Hello everyone....still here?
I've had a lot of changes since I was last here. You already know I switched practices and that continues to have been a great decision. My 'new' practice, aside from small bumps here and there, continues to be great. It's such a nice feeling to work with doctors who actually care about women's choices and aren't jerks if the woman makes a different decision than what is being recommended. It's a great feeling knowing that if I am worried about something that the doc I work with will come in, no questions asked, and evaluate. We did have some drama from the third midwife. After working with us for 2 months she took off and went to our competitors. It was a tough few weeks for me as I felt very betrayed. I struggled to get that damn knife out of my back. But I got to a place where I was able to forgive and reinstate our friendship.
We have a new midwife that started recently - and she seems to be really working out. She has a sense of humor that is like mine and we have fun working together. I think she will be around for the long term. She's a new grad but has been working for years as a L & D nurse. This wasn't important to me but was important to the doc I work for. We are getting her settled and I am thankful for the extra help cause it has been crazy busy. I had patients come with me to my new practice plus patients already there plus all the great word-of-mouth plus my ties with the birth community. Busy!
The nursing staff at the hospitals I deliver at are great, but very different environments. Hardly any idiots at these facilities so very nice to not have those struggles. They have been adjusting to midwifery care for a couple years now but with more midwives coming in and those of us who perhaps practice a little less medical, the staff have had to adjust a bit more but are doing great.
There's a practice whose docs are notoriously against any midwifery care, now hiring a midwifery service. I guess they got tired of all the transfers to our practice :p It's so hypocritical but yet, the more midwives in the area, the better!
I've become so lax in my blogging but am going to try to get back with it and get back to visiting other people's blogs! I've missed the blogging community.
Friday, December 9, 2011
Tuesday, February 1, 2011
I'm Still a Midwife
When I last 'talked' to you guys I was contemplating leaving midwifery and had started to set some plans in motion. I was applying to school to do another specialty.
Since then, I have switched jobs! I no longer want to leave midwifery anymore :) I have a new position that is considerably closer to my home and far more supportive environment. I'm working with a wonderful midwife I have known for about 4 years. Even better, one of the midwives from the 'old' job will be joining us soon!
I miss the midwives but absolutely nothing else at my old position. Things had only gotten worse and I was thinking about taking up drinking - haha. I was gonna call it group therapy though.
I am still planning to pursue an education in another specialty, waiting to hear if I have been accepted. I feel like it's important to have a back up plan :)
Since then, I have switched jobs! I no longer want to leave midwifery anymore :) I have a new position that is considerably closer to my home and far more supportive environment. I'm working with a wonderful midwife I have known for about 4 years. Even better, one of the midwives from the 'old' job will be joining us soon!
I miss the midwives but absolutely nothing else at my old position. Things had only gotten worse and I was thinking about taking up drinking - haha. I was gonna call it group therapy though.
I am still planning to pursue an education in another specialty, waiting to hear if I have been accepted. I feel like it's important to have a back up plan :)
Sunday, October 24, 2010
That Would Be a Good Post
I have had many moments where I have thought "Wow, that would make such a great blog post".
Like the time when a postpartum nurse called me to let me know that a patient's H&H was 6.something. So I ask for vital signs, previous CBC results, and symptoms the patient was experiencing if any. The nurse had none of these things readily available. Hello! You are my eyes and ears Nurse. You gotta give me some info.
So what's been going on? I'm burned out. That's what is going on. I'm so done. I'm tired of my employer and his idiotic and disrespectful management. I left the office an hour early one day (after insuring that someone else would see my last patient if she showed up). Now mind you, leaving early is a once in a blue moon kinda thing. I was informed a couple days later that if I did that again, I would be charged an hour of PTO. This tempts me to keep a running tally of all the times I stay late, work through lunch, come in to help out, etc. What an ass.
I am so burned out that I am thinking about leaving midwifery, or at least trying to find aother job. I would rather be a 'medwife' than deal with the struggle I am dealing with now. We are expected to provide the midwifery model of care in a medical environment. I'm so tired of all the fighting the fight and not really getting anywhere.
I am going back to school to learn another specaialty cause I am so done. I have worked as a CNM for three years now. I would have never thought I would burn out this fast.
Like the time when a postpartum nurse called me to let me know that a patient's H&H was 6.something. So I ask for vital signs, previous CBC results, and symptoms the patient was experiencing if any. The nurse had none of these things readily available. Hello! You are my eyes and ears Nurse. You gotta give me some info.
So what's been going on? I'm burned out. That's what is going on. I'm so done. I'm tired of my employer and his idiotic and disrespectful management. I left the office an hour early one day (after insuring that someone else would see my last patient if she showed up). Now mind you, leaving early is a once in a blue moon kinda thing. I was informed a couple days later that if I did that again, I would be charged an hour of PTO. This tempts me to keep a running tally of all the times I stay late, work through lunch, come in to help out, etc. What an ass.
