Resus Day: Notes of Nursing Student

Thursday, December 18, 2014
Resus Day

12 November 2014.

I was working on the morning shift. After 4 days ‘rest’ from clinical posting because of weekends, classes and visitation program, I pray a lot that day we have at least a case. Last week, I had two days ‘rest’ because none of babies had been delivered on my shift.

First 2 hours, there was admission. Good news I guess. 4 admissions at times, occupied 4 out of 6 rooms. I think we’re going to be busy. My aim was to do CCT. I wish to do CCT from the last week, but because of no chance I wish that day I can do it. But yet, before doing it, I need to gain my confidence. I’ve watched 2 cases of placenta delivered. Because that day, there are so many of staffs including nursing students, nursing, midwifery students and also horsemen, I gained less chances but yet I pray a lot. O Allah, please give me a chance!

I saw 2 cases of delivery. Both babies were 'flat'. No crying. No grimace. But the babies still pink. Both babies were rushing brought to resuscitation. Alhamdulillah, after oxygenation, suctioning, and stimulating them by pain, they cried! I think I was going to cry too.

That day, time flies so fast.

On that day also, we need to find a case presentation. I and my colleague got a case, Oligohydramnios. The patient was 21 years old at room 4. At 1.40pm, the OS has fully opened. I participated to see the delivery as she was my last case for my shift and also the case was my case study presentation. 

As expected, she has prolonged pregnancy. At 2.10 pm, she was struggling to push the fetus. The staffs kindly encourage her to keep pushing. One of the house men said, “Please don’t get 'flat' again.” Yes, because all 2 babies delivered were flat! I keep praying also for her to get a healthy live baby.
The midwife was changed because of the morning shift has ended. But we stayed there. To watch and for me, I’m not going to watch and pray only, but to do CCT (Controlled Cord Traction) as well! At 2.15pm, the baby finally out and she was flatted. The midwife rushing to resuscitate her and I help her to take cord blood for ABG. While I try to get Heparin for ABG sample, my colleague called me.

“Anis! You want to do CCT right? Come, hurry!”

And I gave the syringe to my friend, ask for her help to get Heparin (as I could not find where that bottle was!) and rushing to room 4. I got my sterile gloves and I was so excited to do CCT. It was my first time and I did not expect myself to do it smoothly. And yet I was nervous since one of friend did not get to do it because of retained placenta.

As I was pulling the placenta, it was stuck. Then I insert urinary catheter and empty the bladder as it may be because of the bladder was full. But then it stuck again. I was nervous and the midwifery took the place from me (I guess she was afraid of retained placenta too). Alhamdulillah, then the placenta is delivered safely. I checked it, it was so warm yet completed with full cotyledons, veins, arteries, chorion and amnion. Subhanallah, Allah is the great Creator. I was lived there for almost 9 months, in that warm placenta of my mother. Suddenly I miss her. May Allah bless all the mothers and may everything we did bring us closer to Him.

I went out to see the cute little baby. She is so pink and beautiful. I recite some du’a for her. May she become a good girl for her family and ummah.

Prolonged labor is one of the leading causes to maternal and fetal mortality. There are few interventions can be applied to the mother including ARM or oxytocin or both. If these means fail an instrument or operative delivery may be the only course of action depending on the stage of labor reached (Fraser & Cooper, 2009).  

Besides of these things, the precaution is always better. Prolonged labor or dystocia leads to increased level of anxiety, stress and fatigue to mother. Managing labor should start with appropriate antenatal education. This is the lacking of management nowadays. Most of midwives, including staff nurses and physicians gave health education on the table, the critical moment where the mother is having pain and restlessness.

Advise the mother to have a suitable diet in the early stages of labor to maintain energy levels, positions and activities to encourage a forward rotation where there is an occipitoposterior position are some of the ways that might help to assist the woman in the normal progress of labor. Educate mother for the positions which can help during labor. An upright position might help to facilitate more effective contractions or an alternative position might help to improve pelvic diameters when the position of the baby is posterior.

At this stage, it is also important to maintain hydration, to encourage voiding and to suggest non-pharmacological ways to relieve pain. Educate mothers on the correct ways to deliver is also important to conserve energy and let the delivery process carried smoothly. These health education needs to be done before or during second stage of labor to give mothers preparation to deliver their babies.

This experience really taught me to become better midwife and to handle the critical situations. I respect all staff nurses, including assistance staff nurses for their good job in handling this situation.
I happily back home. This is the feeling of become a nurse. I have fallen in love with this job, again.

p/s: This is my reflection notes for my elective posting: Midwifery. My last post was in January this year! So I guess I need to say, I am alive yes! :)

Picture taken in Labor Room, Hospital Kemaman

Anis Nur Al Basirah,
Nursing Student IIUM.

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