Sunday, September 14, 2008

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.

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