fetal heart rate

anonymous asked:

why was a c section needed? (not bashing by any means just genuinely curious!)

I had originally planned to have a C-section done Monday because she had some discharge that I wasn’t sure was normal. I had called around to a few vets as well as other friends that are breeders. There were mixed reviews, some said it wasn’t beyond the realm of the norm but it was defiantly something not typical, and possibly a dead puppy. Monday morning she showed signs of finally being in Stage 1, which is trembling, panting, nesting, not wanting to eat, etc. I called all my contacts to see what they thought and was told to try and wait the 24 hrs from the start of Stage 1 unless Lighting seemed to be in distress. I scheduled a C-section for Tuesday morning instead because an emergency c-section is way more expensive and I wanted to be prepared. Instead of going right into the c-section we first checked the fetal heart rates to see if they were in distress typically their heart rates are around 200-225 range, they were more around 160-180, which means they were is some type of distress. I made the decision to have the c-section done and as they got her up to go into surgery her water broke. The vet set a timer for 20 mins, which typically after a dogs water breaks a puppy should be ready to appear. After 20 minutes, their heart rates were checked again. One had dropped to 125. So we decided the only way to make sure all puppies survived would be to get them out ASAP. Dr. Gaynor, Dr. Gerbig and their staff were excellent, I can’t thank them enough for how great they were. Lightning did deliver 2 pups naturally as they were prepping for surgery. It’s possible after her water broke that she would have had a natural birth, however with the concern about heart rates a C-section was defiantly the best way to get them all out quickly and alive. Even if she was a champion whelper 5 hours for 11 puppies is a long time to wait with their heart rates dropping.


Edit: Oh yeah and there was no dead puppy. All pups were alive.

J.J.

James from The Freshman/The Sophomore as a dad.  James x MC.  As requested by @hgacutan  This was hard for me to write for some reason (because i’m not a dad and i’m not a son?) and it’s really long! but i hope you like it :) 


My dearest MC,

You are the reason I continue to breathe every day.  Without you I would not be the man that I am today.  As I write this letter, you lay beside me sleeping and I could not be more in love with you than I am right now.  Earlier today you shared with me that we are going to have a child.  For the first time in my life, I was speechless.  Now, I sit here, watching you… so beautiful… and my mind is racing; filled with all the things I want to tell you, tell our child.  All the things I want to share.  No matter what I thought my reasons for living were before, I know now that THIS is why I was put on this earth.  I will spend the rest of my days caring for, protecting and most of all, loving you and our child.  I will strive to be the best father possible.  I will make you proud, I promise.  I will love you more and more every day.  

                                        Love,

                                            James


“James! Come quick! I felt the baby move, I think!” James rushed from kitchen to the living room, falling on the couch beside his love gently placing his hand on her belly.  "What do you mean, ‘you think’?“

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Prolapsed cord is when the umbilical cord falls down thru the cervix. It’s most likely to happen when the presenting part is not engaged and the membranes rupture. Always check fetal heart tones after the membranes rupture!

Here are some helpful tips to remember on Nclex:

- If the cord prolapses before complete dilation = IMMEDIATE C-SECTION.

- If cord is being compressed you will see VARIABLE DECELERATIONS in Fetal Heart Tones.

- If cord ceases to pulsate, it indicates fetal death. You want the cord to pulsate because this tells us the baby is getting oxygen.

- Fetal BRADYCARDIA is an indicator of a prolapsed cord.

#13 Pregnancy Memories Pt. 2 [Requested]

Scott: “Y/N, look at this one.” Scott’s deep voice exclaimed; his athletic frame stood in front of a display model of an espresso stained crib and changing station combo, strong hands shaking the frame. He’d just received his paycheck from Deaton, surprising you with a trip to Babies “R” Us. “It’s definitely safe.” He nodded in approval, lowering his voice as he continued. “I used a tiny bit of wolf strength on it.” The muted thud of the espresso stained pine drawer sliding closed interrupted the complacent silence, Scott squinted his pleasant dark chocolate irises reading the fine print typed on the sales tag. “Babe, it comes in white and cherry if you don’t like this one.” The fact that the true alpha took surreal interest in the purchase of furniture for Noah’s room was heartwarming. He was going to be a protective and loving father. “I am going to tell the cashier we’re getting this.” He briefed with a proud handsome lopsided smirk, warm supple lips pressing a chaste kiss to your cheek. “I’ll meet you by the car seats.”

