Monday, November 9, 2009

Random stuff

Call hasn't been too crazy for a change and life has been nice. Good for me but not conducive to blogging!

I had a woman come in sorta in labor recently. She was having her second baby, but it had been quite some time since the first. I had seen her in the office a couple times and we had hit it off. She's absolutely gorgeous, very intelligent, but has a husband who sounds like a bit of an a$$. From what she was telling me, he has a bit of Peter Pan syndrome going on!

Anywhoo, she came in and was initially 3/60/-2, contracting regularly. Her plans were for natural childbirth. Her first labor had only been four hours, but again, was quite some time ago. I think she had some expectations that this labor would be just as quick if not faster. I had warned her that while that might happen, not to pin her hopes on it.

The nurse sent her out walking for an hour or so, and when she returned she was 4/70/-2. So I kept her. And it was downhill from there! Well, ok, maybe not quite that bad. But it sure wasn't a smooth labor. I had the nurse send her out walking again until I could get over there from the office. Once I arrived she was alternating some walking with resting on the birth ball. She had a goofy friend with her who was very ....manic almost. She was sweet but driving me nuts and I felt like she was throwing off the vibe in the room. I really love a quiet, calm atmosphere. I realize that not every patient wants or needs that but most do. This chick was almost bouncing off the walls with excitement. And the patient was starting to feel irritated as well (shge mentioned to the nurse that she hoped her friend would go soon). The husband wasn't there, and my patient wasn't sure that she was gonna tell him yet that she was at the hospital. I was a little concerned by that as well, as I feel like the patient was anxious about how things were going to go.

I was thinking to myself 'great, what other issues can we drag into this room?' OH, and she has a history of sexual trauma. *sigh* I'm feeling those instincts kick in. Oh, and the baby was doing some strange things on the monitor. The strip would look fabulous then would do funky things. Not bad, just odd. Some of it was dehydration - she admitted to having drank very little that day and reported feeling much better with IV and oral hydration. The baby straightened out a little better as well. But there were still some oddities about the strip. I was still comfortable enough to get her off the monitor though.

After a couple hours went by, we re-checked her and she had not changed. I offered her three options...1. Go home (although due to the oddities in the heartrate I was a little uncomfy with this one), 2. Break water in the hopes of getting things going, 3. Do nothing and just wait. She opted for #2 so I broke her water and sent her out walking again. We both thought she would take off at this point.

She walked for a bit, then used the ball while I rubbed her back, then rested for a bit. Time went by. By this time, her husband was there and was being a great support person. I was very pleased - he wanted to be very hands-on so I had him rubbing her back, etc. My arthritic hands can't take massage too long! Around midnight I decide to check her as she doesn't look like she is doing much. She's 5/80/-2. Great. 1cm in three hours. Not promising. I decide to go lay down for a bit.

Two hours later, feeling a little refreshed, I recheck her. She really seems to be in the same place when I watch her. That makes me nervous. And I am correct...she hasn't changed. Crap. I discuss options with her...#1 augment with pitocin or #2 continue with position changes, walking, etc. I know this isn't a big baby. Her last was 6 pounds and I really don't think this one is much bigger than that. Can't really tell what position the baby is in but believe it's not OP. Her contraction pattern and where she's feeling the most discomfort support that as well. Byt his time, I am starting to think I screwed up and should have just sent her home when she didn't change at 4cms. But oh well, now we are committed. She wants to wait a little longer before starting pit so I encourage her to try some different things. She's getting tired, which always concerns me. Her contractions are spacing out a bit.

A couple more hours goes by...minimal change in the cervical exam, maybe 5-6cms now. She and her husband are now agreeable to pit so we get it started. It starts to work very quickly and I can see the change in her behavior. The husband, nurse, and I continue to do labor support. She decides she wants some IV pain meds, of which she gets two doses before she delivers. She starts to move along nicely. Time goes by and she wants to be checked...she's 8/90/-1 - woohoo! She really starts to zip. Soon she is spontaneous bearing down so I re-check to find her 9.5cms but the last little bit of cervix is very soft and will retract easily if she just pushes with a few grunty pushes, which she does. Then it's gone and I tell her to push however she wants. She goes full force and births a beautiful little baby (and I do mean little - 5-12) in five minutes over an intact bottom. The baby has asynclitic molding...meaning the head was in her pelvis cock-eyed which was the cause of the long, drawn out labor!

Afterwards we chatted for a few minutes before I went home exhausted to my bed. She said she was thinking of asking for an epidural but thought it would be too late. I told her that it wouldn't have been, and I wouldn't have offered it to her though. My general philosophy is that if you want it, you have to ask for it. It's rare for me to offer it because I know how I was when I was having babies. I would never ask for one but when it was offered to me I took it (when I was asked in the midst of a contraction no less!). I'm very glad she delivered half an hour prior to the end of call because I had promised her I would stay until she delivered and I was f*ckin' tired!

Other random stuff...

My husband has been getting on my nerves a little lately - he hasn't been doing much at all around the house and it's p*ssing me off. I feel like I shouldn't have to do a lot of cleaning when I work all these hours. I think he should be responsible for making sure the kids don't tear up the house. We just might have to have a little talk...

I have the rheumatology appointment today. Finally. It's only been two months....geez. I hope that the fact she is so busy is a good sign. It's been a rough couple months for me with these pains, fatigue, and low-grade fevers. I hope to find out what the heck is going on and how we can go about fixing it. I would like to get to feeling better so I can start exercising and making some other changes for my health. My BFF has been very inspirational! Smoking has been gone now for 2 and a half months.

I recently had a killer hormonal migraine alomng with a sinus infection. I'm not a wuss when it comes to pain. I live with it daily and have a fairly high tolerance. But this was the worst headache I have ever had. I was in a tears a couple times because it just wouldn't stop. I was taking vicodin and tylenol with no relief. Finally, after a day and a half, I had my hsuband take me to the urgent care center where I was given toradol IM and some zofran (I was nauseated), which worked beautifully. Time to change my birth control pills! I've only had these headaches since being on YAZ. I hate to give it up because it works so well for my other issues but the headaches and the fact that my sex drive is in the toilet are just not worth it anymore. I'm gonna give Loestrin a try.

Now that you know so way intimate stuff about me, what else can I tell you?


Joy said...

I love reading the birth stories!

Beetus said...

I am SOOOOO proud of you for quitting smoking!!!! : ) It ain't easy and you did it!!!