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 practice...so to be here in the hospital is just very new. I told her to do what she wants....to 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
Tuesday, September 30, 2008
Abortion
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!
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
House
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.
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.
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, gee...do you think weighing 400 pounds has anything to do with it?
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, gee...do 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.
Overall, it was a great trip! We'll be going for a girl's trip in November.
Monday, September 15, 2008
Last Night
I was on call last night...here'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.
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.
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
Watch CBS Videos Online
Watch CBS Videos Online
Reading
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!
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.
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!
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 Doctors...it'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/GYNs...as 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.
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/GYNs...as 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.
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 ER...you 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 homebirth...love 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.
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 ER...you 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 homebirth...love 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 late...it 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!
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 late...it 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!
Wednesday, September 3, 2008
Judge Judy
I was watching Judge Judy yesterday (yes, I love that crazy old bat). There was a...umm..whatchamacallit.....uh...the person who brings up frivilous lawsuits....what are they called? I'm totally going blank here.
But anyway, she was telling Judge Judy how she worked on and off because of disability. Here's the basic convo (not word for word - I took a little creative license)...
Judge Judy: Why are you on disability?
Lady: I have a medical condition called...(wait for it.....wait.....)...endometriosis.
Judy: How do you support yourself?
Lady: I collect disability and have (been totally scamming the system) for the past two years for this condition. I haven't worked the last three months because of it.
Judge Judy obviously knows nothing about endometriosis because she doesn't rip this lady a new asshole.
I have never heard of anyone getting disability for this condition...even if their insides are falling out and dragging on the ground bleeding (how's that for a visual). Never. My husband with a bad heart and ejection fraction of 10% (borderline transplant list) got turned down for disability...twice. Yet Ms Endometriosis got it....please shoot me now.
But anyway, she was telling Judge Judy how she worked on and off because of disability. Here's the basic convo (not word for word - I took a little creative license)...
Judge Judy: Why are you on disability?
Lady: I have a medical condition called...(wait for it.....wait.....)...endometriosis.
Judy: How do you support yourself?
Lady: I collect disability and have (been totally scamming the system) for the past two years for this condition. I haven't worked the last three months because of it.
Judge Judy obviously knows nothing about endometriosis because she doesn't rip this lady a new asshole.
I have never heard of anyone getting disability for this condition...even if their insides are falling out and dragging on the ground bleeding (how's that for a visual). Never. My husband with a bad heart and ejection fraction of 10% (borderline transplant list) got turned down for disability...twice. Yet Ms Endometriosis got it....please shoot me now.
New hours
I'm starting these new hours that I so suckerishly agreed to. Seems I am the only one who said they would be willing to do late hours, come in late and stay late. So today will be the first day of that 12-7. So far it's kinda cool because I am sitting here in my pajamas (didn't want to inspire too many visual images so will leave out the description) blogging and checking out other peoples' blogs. Will let you know how it goes.
Monday, September 1, 2008
Beautiful birth
Had a beautiful birth the other day. This was a gravida 2 para 1 lady that I had been seeing since about 20 weeks. She and her husband are just the sweetest people. She had been struggling with a lot of prodromal labor. We had also been following her closely throughout her pregnancy because of a history of preterm labor and birth. I told her that if she made it to term she would probably go overdue! Seems like if a woman makes it to term that will inevitably be what happens :p
She went into the office for a labor check and was 5cm dilated so the midwife sent her over to me. The funny thing is she was scheduled for induction of labor that evening. She would have been put on hold since L&D was so busy. Anyway, she came over and wanted to walk for awhile so she did that. After about half an hour she wanted to try the whirlpool but didn't really like that. That was a surprise as most women enjoy the tub during labor. She tried the birth ball but didn't get as good of relief as she did with just sitting on the toilet. But she was embarrassed to sit on the toilet. I told her to go for it if that's what worked for her. So she's sitting on the toilet for awhile when she tells me she needs to be push and wants to be checked. So I check her and she just has an anterior lip (this is a way of saying she's 9.5cm) but really needs to push. So I try to break her water but can't quit snag the membranes - must have been the bag of steel! But it popped on its own a minute later. The lip went away and she pushed. She really was very well focused and delivered her son a few minutes later with just a small tear. She did such an amazing job. All told, she was at the hospital for only an hour and a half.
It's kinda funny because there was another lady scheduled for induction who came in during the night in labor. This lady delivered four minutes after the other one. Needless to say I missed the delivery but got to do the placenta - woohoo. Then she's apologizing to me for not being able to stop delivering until I got there (we had a family practice resident who caught the baby)! I told her not to apologize - she had to do what her body was telling her to do! I just think that's funny that sometimes women will apologize for delivering before you can get there.
She went into the office for a labor check and was 5cm dilated so the midwife sent her over to me. The funny thing is she was scheduled for induction of labor that evening. She would have been put on hold since L&D was so busy. Anyway, she came over and wanted to walk for awhile so she did that. After about half an hour she wanted to try the whirlpool but didn't really like that. That was a surprise as most women enjoy the tub during labor. She tried the birth ball but didn't get as good of relief as she did with just sitting on the toilet. But she was embarrassed to sit on the toilet. I told her to go for it if that's what worked for her. So she's sitting on the toilet for awhile when she tells me she needs to be push and wants to be checked. So I check her and she just has an anterior lip (this is a way of saying she's 9.5cm) but really needs to push. So I try to break her water but can't quit snag the membranes - must have been the bag of steel! But it popped on its own a minute later. The lip went away and she pushed. She really was very well focused and delivered her son a few minutes later with just a small tear. She did such an amazing job. All told, she was at the hospital for only an hour and a half.
It's kinda funny because there was another lady scheduled for induction who came in during the night in labor. This lady delivered four minutes after the other one. Needless to say I missed the delivery but got to do the placenta - woohoo. Then she's apologizing to me for not being able to stop delivering until I got there (we had a family practice resident who caught the baby)! I told her not to apologize - she had to do what her body was telling her to do! I just think that's funny that sometimes women will apologize for delivering before you can get there.
Flippant remarks
I was reading my last post and now feel bad for making a flippant remark about the 26 weeker. I don't want to go into detail here about it but she had a bad outcome a couple days later. While I am not responsible I still feel bad. So the lesson of the day is if you feel like something is wrong, don't hesitate to call and go to triage if you are that concerned.
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