Friday, January 9, 2009

An unpleasant experience

I was on call a couple nights ago for 12 hours during the night. What I thought was going to be a beautiful birth, turned into a very unpleasant and teeth-grinding experience.

It starts out with finding out I get an awesome nurse whom I really enjoy working with but rarely get to as she is usually charge nurse. So we're thinking that we are gonna have this really nice birth in the evening, then I'll go home and be in my own bed :)

Not so at all!

The patient was a very young primip who I had seen a few times in the office. I felt like we had bonded but then I hadn't seen her in a couple weeks. She has some extenuating circumstances which I really didn't know any details about, in terms of her social system. Anyway, she's in active labor when I get there (the previous midwife had admitted her around 3 or 4 pm, when she was 5cms). She's planning natural childbirth and has a pretty straightforward birth plan. She has two doulas (one of which is one birth away from being a homebirth midwife - which is what she told the nurse). My first moment of unease occurs when I walk in the room to say hello and the doula is right in the patients' face. I can't really establish a connection as the doula doesn't move away at all. Ok. Well, she has a crowd of people around her aside from the doula so I decide to just say hi and head out of there.

I realize it's not about me but about the patient but it still felt weird to not be able to really establish, or re-establish the connection. I'm not used to that. So I just let it go and kinda chill at the nurse's station.

Later, she requests a vag exam - about two hours since the last (the previous midwife had called her 6-7cms). I check and am disappointed to discover that I can't call her any more than 7cms. I offer to break water....she consents to that. I now figure she will zoom along and we'll have a baby soon.


Next exam - 8 (and this is being generous)cms, no descent. Cxns every 5-7 minutes???? WTF??? Now, I am kinda wondering what is going on. Does the patient have a psychological block? She's also starting to fight the labor - won't relax at all...even in the absence of contractions. The family doesn't seem to be on the same page as the patient and doulas. Whatever, I'm totally staying out of it.

An hour later - the patient feels like she needs to push. Exam - no change. Contractions still not very strong and still spaced out. I decide to have the pitocin talk as patient is not tolerating things very well anymore and is getting exhausted. She yells at me. I leave the room without saying a word.

I'm totally pissed. I've never been yelled at by a patient. I have had it with her snottiness (she has been this way with others as well - the nurse, family). I absolutely cannot stand bad behavior in labor - there's no excuse for that.

The patient sends her sister out to let me know I can come talk to her now. Oh really. The sister says she told her that I looked pretty upset when I came out. You don't say. I tell the sister that I will come back a little later when I have chilled out first.

There were no more episodes like that, at least with me.

Eventually the patient agrees to pitocin after trying some other things first. She begins to progress. She gets to complete and pushes for about an hour to deliver her 9 pound baby with a 1st degree tear and some bruising after a mild shoulder dystocia. I then get the third degree about the repair I am doing. Jeez lady, give me a friggin break.

I'm just glad it's over. While we were finishing all this up triage went nuts, with several being my patients. I delivered a baby for another midwife from another practice and one for the doctor she works with. I admitted one very preterm patient for observation and 3 others for labor. People were having to wait in triage to get beds on L&D, with people waiting for eval out in the lobby, including one of my patients who was scheduled for induction but put on hold - however thought she was in labor. She sat out there for an hour screaming. The patient and her husband are pain in the butts and this was pretty typical of her behavior. I knew she was at least 3 cm since she had a foley bulb that came out during the night. She was 5cms when we were finally able to eval her. Then it was time for me to go home ....thank god.

I hugged the oncoming midwife when she got there.


Loving Pecola said...

What a shift! I think I'm headed for something similar. Goddess help me.... lol

Prisca said...

Oh wow--I have had some run-ins like that and boy, does it make the 12 hrs drag!!!!! Kuddos to you for hanging in there! :) HUGS!

pinky said...

It is scenarios like this that make many labor nurses hate the existence of Doulas. It does seem to us that if a woman has 2 doulas and a crowd, things are not gonna go well. Sorry to hear your troubles. In my hospital we have a new policy whereas Women in labor can have two labor support people besides their spouse. We did this since we have 4000 deliveries a year and cannot have people coming in and out of the unit or getting in the way of the stretcher if a stat c-section is involved. I think it makes for a calmer labor in general when you have a finite amount of people in the room. And, yes, it is harder to establish a relationship in a crowd.