Monday, September 28, 2009

Weekend in revue

I come on call Friday night to inherit an induction left over from Thursday. Great.

The patient is a 300+ pound multip with what feels like a pretty darn big baby to me, although it's hard to tell. The induction was elective and one of the other midwives gave in and scheduled her in for her call day, which was Thursday. The starting exam was 2/50/-2 and the plan was to start pitocin. IMO, this was a poor choice. I have found that multips with this kind of exam take a couple days of pit if you don't do some cervical ripening first. Bring em in the night before for a little cytotec then they are ready for pit the next day...and they will deliver the next day as well. Keep in mind, I didn't agree with doing an elective induction in the first place but casn't really say anything because I have given in to begging, pleading, crying before myself. I try very hard not to but it's difficult sometimes. Anyway, midwife #1 pits the patient all day with nothing happening. Midwife #2 comes on that night and shuts the pit off and rests the patient. Midwife #3 comes on Friday morning and breaks her water because the patient says "if you break my water, I'll take off". Sounds like a great reason to break someone's water at 2 cms. They pit her all day, she gets an epidural at one point and is 3/supposedly80/-2. She stays that exam right up until I take over at 5pm. I stop the pitocin and switch to PO cytotec x 4 doses. The next morning, before the final dose of cytotec, I check her because she is feeling pressure....yahhh!!!! She's now 5/90/-2! Woohoo....snoopy dance. We skip the final dose of cytotec and start pitocin. She delivers, 4 hours later, a chunky (10 pounds 7ounce) baby after pushing only 20 minutes. This baby was about 2 pounds bigger than her last! It was a tight tight fit...I almost had a code brown going on. But anyway, 4 midwives later we had a baby....the only midwife who didn't handle her was the on with no privileges yet!

I was frankly a little crabby that I was left with this induction. I just feel like I often have to 'clean-up' after this particular midwife. She has health issues and only works part-time because of those issues. Many times she has agreed to special a patient for labor. Then if it doesn't go quickly, I have to take over because she doesn't feel well. Then patients sometimes feel abandoned or are unhappy that they have to have me instead of 'their midwife'. It's sucky and unfair.


Other than a precipitous delivery earlier that morning, it was very quiet! I had a little drama with my husband and his heart Saturday night but he's fine. I had a few calls....trivial stuff....

One call was from a patient that just had been recently released from the hospital, where she was an antepartum patient. She had a low AFI and was being monitored. Well, she calls me concerned about the watery discharge she has. I advised her that she should come in to get checked out. She didn't really want to seeing as how she had just left. She wanted to wait until her appointment in the office, three days later. She never showed up. In the future, I think I will start triage phone calls with "What do you want me to tell you?". Because they usually have what they want to hear in mind already :p

Got a call from a patient with pelvic joint pain. No contractions or bleeding....just her pubic pain and hips are very painful. What did you want me to do about that on a Sunday night? Told her to get an appointment in the office and we could get her going on some physical therapy and a belly band.

And I am a Justin Timberlake fan and thought this was's from SNL with Beyonce. Hat tip to my BFF for showing me this....(couldn't embed so here's the link).

Justin and Beyonce Parody


Anonymous said...

Re: pelvic joint pain -- ugh! I had that especially with my second pregnancy. Here's a post I wrote about it, including a few links to tips on what to do (and not do) when you have pubis symphisis disorder, as well as a "do it yourself" thing you can do to help strengthen it, that a chiropractor tells her clients. Maybe this can help some of your clients. :-)


Joy said...

So do all of you midwives work together closely? Is there a lot of communication? I was wondering because it might be a good idea to talk sit down with all of them (or send a letter/email) about softening and dilating a woman more before starting Pit?! That has to be so frustrating for you to have to clean up after everyone.