Wednesday, March 25, 2009

A very nice birth and interviews

I had a really nice birth recently with our student midwife. This was a woman having her first baby. She came in a couple weeks before her due date and was 4/80/-2 on admission. Her plan was to go natural. She did start making epidural noises as she was starting to transition but we worked with her and did stadol instead. I know she could have done it without that but sometimes it can be difficult to know how far you can push a patient. So the student opted to let her have a couple doses. She was able to rest for a little bit then she moved along much quicker. I suspect we also had a malpositioned baby as she had been having a lot of back pain and a slower labor. The baby did come out all twisted up - the head turned into a correct position (OA instead of OP) but the shoulders kinda went the opposite way! That's the third time I have ever seen that. Anyway, momma was very controlled and did a beautiful job!

We are interviewing another midwife tonight. The one we offered the position to turned us down :( So back to square one. I'm hoping this one tonight might end up being a good fit but we shall see. I just know that working the extra hours for what will likely be several months before we have someone up and running, is taking its toll. My joints are bothering me more and I am just more tired than usual :p But I still love my job!

I was disappointed because I found out that while I was out of town last weekend, another patient of mine came in....I had previously blogged about her - she is a sexual abuse survivor. She was only 29 weeks and having some bleeding so the other midwife ended up shipping her out to the perinatalogist. I guess the patient wasn't really happy about that - she told the other midwife that she felt more comfortable with us. I'm just hoping she gets back to us :(

I am going to Mexico this weekend on a spur-of-the-moment decision. A few of the nurses at the hospital are going for a long weekend to Rocky Point. They have a condo rented at a super deal. So they invited me and I (after checking with hubby and mommy - she's have to babysit Saturday while my hubby goes to a class), decided what the hell! Might as well do it since I am off :) Woohoo! I have never been to Mexico so am excited for some R&R. I told them I was just gonna hang out on the beach, read, sleep, and party a bit as well :)

Sunday, March 22, 2009

On the way home

We are on the way home from San Diego. My daughters are lucky to be alive. I was ready to beat them after Sea World yesterday (I didn't). They have managed to coordinate their whining and complainingall weekend long. One would behave then the other would behave. Then they must have synced their watches cuz they would then switch.

There were some good moments though! The girls were blown away by the dolphins and killer whales. They thought it was so neat to touch the bat rays (ok, well the younger one anyway, the older was scared) and starfish.

They shut down the water rides after we had been waiting in line for an hour and were just about to step foot into the raft. Apparently there were some aftershocks or something. I told my mother that it figured...the one weekend I come to California, it drops off into the ocean!

Ok, enough for now...starting to feel a little carsick.

Oh, and I got a text from the midwife on call yesterday. I have three women who are supposed to be keeping their legs crossed for the weekend. Well, one, whose last baby I caught, came in delivered. I know she was in great hands but was just disappointed they weren't mine!

Monday, March 16, 2009

San Diego

I'm so excited. We are going to San Diego this weekend. I actually have a four day weekend....and didn't request it! Our head honcho was trying to balance out the call hours and I guess I was way ahead of the others so she fixed it up. I'm not complaining! We are already working about 60 hours more of call a month than normal, and that will continue until we get a new midwife.

Anyway, my mom and I, and the girls are heading to SD on Friday. We had planned this about two months ago. The main reason was to spread my stepfather's ashes in the ocean but then we decided it would be fun to do Sea World and take the girls. My mom is getting married this summer and I told her she really needed to resolve one husband before getting another! My stepfather loved the ocean and really liked San Diego - so there you have it!

I'm very excited to be getting away...getting a mini-vacation...going somewhere I have never been.

The birth I was waiting on

The birth I was waiting on was really, really nice. This lady was a personal patient of mine and her boyfriend is this really big, kinda intimidating-looking guy. She brought up that he would really like to catch the baby so I had agreed to that plan early on in the pregnancy. Well, she had her baby and he did was very well done and I really enjoyed being a part of their experience! I supported the perineum and guided his hands a tiny bit. He handled the rest and it was fabulous! I love it when things happen so beautifully like that!

