Wednesday, December 31, 2008

Retard moment of the week...

I'm in a delivery with terminal bradycardia and yucky decels. Nursery nurse is standing by and I have my labor nurse at the bedside with me. The patient, who speaks no English, is pushing well and delivery will occur before I can get a doc there to vacuum. The head is crowning, the nurse asks me if I will cut an epis to hasten delivery (and this isn't the retard moment). I say no and instead do minimal Ritgen's maneuver.

Head delivers with loop of cord hanging out.

The head is big.

The patient is very small.

I tell the nurse to pull the emergency call light to get some extra help. She then prepares to do suprapubic pressure and McRoberts all by herself as I can tell it will be a tight fit.

Over the intercom "Can I help you?"

Huh? The normal response when the emergency call light goes off is no one answers it...cause nurses are busy rushing into the room.

I say "We need help in here"

"Who would you like?"

Please shoot me now. What the f*** is going on?

I say "nurses"

No one ever comes. So I am totally pissed off and wondering what the hell happened. Fortunately the nurse and I managed the shoulder dystocia, which was mild, and had a good outcome.

Turns out that someone on the postpartum unit answered the call light and never bothered to call back to L&D to let them know or check if there was a problem.

Lovely. Postpartum was told not to answer L&D call lights ever again.

Oh, the patient delivered over an intact perineum - 8 pound baby and her first as well.


I hope everyone has been enjoying their holidays - Happy New Year's!

We had a great Christmas, lots of family time. Very relaxing just sitting around the fireplace, playing Wii, etc. Christmas dinner, courtesy of my husband, was excellent!

I was on call yesterday and aside from being very busy in the office, it was pretty laid back. I had a Burmese lady who I had never met that came in and had her baby in the late morning. It's really so frustrating when there is a language barrier. It becomes very difficult to make a connection with someone. It really makes me realize how important language is to us. At least with hispanic women I can speak a few words.

Aggravating things in the office this past couple weeks...

1. On Monday I saw at least 6 pregnant women who were dehydrated. Drink ladies drink!

2. Yesterday, the trend of the day was spotting/bleeding in the first trimester. One lady went to the hospital the weekend before Christmas, when she was about 12 weeks. She went even though the midwife on call advised her to stay home and wait until Monday unless, of course, worsening of symptoms occurred. Well, the patient tells me it wasn't convinient (I never can get the spelling right on this word) since she had to work Monday and she just wanted some piece of mind. What she wanted was an ultrasound! The hospital did this whole work up and everything was completely normal. Go figure. As I listened to her talk about it was easier to go to the hospital then wait and come to our office a day later, I kept thinking "well, it's not easier when I have to pay the bill for people who take advantage of their free medical care". Grrr....I once had a patient tell me, when I was a L&D nurse, after I said that I wanted to get the last little bit out of her IV bag..."oh, that's no big deal, I don't have to pay for it anyway". I actually told her "well I do" but I don't think she got it.

3. Spotting on and off for four days at 6 weeks pregnant....a family member asks for an, no.

Anyway, that's enough being snarky....these things sometimes get frustrating though. Plus, it's a really bad time of the month this month for me with PMDD. I've got one nerve left and everyone wants to step on it!!!!

I'm off for the next five days so plan to get some stuff done around the house, chill, watch movies, and of course, catch up on blogging!

Midwives Rock...and people are starting to get it :)

Midwives Deliver

Interesting article in the LA Times by Jennifer Block, who also wrote Pushed

Monday, December 15, 2008

The weekend

The weekend on call was not too bad. I had three babies and those were all convinently (sp) during the day. I spent my nights at home in my own bed. I even got to go to the office Christmas party.

One thing of note...

About midnight last night, just as I had fallen asleep, I got another call from the triage nurse at the hospital. Apparently the doctor on call for the weekend (from another practice) had asked her to see if I would come in for a delivery on a doctor patient that had just come in and gone from 4 cms to 6 cms while in triage.

I like this doctor and have caught babies for her in the past so she wouldn't need to come in....but that was when I was already there! I'm not getting out of my warm bed in the middle of the night for a doctor patient whom I have never met!

I had dental work done this morning - oh joy. But damn that nitrous oxide is good stuff!

Friday, December 12, 2008

Lack of writing

I haven't been blogging much - just very tired and a wee bit overwhelmed with holiday stuff. So I have given myself permission to blog only when I feel like it :) Things may be a bit slow over the next couple weeks in that case.

Vegas was fabulous fun but we made a deposit instead of a withdrawal :p I discovered single-deck blackjack and loved it. I actually made some of our losses back playing that. The odds are supposed to be better anyway with single deck.

Work is busy busy - haven't been on call since before leaving for Vegas but start call tonight until Monday morning. My first weekend....I'm a little nervous.

I'm having a hard time in the office with some of my ladies - there are several that I have been seeing almost exclusively and feel so very bonded with. So then I am telling them I will try to be there for their delivery. I shouldn't be doing this so much though - it can take up a lot of personal time and my girls are always disappointed when I have to leave for a baby :( I feel very torn.

Saturday, December 6, 2008

Busy busy busy

Been busy around here...

I missed three of four deliveries this past week! #1 came in complete and pushing (and it was her 6th baby - she had her legs crossed when she came up in the wheelchair...or so the nurse told me :) #2 happened as I was coming out of the OR from first assisting. I missed #3 by half a minute - got stuck in traffic due to an accident between the hospital and my office (and she came in 9cm, second baby). *sigh*

Finally finished decorating for Christmas today and am exhausted.

We leave for Vegas tomorrow (my husband and I) for a couple nights so will catch up more later in the week!

Oh, and read a couple good books I would recommend if you like to read memoirs.

Playing Catch by Sarah Urang - totally my type of personality, funny, irreverent, check it out!

A Midwife's Story by Penny Armstrong, etc - I love reading about the Amish culture/lifestyle. I came close to taking a job in this area - it's absolutely gorgeous!

Currently reading Brisngr...

Sunday, November 30, 2008

On call part 2

My mexican lady came in and was dilated to 6-7 cms! Woohoo! She took her sweet time but eventually progressed to complete, pushed badly (so we did some towel tug of war which really did the trick), but then had a cute little boy.

In the meantime, the same patient from Thanksgiving night that Medwife had scheduled for induction today showed up for a labor check. She was 6cms! So I kept her and she labored au naturale - and did a beautiful job even when I had to give her a little pitocin. She walked a lot, used the tub a couple times, and did a fabulous job.

Today we put the trees up but haven't done any decoration yet..will probably do throughout the week.

Holy Family Birth Center

The Holy Family Birth Center is in danger of closing its doors...check out this article and then see how you can help.

Saturday, November 29, 2008

On call today

Not much going on yet for today. A spanish speaking patient should be going to the hospital soon as she thinks her water is broke. With what little spanish I know and her very limited english we still managed to talk on the phone :)

Which one of us... not like the others?

There's one of us midwives who is very different from the others....Medwife.

Her annoyingness seems to come in waves. And we in the midst of a huge wave!

Last week, Medwife takes it upon herself to induce my personal patient on her call shift. Ok, I could get over this. But she never calls me to see if I want to come in for the patient! The patient and her spouse asked Medwife 4 times if she was going to call me. Medwife informed them that it would be unethical and inappropriate to call me because it was my night off. WTF????? She's had no problem calling me on my day off in the past for my personal patients. And I know it's not about the money. So, WTF? The nurse tried to page me...unfortunately not knowing that when I am off my pager is off, and I have to be called on my cell or at home. Oh well, was disappointed that I had missed it.

