Labor and Delivery
Exemplar 2 Labor and Delivery When I began my shift at Jord Valley Hospital a woman, to my delight, was about to give birth. I had never before seen the miracle of life unfold, other than my own child birth experiences. The delivering physician had already been advised that the patient was dilated to 10 and was ready to deliver. I stepped into the room gloved and gowned and the nurse asked me to stand opposite of her and hold one of the mother’s legs. I just mimicked what the nurse was doing; cradling her foot in one hand and putting my right hand on the patient’s knee.
Within seconds the doctor arrived, he adjusted the bed to the reverse Trendelenburg position, pulled the lighting down from the ceiling and proceeded to give her breathing and pushing instructions. He asked her to push with each contraction; he and the nurse watched the monitor to see when the next contraction was going to occur. The nurse also kept one hand on the patient’s abdomen and was communicating with the doctor, telling him when a new contraction was coming because she could feel the uterus contracting. This cycle went on for several minutes. When a contraction came, the doctor would tell the patient to push as hard as she could.
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The baby began crowning, then after she stopped bearing down, the infant’s head would slightly recede back into the birth canal. While the baby was crowning, the doctor used his gloved finger to widen the vaginal opening to accommodate the head. This occurred over and over more than 5 times. Finally when the infant’s head was protruding approximately half-way, the doctor grabbed some scissors and cut the perineum to allow more room for the head and shoulders to be delivered. With the head out, the doctor rotated the infants head and told the patient to bear down one more time to deliver the shoulders, which she did.
Within seconds the infant was delivered from the womb and the cord was cut by her partner. The doctor asked the mother if she wanted the baby placed on her chest or placed into the heated bassinet. She opted for the bassinet. The newborn nursery nurses there immediately began suctioning the newborn and performing Apgar scoring on the infant. His score was initially an 8. Meanwhile, the doctor pulled on the cord and the placenta followed from the uterus. He examined the placenta and cord, confirming there was indeed two arteries and one vein present. He then extracted cord blood which was sent to the lab for testing.
Then he proceeded to stitch up the patient’s episiotomy from the inside out using a small curved needle. After that was completed, he began to gently compress her uterus, which expelled a generous amount of blood, amniotic fluid and other birth remnants. The patient expressed that she was cold so I went and got her warm blankets and an ice pack that would be needed to apply to her perineum. The delivery had a successful outcome. Over the next several hours, the nurse monitored the patient’s vitals, checked her bleeding and pad saturation and periodically massaged her fundus. The baby and mother’s projected outcome was excellent.