Friday, May 15, 2009

Office spiels

I spent the last couple days in the office, came close to not going in but totally sucked my dedicated a$$ up and went in :p I feel like I am seeing lots and lots of primips lately. I know this because I keep giving my spiel about how first babies usually come after their due date, just plan to be pregnant until 41 weeks at least, the baby knows when to come and he/she will come on his/her birthday.

Other spiels....

You need to drink lots of water during pregnancy, especially in hot a$$ Arizona.

Smoking is bad for you and baby.

Normal. That's normal. Feeling that is normal. Normal normal normal. (getting this one tattooed across my forehead so I can just point to it!).

Spotting and light bleeding in the first trimester are very common. It doesn't mean a miscarriage will always occur. (I'll get at least one 3am call on this one over the weekend).

On the lighter side of things...I have several term ladies who I would love to catch their babies. Hoping some of them will show up this weekend. Especially the one who is planning hypnobirthing....I'm so excited to see that and how it works. There's also a personal patient of one of the other midwives (she's tied up all weekend so won't be able to come) pregnant with twins, both vertex, term, and 4cms. I've never caught vag twins before so would love to do this....too bad the back-up doc is my least fav on call :p

I'll keep you all posted!


I'm tired. I'm sick and tired of being tired. I wonder if I am depressed.

I have been struggling with some chronic autoimmune arthritis stuff for about 4 years now. Most of that time, I have been on meds that have helped considerably. By that I mean, I only have to live with a mild amount of chronic pain. But lately, things suck! I am feeling so tired all the time, in more pain than usual. So I went and b*tched and moaned to my rheum. She poo-poos me but checks the usual labs. Low and inflammation markers were doubled! Maybe I'm not crazy after all. So she suggests increasing my methotrexate dose to 'nip things in the bud'. I do this....

Now I feel like sh*t because my stomach is all tore up....awful pain and dizziness as well after taking the increased dose. I stick it out for a couple weeks then go back to the original dose. I am feeling better. Not quite my usual 'cheerleader personality' (this is said with full sarcasm) but better.....

for a few weeks.....

Then it starts again....only it starts with what I call a 'spell' - signs of infection (low-grade temps, occ chills, fatigue, generalized achiness) with no obvious reason. These normally last 2-3 days every couple months or so then disappear. This time it hangs on for a couple weeks...again no obvious sources of infection. I go to see the rheum for my regular appointment. I'm told not to take my meds until I'm seen. So I am now a week past when I should have taken them last. My rheum checks urine culture, draws bloods....

and here I sit waiting on results. They called and left a message to call them back at 4:55pm. Guess when the office closed? 5:00pm. Guess when I called back? 5:02pm. F*ck.

This sucks.

Tuesday, May 12, 2009

Happy Nurse's Week!

I realize today is the last day of it but still wanted to send a shout-out to all the nurses out there!

Another beautiful story

I had a lady admitted for induction. Yes, induction at 37.5 weeks gestation. And it weas one of the best births I have ever seen. Here's the story...

I had seen this pediatric MD about 4 times during her prenatal care, the rest of the time she jumped around and saw whoever worked with her schedule. Well, I got a call from her in the late morning. Turns out she was heading in to her hospital (she moved here and took this job based on the close proximity to us!) to round when she had some light bleeding. She decided to go get checked.

*Past history - had a c/s with her other baby, when she was a resident for persistent OP and raging chorio (infection around baby). She ahd progressed to ten centimeters and pushed for awhile but baby tanked.*

So the triage nurse at SomeOtherHospital checks her and she is 2/80/high. But there's more blood than the nurse is confortable with. Turns out she has retroplacental clot - rather large at that - and gets admitted. She's told that if she doesn't stay stable (the baby looks bad or the clot grows) they will section her because they don't do VBACs. So she fortunately gets them to discharge her as she will come directly to our hospital for induction of labor. We pit her and she progresses very nicely. She births in a standing position after a completely unmedicated labor on pitocin early in the morning. I was a little envious of the student midwife as she got to catch! This was my first birth in this position so was thrilled. She looked so amazing! Even with pitocing and continuous monitoring, it was fabulous! The only downside, she had a short perineum and had a nasty tear that the doc had to come repair - which went smoothly and quickly. She was still very happy with the experience and the way things turned out. Baby was nursing like a chaamp also :)

And it turns out, she really had wanted me to be the one at her birth. I had no idea she felt that way! It's so cool how things work out so frequently!