While on call for Thanksgiving, a patient came in that evening - the patient sees Medwife in the office and was scheduled for induction on Sunday. She was contracting a little and hoping maybe we would move the induction up. I didn't do it but maybe I should have :P

Medwife is scheduled on call Sunday she has two inductions scheduled for Sunday. One comes in at 6am and the other at 2pm. So she'll make the midwife on call manage her labors all day (on a Sunday no less - we aren't supposed to schedule inductions on the weekend) then she'll come in to catch. That's messed up and I would certainly be raising hell about it. We are gonna have to have a long talk with her at out next meeting.

Thanksgiving call was pretty laid back. I got to stay home during the day then went in about 9pm for a labor patient. Had a nice birth about 2am, then off to home and in the bed :) The food was delicious and I was thrilled to have spent the entire day at home with my family!

Wednesday, November 26, 2008

Thanksgiving Menu

I want to wish everyone a Happy Thanksgiving!

What's on your menu?

What are your traditions for Thanksgiving?

Our menu...

Green bean casserole
Squash casserole
Garlic mashed potatos
Baked sweet potatos
Dinner rolls
Shrimp cocktail (for my semi-vegetarian mother)
Cherry pie
Brownie Chocolate Chip Cheesecake
We don't really have any traditions for Thanksgiving. I'm on call so hoping for a quiet 24 hours. We'll sit around and watch movies and just chill. And eat, of course.
We will do a little shopping on Black Friday. Then I am on call again Saturday. Then Sunday, we'll start decorating for Christmas :)

Monday, November 24, 2008

Dental work

I had dental work done today...a 'deep cleaning' to be exact. Because I have had dental and oral surgery in the past, I tend to get very nervous about all things dental. I am pretty tough when it comes to pain...except in my mouth. I opted to fork out the extra $25 for nitrous oxide (laughing gas) since my heart rate was almost 110 bpm and I was rather tense (I think I left my butt cheeks indentation on their chair :p).

That is some good sh*t! Sign me up for weekly dental work!

Sunday, November 23, 2008

A funny birth story

I was on call again for 36 hours - this one was much quieter. I got to stay home both nights, only at the hospital during the day.

Two stories of interest...

I thought I was going to have my first run-in with Dr Attitude (he's got a very quick temper, been known to make nurses cry, hates one of the other midwives and let's her know it, has been a complete ass to every midwife, except me, at least once). I have always gotten along fine with him. He's a great doctor and has a nice following of patients who love him. So anyway...

I had a pretermer come in who had been seeing a mix of midwives and doctors for her prenatal care thus far. She requested a midwife when she came in. She's totally not a midwife patient at this point with a combination of recently diagnosed GDM and PTL. She's 2/70/-2...and contracting. She can't have the terb due to the GDM. Her UA is negative except for sugar and ketones. The RN in triage (who really friggin scares me and shouldn't be in nursing due to general lack of common sense and intelligence) doesn't collect a fetal fibronectin prior to the exam so that's out the window. I'm now really limited in a situation where this is true PTL. So I ask the nurse to go and give Dr Attitude the run-down since he is in the OR and can't come to the phone...I mainly just want to know if he agrees with me that we need to mag this patient. He basically gives her a hard time, won't let her finish reporting the situation and tells her to tell me that I need to come in and evaluate my patient.

I was absolutely livid and cussing! It's a teamwork thing for's also really a patient who is out of my scope and he should be handling anyway. It's 8am, I had a rough night due to allergies and my pager going off every 20-30 minutes for the past two hours, and the induction left over from the previous day was just getting going. I have gone and discharged c/s patients for him, when he forgot, or just couldn't get by there, I have handled his induction because he didn't a certain doctor caring for his patient, I have caught babies for him when he couldn't get there or just didn't want. The least he could do was not act like an ass.

So I go tearin' up there, ready to get into it with him. However, I have a quick temper, but also quick to cool off. So by the time I get there I am chillin' again. I decide to just see how he behaves towards me. And he behaved very friendly and helpful! Go I just let it go.

Story #2 - I had a patient that came in 5-6 cms and requesting an epidural. This is her 2nd baby. She gets very comfortable with her epidural. She has a very active baby, at times the nurses are struggling to keep the little one on the monitor. They requested a scalp electrode at one point to which I said no (she's GBS positive). I catch another baby then come out to chart. While charting I notice that they are not tracing the baby again and haveven't been for several minutes. Since I was wanting them to have her start pushing (she had been 10/100/-1 a little over an hour previously) I decided to go ahead and place the scalp electrode. I get a glove on when the patient has a funny look on her face.

I ask "What's wrong?"

She thinks for a few seconds and says "Nuttin', I'm just trippin'."

I pull the sheet back one else is looking...There's the baby born to its armpits already.

I say "no, you aren't trippin'. Hey everyone, take a look"

So with one glove on, I guide the baby out the rest of the way, the nurse lifts him to momma's belly and we were all laughing. The nurse kept swearing up and down that she had just looked down there when she went to turn her again.

No wonder she couldn't trace the heart rate...*giggles*

Thursday, November 20, 2008

36 hours is a long time

I did my first 36 hours of call earlier this week. It's kinda intimidating to think about that many hours in which anything or nothing can happen, stretching out ahead of you. This only preps me for when I do my first entire weekend next month - from Friday night to Monday morning. It wasn't too bad, but I was definitely wore out by the end. Here's a recap...

8:00pm - I get a call from a patient who has a history of fast labor with her first baby. She thinks she's in labor and plans to head to the hospital in about 30 minutes. Calls me back 20 minutes later to let me know her water has broke and she is contracting one on top of each other. So I strip off my pajamas and throw on scrubs and start the mad dash to the hospital to meet her. She lives much closer so I call ahead to the hospital to let them know she's coming and that she will likely be pretty active. Now, because of those stupid photo zones, I can't fly too much but there's no traffic so I still make pretty good time. I'm 10 miles down the road when the hospital calls and says "she's complete and +2, when will you be here?" Twenty minutes. Never gonna make it. I tell them to have a resident stand by. The resident doesn't make it. I miss it by 6 minutes. The nurse and FOB caught the baby :) I was very disappointed especially since she birth standing up (which freaked the poor newbie nurse out) and I haven't caught a baby like that. I would have loved to have done that!!!! Anyway, everything ended well.

So I go back home as there's nothing else going on.

2am - a young primip comes in because she's worried about some spotting/bleeding after intercourse. No pain, just wanted to make sure everything was ok. She's 5cm with a bulging bag of water. But contracting irregularly, and not feeling them. I give orders to let her walk a couple hours and I go back to sleep (I had been asleep maybe an hour up to this point).

4am - she's still 5cm but now feeling crampy with contractions....ok, keep her and I will come in a little later to break her water. I go back to sleep.

6:45am - crap, I need to get out of bed and get in gear. Hit rush hour traffic, arrive at the hospital about 8:15am. The lady is still just mildly crampy, 5-6cms, narrow pubic arch makes me nervous. I break her water and send her walking. She gets going and progresses to complete after walking, showering, and dancing with her boyfriend.

11am - she's pushing

1pm - The caput is +2, head is still at 0. I call the doctor for a c/s for failure to descend :( My first c/s in 4 months :(

I first assist for the first time and it went well! I was nervous and clumsy but the patient was happy that I would be staying with her and helping the doctor. The doc was very nice and helpful as was the scrub tech.

While this is happening, another patient comes in. She is also a young primip. She also walks for awhile and then changes her cervix. I keep her for labor.

I break her water around 6pm - she's 5-6cm now and requesting an epidural.

Shortly before 10pm - we have a really nice delivery, no lacs, after 30 minutes of pushing. She did a fab job.

I go home.

