My placement in the hospital over these past few weeks has been pretty indescribable, but I will give it a try and hope my posts below (more to come) capture my experiences and do them justice. I felt that I would be open minded to anything and everything that I would come across. The whole experience has been like peeling back layers of an onion, or putting parts of a puzzle together and I take away more than I thought I would learn from this trip.
The hospital I am spending my elective at is a three-minute bus ride away. As with all hospitals, the transport links are well-established, with frequent buses and taxis. Laggo, as everyone seems to call it for short, is a large public hospital.
As we make our way to the 2nd floor to the servicio de partos (labour ward), I observe queues of people lining up for various services, waiting in not too comfortable chairs, phones are ringing – halfway across the world, the essence of hospitals seems to be the same, except for the few dogs freely roaming the entrance of hospital. I don’t think that would be accepted as the norm in the NHS.
We pass a contingent of people waiting; standing, sitting on benches outside servicio de partos; their presence doesn’t make sense until the end of my shift. I am introduced around and shown to the changing rooms. Comfortably settled into my scrubs, I strangley feel at home; even though my surroundings are not as modern as the delivery suite/labour ward in my training hospital, the essence of a labour ward is the same, if that makes sense.
I am given the tour of the world. A room I call the dilatation room; a room of 6 basic beds each occupied by a labouring woman. A pre-op room for women undergoing planned caesareans and the recovery room which is so full that women on recovery beds and their newly born babies are settled in the corridors. It’s a very busy day on labour ward today.
Finally I am shown to the delivery rooms, each of which are in essence a mini-theatre: a theatre bed with stirrups, overseen by bright overhead lights, is the central focal point, metallic silver panelling lines the walls.
I am returned to the dilatation room, where I meet the two midwives on shift. They are very friendly, even more so when it’s explained that I speak and understand little Spanish. The intensive medical Spanish lessons have definitely prepared me in the sense that I can understand and construct (at a slower pace mind you) sentences using all the tenses and the obstetric terminology. However, what I quickly find out is that Argentine Spanish is very quick, sounds mildly Italian, and like with any language used in everyday life ,some words are missed out or shortened. Add that to medical terminology and a busy labour ward and it’s a recipe for deep slow breaths to be taken. I hava brief glimpse into how mystifying and a little frightening it must be for a labouring woman in the UK who has no understanding of English; at least I knew what the instruments were and actions would be taken.
The department is staffed with two midwives, a bevy of nurses and doctors, all who are friendly and take the time to speak at a slower pace to ensure I understand most things. There is a student midwife on shift which makes me feel even better. From discussion with my housemates and others, I knew that midwives had a different role compared to the UK, so I was pleasantly surprised them on labour ward.
The women come from triage – where they have been examined and declared eligible for servicio de parto. Their notes are reviewed. I am not sure if antenatal appointments are part of maternity care but some women have appointments from 20 weeks, scans as well, from the hospital and private obstetricians. That will be a question to ask tomorrow.
Much of what happens is familiar to me. Number of contractions in 10 minutes are timed, FH ausculated using CTG USS (without palpating first, which puzzled me) one shared between the 6 women, the beautiful wooden carved pinard left in the corner.
V.Es are performed in the room, in front of the other women, nurses and doctors. The women are expectant of it; any discomfort is winced away. There is no available space for a birthing partner to provide support; the crowd of anxious family members waiting outside the ward suddenly makes sense.
From what I can understand, all women, even those low risk are cannulated by the nurses and are on fluids administered by the nurses, syntocinon 5iu given by the nurses. No pain relief is available, paracetamol or otherwise including the induction women.
There is camaraderie between the doctors, midwives, nurses and student which makes a relaxed atmosphere for the women and myself as a student. The student midwife had to present the patients on the ward round as the midwife was elsewhere. The doctor was relaxed and encouraging of her, she essentially was part of the team – a feeling I can relate to in my final year.
While observing examination of a woman, whose baby I thought was in an OP position, the woman opposite was being examined and FH ausculated. The prolonged bradycardia was heard, audible to everyone I room. One of the midwives went to summon a doctor while the other continued auscultating, no recovery was heard, I could only imagine how that affected the rest of the labouring women.
The woman was speedily taken to the labour room across the hall; shouts of encouragement to push from staff are heard, tense moments later a baby’s cry is heard to my relief and I am sure to the relief of all the women.
A multip, on 5iu syntocinon, who felt like she wanted to push, como “caca”. She was examined by the midwife and declared fully and escorted to the delivery room.
Once in the delivery room, feet in stirrups delivery was the goal: directed pushing, more invasive application of fingers than I am used to, restitution quickly followed and the body assisted out via lateral flexion prior to the next contraction. The baby wrapped, shown to mum and then taken away by the nurses and later returned.
Second birth (well, not really)
The primip with the baby in an OP position I had seen earlier.
She was examined by the midwife and declared ready to push, and was assisted to the birthing room for oxygen as she was hyperventilating and not coping with pain very well. After pushing with no sign of descent, invasive digital manoeuvres were applied to assist with descent, to no avail, the baby was in an OP position with a deflexed head. The labour woman was instructed to adopt an upright position on the side of the bed and alternate squats for 10 minutes to assist descent, with no improvement.
The doctor declared her for caesarean; the energy atmosphere present when encouraging birth dissipated. A wheelchair was brought to the room and she was assisted to theatre.
My questions for tomorrow
Where do the babies go?
When is breastfeeding initiated?
And does every labour woman really have to be cannulated and given an infusion of 5iu syntocinon?