نافع لغيره – BeNeFiCiaL tO OthErS

obstetric & gynecology

Primigravida

Hi readers.

Wassup??

I hope all of you are enjoying what you are doing right now, as we need to work to earn for our living. There’s no such thing as sit down and doing nothing as long as we are fit enough to do something.

Back to labour room, there’s a story I would like to share. There’s a lady, primigravida, in early 20s, admitted to labour room as she was in labour due to increasing contraction pain and os was already 4cm.

Primigravida is the term used for a woman who is pregnant for the first time. That means, this is her first child. So, she doesn’t have any experience related to pregnancy and how to bear down etcetera.

As soon as she felt like bearing down, we encouraged the mother to do so. We tried our best to motivate the mother to bear down, as she had no experience before. She always gave up trying as she felt exhausted everytime she bear down.

We didn’t gave up easily. As long as she could delivered normally, we would try again and again to support her. If she went for Caesarean section, few measures had to be taken care post operatively. The safest mode of delivery is by normal delivery, provided that patient doesn’t have any underlying serious medical problem.

As time went by, it was almost 1 hour the lady was in 2nd stage of labour. We asked her to bear down in an appropriate manner, so that the baby could be delivered safely. She looked tired, and had no energy at all.

Decision had to be made. Whether should be normally, or by operation.

Came our senior officer in the room. She was so eager to deliver the baby via normal vaginal delivery. The head of the baby was already seen. What was remaining, the effort of the mother to bear down correctly.

Episiotomy was perfomed. Everybody taking turns to give fundal pressure, in order to assist the delivery. Time was running out. The baby must be delivered by hook or by crook. Otherwise, he/she would be in distress due to lack of oxygen.

After few times of trying, we managed to deliver the baby safely. But wait, the baby was not crying! Huh?

Moderate meconium was seen coming out together with the baby! The baby was born flat! Something has to be done.

The officer cut the umbilical cord and warned us not to stimulate the baby. We were suspecting that there could be meconium in the oral cavity. Aspiration of meconium should be avoided.

The baby was brought to the incubator and resuscitation was performed. Direct suction was done. SPO2 was checked to assess the concentration of oxygen in the body. Subcostal recession was observed and the baby was still not crying. The baby could be in respiratory distress.

Paediatric team reached the labour room. The baby was then intubated, and transferred to NICU. Closed monitoring of the baby must be done. We have to rule out possibility of meconium aspiration syndrome.

That’s one of few episodes in labour room, which requires immediate action as it is an emergency condition. The more we delay, the more problems the baby would have in the future.

It is never easy. Once occurred, everybody has to take part and help each other. The immediate action is very important.

Ok then. Till we meet again.

Bye2..


The Graduation Day

Halo there!

It has been a long time since my last post here. Really sorry for the long silence without any new updates till now. Just now, when I signed in into this blog, a notification appeared and it has been 2 years already since I joined WordPress family. =) How time flies…

Recently, last week to be precise, I had my graduation ceremony here in our university. It was a simple one to be frank, but still I was proud to wear the convocation robe on that day. After almost 6 years of study plus hardship and struggle, we finished our journey here, and got our degree. We are recognized as MBBS degree holder at last. It was a very competitive route seriously, with ups and downs. It was an unforgettable and lifelong experience for me.

Thanks to all who had helped and prayed for our success.

Our Batch..

Our Batch..

Next plan?

Hmm, after this, going back to Malaysia for good. Gonna miss this country, its delicacies, its people, its culture as well. I really don’t know when I’ll come back here after this.

2 more years internship is waiting ahead of me. I really hope that I can do a lot better during that period. I still feel that I lack the practical work and experience during those 1 year internship before this. There were a few procedures that I didn’t get a chance to perform. huhu

Hopefully, the new work environment after this will be conducive for me to give my service to the people out there.

Till then readers, bye!


“Doctor, I want Caesar…”

I thought I was lucky last week when the senior asked me to go to the operation theatre (OT) as Caesarean section was scheduled for that day. This is my chance to observe the operation as close as possible. There were 2 patients in the ward who were posted for C-section. After checking their condition, the senior decided that the mothers should be transferred to the OT upstairs immediately.

To decide which patient is going for operation, it is not an easy task to do. It requires lots of experience to manage such patient, especially the care of pregnant woman at term because we deal with 2 precious lives here.

The most common reason for C-section is breech presentation of the baby. That means, the lower limb of the baby is engaged in the lower uterine segment. In this situation, the normal vaginal delivery should be avoided and should not be attempted.

In our hospital, any pregnant woman who is going for operation (C-section)  should be given :

  1. Injection Rantac (ranitidine) – a H2 receptor blocker to increase the pH of the stomach.
  2. Injection Reglan (metoclopramide) – this is an anti-vomiting medication. It acts by increasing the tone of lower oesophageal sphincter
  3. Injection Taxim/Cefazoline – an antibiotic, to prevent infection.