11:45pm - I fall asleep.

12:15am - The hospital calls to inform me that the young lady has a large hematoma. After discussing with the doc, he will go in to drain it. I feel obligated to go back as it is my patient.

1am - they are already in the OR and taking care of it. Patient is out cold. I hang around and watch him finish up. I wonder how often the nurse was looking at the patients' bottom, for a grapefruit size hematoma to have formed. The bleeder was small.

2am - Back home - I go straight to bed to rest my bloodshot eyes. Not a peep from my pager the remainder of the night!!!

And I get to do this again this weekend :p

Sunday, November 16, 2008

Sign on the dotted line

Please go check out this statment and sign it! Help support a woman's choice for childbirth!

NY Times talks about home birth

Check out this article from the NY Times about home birth...

Saturday, November 15, 2008

Another one of those

I had another one of those ladies the other day. You of those who no longer wants to be pregnant at a ridiculously (sp) early time in her pregnancy. She fell in that gray area of 34-37 weeks, where outcomes are sometimes fine, and sometimes not. No matter what I said to her, she just wasn't interested. She 'knew' her baby would be fine. I really tried to explain to her why it was so important that babies gestate for the full amount of time but she just wasn't having it. She had told the nurse, prior to my arrival, that she would break her own water if she knew how to. I finally told her that there wasn't a midwife or doctor in our practice, or anywhere for that matter, that would do anything to help her have her baby. I felt the need to tell her that in case she got it in her head that I was the only one who wouldn't help her cuz she just wasn't liking what I had to say. I really was very patient with her!!!! When I finished (finally gave up), I walked out to the nurse's station and asked the nurse if it was wrong of me to want to smack the patient upside the head?

BTW, before any woman flames me because some women have a lot of problems with pregnancy (such as severe hyperemesis, etc) - this woman had no problems...just didn't want to be pregnant anymore.

Wednesday, November 12, 2008

Call yesterday/last night

Lots of pretty normal and straightforward labors and births yesterday/last night. I caught four babies total :) It was my first call this month, due to being on vacation most of last week.

I was aggravated though on the way home from the first round. They have placed these stupid photo enforcement zones all over the interstates I use to get to the hospital and I got 'flashed' on the way home last night. One of the nurses suggested sending them a copy of my badge and explaining I was on call for births...I'm thinking "yeah that would be great but I traveling away from the hospital". Might be hard to get that to fly. The whole photo thing really is a pain in the butt for me. In the middle of the night, if I need to get to the hospital fast I really put the pedal to the medal :p Now I can't do that. Hope women can just cross their legs and hold it in.

Sunday, November 9, 2008


Vegas was great! We had a fabulous but exhausting time. It was me, my mother, and one of our old midwifery students (who had greatcause to celebrate since she just had passed boards). She taught me how to play craps which is wonderful fun!

While we had a great time, there were some things that drove me nuts...

1. People from other countries that seem to have a smaller bubble (thx Lisa) than we do...stay out of my personal space!

2. A man asked me, after touching my tattooed back and arms, "if it was sexy getting tattooed?" Umm, no, duh. It f*ckin' hurts so I guess it would be sexy if you were into S&M.

3. When walking through the casino, do not stop dead center in the aisle and force everyone behind you to squeeze around you. You are not that f*ckin' special princess.

4. When walking through the hotel/casino/wherever watch were you are going. It's kinda hard to avoid running into people when you are walking and looking at the ceiling.

5. When playing Blackjack, do not regal us with your amazing prowness at the game by splitting tens against the dealer's 5. You are breaking up an almost sure winnning hand. And regardless that you think it's your money and you can play how you want - you are f*cking up the whole table.

But other than that, had a fab time!!!!!

Monday, November 3, 2008


I'm on vaca starting this morning - woohoo! It's just another short one but still much appreciated. I was on call last night - very quiet - as I had hoped it would be. I got the typical 5am phone call from a lady who thought she might be in labor. As I have mentioned before - night call will always involve a phone call at midnight, 3am, and/or 5am. I told the lady (a primip) to stay home as long as possible - and baby moving well of course. She rushed right into the hospital - she was surprised I was telling her to stay home. Naturally she was 2cms...

So tomorrow I leave for Vegas. We are having a girls trip this time. It will be me, my mommy, a nurse who used to work at the hospital and a old student nurse midwife (who's taking her boards today and hopefully passing as we 'speak'). I'll be back Thursday so will plan to blog on the trip this weekend :)

See you guys in a few days!

Saturday, November 1, 2008

Halloween fun

We had a nice time last night for Halloween. It's one of my fav holidays....well any holiday that gets me candy is a fav! In fact, it's one of the reasons I had children - great way to get free candy :)

I was a zombie midwife carrying my raggedy zombie baby. Both of us had blood all over us. My scrubs said Ded Midwifery Service - snicker...get it?

My husband was a cereal killer. My mother was a cross between Cyndi Lauper and Tina Turner - she was punk rocker wearing this purple wig that i thought we would have to kill.

The kids were a vampire, red devil witch, and a princess.

I hope everyone who celebrates this heathen holiday had a wonderful time!

Part 2

Lady #2 did an amazing job with her labor. This was her first baby and she did it like a pro. I had seen a lot of her in the office so was thrilled that it had worked out that I would catch her baby (it usually does). She labored all day long and into the night doing various positions, the tub, the ball, etc. Unfortunately the baby was so low in her pelvis that from 5cms on she wanted to push. The ball helped the most but I felt so bad for her. Now, the delivery, I'd love to tell you how wonderful it was but I missed it! I got tied up with lady #3 and was not happy about it. So, a midwife from another practice happened to be there babysitting her two ladies with crappy labors. She stepped in for me and caught. She said lady #2 rocked. It was a big baby boy and no lacs - woohoo! But I was very sad to have missed it.

So while my personal patient lady #2 was delivering, I was stuck with a naughty baby belonging to a very whiny lady #3. Essentially, she and her significant other were very nice people but I had only met them the day before. She spent much of the time when I would visit with her talking about how she went into labor and what she did and didn't want for this induction. For someone who spent so much time begging to be induced she was being awfully picky and high maintenance. After pitting, broken up with some walking and a shower, she finally started moving along. We had started before I even came on call with pitocin and I couldn't break her water until around 8pm that evening. She continued to make progress but then we started getting some really ugly strip...big deep variables with contractions...guesses on what the problem was??? Yes, she had a nuchal cord. So anyway, she had an anterior lip which I was able to reduce. She was about a -1 station at this point but I figured she could push it out in 10 minutes or less. Her biggest baby was 8-4 and she had had three vag deliveries already. So I tell her I want to go for a quick delivery due to the variables. She then tells me she is a bad pusher, had to push a minimum of one hour with all her babies. Greeeaattttt...and she wasn't kidding! For every good push she had, there were about 8 crappy ones. I was starting to think I would need to call the doc in for a vacuum delivery. She finally did it about 12 minutes after lady #2 delivered. Grrr...and she whined the whole way through. I felt a little bad because she was starting to cry but I knew she could do it...we just had to figure out what worked for her. It was just frustrating for her and for us...towards the end we were getting variables down into the 40's but still fairly rapid return to baseline after contraction. I hate hearing that slow thud....thud...thud....and naturally my doc didn't want to come in. I had told him I would work with her for 10 more minutes, and if she didn't make some progress then he was questions asked.

Oh well, lots of healthy, happy parents and babies so all's well that end's well :) Can't ask for much more than that!