I am so burned out that I am thinking about leaving midwifery, or at least trying to find aother job. I would rather be a 'medwife' than deal with the struggle I am dealing with now. We are expected to provide the midwifery model of care in a medical environment. I'm so tired of all the fighting the fight and not really getting anywhere.
I am going back to school to learn another specaialty cause I am so done. I have worked as a CNM for three years now. I would have never thought I would burn out this fast.
Sunday, August 1, 2010
Ode to the Bestie
I just gotta say that my BFF rocks. She really pushes my intellectual boundaries all the time. Lovin' it! We are currently reading the same book together so we can discuss it as we move through the book. I've not ever done that and am really enjoying it.
Can't trust them multips
Had a couple interesting births lately. Both were somewhat complicated with risk factors, which always makes for some excitment :p Both were multips - one having her 4th baby and the other having her 5th.
The first lady came in complaining of bleeding. She was contracting with a good bit of uterine irritability. Was only mildly uncomfortable with her contractions. However, there was enough bleeding that it had ran down her leg prior to her arrival. She has a history of substance abuse and has been in treatment for three months. She had only a few visits in the office, poor historian, being confusing when giving her history. She did not have any of her previous babies, but was hoping to 'keep' this one. She didn't have any idea when her last period was so I only had a third trimester ultrasound for dates (which can be off by 3 weeks either way). She had been measuring appropriately for that EDD. Her exam on arrival was 2-3/60/-1. The baby was very active. By her EDD, she was 38 weeks (which means she could be anywhere from 35 to 41 weeks). After watching her for a bit (she was also having the occasional small variable but otherwise had a very reactive strip) then re-checked. She was 3-4/80/-1 with just a small amount of blood on the glove. She continued to be quite comfortable. I decided to just sit on her for the night and admitted for expectant management. I just felt very uncomfortable with sending her home. Her UDS was negative btw.
Eventually, she got uncomfortable and asked for an epidural at 4/90/-1. She putzed along. Hours later she was 6/90/-1 so I broke her water figuring we were pretty committed at this point. She continued to have periodic bleeding that was always just a little runnier and heavier than normal show. She progressed to 8cms fairly quickly but then kinda stalled out. We flipped her from side to side and she eventually arrived at 10cms with no further intervention. She began to push once she was feeling the urge to do so. She took a good half hour to push the baby out and baby came out screaming covered with a small amount of bright red blood. I expected to see evidence of abruption on the placenta but none was apparent except for a sort of thrombosed vessel at the placental border. Not sure if that was the source of bleeding or what. No lacerations were evident. She was absolutely fine afterwards.
The second lady was being watched very closely due to suspected chronic hypertension. She'd had this issue with each pregnancy and a possible abruption with one previous pregnancy. She would have elevated BPs prior to 20 weeks (which means increased likelihood of chronic hypertension as pre-eclampsia doesn't present prior to 20 weeks). We were treating her with medication for her blood pressure. She came in complaining of contractions, just barely shy of full-term (37-42 weeks). She came in requesting an epidural with an exam of 4/50/-3. She got her epidural and then after a few hours went by, no progress had occurred.
The head was too high for rupturing her membranes so started pitocin instead. I broke her water a couple hours after that, her being 4/80/-2. She took off after that. By 2 hours later she was 9cms. We had just enough time to finish a delivery in another room :p
When I checked her she was 10cms but still very high so even though she was feeling some pressure, I suggested lying on her side (Nurse Crappy was the nurse assigned so you know how that goes!) to let the baby come down on its own. 5 minutes later, it was time. The delivery was great the baby just oozed out on its own. I had dad literally catch. It was awesome to watch!
So you would think that women who have had several babies would just spit those kids out. but not always! In fact, once you get up into 5,6, or more kids, the possibility of complications and labor dystocia increases :p
The first lady came in complaining of bleeding. She was contracting with a good bit of uterine irritability. Was only mildly uncomfortable with her contractions. However, there was enough bleeding that it had ran down her leg prior to her arrival. She has a history of substance abuse and has been in treatment for three months. She had only a few visits in the office, poor historian, being confusing when giving her history. She did not have any of her previous babies, but was hoping to 'keep' this one. She didn't have any idea when her last period was so I only had a third trimester ultrasound for dates (which can be off by 3 weeks either way). She had been measuring appropriately for that EDD. Her exam on arrival was 2-3/60/-1. The baby was very active. By her EDD, she was 38 weeks (which means she could be anywhere from 35 to 41 weeks). After watching her for a bit (she was also having the occasional small variable but otherwise had a very reactive strip) then re-checked. She was 3-4/80/-1 with just a small amount of blood on the glove. She continued to be quite comfortable. I decided to just sit on her for the night and admitted for expectant management. I just felt very uncomfortable with sending her home. Her UDS was negative btw.