Mother's day weekend

Since I haven't blogged in a few days I shall play catch-up now :)

It was a busy weekend for us and I wasn't necessarily up to it...but oh well! Friday night my mom and I had to finish shopping for my older daughter's birthday party. Plus we took the girls to get badly needed haircuts. My older daughter was looking pretty wild and woolly! Saturday we cleaned the house up for company. Then I ran errands, wrapped presents. My daughter's birthday was actually on Mother's Day but she had invited a few friends over for a party Saturday night. It was supposed to be a sleepover, however I had forgotten that Mother's Day was the next day so no one was gonna sleep over - not necessarily a bad thing. They had a good time and my daughter really seemed to enjoy herself. My mom took my younger daughter out for a while to keep her out of her sister's hair. Sunday, I got called in for a personal patient of mine....

This was her second baby, I had caught the first one. I was very excited to be there with her. She is a natural childbirther and does it so beautifully! She had a good bit of tearing with her first and really wanted to try and avoid that this time. She was determined to slow down this time on pushing the baby out. Well, she didn't get much of a choice! She came in and was 8cms with intact membranes. She ruptured spontaneously and felt pushy after awhile. I had her husband take a couple pics of her because she looked so her own place and space. I kinda wish I had taken one but I didn't want to disturb her by asking (I'm trying to really follow what Michel Odent had to say about quietness at birth - I talk a lot and probably too much, even though I am very quiet about it). She started to push a little but soon got frustrated because she felt like the urge wasn't strong enough but she wanted to be done. I suggested a side-lying position (I was thinking this baby was sunny side up), which she tried and actually was able to doze for a bit. Once she started pushing again, she was really serious about it. She pushed for about 20 minutes, birthing a cute little boy in direct OP who weighed more than a pound bigger than his sibling! Her tearting was minimal - I only sutured because there was a little flap of skin that wouldn't have healed right. All told, she was there for three and a half hours. She felt very happy and content with her experience. As much as I wouldn't want to lose her as a client - she really should be doing homebirthing!

I then went home and slept. Got up in time for my mother and soon-to-be stepfather's arrival. We had planned to spend the afternoon in the pool with the kids, having a drink (or four) and cooking out. Then off to bed as I was on call the next morning and scheduled to go in for a section at 7:30am.

Tuesday, May 5, 2009

Nothing too exciting

I've been on call this past few hours and not much has been going on. I did a couple first assists in the afternoon. Both were doc patients and repeat sections. I just admitted a young primip who's 3/90/0 at 40.5 weeks. I don't anticipate that I will need to run in as I think she is just getting warmed up. If she gets active, I will go for labor suppport as I know she was planning natural childbirth. Otherwise, nothing else going on.

I talked to a patient recently who has a history of two sections, with the last being 6 years ago. She wants to VBAC but no one is willing...especially in the area she lives in (which is a couple hours from us). Two of our three docs said absolutely no. The third was willing but that makes it difficult. If she comes in, in labor this doc would have to be on call, otherwise she would get sectioned. Not too mention there are some increased risks for TOL after two sections. I know that myself and the other midwives would be willing to provide care for her if she decides she wants to try it. Just a lot of variables that would have to fall in to place :( She's going to discuss it with her husband and let us know if she wants to give it a go. Of course, she could just show up 9 or 10 cms - then it probably wouldn't matter who was on call as they would likely allow a vaginal delivery at that point (this biggest risk of rupture occurs in early labor). Not that I am advocating that or mentioning it to her! We shall see what they decide.