Friday, October 31, 2008

Yesterday's 24 hour call

So I paid bigtime for all the wonderful and simple births I have had this month. Yesterday's call was stressful :p

I had a lady being induced - she begged in the office to be induced because she was driving three hours one way for her prenatal care. She had some of her previous babies with us and still wanted to see us. Wow, talk about dedication :) Well, we all said no but the doc she saw for a tubal consult had his heart strings tugged from her story so I decided to go along with it. I went and met her for the first time to explain the process and then scheduled her for the next day. That's lady #1.

Lady #2 came in for induction as well, however when I had seen her in the office previously she was already contracting and 3-4/80/-1. She was a primip wanting to go natural. So the plan was just to break her water and see if she would just get going (which she did).

Lady#3 came in during the afternoon - a VBAC attempt with 4 previous vaginal deliveries, she showed up 8cm (according to the nurse).

I had just gone over to the office to see a few patients when I got the call about lady #3. I dumped my patients on the other midwife and headed over to the hospital. I sat at the hospital for about 10 hours before I had the first delivery...grrr. The VBAC attempt was successful after a few hours of watching an occasionally crappy strip with no or little cervical progress...she was really more like 6cm when she arrived. Too high to rupture so I waited and waited for the head to come down. By the time it did she was about 8cm for real. So I rupture her and guess what? Her cervix shrinks back to 6cm...grrr. I leave her alone for a couple more hours...she doesn't change. So we decide to use some 'gentle' pitocin - we started at one mu/min and never got past that. In fact, when she finally kicked in with her contractions we cut the pit off. Well, and not to mention the big decels. That had something to do with it too :p She finally delivered shortly before midnight. I was so glad because the doc I was on with has a low tolerance for 'abnormalitites' during VBAC attempts. He would have had an absolute shitfit had he come in and found out she was there for 10 hours!

Oh, I have to go for now - gotta start getting costumized - I am a zombie midwife :) I will post again tomorrow to finish the tale!


Friday, October 17, 2008

Interesting placenta

I had a fabulous lady who VBAC'ed recently. No fetal issues at all throughout the labor - baby looked beautiful. No unusual history with mom. But this placenta appears to have an infarcted lobe...I thought it was cool having never seen such a thing so got permission to take pictures. The lobe is black almost to the base. Check this out...


An older, tired-looking dog wandered into my yard;
I could tell from his collar and well-fed belly that he had a home and was well taken care of.
He calmly came over to me, I gave him a few pats on his head; He then followed me into my house, slowly walked down the hall, curled up in the corner and fell asleep. An hour later, he went to the door, and I let him out. The next day he was back, greeted me in my yard, walked inside and resumed his spot in the hall and again slept for about an hour. This continued off and on for several weeks. Curious I pinned a note to his collar: 'I would like to find out who the owner of this wonderful sweet dog is and ask if you are aware that almost every afternoon your dog comes to my house for a nap.' The next day he arrived for his nap, with a different note pinned to his collar: 'He lives in a home with 6 children, 2 under the age of 3 - he's trying to catch up on his sleep. Can I come with him tomorrow?'

Grey's Anatomy - doh!

Who wants to go to the hospital where the cardiologist does both adult and pediatric cardiothoracic surgery? After all, we know children are nothing more than mini-adults...not.

Who wants to go to the hospital where the residents...and it's not their speciality even...are starting IVs on children? After all, I see residents start IVs all the time...not.

It isn't about us...'s about them.

If I hear that phrase one more time, I am going to puke. What it means is, midwives do this for the women we's all about the women.

Ok, yes, I care a great deal about the women I provide care for. I want them to have a wonderful, fulfilling pregnancy and birth. I want them to have the journey they envision. These things are the top priority when providing care for women.

But I am a midwife, a mother, a wife, a daughter. Those women are not my top priority in the rest of my life...and yes, I think I have a life outside of midwifery. Granted, midwifery is still a very large part of my life.

I get tired of hearing "you don't go into midwifery to get rich", you don't become a midwife if you want to make money". SCREW YOU! I became a midwife because I love it and couldn't imagine doing anything else. But why can't I make enough money to support myself and my family without struggling paycheck to paycheck? I can't help it if my husband has a horrible heart condition and can either work or can go to school but not both. I think it sucks that we midwives are so willing to suffer and forsake what we deserve because we are so friggin' 'altruistic'. Check out this post Rambling part 2

I realize that others have it far worse - I try to remind myself when I get frustrated, aggravated...

Thursday, October 16, 2008

Happy Trails Dr Induction

Happy Trails Dr Induction!

He was actually supposed to work until the end of the month before he takes off for a job elsewhere. However, he insisted on taking his full break even with several patients waiting. Sooooo, to make a long story short - Dr Boss said don't come back.

Guess who got to see his afternoon schedule?

One of the midwives had to leave sick while this was going on.

Guess who got to see her afternoon schedule.

Another doctor had to leave to go do a delivery.

Guess who didn't have to see his schedule thank god!?

So, yes, I had a light schedule with only 4 patients. they added the other two providers' schedules onto mine. I saw (with the help of the student - I would have been majorly sunk without her help) 17 patients in 3 and a half hours - 2 of which were new OB appointments (which are slotted 40 minutes each). Agggghhhhh! But I did good :) And three of Dr Induction's patients have switched to the midwifery service :)

Tuesday, October 14, 2008

Rectal pressure

There's nothing like a woman saying she feels like she needs to poop that warms an OB nurses' heart.


I spent my whole three day weekend off at home, in the bed a lot. That sucks. But starting to feel better now. Surprisingly so since I am finishing 24 hours of call. Nothing too exciting...caught one baby, or actually the student did. And another in for cervical ripening. Just sitting here waiting to report off to the oncoming midwife so I can go back to bed.

Cochrane Review regarding midwifery care

This was just released a couple days ago from the Cochrane review on the midwifery model of care...just more evidence supporting midwifery care!!!

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.
In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.

Saturday, October 11, 2008

National Midwifery Week

It's National Midwifery Week - actually today is the last day - it was October 5-11th. I just want to say thank you to all midwives fighting the good fight, for all that you do.

My boss didn't do a darn thing for us. Wait until doctor's day comes around...

I was going to post a bunch of funny, sad, and crazy things midwives do but am just too sick right now (got a real nasty cold - trying hard not to sneeze snot all over the computer screen - especially since it is my mother's laptop I am using - she gets upset about that). So maybe later I'll give it a try.

Thursday, October 9, 2008

Call today/tonight

Had a couple nice deliveries with the student today - hung out with some fun patients in the office who are ready to go anytime now (hopefully when I am on call!).

Had two pages from patients this evening - one while I was attending my daughter's 2nd grade concert. Both early first trimester and both spotting.

I understand the worry...really I do - I've had a miscarriage and then bleeding off and on for the first 15 weeks of one pregnancy...but that doesn't mean it can't be monotonous. It's like telling patients they need to drink more water...we live in Arizona for crissakes! It's a cool 90's during the day :p I must tell them to drink more water a minimum of 10 times each day I am in the office.

They come in complaining of urinary symptoms but the urinalysis is completely drink more water...

Anyway, one of the women sound irritated after I spoke to her. I don't think I told her what she wanted to hear...perhaps I was supposed to tell her to rush to the nearest ER? I'm sure Nurse K would appreciate that!


1. I get Bladder infections every week for the past two years.

2. I get yeast infections every month for the past year.

3. I have migraines although I have never seen a doctor and been diagnosed with that - and Tylenol makes them better.

That was off a H&P recently from a very sweet little girl. I should have gotten an academy award for best acting performance in that visit. I kept a straight face the entire time.

Really, as a midwife you have to be supreme at maintaining a straight face. The things we hear and see are sometimes insanely crazy, or sad, or just plan funny. But....straight face.