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Just like it says on the above graphic this is a guide to twin pregnancy. I’m going to start this off with a disclaimer. DISCLAIMER: No two pregnancies are exactly alike and that goes for singleton pregnancies and multiples pregnancies. This guide is based predominantly on my experience and the knowledge I gained through my doctors, reading, research and the experiences of other twin moms that I have encountered. I am writing this guide because I’ve seen a lot of misinformation in guides to pregnancy before and I haven’t seen a guide on twin pregnancy. Seeing as I have firsthand experience with twin pregnancy and pregnancy with one baby I thought it might help someone. So here we go!

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Artowork inspired by the fanfiction “Storm Front” written by @thegraytigress ( I hope you like it xD) .

You can read all the “Heart of The Storm” series on AO3

The chapter in detail is the 19th. You can find all the “Storm Front” story on AO3

Request by @aquajules

Natasha was rapidly discovering that there was a very good reason it was called labor.

“There’s another one coming,” Steve warned her. He could see the contractions on the screen beside her bed. She’d been laying there for an hour already. They’d arrived in the medical ward at the same time as Bruce, who’d looked like he, too, had been roused from a peaceful sleep if his messy hair and bleary eyes had been any indication. He’d immediately jolted to full awareness, however, when he realized this was really it. He’d hooked both the contraction and fetal heart rate monitors back up to Natasha after Steve had helped her changed out of her pajamas and into a hospital gown and boosted her onto the bed. From there, Bruce had performed a quick internal exam and discovered she was four centimeters dilated, completely effaced (whatever that meant), and, in fact, the first twin’s amniotic sac had broken. Then he’d left to make some phone calls. That had been a while ago, and only Steve was in the room with her now, watching the monitors and trying to be helpful. “It’s coming, love. Breathe.”

Yes, it was coming. It was coming hard and harsh, and she barely had a chance to brace herself against it. It was a strange pain, not the worst she’d experienced in her life but certainly not something she could just brush aside. She’d read online that some women likened it to the worst menstrual cramps imaginable. Thanks to what the Red Room had done to her, she’d never much experienced what “normal” cramps were supposed to feel like, but this… It was pretty bad. The rock hard muscle of her uterus tightened and tightened until breathing was a chore, until her back throbbed and her pelvis felt like it was cracking under the pressure, until she could hardly do much else but concentrate on getting through it. But that was what was strange about it. She got through it. They came in waves, in very predictable waves, and like waves, they swelled and crested and peaked and then dipped into release like sliding down into a trough. And the sliding down was such a momentary relief that she almost felt high after surviving each one, like getting through every contraction was a victory. One step closer to this being over.

Climbing up to the crest, though? Like now? Less than pleasant. “Breathe, Nat.”

This was where it got bad. “I swear to God, if you tell me to breathe one more time… Oh, God. Oh, God!”

“Okay, okay, I won’t,” Steve promised. It was hard to focus on him when it got bad. He was right there with her, had been continually in fact, doing everything imaginable to make this easier. Natasha didn’t know whether to hate Bruce or love him for showing Steve how to read the little tracings on the monitor for her contractions, because her husband had elected himself to keep track of them, timing them, letting her know when they were coming and when they were ebbing (it was only a little creepy – and amazing – that he could see all of that from the tiny sensors attached to her bare belly). And he was watching the twins’ heartrates, both of them, and she could see he was driving himself crazy with worry. “I won’t. I won’t. It’s alright.”