So, typical call....I had this really quiet weekend. I was gonna call the hospital Saturday night to make sure they knew I was on call! I didn't get a single page until Sunday morning. Then the damn thing wouldn't stop! We took the kids to movie in the afternoon and my pager went off 5 times! I did get to finish seeing the movie at least before I had to head in.

I went home after the last birth and was asleep about 3am. Then , of course, my pager went off about 3:40am. They had two patients for me, which I admited both. And then went back to sleep. I figured neither would deliver prior to 7am (one was first baby and 4cm, the other was second baby and 4-5cms). I should have known better! At 5:20am, they call to tell me one is now 8cm, no epidural. It's times like these when I want to cry....I'm so tired! But fortunately i work with a bunch of great women. So I called the oncoming midwife and asked her if she would go in instead, which she did. I really didn't think I would make the birth anyway, and she lives a lot closer. She missed it unfortunately, but all went well.

Sunday, March 15, 2009

Fun and Fabulous delivery

I had a fabulous birth recently. This was her first baby and she stayed home laboring all day. When she arrived, it was a good thing I was already at the hospital. She was complete and pushing on arrival. She delivered in a hands and knees position. She plopped the baby out before I could finish getting gloves on. She really caught me off guard with how fast she pushed her baby out. It was so cool how she could just lean back and reach down to pull her baby up to her.

Tonight I am hanging out waiting on a patient of mine to decide to have her baby.

Friday, March 6, 2009


We are taking my daughter out for her birthday dinner tomorrow night and I had told her she could invite one friend. Well, the friend she wants to come is very...ummm...shy....clingy? I don't know....she has a hard time going anywhere without her mom. Or maybe, her mom has a hard time letting her go anywhere. I don't know. So anyway, the friend really wants to come out to dinner with us then back to the house for cake, ice cream, and presents. I call he rmom, who basically is planning to go with us as she thinks her daughter will want her there. Well, I was planning to treat my daughter's friend....surely, the mom wouldn't expect me to pay for her meal as well? What do you guys think? And how do I handle a potentially awkward situation?

Another call day this week

Call yesterday was pretty nice, whcih was good since I had not gotten to bed early enough the night before (had a lot on my mind and just couldn't shut it off!). I had a scheduled section in the morning that I first assisted to do the skin incision again and I though I did pretty darn good!

Then I had a nice vaginal birth with a first-timer. What a sweet couple they were :)

Did my office hours, where I got to see some of my favorite, personal patients. One is due in a week, while the other is due in about three weeks. They are best friends which is so totally cool. I'm just a little nervous though because I go out of town for the weekend with my mom and my daughters to San Diego. The first one would have to go ten days overdue for me to miss it. But the second one will be right around 38 weeks...and it's her second baby. I would be very upset to miss either. I told them both to cross their legs and hold it in if they had not had babies before then. After all, they say animals can stop their labors if they feel why not us?

I went home and was sound asleep by 9pm. Got a call from a patient who's water had broke about 3am so sent her off to the hospital. Then they called at 4am to let me know she was there so I gave orders. She wasn't terribly active so I just went back to sleep (she was planning an epidural). Then they call me at 5am to see if they could give her an epidural. And that was it for the call shift.

The Continuation of Crazy Call

After I finished in the OR, the lady in the tub was dragging her feet...or her cervix I should say! She was hanging out at 9cms. And decided she had had enough and wanted an epidural. She was not interested in trying anything further for pain management so one epidural coming up. We let her rest for a bit and she progressed to 10/100/+2 about an hour and a half later. She was pushing with the nurse when I came in to check on her. The ladies in the room (the family is from Africa) motioned for me to come and cut her to get the baby out. She had been pushing for maybe ten minutes at this point. I shook my head no...I'm not cutting! That's an absolute last resort - not for a patient who has been pushing for ten minutes with great progress and a baby looking fine on the monitor. But I couldn't explain all that to them unfortunately.