Monday, October 6, 2008


Did you know smoking decreases the risk for preeclampsia? And keeps those pesky babies from getting too big?

By gosh, I'm handing out the Marlboros along with the prenatal vits at all my new OB visits.

All kidding aside...smoking is bad for momma and for baby. I can totally relate to how hard it is to give it up - been there done that three times. But you know what made to easier?

Smoking during pregnancy versus placental abruption, previa, fetal death, growth restriction...

Hmmm, tough choice.


Come on momma - you can do it.


It was a busy weekend followed by a conference today...I'm so tired I could.......zzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzzz.................

Oh, sorry! Well you know how it is. I made up in one weekend for the awful slow month I had last month. I did 9 deliveries last month which is pitiful. I did five this past weekend....course my student caught four of those :(

Baby number 3 arrived in the wee hours of the morning (don't they all?). The student talked her out of an epidural at 7cm...I disagreed with this decision but went along with it. Her theory was that the patient was going quickly and she wouldn't get much benefit from it. My theory was that the woman had no desire to go natural because she wanted that experience. She was going natural because she was scared she would be paralyzed by the epidural (a common misperception among many of our Hispanic women). I therefore felt it was a little unethical to withhold the epidural. I don't know - tough call there.

Baby number 4 was my lady that I sent home after the failed induction...she prodromaled...came in the day before with no change. Naturally I was getting ready to go home to bed when she called to say she was on her way. Fortunately this looked like the real deal - 5/100/-2. She labored fantastically and we had a mild shoulder dystocia that lasted to the belly button! The baby was 10-2. Great apgars and no problems... later she tells the student she had the same problem with her last one (which was close to 10 pounds). Um, ok, that would have been nice to know prior to delivery - not that we weren't prepared as I knew this was a big baby and she had a history of big babies (smallest was 9-7 I believe) but that kinda info should have been all over the chart. It wasn't. I looked to see who had done her initial OB visit - one of the WHNPs - and not the one I think highly of if you get my meaning. Figures.

Baby number 5 was actually a doctor patient but when she was informed that her doc was not on call and that it was Dr Greedy from another practice covering...she promptly said she would take the midwife (me of course). Apparently she had started prenatal care with Dr Greedy and transfered to our practice. She had a great delivery. I had the student watch me do this one because I wanted her to check out the differences in our styles. Her style is ok but just not what I had envisioned a homebirth midwife to be doing. I don't know what I expected....maybe zen mantras being chanted and incense burned, etc....:)

There was actaully another baby I caught...Dr Greedy had a patient there who was a gravida 4 para 3. She went from 7 to complete +2 in maybe 10 minutes. The nurse asked me to come in for delivery as Dr Greedy was not going to make it. The patient was fine with this - she didn't care who caught she just wanted to push! Delivery went smoothly, even with the triple nuchal cord! I was going to grab a billing sheet when the doctor who had since arrived saw me with it and flipped out. There was no yelling but the atmosphere was tense as Dr greedy told me he wouldn't bill for doing a favor...blah blah blah. I informed him in polite words that he was full of sh*t and had done it to me a few weeks previously. He said he didn't ask me to do the delivery...I said that a resident would never have made it, the other doctors would all prefer a midwife to having the resident or nurse attend the delivery (no offense intended to either parties btw). Not to mention the hospital policy states the nurses should make every attempt to have a provider present if the attending MD can't get there. You see, Dr Greedy is...well...greedy. He will try to take deliveries from other docs and bill for them...he gets to bill if a nurse or resident catches the baby. I told him that I would never catch another baby for him. I feel bad for the patient who gets burned for his greedy selfish behavior...

Saturday, October 4, 2008

This weekend

This weekend is kind of interesting yet stressful. The doctor (from another practice) on call this weekend never has midwives on call with him except Sunday night. Now that we have gone back to a midwifery service, we are covering for his weekend starting this weekend. After all, you can't tell patients "oh yes, you can have a midwife anytime now....except for this one weekend every 6 weeks".

This doctor doesn't particularly care for midwives - I think he believes we are a liability to him and he says his malpractice insurance doesn't cover us. Well, gee, you're right. Your malpractice insurance doesn't cover us...but ours does. I think the deeper issue is greed. He was making a pretty penny on his weekend covering our practice. We are substantially larger than his practice (he's by himself) so he was enjoying all that extra money.

Greed + dislikes midwives = pain in the a$$

So last night I had two ladies come in for post dates cytotec induction (both multips wanting induction but as little intervention as possible...hmmm). They were both multips so I hoped the cytotec would knock them into labor and we (we being the student and I) wouldn't need to do anything else. Well, naturally...the best laid plans and all that. I was a little stressed about doing it because we normally avoid inductions on the weekend and because this particular doctor was on. I had hoped I wouldn't see him but he came by for a delivery and naturally wanted to know what I had going on. *sigh*

I told him I had the two ladies here for post dates cytotec induction. He promptly mentions that he thought we weren't doing weekend inductions. Well, I say "mostly not, however one came to the office and wanted induction while the other came to triage for antenatal testing and decided she wanted to give it a try". I told him I can't send home anyone 41 weeks and beyond if they are requesting induction. In our awful litigious society, you send them home and tell them to wait and they come back with a dead baby...guess will become close and personal friends with a lawyer. So anyway, he just gave me this condescending smile and that was pretty much the end of it. Whew.

Now, having this scenario, I just knew that nothing had better go wrong or I would never hear the end of it. So it was a stressful night for this reason.

So what happened, you ask....

The first lady had some response to cytotec and ambulation then kinda stalled out. She wanted to continue though so we started pitocin....then she decided that she was so tired she wanted to try an epidural so she could sleep (she had never had one with any of her previous babies). So she gets the epidural. (this is starting to sound like the children's book "If you give a Mouse a Cookie"). She sleeps, we break water at 7cm and she delivers her baby 20 minutes. What a sigh of relief. There were times when the strip didn't look all that great, and she just took quite a while to get going. Her and the FOB were quite content with their little one.

The other lady had pretty much the exact same response...went from 2-3/40/-2, a little firm, to 4/60/-2 and softer. She walked as was kinda funny to see these two ladies out walking at the same time doing the exact same thing (the other one was 4cm by this time but a lot thinner). Well, this lady opted to go home after she stalled out.

In the meantime another lady came in who I had sent home earlier due to barely being dilated and not really contracting a whole lot. Well, she called me just as I was drifting off to sleep about 1am. She was really picking up the pace and sounded pretty uncomfy. She showed about an hour and a half later in active labor - woohoo! Did a beautiful and rapid labor and birth with nary a tear.

So both births were really nice although it's really hard to stand back and watch while the student does the catching. After having such a sh*tty month last month I really need some beautiful births :p Especially when one of these ladies was someone who I had been seeing in the office regularly. *sigh*

So, just waiting to see if the other one shows up sometime this weekend...oh, and back on call tonight at 1am for 18 hours...don't ask - there was a little scheduling snafu so the medwife and myself are covering the whole weekend.

Oh, and am excited - I start my first assist course on Monday as well as having a conference to attend.

My son't birthday is next week - 14 years!

More later...

Friday, October 3, 2008

Funnily (is this a word?) enough...

I had a patient who showed up for a new OB visit wanting an abortion. Sad stuff. So I counsel her, explain that we don't do abortions, blah blah blah. I felt like crying. I just find it hard to imagine being in such a difficult position. Anyway, after she left, I was trying to decide what codes to put on her superbill so asked the doctor (one of the ones I like and respect) what he would put. He then proceeds to tell me I should have sent her for an ultrasound. I guess the reasoning being that she would see the baby, and then decide to keep it.

