I had an interesting situation recently. I spoke with a woman, having her first baby, at the beginning of my call. She had been contracting all night. She opted to go into the office when it opened for a labor check. She was found to be 5-6cms so wanted to come to the hospital. Her plans were for natural childbirth.
On arrival, Nurse Crappy checked her and found her to be 6-7cms. My thinking was 'great, it's gonna be an awesome labor and birth!' Little did I know what was to come.
She was handling the contractions well. The baby didn't look too hot on the monitor but wasn't bad either. I felt the strip was reasonable enough for her to just have intermittent auscultation. I wanted her to be able to get in the tub, walk, etc. Her contractions were kinda irregular. She decided on getting in the tub with lots of bubbles to keep herself covered. She seemed to be very modest. She was very comfy in the tub and was sleeping so i headed over to the office to see a couple patients, do rounds, etc. I told her to have the nurse call me when she got more active again and I would come back.
I returned to the hospital around 3pm which was good timing as the patient was asking for me. She wanted to be checked, which I did. She was 7/80/-2 with a bulging bag of waters (BBOW). She was a little disappointed that she had not changed in that 5 hours. I recommended that she keep doing what she was doing (positions changes, nipple stim, walking, etc) and possibly consider breaking her water. Her husband and mother were present and doing a nice job of labor support.
Around 6pm she wanted to be checked and have her water broken if no change. She was still the same, although her cervix felt slightly swollen to me at this time. I broke her water (light meconium) and figured that would get her progressing again. She did start to contract a bit more but the intensity didn't seem to be changing based on how she was behaving. Then the contractions went back to their previous irregular pattern.
At 9:30pm, I checked her and she had not changed other than the cervix was definitely starting to feel like it was swelling. The baby had lots of molding but was no lower in the pelvis. I'm concerned at this point as she has made almost no progress in almost 12 hours now. She's also exhausted - has been in labor for just about 24 hours now. I start making pitocin noises. She declines. I encourage her to continue with rest breaks alternating with various activities.
Shortly after that, she is lying on a mattress pad on the floor, feeling pressure in her lower back and butt. I have suspected that the baby is OP, but not really sure. She's had a lot of back labor. Her mother tells her to go ahead and push. I say no as I had to just checked her shortly before and she was still 7cms. I suspect that the mother had been encouraging the patient to push when I was not in the room, which was the likely cause of the cervical swelling.
About 11:30pm she's practically a zombie. And she wants to be checked due to the pressure she's feeling. She's still 7cms, head no lower, and cervix swollen. She's starting to get agitated. I again discuss pitocin and pain management with her. She again declines.
Shortly before 1am, she again wants to be checked. We had been using the peanut so I thought we would check her before flipping her to the other side. No change. I recommend an epidural and pitocin. The patients mother wants a second opinion. She tells me "I thought you were supposed to be about natural" or something to that effect. I explain that 15 hours at 7cms with a swollen cervix wasn't normal. The epidural would stop her from pushing against that cervix (which mom was probably coaching her daughter to do). The pt's mother wants to see a doctor. She says "There must be a doctor here in the hospital or the doctor you spoke with should come in". I had consulted with my back-up and shared that info with them. I told her there was no one but a resident around. She wanted me to get this resident and have them check her daughter and offer a second opinion.
I went out to talk to the resident. I'm pretty irritated at this point. Little did I know this resident was a dipsh*t. I was told after my convo with her that she was an idiot. I explain the situation to Dr Dipsht and ask if she could help me out. She looks at me and says "Maybe. I ahve some patients in triage to see after I finish writing this note". Seriously? Maybe? I tell her to forget it. I'm thinking she better not ever ask for advice from me on management of her patients as I will just tell her 'maybe'.
I get my back-up to call and speak with the family. The patient then consents to the epidural and pitocin. The mother sits in the corner and pouts.
The pitocin gets started about 2:30am and I decide to go home. I haven't had dinner and am tired. I eat, start taking my clothes off and the pager goes off. It's 3:30am. I have another patient who's 7-8cms. I turn around and head back in. I'm almost there when I get a call from the nurse who says she got up to four of pit, then the baby had a 15 minute decel. *sigh* She still hasn't changed although the cervix isn't as swollen now. I order terb and they get the baby stabilized by the time I arrive. However, the pt's mother wants to see the doctor. She wants to know why he isn't there if there's fetal distress. She wants a resident to look at the strip. She's ticked cuz we never got her a resident when she asked before. I have the nurse call my back-up and tell him to come in and see these people and evaluate the situation. he calls for a section in 30 minutes and heads on in. I know that there's a very real possibility that these people won't consent to a section. Fortunately the baby looks better when I arrive a few minutes later.
