O&G Labour Week Part 2.

Tiring second half of the week. No joke. Again I underestimated/didn't give labour week enough credit. I thought it was going to be complete crap...but this week has proven me wrong. I wouldn't say obstetrics is my cup of tea, BUT it has certainly earned a lot more respect from me. The midwives are so hard working and enthusiastic despite their ridiculously long shifts. I think the most frustrating part about obstetrics is that it is either very busy or very quiet. When it is busy, time passes by extremely quickly...but when it is quiet - holy smokes...it is painful as all you do is just sit around and zone out.

Day 3 - Because I only had 1 thing left to be signed off on my log book (instrumental delivery) I was literally running around and broadcasting to the midwives and doctors that I need to see an instrumental delivery. Essentially showed up early...again struggled with arriving for 7am, but tried my best. The midwives suspected that one of the rooms will need an instrumental delivery so they told me to keep an eye out. Literally sat and waited for the whole day for this woman to deliver. So a bit of background.

27 year old woman
Prima Gravida (first pregnancy)
Been in labour for 48 hours
Admitted to hospital with cervix dilatation approx 5cm and severe contraction pains
SROM (spontaneous rupture of membrane)
CTG revealed an episode of deceleration of fetal heart - spontaneously resolved - may need C-section if re-occur
FBS (fetal blood sample) taken x2 (both revealed normal blood results)


Plan: Midwife to review every 2 hours for any more CTG decelerations.

Essentially I had been hovering around this lady's room and keeping an hawk eye on the midwife responsible for this lady as I did not want to miss an instrumental delivery. Sat around in the midwife room for hours. Time was ticking and it was getting closer to the end of my shift (5pm)...then 4:50pm - midwife reports that the lady is fully dilated and has tried to push for awhile but the baby was not coming out - called on-call registrar. It was determined that this woman will need instrumental delivery. I obviously perked up and was relieved that I will finally get to observe an instrumental delivery and get my log book obstetrics section completed.

Lady was brought into theatre as there was a bit of cervix which could be pushed back and she was given spinal. Realized that we cannot use the KIWI so we had to use Forceps. I had never seen forceps before and when I saw them it looked pretty crude but it doesn't really do any damage to the baby. Forceps delivery is just crude. The registrar was pulling quite hard and we had to hold the lady back as she kept sliding down the bed as we pulled. The husband nearly passed out as well. After several attempts, the baby was delivered and it was fairly large so I was not surprised why it took a few pulling attempts. Unfortunately, due to the baby's large head and that the lady was quite small, she ended up with a 3rd degree tear. 3rd degree tear = torn perineum and a bit of anal sphincter. Essentially tears are not pretty...seen a few tears now and it's not nice. Essentially the surgeon has to stitch your perineum back together which is pretty much  a mess. It isn't pretty. I don't even get how does the surgeon figure out what to stitch. To me it was just a bunch of flesh torn apart. Certainly looks very difficult to repair and requires a lot of skill and experience. Amazing though. Once that was done it was almost 6pm but the extra hour got me my final signature for my log book.

Day 4 - because my log book was filled and it was a half day as I have a night shift on day 5...i turned up late and observed 2 caesarean sections. Fairly boring day.

Day 5 - 16 hour on-call night shift. Start at 5pm Friday, finish 9am Saturday. I really didn't know what to expect...I like to consider myself nocturnal as I work well in the middle of the night. Unfortunately it was a VERY quiet night and time was crawling. I didn't know what is the proper etiquette for night shifts...do I go sleep or do I stay awake with the midwives? The doctors disappeared midway through the night and I assume they went back to their office to sleep. So what do I do? Essentially I tried my best to stay awake and read 6 chapters of my O&G textbook. 4am - I was getting fed up. Bored to death. Nothing going on. 5am - told the midwives to bleep me if there's anything interesting/if they need to bleep the doctors to also please bleep me. I technically don't have a room but I reckoned the seminar room would be empty so I went to bum on the couch in there. Passed out for about 30 minutes and then my bleep went off. I was so tired...I looked at my bleep and was trying to get up...couldn't. 15 minutes later - woke up and sun was rising...obviously hardly knew where I was...very dazed. I could hardly open my eyes and zombie stumbled to the ward and the midwives said they were trying to bleep me and that there's a patient in theatre. Went to theatre to see the consultant repairing a 3rd degree tear. I'm pretty sure he knew why I was late...but he didn't say anything. Phew. 8:30am - doctor handover. I packed up, got changed back into clinical clothing, and then stumbled to my car. Managed to get home in one piece. But wow WHAT A TIRING/BORING NIGHT. Brutal. Never again - 16 hours. Doctors and midwives only do 12 hour shifts...why the heck do students have to do 16 hour shifts?! Trying to kill us?! At least give us a room or an office instead so we can rest.