Eventually, she got uncomfortable and asked for an epidural at 4/90/-1. She putzed along. Hours later she was 6/90/-1 so I broke her water figuring we were pretty committed at this point. She continued to have periodic bleeding that was always just a little runnier and heavier than normal show. She progressed to 8cms fairly quickly but then kinda stalled out. We flipped her from side to side and she eventually arrived at 10cms with no further intervention. She began to push once she was feeling the urge to do so. She took a good half hour to push the baby out and baby came out screaming covered with a small amount of bright red blood. I expected to see evidence of abruption on the placenta but none was apparent except for a sort of thrombosed vessel at the placental border. Not sure if that was the source of bleeding or what. No lacerations were evident. She was absolutely fine afterwards.
The second lady was being watched very closely due to suspected chronic hypertension. She'd had this issue with each pregnancy and a possible abruption with one previous pregnancy. She would have elevated BPs prior to 20 weeks (which means increased likelihood of chronic hypertension as pre-eclampsia doesn't present prior to 20 weeks). We were treating her with medication for her blood pressure. She came in complaining of contractions, just barely shy of full-term (37-42 weeks). She came in requesting an epidural with an exam of 4/50/-3. She got her epidural and then after a few hours went by, no progress had occurred.
The head was too high for rupturing her membranes so started pitocin instead. I broke her water a couple hours after that, her being 4/80/-2. She took off after that. By 2 hours later she was 9cms. We had just enough time to finish a delivery in another room :p
When I checked her she was 10cms but still very high so even though she was feeling some pressure, I suggested lying on her side (Nurse Crappy was the nurse assigned so you know how that goes!) to let the baby come down on its own. 5 minutes later, it was time. The delivery was great the baby just oozed out on its own. I had dad literally catch. It was awesome to watch!
So you would think that women who have had several babies would just spit those kids out. but not always! In fact, once you get up into 5,6, or more kids, the possibility of complications and labor dystocia increases :p
Thursday, July 29, 2010
Jacuzzi Tub Rationale
I admitted a patient with ruptured membranes, first baby, early labor in the middle of the night one night. I wasn't heading in yet to do labor support as the woman was very early in the labor still...but she was laboring. I left orders for expectant management and to call me when she was a little further along. Apparently the nurse didn't want the woman to get in the tub until I arrived because the head was very low in her pelvis. That's the best rationale I have ever heard to not allow a patient to get a tub. Really? Really.
Tuesday, July 27, 2010
I'm Still Such a Sucker Sometimes
Ok, I agreed to an induction for a patient of mine. Totally elective and the wisdom of inducing this particular patient was lost to me until there was no turning back.
I've known this patient for a couple years, as in providing her care during that time. She's a very large lady, close to not being able to get a weight on our office scale (tops out at 350). She's shy about her body and experiences exhaustion towards the end of pregnancy due to the extra load. I don't blame her a bit, or anyone else for that matter, for being miserable in the summer heat at the end of a pregnancy.
So here she is, term, and begging for induction. Her cervix is very favorable - 4/80/-2. It's her 4th baby. I agreed to an AROM induction.
She had a rough time with the last baby - blaming it on the pain meds she opted for with the last baby. She decided she might get an epidural this time if she needed something. Hopefully, things would go smoothly and she would just take off and birth without needing anything.
And of course, that's not how things went. She piddled around for several hours after I broke her water. She finally asked for pitocin to get things going and wanted an epidural. She was 5cms at this point, contracting sporadically. I advised her that if she was sure she wanted the epidural, to do it now so she could maintain the optimal position for it due to her size. Then we used just a 'whiff' of pitocin and she took off.
When I decided to use the pitocin, I figured I had better touch base with the doc on call with me. Which is when it hit me that the wisdom of the induction in a woman this size was not the brightestmove on my part. I felt so stupid for not having given this any thought prior to doing it, or consulting with the doc prior to now. Ugh.
But anyway, he was fine with starting pitocin....although I didn't come out and say I scheduled this. :p I was a chicken. Everything went very quickly with the labor....5 to delivered in about 3 hours (I even shut the pit off when she was freaking out, we were up to only 4mus). She didn't like the epidural either. I think she just doesn't like the transition stuff - gets very panicked and borderline hysterical.