At this point, I kinda wish these people would just fire us and I could hand them over to the resident :P
My back-up arrives and has a long convo about section versus expectant management after checking her. She is 8-9cms and cervix is less swollen. The baby has a lot of caput now as well as molding. The caput is at 0 station. He doesn't mention any of this until we are back out of the room. He just wanted to section her and be done with it. Frankly I was feeling the same way. The patient informed us she would only consent to a section if the heart tones were down and don't come back up. She couldn't clarify to us how long she would wait. She very much felt that the pitocin was the cause of the decel, even though the baby continued to have some decels with no pit and no contraction.
So no section. We watched and waited. At 7am, we turned the whole situation over to the next shift. I wished the patient the best of luck, hoped she would birth a healthy baby vaginally.
I touched base with the midwife who followed me - the patient delivered vaginally 5 hours later with 9&9 apgars. Go figure.
Tuesday, February 23, 2010
Sunday, February 14, 2010
Valentine's Day Weekend
HAPPY VALENTINE'S DAY!!!!!!
I am having a nice weekend other than the cold my husband has graciously shared with me. And from the sound of it this morning, my younger daughter is getting it as well. Ahhh, the gift that just keeps giving (the cold, not herpes! LOL).
Friday night my BFF and I went out for an adventure. We went to dinner at a japanese fusion and sushi restaurant. We had hot saki, japanese beer, and sushi - yum! We talked and generally chilled there for almost three hours. Then we headed off to a dive gay bar. The men looked like women and the women looked like men. It was interesting to say the least. They had karaoke going on so my BFF sang for the first time. She sang You're So Vain by Carly Simon and SexyBack by Justin Timberlake. Both so appropriate for me :p The only mishap occurred when I couldn't find the toilet in the restroom. I kept trying to figure out why there was a padlock on the stall. I wondered if I was supposed to use the men's room. My BFF went in the restroom and pointed out the toilet in the corner. The padlocked door was a storage closet! Yes, I had had a drink or few.
Last night, I went out to dinner with my husband. Neither of us was feeling really great so decided to keep it to just dinner. The original plan had been to see the movie Legion. We went to dinner at a very nice seafood restaurant. We started off with raw oysters whcih were so delish (except for two that weren't cleaned very well and kinda bland tasting). Then we had salad, lobster tail (with drawn butter - practically orgasmic), crab cake (yummmm), asparagus/green beans/carrot (the asparagus were slightly undercooked), mushroom risotto (bland), and scalloped potatos (to die for). We were sent home with a free dessert due to the long wait times so I chose a tuxedo dessert - will eat that later today. The wait time on dinner was looonggg - at one point, we saw another couple get up to leave and they had leftovers on their table. I told my husband we should go sit at that table - lol! Then the guy beside us finsihed his dinner and had a few green beans left over - I debated about asking if i could have them. In the end I opted not to ask :p
Today - feeling pretty crppy so will chill. Originally my BFF and I were supposed to go to a tea party but we decided we will just have a movie day.
I am having a nice weekend other than the cold my husband has graciously shared with me. And from the sound of it this morning, my younger daughter is getting it as well. Ahhh, the gift that just keeps giving (the cold, not herpes! LOL).
Friday night my BFF and I went out for an adventure. We went to dinner at a japanese fusion and sushi restaurant. We had hot saki, japanese beer, and sushi - yum! We talked and generally chilled there for almost three hours. Then we headed off to a dive gay bar. The men looked like women and the women looked like men. It was interesting to say the least. They had karaoke going on so my BFF sang for the first time. She sang You're So Vain by Carly Simon and SexyBack by Justin Timberlake. Both so appropriate for me :p The only mishap occurred when I couldn't find the toilet in the restroom. I kept trying to figure out why there was a padlock on the stall. I wondered if I was supposed to use the men's room. My BFF went in the restroom and pointed out the toilet in the corner. The padlocked door was a storage closet! Yes, I had had a drink or few.
Last night, I went out to dinner with my husband. Neither of us was feeling really great so decided to keep it to just dinner. The original plan had been to see the movie Legion. We went to dinner at a very nice seafood restaurant. We started off with raw oysters whcih were so delish (except for two that weren't cleaned very well and kinda bland tasting). Then we had salad, lobster tail (with drawn butter - practically orgasmic), crab cake (yummmm), asparagus/green beans/carrot (the asparagus were slightly undercooked), mushroom risotto (bland), and scalloped potatos (to die for). We were sent home with a free dessert due to the long wait times so I chose a tuxedo dessert - will eat that later today. The wait time on dinner was looonggg - at one point, we saw another couple get up to leave and they had leftovers on their table. I told my husband we should go sit at that table - lol! Then the guy beside us finsihed his dinner and had a few green beans left over - I debated about asking if i could have them. In the end I opted not to ask :p
Today - feeling pretty crppy so will chill. Originally my BFF and I were supposed to go to a tea party but we decided we will just have a movie day.
Thursday, February 11, 2010
Come and Gone
The title refers to my tax refund money :p
Here's what I did with my tax money...
