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...

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