Tuesday, April 28, 2009

The 16-year-old

When I got there, my 16-year-old primip was doing very well but also only contracting about every 10-15 minutes. We decided to check her and determine whether to send her back home or augment with AROM. She was 6-7/100/-1 but the cervix was still posterior and a little off center, which made me wonder. She wanted to stay so I broke her water which had light meconium (it was just my weekend I guess, for poop). I asked her to do some walking (which she didn't want to do because she was tired). She ended up in the tub instead.

Fast forward an hour and a half....she's feeling pressure so I check her and she's a solid 7/100/-1...with caput. Something is going on with this baby's head. I couldn't feel sutures to tell position because there was so much caput. She decides she wants an epidural so I agree to that. Afterwards I ask the nurse to change her position every 30 minutes or so (I can't always rely on the nurses to do this!). I go to take a nap (it's something like 12:30am at this point and I have been mildy sleep-deprived all weekend). Oh, before I do this we re-check the patient because I was thinking of putting in an IUPC - her contractions were difficult to trace and appeared to be dysfunctional as they were erratic. She's 9.5/100/0. So I don't put it in.

About 2am the nurse calls me to let me know the patient is feeling 'pushy' so I'm totally ok with that. I have the chills...can't sleep anymore, well dozed a little but between the chills and the fact that the 'doctor's den' is like the arctic.... Wait a minute....wtf? Chills? Not really getting sick, just sometimes get a little temp and general achiness periodically. I think it has to do with my autoimmune issues.

So I go to the room about 3am. She's been pushing for about an hour now. Naturally the nurse had her pushing in the same position the entire time. :p So we get her on her side to push for 15 minutes, then the other side for 15 minutes (the caput is crowning by the time we flip her to the second side!). Then back to semi-fowler's where we had a baby over a small first degree (no repair) vaginal wall tear. The baby was 8-1 and adorable! Unfortunatel;y the baby had a bit of a temp and was grunty so went to the nursery for observation. :pppp

I went home and went to bed - not another call for the last hour and a half of the weekend's call :0

And now I am back on call...

Open letter asks hard questions

I was reading Navelgazing Midwife's open letter to Janet Fraser with great interest.

I haven't understood the extremeness of the UC movement. Here's my response to the post...

My heart goes out for Janet's loss.

The thing that just gets me is that this was a totally preventable death. Just because you can labor for five days, doesn't mean your baby can. I have alway thought that being a mother is about protecting your children from harm. I would do anything (or have anything done to me) to protect my children. That's what being a mother is about. This extreme movement is selfish and obviously has the potential to be harmful to mother and/or child. I understand the desire to protect the birth experience - that is important - but not to the extent of the child's life!

As a thread on Janet's website talks about 'name and shame' a midwife...maybe she's not the only one to be 'shamed'.

Sunday, April 26, 2009

Who needs breastfeeding?

Well....breastfeeding is under attack yet again. Check out this article at http://www.timesonline.co.uk/tol/life_and_style/health/article6169478.ece . The article talks about the drug cabergoline, which is used to suppress hyperprolactinemia. Prolactin is the horomone responsible for breastmild production. Apparentlyit is being given to suppress milk in postpartum moms because they don't want to breastfeed. There's a lot of shock over the use of this drug for this reason. But it seems like it's more about breast vs. bottle. There's talk about the breastfeeding police...I have not seen any such thing where I am! In fact we have to fight to breastfeed around here!

The other thing that really p*sses me off is the comments about breasts being for sex, not breastfeeding. Hmmm...One could say the same about vaginas also. We use those for sex, and we birth babies through them (hopefully). And unfortunately the arguement for elective c/s to protect the vajay-jay is already swirling around!

Let me know what you think!

PS sorry about the lack of an actual link...I'm blogging from my cell so am limited.

Mec baby

My little mec baby showed up around 2am (she was 4cm at 11:30 am). My poor patient made it to 7 cms and then opted for an epidural. As much as I really wanted her to be successful without one, I figured she would make better progress. She was not able to relax very well unfortunately. The other reason I wasn't terribly disappointed for her was that she was wanting natural childbirth only because she was scared of the needle used for the epidural. I really find it irritating sometimes because the woman is running away from something (epidural) rather than moving towards it (birth). And it's totally cool to give the baby narcotics in the form of IV meds during labor. Hm, makes perfect sense to me.

Anyway, once she got the epidural she progressed to 9.5cms in less than an hour. I had her rest for about an hour and a half to labor down also. Then she pushed for about 35 minutes and delivered over an intact perineum - a beautiful little girl with 9/9 apgars. Then I offered to help with breastfeeding...Nope, she wants to bottle feed. Bummer. But to each her own I guess.

