After All These Years, I Still Love It

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My day starts at 5 AM, when I go out for a run to relax and think. I arrive at hospital at 7:30 AM, where nurses greet me with a chorus of “hellos”. Something is up. I receive reports for two laboring women and a postop who had a massive hemorrhage during her C-section. She is receiving her 6th unit of red blood cells (RBCs) with two more to go, she has an Ebb balloon in place, and she’s stable and doing well. A quick review of the laboring women’s charts reveals they are both multips and are laboring.

I review the postop woman’s chart and go to her room to assess her. She’s doing great and wants to start pumping! I review her care for the next couple of hours, with both her and her husband accepting the complications with understanding and smiles.

Next I go to assess the other women. Each have epidurals and are comfortable, and both are FHR category 1! Since the COVID-19 pandemic began, all vaginal births have been discharged in 24 hours, which doesn’t give much time for the women take in all the information they need to know. I just review postpartum care and when to follow up. I hope they will be well and adjust to parenting without issue.

I head back down to the labor and delivery unity, where one woman is feeling pressure…time to birth! She has a beautiful birth, and all is well. The other woman is unchanged from the previous exam…time for the magic peanut ball! I explain to her the reason for the ball and how it helps.

I return to see the postop woman, who is awaiting the next unit of RBCs. Her vital signs are stable and she’s doing remarkably well. I spend time answering her and her husband’s questions, providing emotional support, and discussing a visit to the neonatal intensive care unit (NICU) where their neonate was admitted. I call the NICU to confirm that dad can go when he wants.  

Then, I’m called to see the laboring woman, who is feeling pressure but not quite ready – love that peanut ball! I review the why she feels pressure and help her get through the last few contractions. A few moments later, time for a birth! Beautiful birth and happy parents!

The office calls, sending a woman in for a pregnancy-induced hypertension (PIH) work-up. She arrives, I perform a routine work-up, and await the lab results. Her blood pressure is not elevated here in triage! I’m happy she’s preterm and has no physical features of PIH. She eventually is discharged after consulting with my backup MD.

In the early afternoon, I speak with my backup MD about the postop woman. Her vitals are stable and postpartum assessment and labs all within normal limits. I will deflate the balloon by 20ccs and if all goes well, will discharge it before I go home tonight. I discuss this plan with her and start her pumping, making her aware of issues that may occur due to her trauma. I also let her know that after the balloon is out, she can go to the NICU to see her baby. Several hours later, she’s stable and we can deflate the balloon. All is well and she’s ambulating without issue!

The answering service calls about a woman in labor; she’s on her way to the hospital. She arrives, is very active, and desires an epidural. She’s a multip and is dilated 7cm. After a short discussion, she desires artificial rupture of membranes (AROM) and birth. We help her through the last minutes before birth, and she’s doing great. It always amazes me after all these years how in control women can be while she crowning and awaiting the next contraction; it’s beautiful! On the next contraction, the neonate is being birthed and I encourage her to look and help bring her baby to her abdomen. This is a great way to end my day!

I finish up the day’s paperwork and say good night to the post op woman, with reassurance that she can visit the NICU later tonight and will be transferred to the postpartum floor. She did amazing! I sign out, walk out to garage, and take my mask off – I can breathe! An awesome day on call.