Wednesday, June 10, 2009

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.

3 comments:

Joy said...

Oh that doctor irks me!!! If someone stuck their arm up me, unnecessarily, I'd probably kick them in the face quite literally!!!

pinky said...

At least he did the breech delivery. Many of my Docs will refuse to do a breech on baby number 2 which I think is stupid because baby number 1 got out just fine and paved the way. I have seen some really nice breech deliverys done with baby number 2. It does not have to be brutal. I am upset when a Doc will both refuse to deliver twin 2 breech and refuse to try to turn them. In that case I would personally rather have an elective C-section instead of having one vag and one section. So it is nice she didn't have to have a stat c-section. That I hate too.

pinky said...

At least he did the breech delivery. Many of my Docs will refuse to do a breech on baby number 2 which I think is stupid because baby number 1 got out just fine and paved the way. I have seen some really nice breech deliverys done with baby number 2. It does not have to be brutal. I am upset when a Doc will both refuse to deliver twin 2 breech and refuse to try to turn them. In that case I would personally rather have an elective C-section instead of having one vag and one section. So it is nice she didn't have to have a stat c-section. That I hate too.