“Don’t tell me that, either,” she growled, writhing a little despite herself. God, this was awful. And it wasn’t just the pain. It was the vulnerability. Exposure. Lying there with practically nothing on, only this thin nothing of a gown and a thin nothing of sheet covering her naked lower half. She’d never liked doctors, never felt comfortable in this setting, never cared for the unnatural submission that came to her in the face of medical procedures. The Red Room had done that to her, one of its many lasting curses. Their cruel “physicians” had branded an automatic response into the core of her body and heart: fear and resignation. Struggling meant more pain. Panic was ignored. Her wants were irrelevant. She’d had no choices back then in Brushov’s hands. They’d done to her what they’d wanted, and she’d had no choices.

She knew this was as far from that as possible, but it was hard to shake free of those responses, especially now when she again felt like her choices had been wrested from her. Granted, these were entirely different forces doing that, entirely different reasons (the exact opposite reasons in fact) for being in this bed and in this position. For months she’d swallowed down her aversion, the traumatic memories and inclinations to run and fight, the terror she felt every time someone claiming to be a doctor touched her. She’d slowly adjusted to Bruce’s tentative, practical hands. Now, though, her body was beyond her control, well and truly beyond it, and she felt more naked and unprotected than she ever had before. No clothes. No masks. No mission. No training. Nothing. Nothing but Steve and her own belief that this was okay and she could do it.

 I can do this.

The pain reached its apex, and she didn’t think for a few seconds. Steve took her hand again. That was good. Something to anchor her when it reached its worst intensity. He was right there, looking between her face and the monitor, letting her squeeze his hand. With the serum from the twins pumping through her combined with her own enhanced strength, she wondered idly if it hurt. He didn’t flinch, at least not at that. “It’s almost over,” he swore softly. “You can do it.”

“You… you a cheerleader now?”

“Right now, yeah. Breathe, Nat.”

“Rogers!”

“Sorry!”

Natasha gasped, trying to focus on her breathing (as much as she didn’t want to admit it, she knew he was right – that was extremely important, and it gave her something to do, something to focus on). The steady swish swish swish of the babies’ heartbeats was thunderous as she worked through the contraction, digging her nails into Steve’s palm, twisting his fingers hard enough that, were it anyone else, she’d be worried about breaking them. He just took it. She managed to get her eyes open, managed to look at him, and found him watching her with baby blues that were wide and frightened and desperate to do something to make this better.

Finally came the slide down the other side. There must have been endorphins flooding her brain, because it felt good. Like the serum was trying to make it easier. Rejuvenating her in every way it could in between the contractions. Giving her extra strength, extra endurance, and extra relief. She didn’t know if that could be the case, but it was nice to think it. “Okay,” she breathed out, smiling lazily despite herself. “Okay. Okay.”

“Okay?” Steve asked, now trying to readjust her grip on him without disturbing her too much.

“Yeah, okay.”

He chuckled a little, a tad nervous at her sudden change in mood. This whole thing was so unpredictable. As crazy as it was for her, clamoring for the last vestiges of control over herself, it was probably even more so for him having to watch it. “You look like the cat who got the cream.”

“Better now. I think it's… I think it’s the serum.”

Steve looked surprised. Then he smiled faintly, like he was happy something he’d done was making this better for her. He leaned down and kissed her sweaty forehead, brushing her mussed hair away. “Give you every drop in my body if I could,” he murmured into her forehead.

“No,” she replied, not having the energy to push him away. “We just got yours working again. No.”

He laughed more fully, flushing a bit in embarrassment. “What else can I do for you then?” He was quick to straighten, to grab the damp washcloth he’d gotten for her forehead. Normally she despised anyone fussing over her, but it felt good right now, drifting contentedly in between contractions. He wiped the sweat away from her face and then carefully set the cloth over her brow. “You want some water?”

“Bruce said not to drink,” she reminded muzzily. “Or eat.” Where did he go, anyway?

Steve must have been truly stricken with equal parts excitement and panic to have forgotten what Bruce had told them. “There’s ice,” he said after a beat, triumphant to have come up with that solution, and then he was readjusting the sheet to cover her lower body and legs better and heading to the door.

The next contraction came without warning. “No, no! Steve! Wait!” He turned around and was back in a blink. He scrambled to take up her hand again, and Natasha groaned through gritted teeth. Not going to lose it. Not going to cry. Not going to. Not going to. “Oh, God. God… Steve!”

