Friday, April 18, 2008

Induction doctor

Had a busy busy morning today. I caught three babies in 3 and a half hours - fun! The first, was a young lady who had ruptured spontaneously two days prior with no labor. After trying to help mother nature along with no luck, she finally went into labor last night. She was pushing when I got there and delivered her baby boy a few minutes later. She did a great job and was very much a trooper. She had been ready to toss in the towel the previous day and have a c/s but she rallied. The next one was a young lady who came up at 8cm...she did a great job as well. The third lady had to deliver her baby in triage - not the ideal situation but we had a blast (well she wasn't enjoying it as much as I was maybe).

My fourth lady was not in labor. In fact she was there for an induction. Wanna know why? Because....*gasp*...she was a day past her due date. OMG! Anyone wanna guess who had set this induction up and failed to explain that induction may have to occur over a couple days even though we discussed this very situation a few days ago during a provider meeting? Yes, Dr Newbie. Granted the woman was very much on board with being induced. When I asked her why she was being induced, she looked at me like I was stupid and said "because I am a day past my due date". Ooookay. So she smokes as well...not a problem initially. She was put on hold due to L&D going crazy so she was able to go and smoke when she wanted to do (not that this was admitted to us - naturally she denied that she was smoking, although that perfume nicotine eau du toilette (sp) was very fresh). C'mon, don't lie to me. It's not like I'm gonna put you over my knee and spank you because you are smoking. At this point, if you haven't quit during the nine months of pregnancy, I certainly wouldn't expect you to quit now.

So anyway, about 1230 they get the pitocin going. I decide to go home and get a nap (having trouble with sleeping the last three nights so am exhausted). I get a page 2 hours later from the nurse. The patient is upset, the pitocin isn't doing anything, she wants us to do something else. Her other pregnancy was induced by "giving her a shot, breaking her water, and putting soemthing in her cervix to open it up". Ooookay. Naturally this was at another hospital by another practice. The nurse explains to her the following...

1. How pitocin works, and that it typically takes more than two hours to work, as well as the need for monitoring

2. I'm not breaking her water when she's 2/50/-2 with no contractions (prior to the pit). No, not going to happen.

3. If she wants to continue on with pitocin great but no more starting and stopping so she can smoke (the patient wanted it off so she could go for a 'walk')

4. Offer to forget the pitocin and try cytotec instead

5. Offer to d/c her home and and wait for labor to start on it's own (hmm, novel concept)

God bless her! She wants to go home...good for her. I had the nurse tell her that labor was liklier (is this a word?) to go quicker and better if she just did it herself.