Mel presented herself on this day to antenatal visit and this was my first time to meet her. Mel was 27+4 at this presentation. Mel was a G5p6 who had a NVD in 2005 at 40/40 3742g boy and she also had another daughter in 2008 NVD at 41 weeks. In addition, Mel had 3 previous y m/c before 8 weeks.
Mel reported that she has good family support and this was supported by her mother’s attendance on this day who helped in taking care of Mel’s other children. She tested O positive and all other blood tests were clear. She also had a good booking in Hb at 125g/L, rubella immune, hep b and hep c negative which is her GTT result at 26 weeks fasting 4.2mmol and 5mmol post. A fas was conducted that was NAD which showed that the placenta was posterior and AFI index indicated to be normal. Mel’s nuchal translucency U/S was low risk. Mel said that she was in a stable relationship and reports no D/V. She also scored a 2 on the EDS and this indicated that she was coping well.
Mel had a BMI of 28.57. She hoped to breastfeed her infant baby following the discussion that we had on importance of breastfeeding to both herself and her baby. Mel was smoking cigarettes by the time we first met although she promised to stop smoking in the future following the discussion we had on the benefits of stopping the act. She reported that she had cut down the smoking to 2-4 times per day.
At this visit her Bp was 110/65. However, she reported to be non-symptomatic for urinary tract infections and said that she was drinking adequate amounts of water. Good fetal heart sounds were auscultated via hand held Doppler. Mel also said that she had been feeling lots of movement of her baby and when we auscultated we could hear the baby moving about to get away from the Doppler. We measured the fundal height as 23 cm and that was the end of our meeting. However, I made the next appointment with her to be held on 8/5/12.
8/5/12
G 27+3
Mel was in my morning clinic on this day and she reported that she was sleeping and eating well. Mel noted that her baby makes lots of movements especially at night but I told her that babies usually move all the time even though most women claim that their babies are most active in the middle of the night. She recorded 27+4 and her fundal height was 29cm. The baby’s heart rate was auscultated via Doppler and recorded 141 bpm. Mel still held that she is non-symptomatic for UTIs and her BP remained to be 110/65. I booked an appointment with Mel for a GTT as there were predisposing factors such as having a high BMI. For this test, it required us to see Amy in two weeks’ time in St Mary’s clinic. Mel complained of getting heartburns which was a similar case with her other pregnancy and I suggested to her to take Mylanta. Mel also said that she quit smoking the previous week and that she had gone 4 days without smoking cigarettes. I congratulated her on this and made an appointment with her in 4 weeks’ time.
19/6/12
G33+6
Mel had been transferred to the high risk doctor’s clinic because she had an APH. A CTG, pathology and u/s were attended but they all gave good results and thus she was put back into my clinic.
Mel was accompanied by her partner to the clinic on this day. She was feeling well except some occasional heartburn. I therefore recommended her to take some Mylanta according to prescriptions. Mel was now 33+4 weeks and measured 35 cm on fundal height. The baby’s head was in an upside down and in OP position. At the visiting time, the baby’s HR was 134 BPM and Mel reported a good fetal movement. I also secured the next appointment with her on 17/7/12.
17/7/12
G36+6
Mel presented herself with her mum again and two kids on this day. Her Bp was 117/66 and she reported no discomfort on urination. In addition, FHR was auscultated via Doppler at 126BPM and Mel reported good FM. We talked about the Nepean policy of allowing only 24hrs on NVD before beginning to follow up with the midwife at home thereafter.
Mel was to go home early as she had the other kids to look after since Brad, her partner, can only get 2 days off work. I recommended to her to make use of community nurses and their facilities for breast feeding. I made a follow up appointment in two weeks’ time.
31/7/12
G39+1
Mel was now 39+16/40 and said that she was very excited about the coming baby. We talked at length about the delivery process and I drew pictures to explain how the cervix effaces and dilates. We also talked about birth options and Mel said that she does not know what she wants in terms of pain relief. Nonetheless, she said that she was ready to deliver her child. Her BP was 124/74 and her fundal height was 40. The baby had descended and was engaged ↓2/5. I talked with her about the early signs of labor and that because she was GBS positive, she would have to present herself as soon as her water broke. I therefore made another appointment with Mel in the following week but said that hopefully I would see her shortly in the birth unit.
9/8/12
Phone Call from Birth Unit
The call from birth unit came in retrospectively at 1800 hrs. Mel had gone into labor at home and presented herself not long after to the hospital. I was informed that Mel’s membranes ruptured at 1700 liquor and that the meconium was stained. The midwife who was looking after Mel said she had not done VE as of yet but didn't think Mel was far from delivery. As I was 2.5 hours away in Bathurst and I had just driven from Nepean to home, the midwife said she didn't think that I would make it to deliver her if I drove down again on that day. So I gave my regards to Mel and told her that I would call her on the next day.
10/8/12
Call to Postnatal Ward
I called Mel on the postnatal ward to enquire how the birth had gone and to apologize for not being able to make it to her labor. Mel said it was not a problem as it was so quick. She had experienced some little pain in the morning but ignored it and sat with her partner to watch television. However, the pains became increasingly unbearable in the afternoon and therefore she came to the birth unit and delivered her baby not long after. Mel said that she had a big baby boy weighing 4708g and that he had gotten a little stuck on the way out (on obstetric it showed she had a shoulder dystocia requiring Microburst’s maneuver). She then went on to tell me that baby Blake had difficulty in breathing when he come out and therefore he had to be taken to the NICU. When I checked on obstetrics, it showed that Blake was born with an apgar score of 5 at 1 minute and 7 at 5 minutes. Blake also had respiratory distress and required cpap for 1 hour. Mel said Blake was discharged on that day from the NICU and she attempted to breastfeed him for the first time. Mel said she had no analgesia during labor but local infiltration was used on postpartum to facilitate suturing of a second degree perineal tear. The visual estimated blood lose was recorded to be less than 500 mls. The placenta and membranes were complete and central insertion of the cord which contained three vessels was reported on obstetrics database.
9/8/12
Visit to Postnatal Ward
I called up to the postnatal ward to visit Mel early in the day for I knew that given her history and the business of the postnatal ward, it was likely that she would be discharged early. I met Mel sitting on bed with her partner who had visited her. Blake looked perfectly content in his mother’s arms and Mel said that he had just breastfed him. Mel looked well. I asked her how she was feeling and she said that she was fine and that she was just glad to be going home. I asked if she did not mind if I called her when she had gone home and she said that it was perfectly ok with her and so I excused myself and left as I had to start my shift.
13/08/2012
Postpartum Call to Home
Mel said that Blake had been weighed the day before when the community midwife came and he was 4800 grams and had gained 100 grams since his birth. He also had his newborn screening test on that day. Mel said breastfeeding was going well but had been waking up for night feeds and that her partner has been supportive.
05/10/2012
Postpartum Call to Home and Closure of CCP
Mel was feeling well but tired as expected for a mother with a young baby and two other children. She reported that Blake had gotten into a good routine which enabled her to get 5 hours sleep at night. The breastfeeding was also going very well and that she had plenty of milk. She said she had her six weekly check-up and that everything was fine with both her and Blake. I thanked her for allowing me to follow up on her pregnancy. I told her that I had learnt a great deal from her birth experience and I wished her well in the future.
