Clinical Reflection

Clinical Reflection: This week in clinical I had my first real labor and delivery experience. My patient, RW, was admitted for pre-Eclampsia and headache. She was my first patient to be married and older than me, so my experience was a little different. One of the most striking complications of her pregnancy was her obesity. She had a BMI of 49.89, which complicated her FHR monitoring, mobility, and labor progression. RW had also had back surgery which was complicated by osteomyelitis, so she would not be able to receive an epidural if the need for a Cesarean delivery arose. If she needed anesthesia, she would have to have general anesthesia. Other complications of pregnancy included her HSV infection from May 2010, her rubella nonimmunity, her history of abuse, and her lack of steady income. Despite all of these problems, the patient’s morale was incredible. She was positive about her pregnancy throughout the entire day even though she experienced a lot of pain.
Earlier that morning, she was having problems with cervical dilation. She had dilated to two centimeters, but she had stalled out. The doctors had decided to insert laminaria into the patient’s cervix. The laminaria sticks acted like sponges, and as they absorbed fluid, they dilated the cervix. This dilated her to three centimeters, but even with the pitocin infusion, she didn’t dilate anymore. The next intervention involved a Foley catheter. The resident inserted the catheter into her uterus and filled up the balloon with 4 cc of water. The nurse, Lindsey, was in charge of slowly pulling the inflated catheter out. By the time Lindsey was able to pull out the catheter, the patient would be dilated to 5 centimeters. As Lindsey pointed out, these methods were very “primitive,” but they certainly got the job done.
I really enjoyed working with Lindsey. She was very knowledgeable and always tried to include me in whatever intervention she was performing. I was especially impressed by her