Umm...I didn't say anything to him...yes I am a chickenshit but I am probably the only pro-choice provider in the office. Makes for a wee bit of awkwardness (sp). However, this practice of sending women for ultrasounds to convince them to keep a baby....makes me's hard to put into words. It's just not right for me to do. It seems very unfair and low-handed. So I just said she was already gone and left it at that. I know it's not just him...others in the practice have told me they do this. Crap, I felt like I was sleeping with the enemy!

Tuesday, September 30, 2008

Last night

I was on call last night and during the day. We have a new midwifery student with us as well so she was hanging out with me in the office yesterday afternoon. She was a homebirth midwife and decided to become a CNM :) I expect to learn many things from her and hopefully will have some things to teach her.

We had one lady come in last night for labor....I wasn't surprised as we had done a labor check in the office with her. Kinda worked out nice, the student got to meet this soon-to-be mom. She had a baby girl, and did a nice job birthing her baby! The student caught the baby...I think she was really nervous being the first birth with new preceptors. I tried to put her at ease as much as possible. Part of the weirdness for her is that she has never worked anywhere but in a homebirth to be here in the hospital is just very new. I told her to do what she use or not use the nurses as much as she needs to...just chill and take your time.

The student is coming from another clinical site where the midwives are apparently not very student-friendly. The previous student (who I so bonded with and will be going to Las Vegas next trip with us - woohoo) came from the same site and had many horror stories to share. I think it's so sad that this has happened to them. Talk about a medal for surviving the trenches of Worst Midwife Preceptors Possible. I mean really, this site would brag about how many students have left or been fired from their clinical site. Ummm, duh....

I love to teach...anyone....I think it's just an opportunity though for me to hear the sound of my own voice. :p


I'm not a big fan of political discussions...I am ashamed to admit that I am not following all the debate going on about the issues and the election. I will however, vote. I will vote for Obama.

I was on Navelgazing Midwife's blog reading an interesting post and her excellent recourse on the topic of late abortion. Check it out if you are so inclined.

Here's my response on her site...

I am a pro-choice midwife...your argument is absolutely excellent as were the words of many others. You are far more eloquent then I can ever be.

I echo the sentiments that we need to get beyond whether abortion is legal or not...and focus on how can we reduce the numbers of abortions. But I do not believe the two factions can ever settle their differences to meet in the middle. I don't like abortion, probably would never have one myself....however, I firmly believe that the government should have no say so in our bodies. I believe there are times when an abortion is ok. Each woman must make the decision and must live with that decision...not the government.

As far as the video - what propaganda! I worked as a L&D nurse for four years and no baby was ever left in a utility room to die. And certainly not a term one such as the one shown at the end...jeez!

Sunday, September 28, 2008


Anyone watch the most recent episode of House? I love when one of the doctors cuts an emergency trach - with a scalpel and trach tube that happen to be convienently (sp) available. But he has no gloves on when he does this...umm...gross! Two hospitals I would never go to even if my life depended on it - Grace Memorial (Grey's Anatomy) and House's hospital (can't remember the name). Scary - thank god they are just TV shows.

I would love to be a patient of House and his crew - so they can randomly guess at diagnoses and give me multiple wrong treatments before miraculously (SP again) coming up with the diagnosis which was inspired by something some random person said in a conversation.

I would love to be a patient at Grace Memorial because a nurse will never set foot in my room - the docs will always be at my bedside providing compassionate care while doing experimental treatments on me for which they will forget what the research says at critical moments during the procedure.

Fun. Now you know why I drive my mother crazy when I watch these shows with her.

Oh, and I bawled like a baby when Pratt died on ER. I'm so stupid but I love these shows.

Sunday, September 21, 2008

Birth Planning

This is a fabulous post with really great information...wherever you plan to deliver...

Questions and Answers: Homebirth Birth Plan by Navelgazing Midwife.

Fake pregnancy

So At Your Cervix has a post talking about fake pregnancies and I posted this story...thought I would share here as well.

I had a woman show up for a new OB appointment at my office. She had presented about a week earlier to the hospital claiming she was due and scheduled for a c/s... Ah, ok.... She was told nothing was scheduled. She claimed we were her providers so the hospital calls us - nope never heard of her. She's told she needed to make an appointment with a provider somewhere (she's a huge lady so could easily have passed for term). So anyway, I didn't know at the time this was the same woman. The MA didn't do a pregnancy test - just assumed because of her size she must be pregnant. This was the first time I had encountered this sort of thing in the office so it didn't occur to me that she was not pregnant.

I work her up - history, physical...she tells me she is 41 weeks pregnant, previous c/s x 4! I'm thinking holy sh*t! I try to listen to fetal heart tones as part of the physical...nothing...try to palpate her abdomen...she's so large I can't tell what I am feeling. So, before sending her off to the hospital for further work-up and possible c/s I check a pregnancy test...negative. Hmmm. The patient appears to be shocked, the boyfriend seems worried. I get the ultrasonographer to fit her in for a quick check. A very non-pregnant uterus was found.

The woman is absolutely shocked and crying "where did my baby go" over and over. The boyfriend storms out crying. I tell the woman that I am sorry this wasn't the news she wanted to hear. She starts to ask me why she's not having periods...uh, you think weighing 400 pounds has anything to do with it?

Night Call

I always have such a hard time sleeping when on call at night. It's inevitable - I'll get a call just as soon as I drift off to sleep...or at 3am when I am in a nice sound sleep. The other night the 3am call didn't come until 5am - but I woke up at 1am, 3am, 4am, 5am, and 6am. Not a pleasant night.

Vegas Baby!

Vegas was great! My husband and I had a wonderful time. We were celebrating our 13th anniversary a week early. We had a free upgrade to a spa suite which was fabulous - I took four baths in two days :p We saw David Copperfield one night - he was funny and absolutely amazing. We also played a lot of Blackjack and actually came out winners this time!!!! My husband and I have been studying basic strategy and he's actually been working on some of the more advanced stuff. I could see the difference this time in our playing skills. We came home about $145 up - not a big amount but thrilling for us considering we were down almost $300. I promptly spent that buying gifts for the kids and my mom who babysat.

Overall, it was a great trip! We'll be going for a girl's trip in November.

Monday, September 15, 2008

Las Vegas Baby!

Off to Las Vegas tomorrow for a to you in a few days!

Last Night

I was on call last's how it went...

I first got a phone call around 11pm from someone who had already had her baby a couple days previously. She tells me her bottom is very swollen and its very painful to pee. Ok, this is a legit reason to be calling...I go over some comfort measures and advise her that she should call the office first thing in the morning to be seen but if her pain is that bad and she is unable to urinate then she would need to go to the ER. Simple and straightforward plan. She proceeds to repeat her concerns again, also bringing up that she has had only one bowel movement since having the baby. Oookay - I suggest what she can do for that while advising her that sometimes it takes a while for bowels to get back to normal. She continues to repeat her concerns. *sigh* Here's the thing - I have told you what your options are - choose one and let me get off the phone so I can go to sleep. It's almost as if she wanted me to tell her she should go to the ER now. Well, that needs to be your decision - its your pain. Jeez...oh wait, how about you meet me in the office for a middle of the night exam...or better yet, I'll drive out to your house and look at your bottom. Ah, no.

I got called about 3am from the hospital. I have a lady there who's 5-6cm and its her fourth baby. Ok, I'm on my way. She was still pregnant when I left at 7am (another midwife came on). But it all worked out well because I caught the baby of a little African woman I had been seeing in the office quite a bit. She came in with an anterior lip (9.5 cms) and pushy. She was amazing - did her thing with not a single noise! Then the nurses ask me to stand by for a patient of another doctor. I say sure but then while the nurse is on the phone with that doctor - she says she is twenty minutes away and could I just do the delivery so she doesn't have to come in. Um, ok. I guess she had just gotten home from one of the other hospitals. I would get paid for it so no reason not to and I love to catch babies of course!