“Right here,” he promised, holding her as much as he could.

The pain ratcheted up quickly, faster than she was prepared for, and a slew of Russian obscenities (a few particularly vulgar) blasted through her trembling lips. Steve understood, of course. “Language?” he admonished with a little smile, flushed red with worry.

She glared at him. Glared. It was hard with the pain trying to invert her abdomen, it seemed, but she managed, sitting up a little by digging her elbows into the bed. “I hate you for doing this to me,” she snapped. “Hate you. You… you know how much?”

Some part of her mind still registering what she was saying and thinking noticed that he looked a little upset. But he blinked it away, and she couldn’t hold onto her guilt. He smiled. “How much?”

“So much. So damn much, Rogers. You did this to me.”

“I know, love. Just breathe.”

She was in too much pain to snap at him for uselessly reminding her yet again to watch her goddamn breathing, instead closing her eyes and simply obeying. In through her nose, out through her mouth. She could do that. “‘Be his partner,’ he said,” she gasped, grimacing. The contraction was getting worse, and she was having a hard time doing anything but panting. But she was stubborn. “'Sh-show him h-how to be a SHIELD agent,’ he said.”

“He?” Steve asked, smoothing back her hair and watching the monitor to see if the contraction was ending.

“Fury! Please, God…”

Steve came closer, wrapping an arm around her chest. She latched onto it, curling her nails into his forearm. “You can do it,” he murmured encouragingly. “You’re almost there.”

 "Steve…"

“Breathe, baby. Don’t talk. Just breathe.” He was like a broken record, but her body so craved comfort and relief right then that she couldn’t care. And the muscles of his arms and chest were strong and sure around her until she couldn’t see or feel much else besides him. He was like a shield, like he was trying to block the pain from reaching her. She blinked away tears, concentrating on what he said to do, concentrating on what he was saying. It was hard to focus on his words, but she realized it didn’t really matter what he was saying. His voice was low, a wordless murmur, it seemed, against her ear. She held onto that, onto the sweet, calming nothings he was telling her, and rode through it.

Once again she was sliding down the other side, exhausted and going limp and pliant on the bed. “Didn’t mean that,” she whispered. “Steve… I didn’t mean that… I don’t hate you.”

He actually laughed, the ass. “'Course you don’t. But you don’t hafta like me too much right now either.” He grinned crookedly, kissing her forehead as he leaned away from her. He sniffled, and she wondered a moment if maybe he didn’t have tears in his eyes. She supposed this was fitting, in a twisted sort of way, that he had to watch her go through this without being able to take away her pain just as she’d had to watch him suffer through being sick without being able to touch him. The second that sour thought went through her addled brain, she dismissed it. And he gathered himself quickly. “These are coming fast. Two minutes, maybe three.” She didn’t know what that meant. One of the twins moved inside her – not much longer and they’ll be out and I’ll see them move – and she groaned as that made her uterus tighten again, not quite into a full contraction but definitely a pang of discomfort. Steve was rattled; in these few moments where she was in better control of her faculties, she could see how frayed he was around the edges, how he was putting on a brave front for her sake. There was terror in his eyes, panic in his hands, that she’d never seen before, not even when they’d been facing down some of the worst threats and dangers the world had ever seen. Had she been in better command of her emotions, she might have been amused. As it stood, she needed him to stay calm, because if he lost it, she’d lose it, too. She knew it. “Where the hell did Bruce go?”

So Complicated

Originally posted by superuunatural

Summary: Growing up is hard, especially when you love your big brother’s best friend.  Dean Winchester is that best friend. He’s watched you grow up, let you tag along with him and Cas. Through the years, you develop a crush on Dean and that turns into love. Will Dean ever see you as more than Cas’s little sister?