 

The IV cannula is also set up so that colloids can be given to the patient intravenously. This maintains the hydration status as well as the minerals of the patient throughout the operation.

Foley’s catheter is inserted also to help the voiding of the urine. Delivery of the baby would be much easier. This may also avoid injury to the urinary bladder during the operation.

Some of the patient asks for c-section whenever they cannot bear the pain of the normal delivery. They thought  that operation is the only choice to alleviate the intense pain. The truth is, a strict care should be given to the woman post-operatively, compared to those who deliver the baby normally, without any surgical intervention.

For those who have past history of c-section in the previous delivery, they should not be advised to have normal vaginal delivery. OR, there will be a risk of uterine rupture and consequently the patient end up with the uterus being removed (hysterectomy).

I personally think that, those who work in the maternity ward must have good control of emotion to manage any emergency situation. Why? As the delivery time is so unpredictable, it can happen anytime and anywhere also.

That’s why when the baby is delivered, I think the one conducting the delivery is so fortunate to bring one life to this world. I am so jealous with them and hope one day, I can be just like them…


In The Labour Room

A hospital is equipped with facilities to make sure that people get the best and safe treatment there. If emergency cases happen, it can be managed appropriately. At least, complications that may arise can be prevented and the prognosis of the patient will be better.

If a pregnant woman choose to deliver her baby at home, I think it is an unwise decision when there is none of any medical personnel accompanying the mother-to-be at home. It is a scary situation when only “so-called obstetrician” who barely know about the labour process and the possible risks, act like they have the expertise for years already.

Even for me myself, I feel that this delivery thing is not as simple as withdrawing someone’s blood, it requires a lot of practices as it involves 2 precious lives : the mother’s as well as the baby’s.

After weeks of this OBG posting, I think I enjoyed the work in the ward so much. There are plenty of things to do, although it was just an observation. Eventhough initially I felt a bit lazy, going through it with your colleagues who also have the same enthusiasm may boost your energy and motivate you.

As time passes, I got the chance to assist a normal delivery on my own. I mean full assistant. We were witnessing a delivery in the labour room (suturing of the episiotomy wound was remaining) that morning, when suddenly 2 pregnant women were transferred into the labour room. The environment became so tense. Everybody was shouting.

I looked at my friend beside me, signalling whether we should change or what. He also didn’t have any idea. We were in shocked actually..haha.. Then we decided that we must get prepared at once as we had to assist the senior doctor.

I went to the basin and washed my hand. At the same time, I glanced towards one of the patient who was pushing to her limit. The head of the baby already came out! I could see the face of the baby. One of our senior hold the baby’s head and pull him out. Then, she handed the newborn to the paediatrician. One patient settled already.

After preparing myself, I stayed beside the senior who was waiting to deliver the next baby. Episiotomy was done after few minutes of waiting. The mother was asked to bear down, when finally the baby was delivered safely. I clamped the umbilical cord and cut it. And what makes my day was that I became full assisstant for that delivery. How awesome is that! It was such a heart-pounding experience to deal with the newborn. But it is worth an experience.

To see the baby being born to this world, is a great moment. When the mother was shown their baby, they must be the happiest person in the labour room. They smiled and felt relieved after so much hardship beforehand.

We should be thankful to our parents who raised us all this while till we became what we are now. One thing that all of us can do is, keep praying for their health wherever we are, and whoever we are. That is the proof that we are still remembering them in our life.

Peace.. (“,)


Be Kind to Your Mother, bcoz….

 

Help the nurse to bring this patient to the labour room!“,asked the senior resident one day during my duty in the ward. The pregnant woman, approximately in her 30s, was passing thick meconium of liquor amnii after the vaginal examination (VE). It was a bad indicator for the baby, as the meconium may be aspirated and causing the Meconium Aspiration Syndrome (MAS).

The senior resident kept asking the mother to bear down again and again. She tried to push continuously as instructed. In the meantime, the senior checked the fetal heart sound (FHS) to assess the fetal heart rate (FHR) per minute.

After few trials of bearing down, the resident asked the nurse to get the stretcher. This woman had to be in the labour room. Delivery should be started STAT. The environment in the waiting room changed and becoming hectic. Everyone rushed to the labour room without any delay as this may harm the baby.

You get wash..

She said to me. I knew already that this was the golden chance for me to assist the normal delivery. Finally after few weeks. (It was a bad thing actually because we should have assisted the senior few times before. What kind of doctor are you? What a shame.)

When I entered the labour room, the senior resident was giving the *fundal pressure to the mother to assist the labour process. This is important when the contraction is not that strong and the mother is having no energy to bear down. I was quite blurred at that time. Really it was. This was the first time for me to assist the delivery so I just watched how they handled the case.

The senior checked the FHR again. It was around 80 beats per minute! The baby was having distress somehow as shown by the low heart rate.