All in all...labour week wasn't too shabby. Obviously Monday and Tuesday were my highlight days as I got to assist and scrub in for elective sections. Very good experience as I enjoy surgery so any opportunity to scrub in is an honour for me. Next week is my final "timetabled" week which is Ward Week; however, it is more like 50% ward, 50% clinic. My summative assessment is next Tuesday as well. It involves taking a full Gynaecological history and answering questions about investigations, management, and treatment. Quite nervous as I haven't had time to practice history taking as I haven't had my ward week. Next Monday = catch up time. Probably going to try my best to talk to as many patients as I can on the ward. Final stretch of placement: 2 more weeks. Ward week then "catch-up" week. I'm actually kinda sad that this attachment is ending. Having a blast. Unexpected. Wow.

O&G Labour Week Part 1.

I'm only 2 days in to my labour week and I'm already struggling. I'm supposed to be in for midwives handover at 7am every day. Day 1 - alarm clock for 5:45am...next thing I knew I woke up again and it was 6:30am. Didn't get to the hospital til 7:10am...by the time I got changed into scrubs for labour ward...it was like 7:20am. Day 2 - alarm clock for 5:45am...actually got up this time. Arrived at the hospital at 6:55am and traffic wasn't bad. I actually tried really hard to make it to handover...ran to get changed. By the time I got out...I had apparently missed handover already and the midwives said I should aim to arrive for 6:50am tomorrow. In my head I was like "6:50am?! Yeaaahhh right." Dreading it already. Also I have been sooo tired. I would sometimes catch myself dozing off in the ward because I start so early in the morning...but still get off at 5ish pm. Brutal. And when I get home...I hardly have the energy to eat and all I want to do is sleep. So unproductive.

Pretty exciting first day though. Saw 2 normal vaginal deliveries. Also assisted as a first assistant on 2 caesarean sections (aka I got to scrub in and actually do proper surgical stuff...not just hang around and watch - just the consultant surgeon, me, and a scrub nurse - what a dream). Also witnessed an emergency caesarean section as the baby was stuck. When the emergency button was pressed it was like a TV show. It was crazy. Loads of people ran in within 5 seconds of the buzzer going off and everyone knew what they were doing. Anaesthetist was already making his way to theatre and some of the theatre staff darted to theatre to prep. About 8 of us were racing the bed down to theatre. It was really surreal. Obviously there was a sense or urgency. The mother had to be put under general anaesthetic (most caesareans is under spinal so the mother stays awake and just can't feel anything down below). Staff was frantically prepping the theatre with the equipment...it was just organized chaos. I was so scared to get in the way so I just crammed myself into a tiny corner of the room. I obviously couldn't scrub in as it was an emergency and the registrar had turned up.  Eventually we managed to get the baby out and I finally got to see the link between the paediatricians and obstetricians. The paeds team was already waiting for us ready for the baby and for any resuscitation as it was a complicated birth. Baby came out floppy and wasn't crying/breathing. It was a very tense moment as we handed the baby over to the paeds team. Unfortunately I'm with the obstetrics team so I couldn't go watch the paeds team work their magic. Finally after a few tense minutes we heard the baby cry and you could see the relief on some of the staffs' faces. I'm sure it was pretty scary for the mother herself as one minute she was just about to give birth but the baby got stuck..the next minute she's asleep. Also the father is left waiting outside of theatre after seeing a bunch of people wheel off his wife. Pretty scary situation for the family in general I would think.  I couldn't say I had as much fun  in the afternoon though. Immensely boring after a frantic morning. But the morning certainly made my day though.

Day 2 - quiet morning. Waited til 9am for elective caesarean sections. Again was really lucky and got asked to scrub in and help out...but not to the certain extent of a first assistant. Still makes a huge difference when you're scrubbed in. I even got to transfer the newborn to the crib after we pulled him out. It was really cool. After the sections...again went quiet again. Saw 1 normal delivery and that was it. Next thing to knock off my list: Instrumental Delivery (eg. using Forceps or Ventouse Suction). Really need to get that signed off tomorrow.

Labour week to be continued.......(if I'm still alive by the end of it)