Characters:  Dean Winchester, Reader Novak, (Will be eventual Dean x reader fic) Cas Novak

Word Count: 2835

Warnings: language, a little smut, pregnancy complications

A/N:This is part six of my new series Don’t Take the Girl.  I’m in the middle of a Dean Crisis! And this idea just popped into my head, it will be a 10 part series. The whole thing has already been outlined and titled, I will probably put up a chapter every couple of days. Okay the medical stuff is something that I googled, it isn’t mentioned in great deal yet, but it will be, so all mistakes will be mine.

Tagging: @ellen-reincarnated1967 @demondean-for-kingofhell @winchesterprincessbride@jotink78  @iamdeanfknwinchester @sparklesuperwholock88 @waywardjoy@wingedchildperfection @its-not-show-its-a-lifestyle @green-love-red-fantasyhearts @carry-on-my-wayward-girl @sdavid09 @lullabyjensen @arbitranox @pizzarollpatrol @teamfreewilllovesyou@writingthingsisdifficult @trinity33 @panic-angel3314 @riversong-sam @angelus320 @parisianfall @sandlee44 @random-fandom-imagines-215 @ally-miller16 @growingupgeek@hola-misha-minions @enigmalynne @letsgetyourdeanon @usedandreplaced @teddylupin24@life-is-a-plot-twist @almondjoy338 @ @jpadjackles @carry-on-my-fangirl @mrswhozeewhatsis @skybinx-blog @dauntlessdiva @trinity33 @theydontknowaboutus5 @trustnobodyshootfirst @rockingmotherhood

Part One  Part Two  Part Three  Part Four Part Five  

Present

“Something’s wrong!” you shouted in between panting breaths. You knew it would hurt, but this was beyond hurt. “I-I-I can’t breath! Please!”

“Y/N, you need to calm down. This isn’t good for either of you. You’re going to hyperventilate, breathe slowly-” the doctor stopped when you grabbed her hand roughly. “I need to check you, I know you’ve been at this a while. Just relax for me for just a few minutes.”

Dean was clutching your hand, “Baby, just hold on, look at me! Y/N! Look at me! Focus on my breathing. In. Out. In. Out.”

Alarms began going off, “Y/N? Baby! Doc, something’s wrong!” Dean yelled, your body going limp.

The doctor stepped back up towards your head, taking her knuckles she started rubbing against your chest bone, “Y/N! Alright people, fetal heart rate is dropping and her pressure just bottomed out. Let’s move! O.R. 5 STAT!”

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Planning a Place of Birth

This is all according to one resource, the National Institute for Health and Care Excellence. If anyone (especially midwives) have any other information and good resources on home births and birthing facilities please let me know. I’ll post what the website has as well as what I’ve seen on other resources.

Everyone should be offered the choice of planning birth at home, in a midwife-led unit or in an obstetric unit. Everyone should be informed:

  • That giving birth is generally very safe for both the pregnant person and their baby. (650 people die from pregnancy related issues every year, about half of those giving birth each year have some sort of complication)
  • That the available information on planning place of birth is not of good quality, but suggests that among those who plan to give birth at home or in a midwife-led unit there is a higher likelihood of a natural birth, with less intervention. We do not have enough information about the possible risks relating to planned place of birth.
  • That the obstetric unit provides direct access to obstetricians, anaesthetists, neonatologists and other specialist care including epidural analgesia.
  • Depending on locally available services, the likelihood of being transferred into the obstetric unit and the time this may take. Take this into consideration.
  • That if something does go unexpectedly seriously wrong during labour at home or in a midwife-led unit, the outcome for could be worse than if they were in the obstetric unit with access to specialised care.
  • That if they have a pre-existing medical condition or has had a previous complicated birth that makes them at higher risk of developing complications during their next birth, they should be advised to give birth in an obstetric unit.

I know that a lot of birthing centers do make sure that you are as safe as possible and that if things do go wrong you are transferred to emergency care quickly.