So, she continues to crown but then hits She had this tight band that just wouldn't stretch anymore, nor would it just tear. It was literally holding the baby's head back. The women surrounding me are looking at each other then me, then speaking rapidly in another language. I know what's going on. I'm thinking, this band is like steel...maybe I will have to cut after all....but baby looks ok....I decide to continue with massaging it and her pushing a little longer. I am glad I did - she delivered over an almost completely intact perineum.....barely a tiny little first degree vaginal floor (where the band was) that required no stitches. Perineum was intact! Woohoo! Afterwards, lots of hugs and kisses from the women :)

Next, was another scheduled section that went smoothly with me doing the skin incision again.

Then I hunkered down to watch the final two ladies laboring. The induction lady with pelvic pain, was plodding along slowly still so I broke her water and put internals in at 5/70/-2. Baby was looking great! The patient had just gotten her epidural.

The other, was doing her thing and just wanted to be checked. At my suggestion. After all, she had been there now for something like 6-7 hours with no apparent signs of a baby coming. She was 6/100/-1 with a bulging bag, which was a surprise as we had thought her water had broke about a little bit ago (which is what I hoped for so I wouldn't have to have the whole 'break your water' talk). So I have the whole "break your water to get your labor moving before you wear out" talk, seeing as how she had been laboring since 9pm the previous night with no sleep. No go. Ok....2cm in 7 hours is not exactly normal labor progress. But there are some weird dynamics going on so I don't know if that was contributing or what. I just stayed the heck out of it. I guess mom was tryning to run the show, appeared to not know what she was doing as she was making strange statements i.e. "Oh, maybe this will be the last one (contraction I guess)" or "soon, the baby is coming soon". I believe in encouragement but let's keep it real ok. Later I found out that the mother was snapping at the husband (who was doing really good support) and giving contradictory advice to the patient (for example - when the patient reached 2nd stage, "don't push too hard, just a little push then breathe through the rest of the contraction" - umm ok, we'll have a baby five hours later at that rate!). Anyhow, it was just odd all around.

So another patient comes in labor. She had been a doctor patient during her prenatal care but claims she is a midwife patient. Ok, whatever. She had ruptured her bag spontaneous earlier that afternoon and was 4/100/-2. She was wanting an epidural once she started to really hurt so we sent her out to walk in the meantime.

Meanwhile, my induction lady is moving along a little better.

By this time it is well into the evening...ninish or so.

The lady with her mom as a doula, wants me to check her again. She's 9/100/-1, and finally consents for me to break her water. She wants me to do it while she lays on her side...ok...we get her all settled...then she has to get back up to go to the bathroom. *sigh* I know she was scared, I totally get that. But it's gonna hurt more at some point. Anyway, we finally get it done and she is pushing about 45 minutes or so later. I leave her be to do her thing, as another patient has come in for a labor check.

This one is a personal patient of mine so am very happy to see her although I am not wondering if all of the March babies are trying to get born on my call or what!? She's 4-5/100/-1 and looking active. About this time I send her to the tub as my induction lady is now approaching a section :( So the CRNA will be tied up for a bit and this patient has planned on an epidural.

My induction lady finally made it to 10/100/-1 after two hours of struggling with a persistent anterior lip. Now she's getting hot on me and my baby is tanking. She pushes decently but would have a lot of work to do and I just am concerned that the baby won't hang in there long enough. I call it ....and the patient is ready at this point. Naturally my doc is unhappy about coming in for his fourth section of the day (another midwife had a personal patient of hers who was being induced - normally we don't have many inductions- for being almost 42 weeks and ended up needing a section). He tries to give me a bit of a hard time about 'all these inductions' - I quickly point out that the other three women were all spontaneous labors.

