Happy Father's Day and labor

I wanted to wish everyone a Happy Father's Day!

I was on call recently and I think I was being punished for having taken a vacation! I had a section in the afternoon, finished my office hours. All was well. Then a patient of mine came in thinking she was in labor. She was 4cms which was a change from the day before. But she didn't change anymore after walking. But she was contracting every 2-3 minutes and a little uncomfortable with them. So we discussed breaking her water versus sending her home with morphine for therapuetic rest. She opted for breaking her water. And wow! She delivered less than two hours later! And she did a beautiful job of it. Dad caught the baby and all were thrilled.

So I went home...

Only to be called back for a primip that was 7cms half an hour later. She was going natural, had a doula and family for support, who were all doing a great job. It was a little weird at first, as I walked in the room when I first got there and no one even looked at me. Anyway, her labor was not going as smoothly as one would hope. This was late evening that she arrived. By the morning when I handed off to the next midwife (I was exhausted and had 30 minutes of dozing so had to go home) she was completely dilated. This was after a lot of different positioning, in the tub on hands and knees, and finally breaking her water. Then she didn't deliver until noon! I felt so bad for the momma...I know she was exhausted before I even left. She did get some Stadol a couple times, which helped her to rest a bit. But she did it without pitocin!

This was one of those situations where I was trying really hard to trust labor and birth but just felt like if I could have intervened, she may have had that baby a lot sooner. But I really want to do everything I can to respect what the woman wants for her labor and birth. It can be difficult as you become torn sometimes.

I went home and slept for 4 hours then got up and went grocery shopping with my mother. I felt like a zombie! I probably had drool coming out of my mouth as I stumbled around the store.

Nurse Jackie vs. Hawthorne

I'd really like to know what you nurses and the general public think about all the shows with nurses as the primary character?

The first contender is Nurse Jackie - Nurse Jackie Peyton is far from ordinary. As an ER nurse, she navigates the rough waters of a crumbling healthcare system, doing everything she can to provide her patients with the best care possible. Whether she’s lighting into a smug doctor for failing to heed her advice, or stealing a fat money clip from a man who stabbed a prostitute and giving it to a pregnant widow, or forging the organ donor card of a man who just died, Jackie Peyton is compelled to make sense of the chaos and to level the playing field whenever she can. Right or wrong, it’s Jackie’s brand of justice all made that more manageable by a daily diet of prescription pain medication.

The second contender is HawthoRNe - Pinkett Smith plays Christina Hawthorne, a compassionate and headstrong Chief Nursing Officer heading up a group of dedicated nurses at Richmond Trinity Hospital who spend long days and nights on the hospital’s front lines. Hawthorne is the kind of nurse you want on your side when you or someone you love is in the hospital. She is the kind of nurse who fights for her patients and doesn’t let them slip through the cracks. When necessary, she takes on doctors and administrators who are overworked, distracted or just unable to see the human being behind the hospital chart.

I look forward to watching HawthoRNe tonight and then hearing what others have to say!

Vacation time rocks!

The past few weeks I have been really feeling 'burned out'. Not in a way that I would want to quit midwifery...not at all. I just have been feeling like my resevoir (sp) has dropped really low and is in need of replenishing. So, finally, I started my long awaited week long vacation time. And actually it's kinda nice because I have just one 24 hour shift following the vacation then off for the weekend :)

Part of the vacation was spent in Las Vegas, which was great as always. This trip was a little different as we took the kids and had a family vaca! The kids loved it! It went far better than I had expected it would. My mother got married while there - and I must say the male strippers for her bachelorette party were very nice young men...in many ways!

Now, I am just spending the last couple days hanging by the pool, reading, watching TV, etc.

And the itch to catch babies and see women in the office is back!

Blog Future

I am thinking about the future of this blog. I'm probably not as good at HIPPA-tizing stories as I need to be. I'm worried that I may be outed. I don't know what to do.

Busy busy part III

I was on call this past weekend and it was crazy the first 36 hours! Here's a blow-by-blow!

Friday night - go to bed about midnight. Get called in half an hour later for a labor patient. It's this lady's third baby and she's 5-6cms so off I go. She doesn't speak any English or Spanish, I think her language is Kiren (sp). But she has these two girls with her that are not friends or family, to translate. Oook. Fortunately we knew each other at least, having seen her a couple time sin the office. She has one dose of Stadol and stalls out at 8cms. I suspect an OP baby is the cause. So I move her to the tub on her hands and knees (I know she thought I must be crazy!) and go to lay down for awhile. Fifteen minutes later, the nurse calls me to let me know she is complete and wanting to push. Damn tub...worked too fast! It's something like 3:30am by this time. She starts pushing and is doing a really ineffective job of it. She asks through the translators if I can't just pull the baby out as that is what they did with her other two. Ummm, no. You are gonna push your baby out. Naturally I was on with the worst doc...again. Grrr. I didn't want to subject her to that and I really felt that, even though this baby might be a little bigger than her two 5 pounders, she could do it. While working with her, another patient comes in. She's 5cms, third baby, wanting stadol.

