It’s a numbers game

So it’s been a while, but today’s circumstances mean I really have no excuse not to write. I’m trapped in my car, staring at a massive orange wall in the blazing sun, facing a two hour wait.

It’s my own fault, but still unplanned detainments really annoy me. I was on my way to the birthcentre for a postnatal visit when I got pulled over for a breath check. And before you jump to conclusions I passed that! What I didn’t pass was the licence check. Apparently it’s been expired for a year. Oops. That sort of stuff isn’t ever on my radar. So facing a $400 fine if it wasn’t in the system in 24 hours I had to call in to get a new one on the way home. Loads of locals passed me as I was pulled over too, there will be rumours of the drunken midwife at 10 in the morning flying around town.

Only to be told by vtnz that I had a one to two hour wait! Clutching my laminated number I managed to convince the bloke to let me leave to go to the public toilets (and not lose my place in the queue) I also bought some sushi as I figured the time consuming placement of the wasabi ‘just so’ would help keep me entertained. Anyway it only took eight minutes to inhale that and now I’m bored. And hot. And crabby. It’s amazing how covid has made us just accept stuff, this really is an unacceptable wait time regardless of a pandemic, they wouldn’t even give me the forms to fill in in the car. I’d quite like to walk in there and start ordering people around. I really don’t do inefficiency well. The bloke is deftly avoiding eye contact through the windscreen too, he’s a pro. I do admire that.

So back to babies… the visit I just did was to a baby that was four and a bit pounds when he was born a couple of weeks ago, due to growth restriction in utero. I’ve never cared for a term baby that small - It’s hard not to comment every time you see those little chicken stick legs! But he is going great, heading home tomorrow and will require a bit of extra vigilance on my part but I don’t foresee any major concerns.

This wee man was one of four births I had in a week after a long lull. Always the way. All or nothing.

The first started with ‘Reduced Fetal Movements’, a term that sends a shiver down every midwifes back. Mainly because it’s a complete pain in the proverbial and usually turns out to not be a concern. But there is that slim chance that the baby could be in danger so it can’t be ignored. Every woman has a pattern of movements in the third trimester from her baby that is unique to her. Gone are the days of saying if baby moves the magic number of ten times they are all good. Now it is individualised.

I had my reminder of this with one of my clients having her sixth baby. At 39 weeks during our usual appointment the movements were ‘different’ she said. Now different how? Less decent kicks and more rolling - as is often the case - or less often, kicking into a different place, a different time of the day maybe? There’s a whole lot of investigating to do, all of which culminate in a trip to the birthcentre for a half hour monitoring.

This never usually happens at lunchtime. It’s always at 11pm when she’s slowed down for the day and had time to notice. It’s one of those emergency call outs for a couple of hours that your plumber would get $500 for. And usually the trace of baby's heartbeat is reassuring and baby palpates in a different position under our hands to explain why the movements felt different. So the woman gets sent home again and we put a little red flag in our brain that if it happens again it may need escalating. Then we get home at 1am and try to sleep.

For this client though the trace wasn’t reassuring. Baby was having decelerations of its heart rate. With no accompanying contractions as the possible cause this was really concerning. So she was sent up to the hospital and a plan was made to induce her labour. I was phoned a couple of hours later when her waters had been broken and contractions had started. I went up immediately as this client had a history of very fast labours. The last one was 28 minutes from first contraction to baby crying. We made it to the birthcentre with only two minutes to spare. Due to her precipitous labour’s (yes that really is the term) she doesn’t enjoy her births and in fact was dreading the whole experience. She tends to detach herself from the situation and pretend she’s somewhere else. Good to know.

On my arrival she was 5cm dilated (whew loads of time) and while the staff midwife was handing care back to me the baby started to have another deceleration, which turned into a ten minute bradicardia down to a heart rate of 40bpm (normal is 110-160bpm). We rolled her on to her side as sometimes it is baby impacting on their own cord that causes this issue. Then the emergency bell was pushed and the troops started racing in. All at the same time as this client disassociated herself from the situation in order to cope and became unresponsive to our requests. Hard to convince a room full of panicked medical staff that this was her normal reaction to birth and we didn’t also have a medical problem with the mother

She was then acting transitional (panicked and writhing on the bed) as they prepared to go to theatre for an emergency caesarean. I wanted to know if there was time to actually get there before baby came, so I did a vaginal exam - on her side as she wouldn’t roll to her back - still lots of cervix, although no way to get an exact dilation in that position. Then we were told theatre was full. So then they were ringing main theatre which is a four minute sprint to get to. Baby’s heart rate was slowly going thud… thud… on the machine. All twelve people in the room could hear it. Midwives, baby doctors, obstetrician, nurses and a health care assistant to fetch stuff.

There were too many yelling voices and too many chiefs. The consultant at the end of the phone adviced the registrar to give a tocolytic to try to slow down the contractions. Like me he thought we didn’t have time to get to theatre, that the baby was coming. The decision was made to head to main theatre anyway. I changed into scrubs in the room as dad was doing the same thing in the bathroom. The poor dad and those twelve medical staff all saw me in my undies 🤣. What a treat.

Thud…

Thud…

As we were transferring my client to a theatre bed (maybe they have faster wheels???) that had been bought in and placed beside the bed she was on, she then became a complete dead weight and in agony with the pain. The only option was to drag her over. I shouted at the room again to find a birth pack as I was sure baby would be born on the way - with my luck probably outside the cafeteria. Still there were a load of shouting voices and racing feet with only me with the woman, they were all so busy. This then culminated in me catching a baby after only one push - while the mothers legs were on one bed and her torso on the other! I then acted like an elephant impersonating a ballerina (on one leg )- to lunge over and catch the baby. Only one other person in the room realised he was coming. The others noticed when the baby instantly cried and I instantly laughed.

Probably like a maniac.

The bed linen was spotless. The floor in between not so much.

Wow. That was fast. It was 12 minutes after my arrival.

It’s ok though, eventuallly I stopped laughing.

Oh gotta go… he’s looking at me!!! And I’ve lost my bloody number.