Shortly before this, weird vibe patient had delivered very nicely. I did some perineal massage with the saffron oil she had brought and she brought her baby out over a small first degree requiring no stitches. But guess what happens? The placenta decides it like sit in her. She wants no intervention. I give her hour goes by. Bleeding is absolutely fine so I can afford to be patient and try to get her what she wants. However, eventually, I gotta make things happen. I basically give her the "ok I tried to do this your way, now we are doing it my way" chat. And we finally had a placenta another hour after that without me having to get my doc to intervene. Whew...I was happy it was over with. Later I heard from another midwife who rounded on her the next day, that she was very happy with her experience and thrilled with my care. Good, after all, it matters most what her perception of the experience was. I am glad it was good :)

During this time, previous doc patient, not midwife patient screamed her baby out....yes, screamed. That was the longest, loudest ten mintues of my life I think! A conversation we had at one point during this screaming...

"Pull the baby out!" (her first baby was operative vag delivery)

"Midwives don't pull babies out"

"Then get me the doctor!!!!!"

"He's in the OR, so you are on your own my dear"

"You're mean!!!!!!!!"

We all tried hard not too laugh but it was funny! She did great though, nice delivery, screaming aside.

My induction lady had an adorable baby that was doing pretty good, aside from coming out with a temp.

So my personal patient was left. She had also progressed to complete at the same time as the screamer. She pushed for a bit and delivered a beautiful little girl over just a couple skidmarks!

I charted for an hour then went home to bed at 5am.

My pager went off at 5:30am. I vaguely recall admitting another laboring patient. It was her fourth baby and she was 6-7cms. However the nurse told me she looked quite comfortable. I took that as a sign to go back to sleep, which I did. I'm not sure if I could have driven safely back to the hospital as I was trying not to fall asleep on the way home. Fortunately, this lady didn't have a baby until tennish.

And there you have it!

Tuesday, March 3, 2009

Crazy Call Part 1


Call was crazy yesterday!

I was doing my usual 24 hours of call and knew it would be a busy day but this went beyond that.

First thing in the morning I first assisted for a repeat problems there. In fact it was kinda cool because the doctor let me suture the skin incision, which I had not done yet. He was great about it, teasing me just a little about my hands shaking! I didn't do too bad - I really wanted it to be perfect for cosmetic reasons. Yeah, so I set high expectations :p But it looked good!

Shortly before I went into the OR, a midwife patient came up. She is the type of woman who is a little spoiled and who wants natural childbirth - militantly. She has read everything she can get her hands on, including medical stuff. She knows every complicatioon and horror story that could possibly happen with any intervention possible. *sigh* And naturally she rolls up on my call. It's also kind of odd because her mother is her Bradley instructor and doula. I check her before I go into the OR - she is 4/100/-2 and looking very active. Ok, I am determined to make the best of this. Her husband and mother are there for her support and I plan to just oversee, make suggestions, and otherwise stay the hell out of their way.

After the section, I discover there is another patient there for me who the staff thought was a doctor patient. Not sure why as she had never even seen a doctor on her prenatals and it said CNM on the prenatals for provider. Hmmm, tough to figure out. Anyway, this poor lady is writhing in pain at 8-9 cm in her bed on the monitor. She has a low-risk history with no problems in labor, baby looks great. I take her off the monitor and get her in the tub which helps her a great deal. The nurse, who I like personally, is so friggin' lazy. She does the bare minimum to get by and complains about that. I tell her what I did and she's like "Oh that's wonderful!" So you couldn't have done that yourself????? Jeez!

I also have an induction there as well...a primip who has a suspected separated pubic bone and was in such pain that I agreed to induction as did my collaborating doc. She had come in the previous day to start cervical ripening so by this time was 4 and 50. Eh.

Ooops, have to go pick up my kids....will finish this later!