So when I reflect on this experience, it wasn't one of my better labor managements :p
I've known this patient for a couple years, as in providing her care during that time. She's a very large lady, close to not being able to get a weight on our office scale (tops out at 350). She's shy about her body and experiences exhaustion towards the end of pregnancy due to the extra load. I don't blame her a bit, or anyone else for that matter, for being miserable in the summer heat at the end of a pregnancy.
So here she is, term, and begging for induction. Her cervix is very favorable - 4/80/-2. It's her 4th baby. I agreed to an AROM induction.
She had a rough time with the last baby - blaming it on the pain meds she opted for with the last baby. She decided she might get an epidural this time if she needed something. Hopefully, things would go smoothly and she would just take off and birth without needing anything.
And of course, that's not how things went. She piddled around for several hours after I broke her water. She finally asked for pitocin to get things going and wanted an epidural. She was 5cms at this point, contracting sporadically. I advised her that if she was sure she wanted the epidural, to do it now so she could maintain the optimal position for it due to her size. Then we used just a 'whiff' of pitocin and she took off.
When I decided to use the pitocin, I figured I had better touch base with the doc on call with me. Which is when it hit me that the wisdom of the induction in a woman this size was not the brightestmove on my part. I felt so stupid for not having given this any thought prior to doing it, or consulting with the doc prior to now. Ugh.
But anyway, he was fine with starting pitocin....although I didn't come out and say I scheduled this. :p I was a chicken. Everything went very quickly with the labor....5 to delivered in about 3 hours (I even shut the pit off when she was freaking out, we were up to only 4mus). She didn't like the epidural either. I think she just doesn't like the transition stuff - gets very panicked and borderline hysterical.
So when I reflect on this experience, it wasn't one of my better labor managements :p
Monday, July 26, 2010
OMG
You guys make me wanna cry. The comments from the previous post are so wonderful. It makes me not want to give up up on public blogging. Will ruminate about it a bit more.
I had a beautiful birth recently. This little momma was having her first baby. I had met her only at a birth class recently. She came in in labor, was about 4cms, changing to 5cms after walking for an hour. She was contracting very regularly and mildly uncomfortable. She was kinda chilling in the tub, walking around, not doing a whole lot. After a few hours had gone by, I suggested checking her cervix with the possibility of breaking her water or sending her home if she wasn't changing. Unfortunately, she had not changed and did not want to go home. She agreed to getting her water broke, which we did.
Since she was fairly comfy I decided to head over to the office to see a few patients. I knew the patient would have the nurse call me when she needed me to be with her. About two hours later she was ready for me. The nurse had said that she didn't want to do anything like the tub or the birth ball. She was very opposed to moving, which was fine! I just sat with her. Finally, she seemed to be losing focus, crying instead. She asked me for something for the pain. I told her, let's check your cervix, if you are close then you just keep doing what you are doing. If not, then we'll discuss the options.
Woohoo - she was 8-9cms! So I encouraged her to get in the tub which she agreed to. However, she was unable to sit and felt better standing. She began to get more vocal after a few minutes of standing in the bathroom. Then I saw the first little pushes as she involuntarily beared (or bore down? That sounds weird too) down. Then she says "I feel something!"
She climbs into the bed and pushes, totally spontaneous, and I see a little bit of the head. Now, she was -1 station before she stood up! Woohoo - gravity rocks. She pushed her baby out in ten minutes flat :)
I had a beautiful birth recently. This little momma was having her first baby. I had met her only at a birth class recently. She came in in labor, was about 4cms, changing to 5cms after walking for an hour. She was contracting very regularly and mildly uncomfortable. She was kinda chilling in the tub, walking around, not doing a whole lot. After a few hours had gone by, I suggested checking her cervix with the possibility of breaking her water or sending her home if she wasn't changing. Unfortunately, she had not changed and did not want to go home. She agreed to getting her water broke, which we did.
Since she was fairly comfy I decided to head over to the office to see a few patients. I knew the patient would have the nurse call me when she needed me to be with her. About two hours later she was ready for me. The nurse had said that she didn't want to do anything like the tub or the birth ball. She was very opposed to moving, which was fine! I just sat with her. Finally, she seemed to be losing focus, crying instead. She asked me for something for the pain. I told her, let's check your cervix, if you are close then you just keep doing what you are doing. If not, then we'll discuss the options.
Woohoo - she was 8-9cms! So I encouraged her to get in the tub which she agreed to. However, she was unable to sit and felt better standing. She began to get more vocal after a few minutes of standing in the bathroom. Then I saw the first little pushes as she involuntarily beared (or bore down? That sounds weird too) down. Then she says "I feel something!"
She climbs into the bed and pushes, totally spontaneous, and I see a little bit of the head. Now, she was -1 station before she stood up! Woohoo - gravity rocks. She pushed her baby out in ten minutes flat :)
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