Well, gotta head in....a 16-year-old primip that I sent home this morning (she was 4/80/-2 but her contractions petered out) is back now (5/90/-1 BBOW) and way more uncomfortable. She also plans only IV pain meds (but I'm gonna try and help her through without them!) probably because she is scared of the epidural...sigh. I wish some of my patients would come in....they want natural childbirth for all the right reasons (and that includes no drugs!).

Saturday, April 25, 2009

So far

The young lady I mentioned earlier who had mec is just chillin' at this point. I keep encouraging her to go walk as she does feel them more but she keep sneaking back to her room. She doesn' want to do anything that makes the contractions stronger. Boy, have I got news for her! I did explain that pain is a good thing. I'm going to recheck her in a bit as it will have been four hours since SROM and mec. I may just need to start pitocin if she's the same. I'm thinking there will be no or minimal change as she looks way too comfy.

My first bit of excitement

I had a patient who has a history of quick labors witht he last three babies. She went so fast that the midwives never made it for delivery with the last two. I was determined to be there for this birth. I had told her to call me the minute she thought she was in labor so I could head on in to the hospital to meet her.


I get a call in the wee hours of the morning from a slightly panicky father. He tells me she is contracting very frequently and he is not sure if they can make it to the hospital. They live 15 minutes from the hospital. So I advised him to stay home and call EMS if they didn't think they would make it, which he ended up doing. Fortunately he had caught the last two babies so this wasn't his first time :) They had the baby about 10 minutes after I got off the phone with them.

They came in to the hospital by EMS with the placenta still undelivered. The guy from EMS tells me they kept tugging on the cord every five minutes but it wouldn't come out, but bleeding was stable. In my head I'm thinking..."why are you tugging on the cord then?" But I kept my mouth shut. Mom rolled up with an IV and oxygen! So what else could I expect - poor guys were a little out of their element.

Anyway, I told the patient she didn't give me a fair chance at all!

Just got a call a little while ago about a young primip who is ruptured with thick meconium. Yah.

Friday, April 24, 2009

The weekend...

It's my weekend on call....I wonder what the weekend will hold.

Will it rain babies left and right?

Will membranes be ruptured?

Will women succeed in natural childbirth?

Will something bad happen?

Will women call me all night long each night?

Wille the nurse piss me off?

Oh, the anticipation of what the weekend will hold for me!

Permission to touch?

I thought this post by the Traveling Midwife was rather interesting. This was my response....

Hunh. Great food for thought. I think I do ask permission but not in so many words. I think I have thought that if I explained what I want to do and you pull up your shirt or take your clothes off...well, that's permission. Or is it?

What do you think?

Sunday, April 19, 2009

Follow up on the nurse run-in

I have to share with you all the lovely follow-up to my run-in with a nurse I blogged about in this post.

That same day, the student and I had another patient as well. The lazy nurse took over her latter that day...grrr. I thought "wow, someone is really testing my patience...or lack of."

The nurse was a little better but still exhibiting some passive-aggressive behavior. I let it go.

Then a couple days letter I get a call from the midwife in my practice who is technically 'in charge' of the students. Apparently this nurse told her she was concerned about how much I left the student alone that day. Specifically, I left the student alone to finish the repair. Now in my defense, the repair was a very small tear that required three stitches total. I inspected the patient's bottom with the student, reviewed what the repair would be, and then left her to do it. My thinking was this would help boost her confidence. Anyway, the nurse claimed that she had to tell the student how to do the repair! Hmmm, excuse me, but when did you learn how to do repairs?????? Anyway, no big deal, but it really pissed me off as I know it was a ploy to 'get back' at me. Jeez.....

So, I decided that I will bang my head against the wall if she gets another one of my ladies. And guess what? Yep, next time I am on, she has my patient again. I thought I was gonna fall on the floor laughing at the irony. I decided to try things one more time to see how she behaved. And she was ok....other than sticking a bottle in the baby's mouth afterwards when mom was breastfeeding. And my IBCLC student midwife had gotten the baby to latch on with mom. Grrr.

Catch up

So it's been a while since I have posted. Let's play catch-up.

We have a new midwife - YAHHHHHHH!!!!! But she doesn't start until July - BOOOOOO! She doesn't finish school until May and will be moving here from somewhere East Coast at the end of June. I just have to be patient for a little longer...just a little longer....oosahhhh.

In the meantime, April has slowed down a little for me. March was crazy busy. I had the highest numbers again...but they were higher than what I had been doing previously. In fact, it was more like the old days before we went back to a midwifery service. I'm totally ok with kicking back this month and letting others do the work :) It also helps that we have a midwife helping us out part-time in the office right now. She'll also do a little call once she gets credentialed at the hospital.

