I love B ward (subtitled: ups and downs today)

Today was brilliantly sunny until about noon, then the horrible rain rolled in - as seen to the left. This meant that power came and went like the wind, as did the functionality of the lab and X-ray machines.

The nurses do the vaginal deliveries on B ward. They call us - whoever's on B ward - for C-sections or problems or pretermers or things like that, and so it behooves one to check every now and then and see if anyone's in labor or not. And they do things very differently here.

Today was an up and down kind of day; morning went swimmingly well and I did several abdominal ultrasounds without feeling like I needed to call for help. Came back from lunch and got mobbed by nurses from B ward. They had a woman in labor, G2, previous C-section for transverse lie, "oblique lie" and they wanted me to come see whether she'd stalled out. Now here's the creepy bit about working here, for those of you out there who do OB: Patients with one previous C-section are allowed to labor, and sometimes they even get pitocin. Fetal heart tones are ascultated hourly, and the women are otherwise unmonitored. That idea took some getting used to. So I walk into the room - their L&D rooms are three cubicles with curtains - and grab a sterile glove ("What size, doctor?" "Whatever you have.") - today I'm in 7 1/2's, last time it was size 8. She has meconium-stained amniotic fluid and a left-sided cervical lip and I'm certain the baby is ROP to ROT, no caput, no molding. And I look around at the room and the nurses and I tell them she's OP, get her up and let her labor some more, let me know.
Three hours later, after everything else that happened today happened, she's been pushing for 50 minutes and they want me to come back and check. "Her contractions have stopped." I'm not entirely certain if this is true, but I successfully avoid starting pitocin by encouraging them to give her a primigravida's worth of pushing time.

And an hour after that I'm skipping out on the last half-dozen clinic patients to go see how much bleeding is "a lot" around here. And I might have muttered Carlton Lyons' name under my breath while staring at a delivery table covered in at least a liter of the red stuff, and I'm taking report from the midwife: vacuum extraction with episiotomy, shoulder dystocia, postpartum hemorrhage. But I didn't panic. We got some pitocin running and an IV started, I closed the episiotomy and the left paramedian extension and I put her perineum back together pretty. (The nursing students watched me, curious, amazed that I used a single continuous suture to close the extension and another continuous suture for the episiotomy; apparently they sew with interrupteds here). It wasn't the best needle, on 3-0 Vicryl, but it worked, and she stopped bleeding after I pulled a gigantic clot out of her posterior fornix. And as I was writing up my note, the power went out for the fifth time that day.

And that was the good half of the day. We're headed up to Becky's for game night, so I'll post this - and save the bit that had me standing in the rain sobbing for later.