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- My “Coming Morning” Priority – Housemanship Diaries
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- My Second Posting During Housemanship – Obstetrics & Gynaecology
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The Labour Ward.
When I first entered this posting during my tagging period, I was allocated to work in the labour ward. This is the place where the taggers would be allocated initially before being shifted into other wards such as maternity and gynae.
The labour ward is an extremely intense place yet also the best place to learn upon first entering this posting. Firstly, because the whole on-call team will be there which are the on-call medical officers, registrar and also specialists. Hence, it is not as daunting as it seems. You are never alone and help is always within reach.
The labour ward in Sarawak General Hospital is located on Level 4 of the main building, situated opposite the nursery.
Upon entering the labour ward, is the Pregnancy Assessment Centre (PAC), followed by the rooms at the back where patients in active phase of labour or patients who are being augmented are situated.
On normal days, there would be one house officer allocated to PAC and one house officer allocated at the back. On good days when there is more manpower, the work is not as tiring. However, on bad days where the manpower is anaemic, only one house officer would be in charge of the PAC and the labour ward.
1. PAC (Pregnancy Assessment Centre)
When the patients first present to the hospital, 90% of the time, they are directed straight to PAC where the patients will be clerked and assessed based on their presenting complaints.
Some may come in due to contraction pain (which is most common), bloody show or bleeding, leaking liquor (which means their water broke), miscarriages, nausea and vomiting in pregnancy, elective admissions for caesarean sections or induction of labour, reduced foetal movement, menorrhagia, etc.
The PAC / labour ward serves as the emergency unit solely catering to antenatal mothers or gynaecological issues. Unless of course, the patient is too unstable to be transferred to PAC from the main emergency department.
The patients presented to PAC are usually attended based on the severity of their presenting issue and not according to order.
As a house officer, we will usually clerk the patient as well as perform their physical examinations before performing necessary tests such as vaginal examination for term mothers presenting with contraction pain or speculum for patients presenting with leaking liquor followed by collecting the HVS C&S (High Vaginal Swab Culture & Sensitivity) and coming up with our own impression (diagnosis) followed by a plan before presenting it to any medical officers whereby our reviews will be counterchecked or rewritten if necessary.
From the PAC, the patients will either be admitted to maternity ward for observation or gynae or labour ward if they are in active phase of labour or straight away posted to OT if necessary or even sometimes discharged.
On days where the PAC is “burning”, we would not have time to sit and properly clerk the patient, hence as a house officer, we will be asked to take bloods or post case or fill forms, set branula or to send bloods.
2. Labour Ward
Once you understand the flow of work in the labour ward, it is pretty repetitive for almost all the patients.
Most of the time, when a patient is brought to the labour ward, it is for augmentation of labour.
The moment the mother is brought into the room, as a house officer, it is our duty to do a transfer in review, set a branula if it is not set, check for their full blood count results and any GSH (Group, save and hold) if available.
Once that is done, we will do a vaginal examination to check the opening of the os and also artificially rupture the membrane of the patient with an “amniohook”. From there we will assess the colour of the liquor and the patient is put on continuous cardiotocograph monitoring till delivery.
Of course there are instances whereby the mother delivers upon being transferred to the labour ward.
The spontaneous vertex delivery is usually conducted by the midwives. As house officers, we are able to conduct as well under the supervision of midwives. However, our main duty is to continuously monitor the CTG and inform if there are any decelerations or abnormalities, as well as to prepare for emergency caesarean section or vacuum assisted delivery if needed.
All in all, the labour ward can be a relatively fun place to work. Personally, I have enjoyed my time working in the labour ward especially when the nice team is oncall.
Related posts:
- The Orthopaedics Posting – Housemanship Diaries
- My “Coming Morning” Priority – Housemanship Diaries
- 8 Best Advices I Will Remember For The Longest Time – The Orthopaedic Posting
- My Second Posting During Housemanship – Obstetrics & Gynaecology
- I Survived 26 Days Of Tagging In O&G – Housemanship Diaries
The Theoretical Doctor 