I was at the hospital a few nights ago for a really nice birth. However I was a little irked by one of the nurses, whom I normally never have a problem with. The hospital's idea of intermittent monitoring is 20 minutes of strip out of every hour. What I order is before, during, and after a contraction every 30 minutes during active labor and transition. This nurse said to me (they were very busy this particular night) "Well, if she had come in earlier when it was crazy, that wouldn't have been happening". This implied to me that what I had ordered was too labor intensive or time-consuming. But when you think about it....we are talkin' maybe 4-5 minutes of auscultation out of an hour...I would think that would be much better for the labor nurse? Unless of course just being on the monitor continuously would be more convinient (sp) for everyone? Oh, except my laboring mom who is birth naturally....but she's not the top priority anyway. Jeez. I basically just said that I would then have done the monitoring if the nurse assigned to my patient was just too damn busy to do it. I realize I am asking a lot...you know, being at the bedside from time to time. Whatever did nurses do before monitors came along. Oh wait...I know...bedside nursing and one-on-one care! Wow, what a freakin' concept.

Now I understand that it's not always the nurses' fault. I understand all the factors that come into play (2 to 1 ratio on L&D, higher rsik patients, lack of staffing, etc). But there are times when nurses have the time to be there with patients...and they don't. None of them. Very little labor support happens....other than "ok honey, breathe". The nurses where I catch babies are decent - they are supportive and there are some true gems there, but I get so frustrated sometimes.

Ok, so that really evolved into a tangent.

Easter was nice. We did the usual - kids found eggs in the morning, family came over for a fabulous feast cooked by my husband in the afternoon. Kids ate candy for breakfast, etc. Very nice weekend. My mom and I went shopping the day before to get clothes for her wedding - other than going all over the place to find certain items it went well. We are mostly decked out for the wedding. I hope everyone had a fab Easter :)

This weekend has been pretty laid back, which was fine with me. After all, here's my last four weekends....

#1 San Diego trip
#2 Mexico trip
#3 On call
#4 Easter weekend with shopping and family, etc

So this weekend I have been doing a little of this, a little of that, and not much of anything.

Today I turned on the air conditioning....it's 93 degrees outside - ack! I think next weekend, we will start swimming - woohoo!

Friday, April 3, 2009

Sense of unease

I had a delivery recently where I wonder if I did the right things. I think I did but my outcome was less than optimal. When that happens, which is rare fortunately, I can't help but wonder if it was somehow something I did or didn't do. What do you do about these types of feelings?

Wednesday, April 1, 2009


I went to Mexico for the first time last weekend. Some of the nurses at the hospital were going and invited me along. I figured it was doable since I was off and could free up a little money. I had a great time! Those girls are crazy though - and single, whereas I am not. So I went out with them Friday night but started to get a little bored at the end of the night (and tired as I did have several drinks...and shots....well, you get the picture) since they were all hooking up. But other than that it was lots of fun. Saturday was spent sleeping, reading, sitting on the beach. We then went out to dinner, which was pretty unimpressive. They were planning to go out again that night but I opted to just hang out at the condo. And Sunday we came home. I think it's pretty safe to say that a good time was had by all!

4 really nice births

The student and I had 4 really nice births last night. No complications, just really smooth, pretty deliveries. So nice. And I got to spend the night in my own bed :)

I did have a bit of a run-in with one of the nurses though...I had an episode of my mouth running faster than my brain. My student was planning to go in to AROM a patient. Here's how the conversation went at the nurses station between me and the nurse (the student was already in the room).

Me: "the student is checking the patient and probably going to rupture her membranes."

Nurse: Just sits at the nurses station and says "ok".

Me: "Well, I thought you might want to go in the to help as she is by herself in there?"

Nurse: Makes a face and gets up to to the room.

Me: "Oh, I'm sorry, I didn't realize we weren't providing nursing care today."

Everyone heard me. And everyone told me I was absolutely on the spot as this nurse has a big reputation for being lazy, not being a team player, etc.

So, yes, I know, not professional of me - but I never claimed to be the epitomy of professionalism! So anyway, the student and I then had to suffer through passive-aggressive behavior from this nurse the rest of the woman's labor and birth.

For example...

The nurse checked the patient four times in 6-7 hours....even when we were right there! In fact, the student was providing labor support when the patient was 9cms. She had to run to the bathroom so told the nurse she would be right back. The nurse checked the patient again while she was gone!!!!!!

Ugh, aggravating stuff!