Saturday, August 8, 2009

One p*ssed off midwife

I had a patient who had come in with ROM prior to the start of labor. It had been twelve hours and she was 4cms but she was ready to get the show on the road. So the plan was epidural and pitocin, then baby. This would be her 5th baby. She did not want to do NCB, although she had done it with the first three. Go figure.

So the patient opts to get the epidural prior to the start of pitocin. She was having some irregular contractions with very little discomfort. I know the birth junkies are cringing as they read that! I'm cringing a little as I type it. But that's they way she and I decided we would do this.

I was at a friend's house about ten minutes away hanging out (and I let the nurse caring for my patient know this). I get a call a little later from the nurse to let me know that the patient is having a whopping prolonged variable (baby's heart rate was down in the 90's for about ten minutes before returning to baseline). She tells me the heart rate is coming back up and the drop seemed to be totally random as the baby's strip was reactive immediately prior to the variable. So anyway, I head on in to check things out. They had told me the patient was still only 4cms and there was a bag that they ruptured when they put the scalp electrode on.

I'm almost to the hospital when the nurse calls me back to tell me that someone paged the doctor on call, who said to get the OR ready. The nurse tells me that the heart rate has recovered and she isn't sure why the doctor was called. But he was called by the labor nurse who used to be a midwife with us (she 'resigned' from our practice - awkward). I tell her to call him back and tell him I am almost there, will evaluate and call him if I need him.

I was so freakin' p*ssed! It was not the responsibility of this labor nurse to be calling the doctor without discussing with me first. It's my patient, I am responsible. I get to make that judgement call...not the nurse who used to be a midwife with us and thinks she can still work in that role and no one is gonna say anything. I get mad just thinking about the incident. The director of the unit happened to be there and was involved. I went off on her and the nurse/midwife. I was given some excuse about miscommunication and I let it go at that. But I felt like I made my point clear!


Joy said...

Well I would hope you made it clear how unhappy you were! That is completely nonsense, especially as baby stabilized and you were only 10 minutes away.

AtYourCervix said...

I have had moments (not too often), where I tell the charge nurse to be on stand by for the OR, and get the in-house attending (we have one in house 24/7 for their own clinic patients, plus as back up for the other MD groups) on stand by also, while also calling the patient's physician/midwife to report the situation. Sometimes, I just want to be prepared --- the decel/bradycardia may not recover, despite interventions, and the mom might need a stat c/s before her doctor/CNM can get in to the hospital.

It's not a personal affront - I'm looking out for the best interest of both mother and baby.

Also - I'm not calling the c-section - the attending/resident who is in house and covering the MD/CNM who is not present is going to make that judgment call.

Ciarin said...

Here's the thing....I was closer than the doctor was. There is no in-house attending except family practice residents, which are useless for us in this situation. The baby was recovering as I was communicating with the nurse. Had I been at home, which is further away, I would have told them to call the doctor in because he would get there before I would. Your take on the scenariop is different and reasonable because you are in a tertiary hospital. I am not.