What a night!

I just had the best night in L&D since I began school. Finally my preceptor and I had laboring patients. Not cervidil inductions with "therapeutic" rest or Pitocin inductions. Actual patients who were in real labor, on their own terms. Freakin' finally! So when we got on shift, we had a pt who was pushing. Her birth was alright ... her OB showed up for literally five minutes, to yell at her for her pushing, impatiently cut a ML epis, delivered the baby, the placenta, threw a stitch in the perineum, gave a quick fundal massage and abruptly left. I swear he was there for no more than five minutes. We finished her recovery period, did pericare, fundal massage, took VS, straight cath'ed her, got her cleaned up and ready to go upstairs (postpartum). Pretty much within minutes, we were admitting someone else in actual labor. She was sent from the office because she was dilated 4/80%/-2. She denied feeling any of her q 2-3 minute contractions, but happily made progress until 7 cm when she politely asked for her epidural. She was such a wonderful patient. I wished we could have been there for her delivery.

My most favorite patient was this woman who suffered from Marfan's syndrome. She had a PMH of preterm labor and she labored quickly. She came in dilated 4/80%/-2 with regular contractions. We got her comfortable and she labored well. I got to check her cervix twice after she got her epidural. She went quickly from 5 to 7 to complete. She pushed maybe a half a push and her baby was born. Her OB was fantastic. Probably the best OB-attended birth I've ever seen. He didn't break down the bed and put the pt in stirrups. He sat at the edge of the bed, encouraged her to push when she felt ready, basically caught the baby, let dad cut the cord and told him to "present" his baby to the world. Dad picked up the baby and presented him to mom and grandma. Baby went immediately skin-to-skin with mom (this has been the first time I've ever seen the illusive immediate postpartum skin-to-skin.) Mom's OB said that his midwives had been rubbing off on him. Intact perineum, no rough man-handling of the placenta, no loud provider-directed pushing, no alarmist comments; overall, very reassuring, calm and collected. He stayed for a little while afterward, but it was a really quiet, low-key birth. Awesome way to end an 8 hour shift.