Saturday, November 1, 2008

NVD

So I narrowly escaped having my baby cut out by a gynae.

Due to unforseen circumstances, I ended up having my baby in Cape Town. This meant I had to find a new gynaecologist/obstetrician. My cousin suggested her gynae and I went with him.

I started having contractions last Tuesday morning. As I've mentioned before, my first labour went very quickly, so I was anxious about waiting too long before going to the hospital. When my contractions started getting reasonably strong I decided that maybe it was time to go in. My partner suggested I rather call the gynae first. So I did and he suggested I go to his rooms and he'll check me out. When I got there, I was having fairly strong contractions. However, my cervix was still closed, but because my first labour had progressed so quickly and I was already having strong contractions, the gynae wanted me to go in to hospital. Both my partner and I were uncertain about this but we decided to go through.

We went home first (my parents' home) to pick up our son and my mother to go along to the hospital. When we got to the labour ward, the nurses remarked on how the gynae had been phoning constantly to see where I was. Not a good sign.

The midwife set me up in the labour ward and gave me an enema as per the doctor's instructions. Unpleasant. Anyway, she then told me she would call the anaesthetist to get me an epidural. I said I felt it could wait (I wanted to know how far I had progressed first because I didn't want to have the epidural too early) but she told me the gynae had said that the anaesthetist was very busy and that if I didn't get it then I might end up not getting it at all. My contractions were starting to get quite painful and I didn't want to end up not getting an epidural. Also, I knew they could top it up if started to wear off, so I agreed to go ahead with it. The anaesthetist who was first on call was indeed too busy so the second on call came in. He also apparently had alot lined up that night so in the end I was happy I'd gone for it then.

The epidural was much more painful than my first one had been and I reacted quite badly to it. At a stage the anaesthetist even dropped my bed and drew up some adrenaline. I recovered with only fluid resus though. I felt terrible though and at a stage I even wondered what was worse: the pain or the effects of the epidural? (The epidural started to wear off later though and I came to the conclusion that the pain is definately worse!)

Then my gynae came to see me. He remarked to the anaesthetist that he was exhausted. I knew this didn't bode well. He did a PV. I was only 1cm dilated. He seemed unhappy. It was already about 8 in the evening by now. He decided to rupture membranes to speed things along. He came back to check on me about an hour later. 1 and a half centimetres. I knew he would soon try to sell me a caesar. He started talking about how I should have progressed much further by now and started throwing around phrases like "big baby" and "malposition of the head". Then it came: he said that we could either wait and see or we could just call it quits and go for the caesar then. We told him we'd wait.

He decided to go home and asked the midwife to check my progress in about another hour. My partner and I discussed the situation. I felt he should only check on me in another 4 hrs seeing how I was still in passive labour. We both knew there wouldn't be much change in an hour. We knew he would try to coerce us into taking the caesar.

After about an hour, the midwife came to check on me. No change. She called the gynae. She came back with the message. He had given it a chance but I was not progressing so he would book theatre for a caesar. I said no. I told the midwife that as far as I was concerned there was no rush. I was still in passive labour and doing fine and the baby was being monitored and she was fine. If anything went wrong, we would know immediately and then we'd agree to a caesar, no question, but right now, there was no need for it and we were happy to wait.

She seemed to agree with me but said she'd give us time to discuss it.

We agreed that there was no reason to have a caesar. My partner decided to call my original gynae (a colleague of his) to cover our bases. He confirmed what we suspected. We turned down the caesar. The midwife relayed this to the gynae and he asked us for a time frame for how long we were willing to wait. It was nearly 11 at night by then. We said we'd wait until 6 in the morning. She came back and said that he'd told her that if nothing had happened by 06h00 he would book theatre. I was still not happy with that and told her that if nothing had happened by then we could discuss it again. She said that would be easy enough to do.

We decided to try and get some sleep. I was unable to rest easy though. At about 02h30 the midwife came to check on me again. She said she thought something was happening. She was right: I was 5cm dilated. Relief washed over me (and my partner when he woke up an hour later. He slept slightly better than I did ;) ).

By about 05h30 I was fully dilated and the midwife called the gynae. At 05h47 I delivered a perfectly healthy little girl. (He made some remark about how the head must have turned at some stage. Yeah right.)

I ended up having an episiotomy and a vacuum extraction as the baby's head remained high, so it wasn't actually an NVD, but at least I escaped having unnecessary major abdominal surgery.

15 comments:

rlbates said...

So glad you missed out on the C-section. Happy that you and the baby are well. Blessings.

Dragonfly said...

Glad that turned out all right. Why would an enema be performed?

amanzimtoti said...

Thank you Ramona :)

Dragonfly, it's an old practice. I think the intestinal spasm supposedly enhances uterine contractions. It definately seemed to do that in my case.

Karen Little said...

Well done for standing your ground! Did that dude know you were a doctor? He sounds dodgy...

I always thought the enema wasso that when it came time to push you didn't have any poop left to squeeze out with the baby. I once accidentally wiped baby down with the poo-towel. I felt really bad - what a crappy way to start life...

amanzimtoti said...

Karen, he knew I was a doctor alright, but he's a gynae in private practice in South Africa - caesars are the norm. I know of a gynae in Nelspruit who only does NVD's on Tuesdays. Seriously. Only on Tuesdays.

Dragonfly said...

Cool, good to know, shall remember that.
Have certainly seen lots of poop on table...(ROFL about what Karen said).

Jeffrey said...

congrats!

amanzimtoti said...

Thank-you Jeffrey.

Bongi said...

i know of a gynae in cape town who doesn't do nvds at all... or at least up until quite recently.

there was also a comment about needing to book theater which was rebuffed if i remember?

amanzimtoti said...

That was when the midwife checked me an hour after he'd gone home. He said he'd given it an hour so now he'd book theatre.

I suppose at least that Nelspruit gynae is honest about his intentions.

amanzimtoti said...

Also, after we refused that and he asked for a time frame and we said 6am, he again said he'd book theatre if nothing happened by then. He also spoke about the time frame being reasonable so he could organise theatre time. That's when you made that snipe that a gynae can always bump anyone off the list :) The sacred organ!

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Anonymous said...

I started having contractions last Tuesday morning. As I've mentioned before, my first labour went very quickly, so I was anxious about waiting too long how to lose weight fast before going to the hospital. When my contractions started getting reasonably strong I decided that maybe it was time to go in. My partner suggested I rather call the gynae first.

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Kathy said...

Aww, so sweet. Thank dog for you being a DOCTOR and all. I bet the midwife being there to take out the trash and clean you up when you suffered bowel incontinence with pushing, had nothing to do with your positive outcome. I am remembering previous post when you lost pregnant patient because of stupid nurses at the hospital. The thing is , with a little patience, it is actually possible to examine a cervix no matter how posterior, with a little patience, and experience. Surprising to some, don’t even have to be a DOCTOR .
I think what is important to understand here is that things could have gone the other way. Again, what a blessing that with your background in infectious disease, you were able to cut through the uselessness of those with much experience and knowledge in obstetrics. Many spend years learning best practice to support laboring women. You, on the other hand, are about as arrogant as a box of rocks and you managed to have a good outcome.