Reflective Journal
(this was the journal that I was assigned to do during my obstetrics posting)
Stages of labour
On last Tuesday, I observed a vaginal delivery in the labour ward.
As from what I was taught in school, there are stages of labour and I managed to see for myself on how the stages differ.
The 3 stages of labour are, firstly, it is the beginning of uterine contractions that opens the cervix. The stage will then end when the cervix is completely dilated.
Secondly will be the expulsion of the fetus. It begins when the cervix is fully dilated and the stage ends when the baby is born.
The final stage will then be the placenta separation and expulsion.
Initially, I saw discharges flowing out from the perineal area. That marked the first stage of labour whereby the cervix was dilated which helped to open up the cervix for the fetus to pass through the cervical canal.
The patient felt pain during intervals and the doctor ordered her to take a deep breath and push out the fetus; long and hard.
I noticed the doctor injecting IM Syntometrine into the lower part of the perineum area. It was to prepare the mother for the third stage of labour.
After the cervix was completely dilated, I saw the baby's head trying to pass through the canal. The mother tried to push the baby out from her womb however, the baby was still inside.
Episiotomy was done to allow the baby to pass through easier and the doctor then used the complete vacuum delivery system to suck out the baby by putting it on the baby's head.
That was when I heard the first cry of the baby once he was expelled from the womb.
The baby is a boy!
The staff nurse then quickly covered the baby with a drape in order to keep him warm. It was the thermoregulation way whereby conduction took place. This was to maintain the normal body temperature which ranges from 36.5 to 37 degree celsius via the axilla route for babies. The baby should not be left exposed unnecessarily to prevent him from being hypothermia.
The staff nurse also performed an oropharynx suctioning to the baby. This was to secrete out the mucus which could block the airway and to maintain effective breathing patterns.
Apgar scoring was also done to check the physical well-being of the infant. A score was given at 1 minute and at the 5th minute after birth. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures. Apgar scores of 3 and below requires immediate resuscitation. For this case, the infant is normal.
The staff nurse injected the Vitamin K and Immunoglobins into the baby at the thigh; vastus lateralis. As the liver of the baby was still immatured, it could not produced Vitamin K. Thus, it was then administered so that the baby will remain free from haemorrhage.
As newborn infants are prone to infections due to the immatured immune system which causes low IgM (enteric infection) and low IgA (respiratory, GI, eyes), IM Immunoglobins was administered.
Cord blood was then taken by the doctor for investigations such as G6PD screening and congenital hypothyroidism. The blood was drawn out from the cord which was attached to the placenta.
Finally, it was the last stage of labour; the separation and expulsion of placenta and its membranes.
I noticed that the doctors were checking the cord before they removed the placenta. I believed it was to observe for signs of placental separation. They are, well contracted uterus, lengthening of the cord, gush of blood from vagina and the rise in uterine fundal height.
The placenta and its membranes were then delivered by controlled cord traction.
The doctor then stitched up the gape at the lower perineum area, the portion where she performed episiotomy during the 2nd stage of labour.
After the whole procedure, my friend and I followed the staff nurse to the disposal room. She taught us how to check the placenta before disposing it appropriately. I managed to feel for the two umbilical arteries located at the tip of the cord. We also saw the two membranes surfacing the placenta; amnion and chorion. The amnion was more translucent and was located at the inner part of the placenta. We also felt for the cotyledons and checked that the placenta was complete with no membranes being detached from it.
When I returned back to the room where the labour was held at, I noticed that the mother was breastfeeding the baby. This is one of the immediate care of the newborn that ought to be done as early feeding helps to prevent the baby from having dehydration, maintain blood glucose level and to lessen initial weight loss.
Breastfeeding is good for babies as the breast milk contains abundant nutrients and antibodies. It also helps the mother to regain back her body shape, promotes bonding between the mother and her baby, and reduces the risk of having breast cancer and ovarian cancer.
So this was the end of the labour.
It's just an unforgettable, and enriching experience which I'll never forget.
:)
---- The end of my long-winded story ----
Well, well.. This posting was so different from the general ward. However, it's interesting despite of some moments which were dreading.
I managed to observe a mother giving birth, papsmear, ultrasound, bathing & feeding the cute little babies and familiarise myself with the medications given to patients. I've been serving medications with the staff nurse for the past few days. It was fun though! =)
The lecturer has been praising me. Sometimes, I nearly bursts out laughing upon receiving her comments.
She said I'm a good girl as I did the research on jaundice. She said I'm intelligent and confident. I know my work well. And that I have a positive working attitude and should pursue a degree in nursing.
I was like 'HUH????'
Stunned.
Of course my parents would be happy and proud of me if they were to hear such things about me but I wanna be known as a silly person.
Hmmmm... now I shall say something about what's going on between me and him.
It's complicated I must say.
To cut the long story short, he said he asked for the break up coz he wanted me to realise my mistakes that I made in the past. It's more like a wake up call.
However, he asked for a patch up a few days ago.
Unfortunately, after realising what he'd done to me, I've became so heartbroken that I've lost all my hopes in the relationship. Tawar hati.
He ditched me during the times when I needed him so much as I was facing several problems back then.
He did horrible things to me for the past two weeks yet I was there when he needed my help.
Haiz...
I know I was really stupid.
He just sent me this sms saying that he didn't wanna let me go just like that. He wanna give a second chance to us.
All I can say is, I'm all broken up.
Ok enough about all that.
Wanna know something exciting yet ridiculous???
I received an email from the Northwest CDC regarding about
'Volunteers needed for Riding for Disabled Association of Singapore.'
I was like what???
The first thing that came into my mind was, I can't imagine myself riding a horse!
Obviously I bursts out laughing after that!
Haha!
But well, that program sounds very interesting!
I'm giving it a try.
Hopefully there's still vacancy.
I wanna help the disabled too anyway.
I pray that I can get in.
If I really could, I'll be booked by the people for horse riding trainings every Saturdays starting from next week till September.
Hee.. I don't mind at all.
This is gonna be fun!
{the riddle of red}
