Have you ever wondered what a midwife gets up to in her day to day work? People often ask me what I actually ‘do’ during my shift when I’m not ‘delivering a baby’. So I thought I’d give you a little insight into my shifts over the next couple of weeks.
Week 4 – Elective Cesarean Section List
*Disclaimer – This post is based on a typical day working in obstetric theatres and any resemblance to real life is entirely coincidental*
07:30 Midwife allocation to Caesarean Section List
Today I have been asked to accompany three women who have been scheduled to have a cesarean section to theatre. On weekdays there are up to 5 caesareans planned per day so this work makes up a large proportion of the day’s activities. There is a separate medical team to ensure it runs smoothly and on time, which allows the doctors and theatre staff who are on call to concentrate on any women who might need their expertise whilst in labour on the delivery suite. I go to the ward to say hello to the three women and their birth partners before the surgery begins and then I head to theatre to ensure I have all the necessary equipment I am going to need for the day.
The team who are are going undertake the surgery all huddle together to plan the days activities. It is a large team consisting of myself, 2 obstetricians, an anaesthetist, an ODP (operating department practitioner who helps the anaesthetist), a scrub nurse (who will pass the instruments to the surgeon during the surgery), a healthcare assistant and in some cases a neonatal doctor may be required. During this briefing, we discuss any complications that potentially might arise, ensure all the necessary equipment has been checked and is working and decide which order the caesareans will happen.
08:30 Prepared for theatre
I return to the ward to ensure all the women have been correctly prepared for their operations. This means listening to the baby’s heart rate or possibly completing a CTG trace. With help from a healthcare assistant, we also check their observations, ensure they haven’t eaten recently and that they have taken their pre-operative medication. We also make sure they are ready for the theatre environment, so help them in to gowns, remove any jewellery or nail varnish and fit them with anti-embolism stockings to help prevent deep vein thrombosis (DVT).
09:00 To Theatre
We are all ready! I walk the first client and her husband to theatre and they excitedly tell me all about their pregnancy and what names they have picked out for their baby. This is their first baby and it is unfortunately lying in the breech position. After an unsuccessful external cephalic version (ECV – a procedure where the practitioner attempts to turn the baby in to a head down position), they have decided that the best option for them is to have an elective Caesarean section. There are many different reasons a woman may have an elective caesarean section and a baby in the breech position is a common one
After initial checks and monitoring in theatre the anaesthetist is ready to site the spinal anaesthetic. The Dad-to-be has changed in to theatre scrubs and is attempting to do his best George Clooney impression! The helpful theatre staff help position the mum for her spinal injection and once the procedure is complete she lies down ready for the birth. I insert a urinary catheter as it is really important the bladder is empty before the operation and then get ready to meet the baby.
09:50 Elective Caesarean Operation
Once the doctors start the operation it is not long before they lift out a beautiful baby boy, they wait 60 seconds before cutting the cord then hand the baby over to me. I dry and wrap the baby and take him over to his mum for some cuddles and skin-to-skin contact. Whilst mum and dad are meeting their new arrival I am busy checking the placenta, completing paperwork and cleaning equipment that I have used. I then go on to weigh, check, label the baby and administer an injection of vitamin K that the parents have requested. For more information about Vitamin K for your baby then have a read of this leaflet.
10:30 Operation finished
As the caesarean comes to an end the team calculate how much blood Mum has lost (not much), put a dressing over her new wound, transfer her to a fresh bed and we wheel the new family into the recovery area. Here, I hand over all the important details to the midwife working in recovery. She will ensure that Mum is stable, the baby has had a feed and I complete the legally required birth registration. I wish them best of luck with their new family and head off to collect the next couple waiting for her caesarean.
11:00 Theatre turnaround
In the short time it has taken me to handover in recovery and collect the next woman, the theatre team have been working non stop to clean and turn around theatre for the next case. The next couple are expecting twins, so we need double the equipment available for when the babies are born. Once the spinal anaesthetic is in and working well a second midwife joins me to help with the two babies.
12:15 Twins are born!
Both twins were born in good condition, one boy and one girl. My colleague helps me weigh, check and label both babies and then we support mum and dad taking it in turn to hold them. Unfortunately, the Mum loses a little more blood than we’d like, she receives some special drugs to help reduce the bleeding. One of the risks of a caesarean section is an increase of bleeding in comparison to a vaginal birth, all the risks are discussed with the parents prior to the operation. The doctors finish stitching her caesarean wound back together and once clean and comfortable we transfer them all to recovery, where she will remain for a few hours to ensure she is stable after losing a larger amount of blood than normal.
13:30 Final Elective Caesarean of the Day
The team working are keen to continue and finish the caesarean section list so I gulp a quick drink of water and scoff a banana before going to collect the final woman and walk her round to theatre. Due to a few medical conditions, it has been necessary for this lady to have a caesarean section a little early, she is only 36 weeks pregnant, therefore I ask a neonatal doctor (specialist in newborn care) to attend the birth. The baby girl is born in excellent condition and after a few initial checks from the doctor, she is left with her parents and I support Mum to do skin-to-skin with her. The baby will need a few extra checks as she is pre-term, so I explain these to the new parents.
14:30 Time to finish
Phew – what an exhausting day! I have witnessed three caesarean section operations and seen four babies born. The last woman is still in theatre, as my shift is finishing they send another midwife in to take over from me and she will help transfer them to recovery. She will stay in recovery for an hour or so before being settled on the postnatal ward. If you are wondering what the recovery following a caesarean section is like then read the NHS information here.
If you are interested in midwifery or thinking of joining the midwifery profession then read my experience of becoming a newly qualified midwife ‘The Birth of a Midwife’.
Did you like hearing about what I got up to during this shift? Have you read my previous posts in this ‘A day in the Life of a Midwife’ blog series? Follow me working as a Midwife in the delivery suite, birth centre and maternity triage.