It takes several attempts to get her IV started and she's screaming. I suggest to the nurse that she check her prior to pushing that stadol. The nurse comes to find me in the first lady's room, where she is still pushing, to let me know that patient is 9cm now and moving fast. My little Kiren lady does not seem to be in any danger of delivering soon so I go to the other room where we have a baby shoot out ten minutes later. She almost screamed that baby across the room! He was two pounds smaller than her biggest! She delivered just under an hour after arriving :)

I go back to the Kiren lady and she is making slow but steady progress. She finally delivers a cute little boy, big for her at 6-9. She promptly zonks out.

By this time it is 6am Saturday morning. I go make postpartum rounds and am home asleep by 8am...

to have the chinese phone torture start.

I received 12 pages in five and a half hours. I threw the pager at one point. Finally at 1:30pm, I get up to go into the hospital. I have another lady of mine there, who is having her second baby and really wanting natural childbirth this time. She was 4cms on arrival. I grab soime lunch and head on in. Which was a good thing because I get a call that she is now 9cms and it's 3:30pm. Geez, so much for labor support. I get there in time for her to start pushing. After 30 minutes she pushes out a beautiful baby. This baby was a lot bigger than her first. She was so focused, once I asked her to stop screaming. I think she was screaming because she felt like that was what she was supposed to do. I told her that making noise was fine, but screaming tends to be more of a fear based mechanism, unlike low-pitched moaning, groaning, etc. She had no problem stopping the screaming at all! While I was finishing up in there, another patient came in.

This lady was a primip, ruptured, contracting but only 1cm (unfortunately the nurse in triage felt it necessary to check her - grrr). This patient was planning an epidural so I decided to go home and get some sleep. Which I didn't get a whole lot cuz I couldn't sleep once I got home. I finally went to bed around midnight after admitting another lady, a G9P5 who was 4-5 and getting an epidural. I realize that was risky but was so damn tired. I slept for three solid hours before having to go in. The grand multip was 6cms, I broke her water and she delivered 45 minutes later. Easy peasy! Unfortunately, the primip had a less than optimal outcome. We sectioned her for chorio with the baby being shipped out...sigh. I was very distressed, because even though I did all the appropriate care and the timeline was appropriate, it just sucks to have a bad outcome.

I think in this particular field, the outcomes are so good so frequently, that a bad one really just is unexpected. Sigh.

I made postpartum rounds and was home and in bed assleep by 9am. I had one page that afternoon from a patient with a question. One page at 4am Monday morning from triage, with the patient being sent back home.

I am so ready to be on vacation. I was in the office yesterday and on call /office today, but only until 7pm. Then gonna hang with my new best friend and watch Nurse Jackie and Weeds. Then tomorrow, I start vaca! 7 straight days.....ahhhhhh. Then 24 hours of call.....then my three day weekend off. :) Happy happy happy! We are heading to Vegas on Friday for three nights. This will be the first time the kids have gotten to go so they are very excited to see this place where mom and dad go so often - lol! This is our first trip this year.

Ok, off to get ready to go round and hit the office.

busy busy part II

I forgot to tell you about the twins!!!!!

So in a previous post, I mentioned that my weekend on call was coming up with the least fav doc and their were twins roaming around. Here's the story...

She came in on a Saturday evening thinking she was in labor, contracting regularly, uncomfortable. She was 5 cms. Unfortunately she didn't change so we decided she would go home and that due to the doc on call, this might be the best thing. This was after having a discussion with the patient and her husband that they may have to advocate for themselves if the doc wanted to do something that wasn't necessary. I would normally never do something like this but this doc could very likely intervene in unnecessary and brutal ways.

So she comes back the next night, this time it is the real deal. She decides she wants an epidural. She apologizes to mefor wanting one! I told her it wasn't about me, I just didn't want her to regret it afterwards! So she gets an epidural. She's 9cms after that with a bulgy bag. We move her to the OR, but she gets to stay in her own bed. The doc didn't like that...he said what if we have to section? And I said, we won't have to...but if we did, we had enough staff to move her without difficulty. I told him, she wants to be upright for pushing the babies out, not laying in the dead cockroach position! I know this doc would have much prefered that he handle this and that midwives shouldn't be doing twins. But I did my best not to let him take over the process completely.

