As I mentioned in my last post, the first few days of clinical placement were a nice, gradual (albeit exhausting) introduction to midwifery.
By Wednesday evening, I was tired, but also way too excited about the next morning’s twin induction to sleep. I finally fell asleep around 11:30pm, only to wake up and commute to Brantford the next morning at 7am. Upon arrival, I met the client and began what would be a long and amazing day of clinical work. I worked closely with the nursing staff to take the mother’s vitals, start IVs, and chart findings. I was also able to assist in the monitoring of the twins heart rates using external fetal heart rate monitors (EFM), which, I have to tell you, are kind of a nuisance. The mother can’t move, and since the baby IS moving, you are constantly adjusting the belt to catch the baby’s heart rate properly. The evidence also doesn’t support the use of EFM over intermittent auscultation (where you listen to the heart rate with a Doppler or stethoscope at set intervals), but again, another topic to share another day.
EFM is made even more complicated with twins, because just when you think you’ve got two individual heart rates, one twin moves, and suddenly both monitors are picking up the same heart rate. They say that there should be at least a five beat difference between the two heart rates in order to assure you that you’re picking up the two distinct heart beats. Good learning for me, though, and reassuring to know that even the most experienced nurses still struggled with it.
When we arrived at the hospital, we had a discussion with the obstetrician (OB) and nursing staff to decide who was responsible for what during the twins care. Because both a midwife and an obstetrician were involved in the prenatal care of the client, it was important to clarify and communicate who the most responsible person (MRP) was in the case. We agreed that on paper the obstetrician would be the MRP, but that the midwives were able to support clinically and that the nursing staff would also support. Post-delivery, the care of the newborns would be the responsibility of the midwives (me and my preceptor). While we were having this conversation, the OB turned to me and asked if I had ever caught a baby. Our interaction went something like this …
Me: “No sir, this is my first week. Day 4.”
OB: [Turns to my preceptor, then back at me.] “Well, why don’t we get you catching these twins today? That counts as two for you, right?”
Me: “Yes it would, and that would be a dream.”
OB: “Alright, get ready then! Have you ever done a vaginal exam?”
OB: “Today’s your first. Let’s go.”
He then paraded me into the client room and coached me through my first ever cervical labour check. I’m not sure what I felt exactly, but I am pretty sure I felt a slightly dilated cervix. He confirmed it was 2cm. At the time, I felt like that was the coolest clinical opportunity ever. Little did I know …
Throughout the day, we monitored her progress and I learned allllll the clinical skills and paperwork.
There. Is. So. Much.
When she was ready to push, the OB and my preceptor prepared to help her deliver the baby, and I quickly began to put on my sterile gloves to assist. As we started to see the head, the OB turned, pointed at me, smiled, and said, “You’re up. You ready?”
Classic Sonia, I was in the middle of struggling to put on the second sterile glove, which I naturally had on backward. Despite my awkwardly weird and slightly inflated, gloved hand, I confidently nodded a yes in his direction, fixed the glove, and made my way to deliver Twin A.
With my preceptors support, I got to work, guarding the perineum and putting gentle backward pressure on Twin A’s head to protect against tearing. During crowning, my preceptor asked me if I noticed anything – and sure enough, the forehead was facing upward. Most baby’s are born face down, but Twin A was coming in sunny-side up. As I wrapped my head around the implications of that (typically more challenging labours, longer pushing), the client began to push again with her next contraction and all of a sudden the entire baby flew out. I caught the baby, with my preceptor quickly assisting, and we had Twin A out for skin-to-skin contact. Dad cut the cord, and after some moments the OB took over and began the transition period between Twin A and B. For confidentiality reasons I won’t go into detail, but many clinical opportunities presented themselves and I just soaked in as much learning as possible. The OB even began to quiz me during the hour pause between twins, which was both intimidating and useful.
I have a lot to learn.
It took about an hour for Twin B to come down enough for pushing. The atmosphere in the room between twins was a learning experience all in itself, with clinicians talking to each other and Mom labouring on. I encouraged Dad to come over with Twin A to see Mom, as I felt the bonding between mother and child might help increase her natural oxytocin levels and help to bring Twin B down more readily.
The OB had taken over helping to bring Twin B down, so I figured I was done for the delivery. But. When the baby began to crown the OB suddenly yelled, “Where’s Sonia?”
Standing behind him (and probably way too excitedly) I quickly said, “Here! I’m still here!”
He motioned me forward.
I delivered Twin B with the OB’s support, this time in a more expected (and normal) fashion. The OB then taught me how to take blood from the umbilical cords for testing, and like a grand climax, the OB had me deliver the placenta.
We subsequently did newborn exams (including listening to baby hearts and baby lungs, checking baby reflexes, and swaddling them up for warmth) and checked on mom in conjunction with the nursing team.
By this time, it was nearly midnight but I still felt filled with glee. It was an unbelievably life affirming day. My first catch(es) will stay with me forever, and I can’t believe how lucky I was to have been able to learn from such experienced clinicians and to be able to say that I caught TWINS during my first week of placement.
The week goes on, and I continue to ask questions and take note of everything that I can. I’m already exhausted, and trying to get used to being on call, but. BUT. I’m in the right place; this is what I’m meant to do, and knowing that feels pretty amazing.