Factors to consider when planning the place of birth

1. Medical conditions that may indicate a need for obstetric care.

These conditions include:

  • Confirmed cardiac disease
  • Hypertensive disorders 
  • Asthma requiring an increase in treatment or hospital treatment
  • Cystic fibrosis
  • Haemoglobinopathies – sickle-cell disease, beta-thalassaemia major
  • History of thromboembolic disorders
  • Immune thrombocytopenia purpura or other platelet disorder or platelet count below 100,000
  • Von Willebrand’s disease
  • Bleeding disorder in the adult or unborn baby
  • Atypical antibodies which carry a risk of haemolytic disease of the newborn
  • Risk factors associated with group B streptococcus whereby antibiotics in labour would be recommended
  • Hepatitis B/C with abnormal liver function tests
  • Carrier of/infected with HIV
  • Toxoplasmosis – receiving treatment
  • Current active infection of chicken pox/rubella/genital herpes in the adult or baby
  • Tuberculosis under treatment
  • Systemic lupus erythematosus
  • Scleroderma
  • Hyperthyroidism
  • Diabetes
  • Abnormal renal function
  • Renal disease requiring supervision by a renal specialist
  • Epilepsy
  • Myasthenia gravis
  • Previous cerebrovascular accident
  • Liver disease associated with current abnormal liver function tests
  • Psychiatric disorder requiring current inpatient care

2. Other factors that may suggest needing obstetric care

Situations where there is an increased risk for parent or child:

  • Unexplained stillbirth/neonatal death or previous death related to intrapartum difficulty
  • Previous baby with neonatal encephalopathy
  • Pre-eclampsia requiring preterm birth
  • Placental abruption with adverse outcome
  • Eclampsia
  • Uterine rupture
  • Primary postpartum haemorrhage requiring additional treatment or blood transfusion
  • Retained placenta requiring manual removal in theatre
  • Caesarean section 
  • Shoulder dystocia
  • Multiple birth 
  • Placenta praevia
  • Pre-eclampsia or pregnancy-induced hypertension
  • Preterm labour or preterm prelabour rupture of membranes 
  • Placental abruption
  • Anaemia –- haemoglobin less than 8.5 g/dl at onset of labour
  • Confirmed intrauterine death
  • Induction of labour 
  • Substance misuse
  • Alcohol dependency requiring assessment or treatment
  • Onset of gestational diabetes 
  • Malpresentation – breech or transverse lie
  • Body mass index at booking of greater than 35 kg/m2
  • Recurrent antepartum haemorrhage
  • Small for gestational age in this pregnancy (less than fifth centile or reduced growth velocity on ultrasound)
  • Abnormal fetal heart rate (FHR)/Doppler studies
  • Ultrasound diagnosis of oligo-/polyhydramnios
  • Myomectomy
  • Hysterotomy

Now many health organizations, like the World Health Organization, say not to focus too much on high risk pregnancies as this causes many supposed “low risk” pregnancies to not get the level of care they need and also limits choices for “high risk” pregnancies that may be totally fine and not need obstetric care.

3. Medical Conditions that aren’t necessarily reasons to have obstetric care but may indicate further consideration

  • Cardiac disease without intrapartum implications
  • Atypical antibodies not putting the baby at risk of haemolytic disease
  • Sickle-cell trait
  • Thalassaemia trait
  • Anaemia – haemoglobin 8.5–10.5 g/dl at onset of labour
  • Hepatitis B/C with normal liver function tests
  • Non-specific connective tissue disorders
  • Unstable hypothyroidism such that a change in treatment is required
  • Spinal abnormalities
  • Previous fractured pelvis
  • Neurological deficits
  • Liver disease without current abnormal liver function
  • Crohn’s disease
  • Ulcerative colitis

4. Other factors that aren’t necessarily reasons to have obstetric care but may indicate further consideration

  • Stillbirth/neonatal death with a known non-recurrent cause
  • Pre-eclampsia developing at term
  • Placental abruption with good outcome
  • History of previous baby more than 4.5 kg
  • Extensive vaginal, cervical, or third- or fourth-degree perineal trauma
  • Previous term baby with jaundice requiring exchange transfusion
  • Antepartum bleeding of unknown origin (single episode after 24 weeks of gestation)
  • Body mass index at booking of 30–34 kg/m2
  • Blood pressure of 140 mmHg systolic or 90 mmHg diastolic on two occasions
  • Clinical or ultrasound suspicion of macrosomia
  • Para 6 or more
  • Recreational drug use
  • Under current outpatient psychiatric care
  • Age over 40 at booking
  • Fetal abnormality
  • Major gynaecological surgery
  • Cone biopsy or large loop excision of the transformation zone (LLETZ)
  • Fibroids

For more information on planning your place of birth, visit this post!

