First catch

So I'm all over that whole back-dating, cheating-on-when-you-post thing I guess. Here's the story of my first catch:

At 6:20 am I jumped out of bed and took one of those showers where all your hair comes out. You know, the kind after you've skipped a day and worn a ponytail all day to disguise the grease. I am technically supposed to be at the hospital by 7, but most of the nurses have this nasty habit of showing up at 6:30, so whatever. Anyways I was 15 minutes late but it was okay because my preceptor had been on call all night and was still sleeping in the call room when I arrived. :)
I went to resident rounds, spoke up and felt really dorky in front of the docs, saw the single postpartum patient with the midwife, and started to sit around and talk to the care partners and get bored. Around 10 the charge nurse said, "good news! a midwife patient is coming in, she's in labor!"
So I jumped a lot in the hallway.
She didn't speak much English, was Muslim and only wanted female care providers. Mostly her husband talked for her, but when he went out to smoke we talked about her life before Tennessee and her family. This was her 4th baby, she'd had one previous section and the last two were vag deliveries, so she was cool to have another one. She was 40 weeks and a few days. She came in at 5 cm, contracting every 3-5.
She asked for an epidural at 6-7 cm, about an hour later, and everything just stopped.
She went to sleep for a couple of hours and I just sat there and talked with her husband. When I asked him, he said he wanted to do that thing where the first words the baby hears is her father's prayer in her ear. Later I went around and told the nurses that we should try to be quiet after the head was born so they could do that. That was probably sort of annoying of me but I was REALLY excited that I remembered that thing about Muslim births, and wanted to advertise my cultural competency probably. Whatever.

After 4 hours of sleeping with contractions getting farther and farther apart, like 15 minutes, we asked her if we could break her water. She said yes. She had a few contractions, and I sat her up in bed, and an hour later they were almost gone and she was sleeping again.
Then I thought, "I can't be a midwife. I'm too impatient. This is making me crazy." And I felt like I understood why people get in such a rush sometimes, when there's not really any indication. The baby looked great on the monitor, there was no mec in the amniotic fluid, things were fine. I didn't feel the urge to check her a lot, just to get things going again.

So I tried to read my textbooks about the dangers of using pit in a VBAC and chill out. Then the midwife was like, "yeah, let's pit her, she's totally stalled out." I was really excited, because our shift was over in like 2 hours and I really wanted to catch this baby. After a lot of discussion and an embarrassing faux pas with the nurses, we got in there with the pit, explained our recommendations, checked her, and discovered she was complete. So, no pit. :)

After a few minutes, she started pushing, and the midwife had me check to see if she was actually moving the head further out with each push, because she still couldn't feel anything. Then I was the one at the end of the bed, encouraging her to keep going and also to take a break and I felt a little awkward but psyched. When we could see the head, I gowned and started supporting the head like the midwife was showing me, one hand on top and one on bottom. And then I think a lot of nurses and people were in the room, and the midwife's hands were on the sides of the head, pushing back her labia gently. The head was born, and I did the bulb suction thing even though I wasn't planning on it, it didn't seem like the time to argue with the midwife, and then I started to push the head down, but the midwife wanted to do like a see-sawing thing with the head to get the ant. shoulder out. It came, and then I tried to squish the shoulders in towards each other so the baby wouldn't fling an arm out and make Mom tear, but I was trying to hold the head at the same time and I couldn't really squish with one hand. The top arm came flailing out but luckily she didn't tear.

Then it was all out and I put her up on her stomach and all these nurses started rubbing the baby all over, and I tried to help but the midwife was like, "ignore the baby, you need to focus. what do you want to do with this cord?" It was a pretty short cord, so I clamped it and the Dad said he didn't care about cutting it, so I did so the Mom could hold her close. Then I had my hand on her belly, and the midwife asked me to run through the signs of placental separation, and by some miracle I remembered all 4, but the only one I actually saw was cord lengthening. I guarded her uterus and had gentle traction on the cord (actually it was harder than I thought it would be) and after a few minutes, followed the cord up with my fingers to see if the placenta was waiting inside the introitus. It was, and so we see-sawed again, and asked her to push, and then it started to come so the midwife grabbed it and started to twist but I took it away from her because I knew what to do. :) It was really slippery and weird, like trying to hold together a cup of water in an unzipped baggie, except it was as big as a restaurant dinner plate. Then it came out, and I started massaging her fundus (which was also supposed to be harder than I had anticipated) and her uterus got nice and firm so I stopped to see if she would bleed. Then the nurse asked me for estimated blood loss, and I said 200 mL, and the midwife said "perfect. exactly what i would have said."

Then I looked for lacerations, and checked the placenta, membranes and cord, and then the Mom and Dad were like thank you so much, and THEN I started crying and the midwife made me go chart this long delivery summary thing while my nose was still running.

It was brilliant. I can't wait to do it again.