Labor and Delivery Nights

Last week I was on L & D nights which started at about 5:00 pm and went until 9:00 am the next morning. I had some long nights but I really liked the work. I hated being away from home and when I was home I had to sleep while everyone was up. That part was not fun and I think it gave me a taste of what some of my residency will be like. Basically, with a long schedule like that you pretty much just work at the hospital and sleep with no time to do anything else. 

Like I said, I did enjoy the work. I was in charge of evaluating any new patient sent to L & D by their private doctor or by the Emergency Department. Many of the patients were in real labor and showed up to deliver. There was also a large group of patients who were in false labor and finally we had many who were in preterm labor with complications. I would examine each of these patients, I would take a detailed OB history asking about their number of pregnancies last menstrual period, Expected due date, related problems, past medical / OB history, etc. Then I would do a cervical exam to determine the status of the cervix, I would see if the cervix was dilated. I would also take samples of fluid to test for certain infection like gonorrhea and chlamydia. I also would test the fluid to determine if it was amniotic fluid. You put the fluid on a slide and let it dry and then look at it under the microscope and if you saw "ferning" you could figure that there membrane had ruptured (water broke). A second test for ruptured membranes that I also did was nitrazine paper test. If the nitrazine paper turned blue when exposed to the fluid, it also indicated membrane rupture. The nitrazine test reacts to the pH of the vaginal fluid. Amniotic fluid has a more alkaline pH compared to the normal vaginal fluid. 

If the patient had premature rupture of membranes then we had to manage them according to how far the pregnancy had progressed.  Following these tests / exams I would do an ultrasound to determine how the fetus was doing and look for any complications. I also would hook the patient up to a fetal monitor and check the fetal heart tones and monitor contractions. By the end of the week I could go through these exams fairly quickly and determine if the patient needed to be admitted or discharged. This was a good rotation for me because these skills will be required in my residency and practice after residency. 

I also saw lots of complications of pregnancy; drug abuse, premature delivery, fetal demise, preeclampsia, eclampsia, and the list could continue. I had my fare share of normal deliveries and was able to help in some c-sections. We made every attempt to deliver the babies vaginally but in some cases a c-section was ultimately required. I really enjoyed delivering the babies. I had some very sad cases where the baby was born dead due to various problems and these cases where always difficult. The family was always devastated and there was not much that could comfort them. Fortunately I did not have too many of these cases. The drug abusers were also difficult cases because it was hard to see these innocent babies born with addiction and into that kind of environment. It was hard to have hope for those children given their environment and inept parents. 

It was a great week. I am tired.