Anyone out there do VBAC in this scenario?

Happy International Midwives Day!

I want to wish a Happy International Midwives Day to all the midwives out there. Thank you for all that you do!

Sunday, May 3, 2009

I love the tub for laboring

Laboring in the tub

Follow-up response

I want you to know ('you' being those who posted in disagreement with my comments) that I was bothered by your comments. This means I found them thought-provoking and in some cases sarcastic (Maria - you weren't interested in educating - but instead chose to be a smarta$$).

As I was writing my response to the original posting about Janet Fraser's loss and the UC movement, I was thinking of my children. I had a very visceral response to this story because I was thinking of losing one of my own children. I was accused of being cruel, and that was not my intention. I have no desire to 'kick some one when they are down'. I was having thoughts of losing one of my own babies. Pure and simple.

Maria - I can only verify the story through the newspaper (see above link). I understand that the media does not always report the whole truth. I get that. But it is all I had to go on as this is alll being kept hush hush on the Joyous Birth website. It's not reasonable to expect to live your life in the limelight promoting a cause, then be able to command privacy when something negative happens. Ask any celebrity, political figure, etc. That's not the way notoriety works. And yes, I am aware that stillbirths can happen to anyone, regardless of where they may be delivering. And we (we being medical and midwifery providers) question why and how did this happen. Every single stillbirth is questioned. Why should Janets' be any different? The questions for her are just very public (again that noteriety). As for 'people like me' spouting opinions about things which we know nothing about...THIS IS MY BLOG AND THIS IS THE USA. I can spout whatever opinions I want here because this is a blog about my thoughts. If you don't like - don't read it. Just like I don't believe in UC and therefore I don't go hang out at the website for it.

i-am-a-mama - I was not casting judgement on Janet as that would be unfair. I simply stated my belief as she has done so publicly. Just as you are now. I suspect you are being overly sensitive because this was a post criticizing your belief. Just as I feel like I am being judged for having stated my personal opinions and beliefs. As far as the blog post I referenced....Navelgazing Midwife and Janet Fraser know each other and have exchanged many thought provoking conversations in the blogosphere. Navelgazing Midwife has even written an article for the Joyous Birth website. I know Navelgazing Midwife through Facebook and know firsthand what her intentions were. And they weren't to 'rub it in'. You then ask me how heartless and cruel can I be? Who's judging now? Heartless I am not....see above part of the post regarding my children. Ask the women I provide care for and dedicate a great deal of time to assist them in having the childbirth experience they want. And cruel - I wondered if maybe I was being cruel so I went back and re-read my post a couple times...and I stand by it.

Nepenthe - Yes, I don't know every detail as I have not seen the coroner's report. But the fact that she was having a 5 day labor sounds awfully suspicious to me. The baby is not equipped to last five days of labor even if momma can. I am making the assumption (granted this may be incorrect) that that baby was alive when labor started. Had someone, anyone been present to doppler periodically, yes, that baby may have been born alive. There would have been heart rate changes that indicated a compromised baby. I have no idea what type of prenatal care she had and I don't care. This has nothing to do with what prenatal testing she may or may not have had. Many woman I see decline all sorts of prenatal testing - no problem. The only assumption I make is that the baby was alive prior to the start of labor. I question this birth just as I would anyone who delivered in a birth center or a hospital or at home with or without a midwife. In fact, it's called peer review. Any bad outcome is investigated, regardless of where it occurs. And a preventable death in the hospital makes this ok I guess. NO! It's not ok anywhere. I am not ashamed Nepenthe.

I won't be 'named and shamed' by women who find it ok to put the experience before the health and well-being of their babies. The experience IS important but not the ultimate goal!

I would like to remind people that Janet did seek out help when the baby was in 'cardiac arrest' and for herself as well. It's unfortunate that it was too late.