I go in to meet the patient and ask the nurse if there's anything I should know. The patient is 17, second baby, late prenatal care, history of substance abuse. Ok. Her first baby was only 6-9 and had to be vacuumed out. Ok, sounding even better. But this baby looks to be small as well. It wasn't. The baby was 8-3 and she pushed her out with just a small tear. Not bad.

Sunday, September 14, 2008

You know you're a nurse when...

1) the front of your scrubs reads 'Nurses... here to save your ass, not kiss it!'

2) you occasionally park in the space with the 'physicians only' sign... and knock it over.

3) you believe some patients are alive only because it's illegal to kill them.

4) you recognize that you can't cure stupid.

5) you own at least three pens with the names of prescription medications on them.

6) you believe there's a special place in hell for the inventor of the call light.

7) you believe that saying 'it can't get any worse' causes it to get worse just to show you it can

8) you wash your hands BEFORE you go to t he bathroom.

9) you believe that any job where you can drive to work in your pajamas is a cool one.

10) you consider a tongue depressor an eating utensil.

11) eating microwave popcorn out of a clean bedpan is perfectly natural.

12) you've been exposed to so many x-rays that you consider it a form of birth control.

13) you've ever heard a patient with a nose ring, a brow ring, and twelve earrings say 'I'm afraid of shots.'

14) you've ever placed a bet on someone's blood alcohol level.

15) you've told a confused patient that your name is that of a coworker and to call if they need help.

16) your bladder can expand to the size of a Winnebago's water tank.

17) you have seen more penises than any prostitute could dream of.

18) you believe that not all patients are annoying... some are unconscious.

19) your family and friends refuse to watch medical sitcoms with you because you spend the whole time correcting everyone and pointing out upside down x-rays.

20) you don't get excited about blood, unless it's your own.

21) you've sworn to have 'do not resuscitate' tattooed on your chest. Soon.

22) discussing dismemberment over a gourmet meal is perfectly normal to you

23) your idea of fine dining is anywhere you can sit down to eat.

24) your idea of a good time is a cardiac arrest at shift change.

25) you believe in the aerial spraying of Prozac

26) you believe that 'shallow gene pool' should be a recognized diagnosis.

27) you believe that the government should require permits to reproduce.

28) you believe that unspeakable evils will befall anyon! e who ut ters the phrase 'Wow, it's really quiet, isn't it?

29) you have ever wanted to write a book entitled 'Suicide: getting it right the first time.'

30) you have ever had a patient look you straight in the eye and say 'I have no idea how th at got stuck in there.'

31) you've had to leave a patient's room before you begin to laugh uncontrollably.

Ruth Lubic

Ruth Lubic is a midwife Goddess - check this out - she's really helping to get the word out there!!!!

Watch CBS Videos Online
Watch CBS Videos Online


I'm so proud of my older daughter! She's really improving with her reading skills! And she's reallyworking hard at it. It makes me want to cry when Isee her sitting in the chair reading a book instead of playing her nintendo DS! Last year she was really starting to lag behind with her reading skills. I was worried and disappointed because I am an avid reader and always have been. I was reading adult books (not porno stuff silly) by the time I was in the 5th grade. I would sneak my mom and dad's books to my room to read under the covers. So anyway, am thrilled she i doing better. She's not completely where she needs to be but is making good progress. We got her progress report - she got a B in reading, A+ in science, A in math, A+ in writing. Not bad!

My toher daughter who is in Kindergarten is doing well also but as a bit of a talking issue. I'm not sure where she gets that from *snicker* I tell my husband that our daughters are such talkers and must get it from his side of the family...he rolls his eyes. You see, I spent half of the third grade with my desk up against the chalkboard because I wouldn't shut up...and not much has changed!

Another 24 hours

I had another 24 hours of call and two really nice deliveries, where I kinda didn't expect them to be quite so nice.

The first one was a teen primip (first baby) who I had been seeing in the office a good bit. She was scheduled for induction a week later but showed up in labor this week which is always nice. I hate to induce anyone - it's always a little better and easier if a woman goes into labor on her own. This young girl showed up and was 3cm dilated (she had been 1-2/90/-2 in the office a week earlier). I had her walk although I really suspected she was in labor - she just looked it but I like to be sure before I go admitting anyone. After walking she had changed to 4cm so she got to stay. She progressed nicely (she did get an epidural a bit later) and was 9cm with a very bulgy bag by the time I got back from seeing a few patients in the office. I broke her water and had her labor down (with an epidural, a woman can opften rest for awhile and let the contractions do the work of pushing the baby further down). After a couple hours, she was feeling pressure - yah! So we did a trial push (she was 10cm of course) and she pushed like a champ. We had such great communication going on between the patient, myself and the nurse! The nurse coached her through the pushing - none of that hold your breath and count to ten stuff. We had a very slow controlled delivery - 6 pounds 6 ounce baby over an intact perineum - and she actually only pushed 17 minutes! That's how I like to do it!!!!

The other lady was originally a doctor patient, however her doctor called me and asked if I would take over management since he was going off. He didn't want Dr OMG He Did What?? to take over or the weekend covering doc (who's from another practice). I said sure if the patient was ok with it - she was - we had met in the office a couple days prior. She had been getting cytotec all night and part of the day with orders for a couple more doses. I decided to check her prior to the next dose - she had been previously 1-2/30/-3 which is very unfavorable! As far as I could tell we were inducing for elective reasons :P When I checked her she was 2-3/80/-2 so I started pitocin and she delivered three hours later. This was her second baby although this one was almost a pound bigger! I was actually planning to go to sleep for a bit, when the nurse asked me for a scalp electrode first. She was having trouble keeping up with baby. So I go check her and how cool - she was 10cm and +1 station - woohoo. So I have her push and she motors that baby right on down to +2. The nurse says "You might want to wait a sec, i don't have a table set up". Uh, ok, why not? So anyway the patient is saying I feel the baby moving down while the nurse is frantically setting up the table. Two contractions and we had a baby! No tears again :)

Then I went home and went to bed....but before I fall asleep a nurse calls and says we have a patient here who is 7cm. She saw midwives and NPs through her whole pregnancy but wants a doctor for delivery. So why are you calling me? Because the charge nurse said I should. Nooo, if they want a doctor, call the doctor. *sigh* They'll get it eventually.

And no one from our practice warned the doctor on for the weekend about the changes (she's from another practice). She had three patients that same night and didn't understand why the midwife wasn't taking care of them. Left me in an awkward position.

Wednesday, September 10, 2008

24 hour call on the new midwifery service

I did my first 24 hour call shift on the new midwifery service. I was quite busy with things during the day. I started the day by missing a precipitous delivery. A Muslim woman came in with her husband completely dilated and ready to push...and it's her third baby! I'm sitting at home, showered but in my lounging clothes. Damn. So I change and go rushing off to the hospital. I have the secretary call for a resident to stand by cuz there is no way I will make it. And I don't. I walked in as the placenta was coming out. And appreantly it was a whopper of a birth. The baby came out fine but the resident happened to be a male so the woman refused him. They apparently comprised by allowing him to stay in the room while the nurse caught the baby under the sheet. *giggle* Understandably the nurse did not want to be alone in the event of an emergency. So, I show up in time to check out the perineum. They don't want me to touch her there since she is in pain and tired. I try to explain that it will only take me a few seconds to look and I will be gentle but that I really need to look. She finally consents to let me look after I agree to let her have a shot of pain medicine. She has a first degree perineal tear that fortunately can go without repair - whew.

