A New Challenge

Saturday July 28th
Saturday I had swing shift and was second up. One of my roommates and I walked to shift, which was quite refreshing.
Once we got to shift I kept joking about fully dilated patients coming in. I am getting pretty goofy about catching another baby since I will be leaving so soon.
I did have a patient come in at 7:10pm reporting BOW (bag of water) rupture at 7:08pm. This was her second baby and so I had hopes that she would possibly deliver on my shift. After we checked her, she was only two centimeters dilated but was required to stay based on our BOW rupture policy. She worked very well walking, rocking her hips and drinking water. She was a cute 23 year old who told me about her other baby at home. Unfortunately, her bana is a jeepney driver and wasn't able to be at the clinic to support her so her mama was there and she didn't want to have her mama in the room. So her mama slept while I labor watched her. Additionally, her baby was in a position in which its spine was in line with mamas and was facing outward whereas typically baby's spine is facing out and face looks at mama's back. This position is okay because the head was down but it creates  slower progression and more pain during labor.
Near endorsements, I decided to stay into the next shift to labor watch and hopefully catch her baby. I really enjoyed working with her and both her and my supervisors agreed to it. Plus it meant that I would get to work a shift with Kelsey! Because I hadn't planned to stay into the next shift, I didn't have any extra snacks and so we as a shift ordered McDo and the guard went out and got us Jollibee (the Philippines version of McDo).
I continued to monitor her contractions, baby's heart rate, and leaking BOW (which she had A LOT OF!). Everything was normal and we talked about our 12 hour BOW rupture policy- in which we transport to the hospital if it has been 12 hours due to the risk for infection both for mama and for baby. She began to get tired around 1:30AM, and I assured her that it is normal and okay to rest for about an hour. I could tell by 2AM when I did a repeat IE  (internal exam) to check her dilation that she was getting pretty tired. She was then 4-5 cm (good progress) and getting even more tired. I encouraged her to rest but she reported constant pain.
At her 3:15AM check, she told me that she wanted to go to the hospital. I assured her that her baby was okay and we would continue to monitor her contractions. She was very discouraged because while she was laboring, four other women had delivered babies and two or three had come in while she hadn't changed much in her contraction patterns. I could tell that she was tired and I checked baby before talking to my supervisor. My supervisor agreed that if it was patient's wish to be referred that we would transport her.
I prepared the papers and reassured her that baby was doing well and she could continue to labor at our clinic safely until 7:00AM. After all, every labor is so very different and she could have her baby by then. She said that she would go to the hospital so we got ready to transport her in the ambulance. This is where there was a bit of a hang up. She said no, that they would just take a taxi and go when her contractions got stronger. My supervisor stepped in and said that for safety reasons we had to bring her the hospital since that was her wish. After some exhanges both with my supervisor and the guard my patient, her mama, and brother reluctantly agreed to be transported to the hospital via ambulance. Because they spoke in Vesyan, I was unable to understand much of the dialogue but I could tell that they were uneasy about the situation.
On the way home from the hospital at 3:40AM I asked the guard what the conversation was about. Basically, the patient was tired and wanted to go home until her contractions were very strong. She then would go to the hospital. Despite the fact that we had described to her the increased risk of infection with BOW rupture, she and her mama wanted to go home and wait until later. Also, she was discouraged because her bana could not make it to the clinic to support her and her mama was sleeping while she was laboring.  I could tell that she was very tired and wanted to rest.

This was a very difficult case for me because I am left questioning my management of her case. She seemed to cope with contractions well and handled labor well. I think that a main component in her exhaustion was lack of support person and hearing other patients deliver, both of which are quite understandable. I was so very heartbroken to transport her and see her so discouraged. I do know that I did everything I could think of and consulted other midwives for tips and assistance.
This was certainly one of my more challenging cases and left me praying and reflecting for sure. I am so glad that I was blessed with this opportunity to learn about my management style and to learn more about safe practices in midwiffery.
Lord I pray that S.M. (my patient) will deliver a healthy baby and that she be able to get some quality rest while her labor progresses and after. Lord please give her the patience and wisdom to work with her body. Thank you for this opportunity, please help me to use this as a further learning experience for the future!