with mum and felt i would be abandoning her so I took over. I actually remembered more than i thought i would and managed to do the fluid balance chart and obs chart ok! Did balls up the Iv antibiotics though- was trying to mix it but couldnt get the water into the vial- pleb! Then when i was putting it through the cannula, slipped out and sprayed all over me and mums faces! 
She had synto running, restricted IV fluids, frusemide running as reduced urine output, a PCA, IV antibiotics and the Rusch balloon was slowly being reduced! She had also had 4 units of blood cos Hb dropped to 6.0 
The Rusch balloon had had 400ml taken out and they were doing 100ml an hour- however I remembered the consultant saying yesterday that once 100ml was taken out- if she was gonna bleed she would then, so i passed it by her then whipped it out!
Her urine output was fine after the frusemide so after running the synto for an hour, I reduced it down, then took EEEEverything out to the joy of mum! (basically said to registrar- this is this and that is that so this is what i'm doing- that ok?!)
I then took her to see her beautiful babies for the 1st time. Twin 2- the boy, is in the intensive care room but just on CPAP and doing great. He weighed 2lb 2. Twin 2 is just in high dependency and just in an incubator on air- no CPAP. She weighed 2lb 12.
Have realised how important our job is in these sorts of cases. I love my normal midwifery and helping women achieve the birth they wanted, but we can be just as and even more valuable to women like this one. One thing she said will always always stick in my head. When the babies came out and were being worked on, I was busy listening to the heart rate and letting the reg know what was going on and forgot mum was lying there worried sick. She told me she was scared stiff and looked for me, when she caught my eye I stuck my thumb up and smiled and she 'knew everything was going to be fine and felt ok again'. How special is that?
I'm off the weekend so cant follow things up but they are going to be fine!
(* Rusch balloon for those who dont know cos we've only started using them! When a woman is having a PPH- this thing can be used to stop the bleeding. It looks exactly like a catheter but with a floppy balloon on the end. Its put through the cervix into the uterus and inflated with 600- 1500ml of warm saline. This puts pressure on the walls of the uterus in the same way as you put pressure on a cut anywhere else on the body. It is kept in there until it is safe to take out- (ie when an obstetric consultant is around and consultant radiologist). You then take out 100mls. Once 100ml is taken out, the pressure is taken off the uterus so she would bleed at that point if she was going to. Once you know she's not it can all just come out)
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Twins!
Had a very exciting day today! Came on an early to find the lady I saw on Sunday with the SROM (waters broken) at 30 weeks had come back from the AN ward with tightenings and signs of infection (high temp/ racing pulse/ generally unwell). I offered to look after her as I knew her well, and it would be good experience for me.
When I went in, her obs had settled down with IV antibiotics but she was still tightening. We got her latest bloods back and her WBC count had risen a lot (sign of infection). We were waiting for further bloods so I had to phone biochemistry and sweet talk a doctor to do them asap (he 1st told me 2pm at 8 o clock!)- i got them back at 10am and they also showed signs of infection. I learnt a lot about bloods I'd never heard of! Twin 1 had no liquor and Twin 2 had no EDF (end diastolic flow- placenta not working properly basically!). With all this, the decision was made to deliver the babies.
We hung around from 11am for a theatre to be free but this helped me out cos I knew I had done everything then! (IV antibiotics/ TEDS/ gown/ canvas/ ranitidine/ consent/ baby notes etc etc). By the time they were ready it was 2pm and my shift was over but I couldnt leave then! The afternoon midwife was happy for me to come in as 2nd midwife.
They were teeny weeny, looked more like 27 weekers- twin 1 went to the paed SHO and just needed a few inflation breaths. Twin 2 came to the paed reg and myself and wasnt doing so well. I had to listen to the heart rate and tell the reg what it was- er, shitting myself! It was easier than I imagined tho- his heart rate was around 80bpm for a good 3 minutes (not great) so he was intubated. It then came up to about 120bpm. I was surprised how easy it was to hear- all those years of listening to CTGs ba boom then slowing down was good practice! The reg was using the neopuff through the ventilation tube to breath for babe so i asked if I could have a go (I always ask to do anything possible!). Very good practice and it was obviously easy enough but surprisingly scary being responsible for this scrappy little thing's breathing! He was attempting breathing himself by the time he went to SCBU (in his plastic Tesco carrier bag no less!) so he should be fine!
Will update on how much they weighed and how mum is doing when I know.
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More quickness!
Today was looking after a P0 who had come in at 1cm dilatation and wasnt coping so was given an epidural and syntocinon. She was contracting beautifully all day. 4 hours later she was still 1cm. 4 hours later still the same. At 7pm she was deciding on wether to have a cesaerean or not.
I walked out of the room at 7:20 to get her an epidural top up and an MCA called from another room that she needed a midwife 'quick'! I ran in to find a woman on all fours on the bed pushing- she had arrived 2 minutes before. 8 minutes later we had a baby! The sister in charge came in and said i needed a doctor cos she was only 35 weeks- i said i didnt even know the womans name! Babe was absolutely fine though. She went up to special care cos was having to work a bit hard at breathing but was otherwise cool! I then introduced myself to mum!
Great shift!
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