I get the rest of the story from the nurse afterwards. The woman came in screaming and crying...very much out of control. The husband was crying and saying his wife was dying...asking for an epidural...asking for a cesarean section, etc. My conversation with the nurse went something like this....

Me: I thought she had had babies before?
RN: Yes, two of them.
Me: Vaginally?
RN: yes
Me: But they didn't seem to understand what was happening?
RN: Right.
Me: Ooookkay.

Now granted, her first two babies were in another country. So from her perspective I can only imagine what it must have been like to be in your first US L&D room in extreme pain, with a bit of a language barrier, and everything happening fast. But she was very much ok once it was all done and over with, thanking us profusely....(I'm thinking, gee all I did was look at your bottom...but ok, you're welcome).

I went and made postpartum rounds when I get a call from another nurse. She has a doctor patient and was asking me if I could put in an IUPC (intrauterine pressure catheter). Umm, did you call the doctor and ask him? The nurse says no. Well, don't you think maybe you ought to? Oh, ok says the nurse. I told her I would put it in since I was there if the doc wanted me to. She calls me back and says yes please. So by the time I finish rounds and get back there, the patient (who is preterm at 34 weeks) is complete and ready to deliver. So intead of the IUPC, I stand by for delivery until the doc can come. I caught the little peanut and then was off to the office for a meeting and then a few patients to see. I followed that up by attending a lecture on Preeclampsia which I enjoyed. Then home I went.

The night was quiet - I had one patient call trying to determine if she was in labor, which she ended up not being. Slept the rest of the night!

Doctors TV Show

I am so incredibly irritated after watching The's a spin-off from the Dr Phil show featuring doctors from different areas of medicine. One of the doctors is a OB/GYN and today's show had a segment on homebirth versus 'traditional' hospital birth. I really feel so ticked off right now I'm not sure where to begin. But I need to calm down so I can write a letter to this show so I'll vent here.

One of the things that really irritated me is how this doctor talked about her work in underdeveloped countries at improving maternal and neonatal mortality rates. Don't get me wrong, its wonderful that she does that kind of work. But she then said that she was helping to improve things there like what was done here in the US....what???!!!! She made it sound as if the US was number 1 with lowest mortality rates which is totally not true. Last I read, we ranked #26, with many European countries (where incidentally midwives do a bulk of the deliveries and home birth is much more common) beating the pants off of us.

She then talked about how safety was the top priority for OB/ if midwives don't care about safety. The plastic surgeon mentioned at the beginning of the show that people talked about how doctors are trying to control everything and laughed. Shut the hell up - what would you know about it. Grrr...

I felt so incredibly bad for this couple who are looking into homebirthing but haven't decided. They had a couple who delivered at home and had a wonderful experience on for about 2 minutes. They had a couple on who's baby ended up with some rare kidney disorder fourteen years ago that was missed - so they had major problems right after delivery. Birth centers were briefly mentioned. The OB mentioned how birth centers aren't set up for emergencies?????!!!! She talked about how OB/GYNs are trained to handle all these emergencies. She also talked about all the major obstetrical emergencies such as shoulder dystocia, hemorrhage, fetal distress.

There was no discussion about midwives, and the various types of midwives - she discredited all of us. No discussion about how midwives were around far longer than doctors...not to mention how intially mortality worsened when poeple started using hospitals and doctors. Anyone remember 'twilight sleep' and forceps delivery for everyone? No discussion of research at all. It was sensationalism at its worst. Needless to say I won't be watching the show anymore.

Ok, anyway...I know, I shouldn't have been surprised. I need to go see who else is blogging about this and write a letter.

Monday, September 8, 2008

Nurse Midwifery Service

Today is the first day of the nurse midwifery service - woohoo!!!! I hope that things are going well for the new midwife in the office. I left a welcome note on her desk along with clearing off Dr I Never Chart's charts. I love this doctor but dear god, he's like a dog marking his territory - everywhere he goes he leaves a stack of charts.

I am on call tomorrow for 24 hours and we have a provider meeting as well. Should be interesting - I hear the docs are having issues amongst themselves.

Blogs I like

I'd like to tell you about the blogs I follow...

At your Cervix - Tales of labor and delivery as well as a CNM in the making, also lots of beautiful photography and interesting personal stories. A must Read!

Billybob's Wild Ride - a gentleman who has some very serious health problems along with amazing talent as a graphic artist.

Crass Pollination: an ER Blog - A nurse with extreme attitude who tells fab stories of life in the won't get this version on Trauma in the ER.

My Labor for Love - a nurse who tells great triage and L&D stories with a nice sarcastic hint of humor (which I love). In fact, she sounds so much like a Nurse at the hospital I sometimes wonder if its her!

N is for Nurse - a blog I just started following today. This nurse is a newbie working L&D. She tells the good and the bad about her struggles as a new nurse. Anyone in nursing and/or midwifery should be able to relate.

Navelgazing Midwife - Tales of a midwife from a more political and activist view

OB/GYN Kenobi - tales from a OB/GYN - I find this interesting because it's neat to get the perspective of the 'other side' - meaning hearing a doctor discuss their adventures.

Sage Femme - Tales of reading her posts and sometimes a little green with envy

The Midlife Midwife - a CNM not doing births but love reading her, sometimes almost poetic, writing about life in the office. I can very much relate to many things she writes.

Sunday, September 7, 2008

Office scheduling

I'd like to take a little time to explain to women how an office schedule works. Now this may not be typical for everyone, it may vary a little from practice to practice. Productivity is key while also trying to maintain quality. This is a nearly impossible task that is only worsens when someone shows up late for their appointment.

The owner of the practice I work at does not want us to re-schedule patients for any reason (including their being late) unless we absolutely have to. We also take walk-ins.

Our time slots for various visits are as follows...

New OB Visit 20 min
New OB visit new to our practice 40min
Return OB visit 10 min
Gyn 20min
New to our office Gyn 40min
Consults 40 min
Postpartum visits - 20min

The doctors have it worse - they get less time for some of those visits. Also keep in mind that some of the time allotted is used by the MA (vitals, restroom, etc).

So, if I have woman booked back to back for various types of visits (which I usually do - my schedule stays pretty full) and say...1/4 show up late (this is probably slightly underestimating) anywhere from 5 to 30 minutes late...guess what happens?

I am a big believer (naturally, I'm a midwife) in quality visits. I want to address everyone's concerns, questions, etc. I want to bond and educate as well. If a woman needs the time and attention, I give it to her. However, if women show up makes it really unfair to them, me, and the other women who showed up on time. Everyone has to wait. I have to be stressed out about how far behind I am. I have to practice the art of getting the quality in there but cutting down on time spent in te room. I work through my lunch every now and then. I stay late, which means sacrificing my time with my family and children.

I understand that many of our clientele may have transportation issues...if the bus is late I totally get that. Maybe babysitting issues...bring them with you - I don't mind (most of the time - like the woman who brought her 3 year old son who kept repeatedly hitting her while she just ignored him - it was all I could do to not turn him over my knee and whack him). Kids are ok - I can work around them most of the time. But don't give me the " I forgot what time my appt was", "I ran into traffic" (for god's sake you know where we live - the friggin' traffic capital in the state!), etc.

Be on time please!!!!! Be considerate. Be early! Sometimes when a woman shows up early I will attempt to get seen early so they don't have to wait. I thank them for being early - I appreciate early and on time.

I hope this helps those on the 'outside' understand a little bit about life on the 'inside' at the office!