One of the many perks of being a medical professional: one of the gyn surgeons who I am friendly with walked me right up to the OB unit in between his cases and did an ultrasound for me. He knows all about my miscarriage and knows how uneasy I have been about not knowing the current baby’s heart rate.

I now know that my baby’s heart rate is 136 and strong :) All is well!

The picture isn’t great but I was too shakey to take a better one!

Happy Valentine's Day to me!

This morning I had my ultrasound to see how things were going due to the cramping last week.  I received the best Valentine’s Day gift ever when they measured the baby to be 6w1d which is the exact time I had.  To top it off, I heard the heartbeat of our tiny baby!  It was beating at 122 bpm which is normal at this point (or at least this is what I was told).  I am so happy!

What were your fetal heart rates in early pregnancy?

Grey’s Anatomy Sides Episode 23

MITCHELL (NEW INTERN) – It’s his first day. Beth, a pregnant patient who was in a car accident, is his patient. He is telling her to do what she’s doing, trying to cheerlead, but nervous as hell. She can’t breathe. And he knows it. He prepares a chest tube. It’s going to help her breathe. Beth is worried, she wants to see her daughter. Her daughter is okay. She needs to stop moving. Beth wants to see her. Beth flails and Mitchell stabs her. As the scalpel breaks the skin, Beth screams. Mitch apologizes, frozen in horror.

Scene 2 – Doctor Smith berates Mitchell – If you didn’t know how to insert a chest tube, why’d I walk in on you inserting a chest tube?! He thought he could do it. He thought?! Mitchell almost had it, but she moved. Oh, so it’s the patient’s fault? No. he got nervous. But she told him before to be decisive, and he decided to be decisive. Then she couldn’t breathe and he got nervous and then he got frustrated that he was nervous. It’s a problem he has that he’s working on. But his mind works faster than his hands and oh god, did he kill her?

AUBREY – (Looking over Isaac’s shoulder) He’s looking in the wrong place, it’ll be in his pneumothorax notes. He thanks her. She tells him that he shouldn’t feel bad he skipped the U-stitch. It’s not a very intuitive step. You just have to always be thinking two steps ahead. If she knew he was skipping it, why didn’t she say anything? Really? Yeah, she watched him fail. This is the big leagues. This is life and death. She can’t be looking over his shoulder all the time, helping him. He’s a surgeon just like her at least on paper. He shouldn’t want her help. He shouldn’t need it. He’s better than that. Or he wouldn’t be there. Man, get it together. He tells her she gives really crappy pep talks. That wasn’t a pep talk! She gives great pep talks. And when she gives him one, he’ll know.

BETH (Pregnant accident victim) – Dr. Palmer comes in with the fetal monitor. Beth wants to know if her baby is okay. Fetal heart rate looks good. Thank God. It’s just, she made Keith drive. He wanted to take the train, but she thought driving would be faster. How long have they been married? They’re supposed to get married next week. They met nine months and three days ago. Surprise! She barely knew him. Wasn’t sure she wanted to have a kid with him. But it’s crazy how much you learn about someone after you get knocked up on the first date. So, they’re getting married next week. Tell her that they are getting married next week? Beth, look at her, everything is going to be okay.

Scene two – Ultrasound machine is rolled away. Beth, your ultrasound looks good. Thank you. She can’t breathe. Ma’am, are you okay? She can’t…she can’t breathe. Dr. Mitchell calls for a chest tube and attempts to make an incision, Beth moves and he stabs her with the chest tube as Beth screams…

HAL (40s, rescue worker, freeway) – A full investigation will need to be made, but the roads were pretty icy from last night’s storm. Dr. Franklin asks to know how many victims inside? They’re still doing sweeps but they think he’s the last one. Careful. Dr. Franklin follows Hal to the car. He’s alert, but borderline hypotensive. Any iv access? His name? Keith. Sayers. They haven’t been able to fully secure the car yet. So be careful. Okay?

