All last week I joked with my nearly due patients that I would see them on Labor Day. This joke is inevitable in OB/GYN, and yet, every patient that comes up with it believes that they originated the idea. I had a wonderfully relaxing weekend, despite being on hospital call. My office is closed today, but somehow I just knew that I wasn't going to get away with a true 3 day weekend. The better part of last week, I was focused on buying one of my patients, PreTermMom, just a few more days of pregnancy. She has a history of two prior term deliveries, however, she had pre-term labor with both of the prior pregnancies. This pregnancy, too, was plagued with pre-term contractions amongst other complications. She has been in and out of the hospital, on various tocolytic regimens, but all medications were stopped just recently. My personal goal was to keep her pregnant until she hit the 36 week mark. She fell just a day short of this goal. Her water broke around six this morning, and I got a good morning wake-up call around seven from labor and delivery. Not willing to be burned by a precipitous delivery again, I dressed, showered, and got to the hospital within 40 minutes. It turns out that I didn't really need to rush today, but had I taken my sweet time, I just know that baby would have been out in the bed before I could get to my car!
PTM was having intense contractions, and really hurting through the peaks. She really didn't want to move around very much, but she happened to roll to her right side during one contraction and the baby did not want to go there! She had a 5 minute deceleration to the 90s, and for a few heart-stopping seconds, I was afraid that I was gong to have to rush her back to the OR. Luckily, we found a position that the baby favored, and the heart rate returned to normal. She requested IV pain medicine, which seemed to take the edge off of the pain, but it also slowed her contraction frequency. She was 4 cm on admission, then 5 cm, then 5-6 cm (the repetitive checks were due to her constant sensation of pressure and the need to push). I think that the mere scent of pitocin hanging in the room was sufficient for her to turn the final corner; I don't believe that it even reached her IV.
Right at the time that she was ready to push, her husband began to get ill. He was gagging and trying not to vomit, yet he stood valiantly at her side, not running for the bathroom. Poor guy, labor can be pretty gross if you stop and really think about it! Just three pushes, and the baby was really crowning well, stretching the perineum. Since the baby was tolerating the labor well at this point, I helped things along with perineal massage (not super-popular these days). She had a history of a significant 3rd or 4th degree laceration with a previous pregnancy and was very leery of another tear. Thanks to a small baby and a controlled second stage, she had but one small vaginal tear that required one stitch. Though small, the early baby was pink and screaming as she entered the world, and her birth time was in double numbers...good luck! This small baby was due in October, tried valiantly to be born in August, but compromised on September. In the process she gets to have a pretty birthstone (Sapphire) , and her parents get to have an actual Labor Day labor story. What do I get? I get to write off this day as an "un-used" holiday, and, even better, to extend my upcoming vacation by a day without using precious vacation time! Woot! Now if we can only manage four quarters of football without embarrassment and, perchance, win? Then all will be well in my little corner of the world. Happy Labor Day!