Then came a junior resident, a male doctor. At once, he continued giving the fundal pressure again while of the senior was pulling the baby out. They did it really quick to save the baby’s life. The baby was finally delivered safely but, he was not crying immediately after birth. This was another bad sign…

In the blink of an eye, the other senior clamped the umbilical cord and and cut it. The baby was taken by the paediatrician and he started giving resuscitation to the baby. Thank God, the baby finally cried in the incubator after tactile stimulation was given to him. =)

Changla na?” (He is fine right?)” asked the senior to the paediatrician, when he said that the baby was fine. All iz well..hehe

The tension situation deteriorated. Everyone was so happy with the new member of the society, especially the mother of course. She was so relieved to see the baby, safe and sound.

The last part of normal delivery, suturing of the *episiotomy wound. This is a must know skill for us interns during this posting. It is a compulsory knowledge to know how to suture any wound, in this case, the wound of the perineal area. Even though I didn’t have the chance to cut the umbilical cord at least, I managed to learn how to do the suture. Maybe next time, I will ask the senior to let me do the suturing part.

 

How innocent are they

How innocent are they

 

This is not a full assist, it is a partial one I assume. haha

As for conclusion, normal vaginal delivery is absolutely a painful situation for the mother. Even me myself who just witnessed the mother also felt pity for them. That’s why nowadays, many of the pregnant lady opted for the operation, which is Caesarean section (CS) because they cannot withstand the pain of normal delivery.

For all mothers out there who prefer normal vaginal delivery upon the operation, I salute all of you. Your pain threshold is higher indeed as what was shared by my friend, and you have proven that you are stronger enough to endure such pain and hardship of delivering your precious baby. (“,)

Thank you mother for all your patience and hardship during those tough times…

 

* fundal pressure – the pressure which was given to the fundus of the uterus, to assist the expulsion of the fetus

* episiotomy – an incision into the tissues surrounding the opening of the vagina (perineum) during a difficult birth.

 


The final lap to go

 

When this journey is about to end soon, I feel so happy as I will be able to meet my family so often after this. I will use those times wisely before I join the new episode of housemanship life in the local hospital. I hope I get the chance to work in the hospital near my house so that I can go home and take care of my parents and siblings.

After this also, there won’t be any issue of a tiring and long journey for me. Travelling by a flight plus by road after that, is a tiring experience for me, but it is unforgettable. It is this kind of journey that makes us to be stronger everytime we face any problems afterwards.

As time goes by, I am in my last posting at present. I felt so jealous with the obstetrician everytime she ‘brought’ a new life to this world during Caesarean section (CS) in the OT. I wonder how many babies had she handled before this. I thought that this job of dealing with 2 lives simultaneously, is such a tough job to do but still, it brings a deep satisfaction for the doctors themselves. It was a joyous moment for both doctors and mother to welcome this tiny, amazing member in the society. The first cry of the baby is like a remedy to the pain endured by mother beforehand.

Last anaesthesia posting, I still remembered a CS when a twin was delivered safely. And guess what, the mother is still in her early 20s! Both babies were given to the paediatrician who was responsible for cleaning the baby, do suctioning of the oral and nasal cavity, cutting of the umbilical cord and weighing the babies.

It is a normal situation to see young pregnant woman in 20s. Most of them are villagers, working as farmer and they get married quite early also. So it is a duty of a doctor to gave advice to these people regarding family planning which benefits most of them.

May the remaining weeks onwards will have a different stories to be shared here…


The Concept of Mutualism

It is an amazing experience to see the delivery of the baby in the labour room. The situation is heart-pounding and full of nervousness. I think every child has to be there when their mother is going to deliver the baby, so that they know the hardship mothers have gone through and be respectful to them in all aspect of the life.

Labour room has been a union place between 2 departments, OBG as well as Paediatrics department. Prior to delivery, a paediatrician is called to be ready in the room. He has the resposibility to give resuscitation to the newborn babies and assess the babies condition. The obstetrician do their work of delivering the baby as fast as possible. This aims to prevent any stress or occurrence of birth asphyxia to the baby.

Next, the baby is ‘delivered’ to the paediatrician for next task ; resuscitation of the baby. This involves the procedure of oral and nasal suction, cleaning the baby and cutting of umbilical cord as well as observation of presence of 2 arteries and 1 vein. After that, birth weight is measured to rule out if the baby has low birth weight.

I remembered one time in the labour room with the PG student. He said that, the crying of the baby is a good sign. It is a sign of life. In addition he said, “If they are not crying, we cry..” haha. What a nice line from him.

If let say the baby is not crying, something is not good. Stimulation has to be done. Doctors have to work faster to avoid any major problems. One of the vital solution is to do mechanical intubation to the newborn. This is to provide good airway for the respiration to take place. If there is no improvement, the baby has to be taken to NICU as soon as possible.

Really, we have to work with each other in this world. Mutualism, that is the value that we should practise. Even in all religion also, cooperation is one of the good value which is emphasized to produce a better society. Nowadays, do you think our society around us is the best one? If not, how should we tackle the problem? Me myself and you all have more work to do in creating a peaceful environment which is safe and promise a healthier life generation to generation.