KEITH (AKA KEVIN) - Dr. Simon examines Keith’s wounds as Keith focuses on his breathing. You really think I’m going to make it? He has to right? He’s going to have a baby. Beth. He tried taking her to those natural birth classes. She laughed. Keith is afraid he’s going to die there. He’s going to die and leave Beth and his baby all alone. Dr. Simon gives Keith sedation meds. Keith asks him if he has any kids. He’s got two. Wow. One is freaking Keith out. They did it all backwards. You know, you meet, fall in love and get married and have a kid. It all gets bigger. Beth and he met and did this huge thing first. We’re having a baby. Nice to meet you. And then we started learning little things. And it’s good stuff. That she sleeps with socks on. We like watching tennis but not playing it. And she likes techno music…which might have been a deal breaker…but we had this big thing baby coming, so you know…Dr. Simon wants to get the tube ready. Keith explains that he’s liking the little things.

whoaadreambigg  asked:

Hello! I was wondering why x-rays are commonly done on pregnant animals, when they're considered dangerous for pregnant humans?

Loving this question! In general I don’t approve of radiographs on pregnant animals either, and neither does the Orthopedic Foundation for Animals–for the mom, not the puppies. This is because her hormones during this time can cause joint laxity and even luxation during positioning. And you are right, there are risks to exposing the fetus(es) to radiation. But there is one specific time when I do–and just took one yesterday, in fact!

Let’s say for the sake of argument that you have a Chihuahua that was bred about a month and a half ago–she’s at the 48 day mark, in fact! Well, around day 45 the skeletons of the pups inside her have begun to ossify. Prior to that they were cartilage models, present but utterly moot when it comes to taking radiographs because they blend in with the other soft tissues in mom’s abdomen. Day 50 is when they should be at their strongest, so I like to try and wait until then until radiographing.

Now, a Chihuahua is a tiiiiiiny dog. Her puppies surely can’t get so big they’d cause a problem, right? Wrong. If the breeding only resulted in one puppy (and sometimes often does), that puppy doesn’t compete for any nutrition or room in the mother’s abdomen. She still swells up because the puppy grows so big! So in Chihuahuas (or small breeds in general, or breeds with big heads, like Bulldogs (who don’t even whelp naturally in most cases but that’s another rant for another time)) it’s important to know if there’s only one puppy in there, or several. We can measure the widest diameter of their skull against the most narrow point of the mother’s pelvis to make sure the skull can even fit through the pelvis. If it can’t, the pup would get locked in place during a natural delivery, forcing an emergency c-section rather than a much calmer planned one where mom isn’t already stressed from trying to deliver the puppy and exhausted from failing to do so.

That’s really true of any breed, but more obvious in our tiny or otherwise weird looking ones. So why, yesterday, did I take a radiograph of a Goldendoodle?

Still for the puppy count, but for planning reasons. Without radiographs, if mom had stopped whelping after puppy nine at home, how do you know there isn’t a tenth puppy? With a radiograph, we can give a reasonably accurate head (or spine) count so that if mom stops whelping (and isn’t just taking a break) we know that something’s going on. Maybe the next puppy is stuck, maybe the next puppy is dead or even mummified, maybe she strained so hard to push the last puppy out that she ruptured her uterus and now the other puppies are actually IN her abdomen. It’s basically a way to know for sure that everyone is out. In humans, ultrasonography is pretty good at doing a head count and actually identifying problems with babies. And before the skeletons come around, we veterinarians can use the ultrasound to diagnose a pregnancy and to check fetal heart rates, which can indicate stress. But it’s really sucky at doing head counts. There isn’t as much of a “window” around the fetuses to differentiate them from the abdomen or each other (less amniotic fluid, that is), especially late in the pregnancy. And that’s why we go with the radiographs.

Annnnnd sometimes there’s water babies who defy predicting the odds, but that’s another story.