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*


Prisca said...

Hi! Thanks for your comments on my blog--

Actually, I knew that about cord cutting. The rationale at out hospital used for immedicate cord cutting is some study that found that the increased blood flow leads to more instances of hyperbilirubinemia. I've been to a few births where the cord was allowed to cease pulsing before it was cut and all was fine. Ya know how hospitals are--I want worried about the cord at all until everyonbe started yelling at me to cut it-haha!!!

mm said...

One of our MD's caught my pts baby with the sleeves of her gown the other day! LOL... she kept sitting on the bed checking her and I was thinking "what's she doing? ...better gown up".... too late!

Ciarin said...

Prisca, yes there can be a down side to delayed cord clamping. However, the nice thing is (other than not depriving an infant of its blood volume) infants had higher hemoglobin rates at 6 months (which means less rates of anemia - woohoo!). I encourage moms who are breastfeeding to do so as often as possible, and bottle babies tend to have less of an issue with hyperbilirubinemia.

The most important reason to absolutely have delayed cord clamping is in a compromised infant...if there's any concern that the baby is hypoxic, then absolutely delay the clamping...resuscitation can be done on mother if need be. Course you may be fighting the nursery nurses/peds/L&D nurses on this.

I figure, the nurse can't take that baby away until I have dad cut that cord ;)

AtYourCervix said...

"Nuttin', I'm just trippin'."

Classic. Pure classic!