She was pushing the first baby out and had him at a +2 station when the doc wanted to vacuum the baby out because the heart rate was dropping with contractions. I couldn't believe he felt that was necessary, as she was moving the baby right down. Fortunately, the patient said no! I thought it was great because he asked again - he must of thought he had misheard her - and she said no again. I jumped in and said ok, push your baby out, which she promptly did. Over an intact perinium. That's important. Baby boy was doing wonderful.

Then the doc jumps in and sticks his whole arm in her and says the second baby is breech. I have never even seen a breech delivery, let alone, done one. I know how in theory, it's mostly a hands off kinda thing. So I stepped back to let him handle it. I wish I hadn't! He was so rough and so hands-on with that baby. He was very aggressive and that baby delivered over a second degree laceration, requiring some resuscitation. The baby did fine after the first couple minutes.

So the experience was ok...it could have been worse, but it could have been a whole lot better! Then we had to fight with the nursery to get the babies to bedside for breastfeeding. Grrr.

Busy busy Part 1

Sorry I haven't been around much lately but things have been so busy! Let me see if I can do an update for you before I head off to the hospital for rounds.

I have had a lot of really beautiful natural childbirth lately. It's been great! I had a lady come in, who I was supposed to meet in the office that week, in labor. This was her third baby and she had had epidurals with the first two. She really wanted to have NCB this time. And she did it! She came in and was 5cms. We tried her in the tub but she didn't like that, which always surprises me because more women then not love the tub, but to each her own! So then she tried the birth ball, didn't really care for that. She really just wanted to lay in the bed on her side. And that made me think of the talk by Michel Odent. He spoke about women who are in active labor should be allowed to rest and that most of them would do that if left alone. He also believes that this is NOT detrimental to the woman's labor. Interesting because we tend to keep em moving more in this country. I'm really proud of myself because I am developing my ability further to just watch and not be a participant in birth unless needed by the woman. It's her show, not mine....after all! I can really tell that I am evolving as a midwife and loving it! Anyway, she progressed to complete and began to push. The bag of waters popped as it was crowning :) And the baby was right behind. She was very controlled and focused. It was beautiful to watch her. She had a great doula (who later posted the whole birth story in detail on a forum in our area - someone saw it and sent it to me, I was spoken of very highly and was so flattered!). Mama was so ecstatic afterwards!

I had another lady the next night, a 17-year-old patient of mine. She ruptured prior to labor starting. We gave her some time to get going but she really wasn't doing anything (no one had checked her but you could tell based on what she was saying and how she looked). Eventually, maybe after 12 hours had passed and she was tired, I decided to give her a little pitocin (with her consent of course) and give her uterus a kick . We only used the pitocin for about three hours, by then she was 5cms, and I shut it off. I wanted to be able to get her in the tub and off the monitor. Most women will continue their labor once established, if the pit is shut off! She moved along at a nice pace and did a wonderful job. Once she started getting restless, I knew she was transitioning but was still worried in the back of my head that she would still only be 5! Just paranoia and yes, some distrust in the labor process (I'm working on this and getting better at it all the time!). She started asking for an epidural so I asked to check her before she made that decision. I told her that if she found out she was close, that might give her that little extra oomph to keep going. She was 9cms! And this was only a couple hours after cutting the pit off :) So forget the epidural. She progressed to 10/100/+2 very rapidly and began to push in earnest. Fifteen minutes later she pushed out a beautiful baby girl! I was so proud of her!

I had one recently who had only a dose of Stadol during her labor. She whined and screamed her way through it. She didn't want to push and wanted me to 'pull' the baby out. The nurse was looking at me like "what do we do to make her push?" The baby looked fine and I told the nurse that eventually she would get tired of fighting it and push the baby out. It was a little miserable listening to her scream and whine. I also felt bad in a way because I couldn't do anything that seemed to help.

Another patient of mine, who had her first child naturally at 36 weeks, came to see me in the office for a labor check. She had been 1-2cms when I saw her the day before for her regular visit. And she was also past 38 weeks, which was weird for her. She was 4/100/-1 and intact bag. But she didn't look particularly uncomfy. I asked her if she wanted to go back home for awhile but she really wanted to go to the hospital now. She just knew that this was really it. So off she went. And she did her thing and delivered 2-3 hours later! Another beautiful, focused birther! And I am always so happy to catch when it's someone I have been seeing in the office throughout the pregnancy. It just becomes extra special...

Sorry!

Sorry I haven't posted in awhile....post to follow soon :) Been crazy busy and having lots of beautiful births!