Monday, November 9, 2009

More call recently

I took over on a patient who was only 34 weeks by a third trimester ultrasound but 38 weeks by a shaky LMP. We were using the US EDC because the baby did not have the appearance of an IUGR baby, which is what it would have been had we used her shaky LMP. The patient was not exactly reliable. Her prenatal care was very hit-or-miss. She had been in the previous night for contractions, was supposed to be on pelvic and modified bedrest, but the boyfriend apparently threw her under the bus while she was in the restroom and told the triage nurse that she wasn't listening. So the triage nurse ends up sending her home after scaring the crap out of her by telling her that her baby would "live with her the rest of her life if born now". The triage nurse was none other than my BFF! Her goal was to scare the patient into being compliant. I know where she was coming from but told her that was mean!

Anyway, the patient returned with her water broke this time. She was 3cms on arrival. So we got ready to have a baby. She wanted an epidural which she got. A touch of pitocin and she delivered a short time later. Fortunately the baby came out looking more like a 36 weeker and was breastfeeding very well. She'll go home with her momma after all. And hoepfully not live with her for the rest of her momma's life. LOL!

I had another patient who I took over on and was not real happy with the management. The midwife on call never came in during the night to do labor support. The pateint had been there since late evening and had 4 doses of stadol at that time. Her labor was essentially stalled by the time I arrive that morning. She was 7-8cms. After trying everything possible and suspecting that the baby was too big and OP to boot, we sectioned her. It was totally the right call....the baby was straight OP and 8-3. Her pelvis was so little there was no way that kid was coming out of there. The doc on call (from another practice) was a little crabby when I updated him on the phone - he couldn't understand why I had waited so long to call for a section. Uh, well cause the baby looks fine and I wanted to give her every opportunity to deliver vaginally. There have been many times where other providers would have cut a patient but because we midwives understand that not every labor goes by Friedman's curve, we have gotten a vag delivery.

I had another patient who precipted (sp) - she rolled in the door and was 6-7 cms, delivered less than an hour later. She was so mad at me and th enurse because we wouldn't give any Stadol (I was willing to give her some but she delivered by the time the pharmacy had it in the system so just as well). I felt so bad because she was looking at us with these pleading eyes. Afterwards, it took her a while to smile at us (she was spanish-speaking). She did a beautiful job though pushing a big baby out!


pinky said...

Wow, lately I have been looking at the literature on pain relief. Amazing how folks can do without an epidural when they are in the right mind space. Also amazing how poorly a person can do when anxious or if they have decided they NEED an epidural. I have spent so much time, rebolusing epidural patients that I have come to think folks are so much better off without epidurals and working through the pain. some folks no matter how much drug you give them their anxiety will give them pain. Most amazing.
And I have had a baby without an epidural so i am not speaking cruel and unusual treatment.

Beetus said...

Okay, that totally came back to bite me in the ass! I swear I've never said anything like that before!!!

But she was like talking to a teenager, she didn't seem to understand the concept of behavior leading to consequences and she had the attention span of a teen as well.

Here's parts of our conversation...
Me: When did these contractions start?
Her: I'm cold.
Me: Do you remember when they started hurting?
Her: Geez, I'm cold. Can I have a drink?

Her: God I'm really cold and I feel sick to my stomach.
Me: Let me get you some warm blankies
Her: Can I have some french fries from McDonalds?

I really liked her quirky self despite the challenges of extracting important info. I even made a nest of warm blankies and put her to sleep (30 minutes of solitude while hubby ran and got fries) so I wasn't trying to mean, I was just trying to introduce some reality. :pp

So what I said was..."Hey guys, this bedrest thing is really serious. Most 34 weekers do fine, but by not following your midwife's recommendation, you run the risk of a baby with problems. You don't want to have a baby that might live with you the rest of your life. (WAY over the top with the last bit!!)

Since she mentioned it to you the next day, clearly, I went overboard!! Mean nurse award!!

Next time I'll say " You really don't want a baby that will ride the short bus someday." Does that sound better?