I bought tickets for a Cirque de Soleil show in Vegas later this month. I'm treating my mom and my BFF on that.
I bought full access passes for the Dinah Shore Palm Springs thing. For those that don't know - it's a total lesbian fiesta. Since my BFF is totally gay and never been, I agreed to go. I am psyched - should be lots of fun. My BFF is paying for the hotel but I told her she couldn't be hitting on me and better get two beds! LOL!
I caught up my student loan payments.
I bought airfare for myself and my family to Florida this summer for a family reunion/vaca.
I paid some bills.
That's the gist of it. :pppp
Here's what I did with my tax money...
I bought tickets for a Cirque de Soleil show in Vegas later this month. I'm treating my mom and my BFF on that.
I bought full access passes for the Dinah Shore Palm Springs thing. For those that don't know - it's a total lesbian fiesta. Since my BFF is totally gay and never been, I agreed to go. I am psyched - should be lots of fun. My BFF is paying for the hotel but I told her she couldn't be hitting on me and better get two beds! LOL!
I caught up my student loan payments.
I bought airfare for myself and my family to Florida this summer for a family reunion/vaca.
I paid some bills.
That's the gist of it. :pppp
Chaos
I had a patient who was being induced via AROM but wasn't very active yet. My plan was to go get some dinner then be available for labor support. I had gotten a couple free tickets to our local NBA game. The plan was that my husband and older daughter would go as they both like basketball. He was gonna bring both daughters up to the hosptal to get the tickets from me and leave my younger daughter with me. I would then take her to my BFF's house, have some dinner, then go do labor support while my BFF watched my daughter. Welllll......
At the time that my husband was meeting me at the hospital, the ER called saying they had a screaming patient from our practice. So I decide I better wait and see what's going on. I asked my BFF (and she is such a fab BFF!) to meet my husband and get my younger daughter.
the patient came up and she was a doc patient. But she was 10/100/+2 so there was no way that the doc was gonna get there in time so I stepped in.
No good deed goes unpunished.
I ended up haing the tech get the tickets out of my bag and take them down to my BFF who was waiting in the parking lot for my husband to show. I had her take me phone so she could answer it when my husband called. It was chaotic! In the meantime, the patient delivers her baby but then promptly has a postpartum hemorrhage. So we get that dealt with then she needs a repair. It's not a big tear but is very awkward to repair. It was a first degree perineal but the skin had sheared away partly up the labia. So getting that to all approximate was difficult. That's only the second time I have ever seen a tear like that. I get her all situated.....do pictures, etc.
My other patient is now active and needs labor support. So much for dinner. I quickly call my husband tomake sure he's on his way to the game and my other duaghter is in the hands of my BFF. All is well.
I go do labor support for my other lady and have a rockin' natural birth with her. Then I got to stay home the rest of the night - sweet!
At the time that my husband was meeting me at the hospital, the ER called saying they had a screaming patient from our practice. So I decide I better wait and see what's going on. I asked my BFF (and she is such a fab BFF!) to meet my husband and get my younger daughter.
the patient came up and she was a doc patient. But she was 10/100/+2 so there was no way that the doc was gonna get there in time so I stepped in.
No good deed goes unpunished.
I ended up haing the tech get the tickets out of my bag and take them down to my BFF who was waiting in the parking lot for my husband to show. I had her take me phone so she could answer it when my husband called. It was chaotic! In the meantime, the patient delivers her baby but then promptly has a postpartum hemorrhage. So we get that dealt with then she needs a repair. It's not a big tear but is very awkward to repair. It was a first degree perineal but the skin had sheared away partly up the labia. So getting that to all approximate was difficult. That's only the second time I have ever seen a tear like that. I get her all situated.....do pictures, etc.
My other patient is now active and needs labor support. So much for dinner. I quickly call my husband tomake sure he's on his way to the game and my other duaghter is in the hands of my BFF. All is well.
I go do labor support for my other lady and have a rockin' natural birth with her. Then I got to stay home the rest of the night - sweet!
Sunday, February 7, 2010
Homebirth
Does this make sense?
Patient #1 comes in with spontaneous rupture of membranes. She's a multip, contracting every 3 minutes, mildly uncomfortable. The nurse doesn't check her.
Patient #2 comes inwith spontaneous ROM. She's a multip who is VBACing (has had three vag deliveries prior to the section). She's not contracting or complaining of any pain. She's been ruptured for 5 hours. The same nurse checks her.
Does anyone see the illogic behind this? Why wouldn't you check the patient who was contracting regularly and leave the VBAC (especially want expectant management for her!) unchecked since she isn't contracting!!!!!
Please put me out of my misery. I had a temper tantrum about it at the nurses station. One of the nurses tried to use the "well the docs want to know" logic with me. I promptly replied that the nurses ought to friggin know how to approach midwife patients. After all, I've had this very discussion with this nurse (the one who checked the one patient and not the other) in the past. AND we midwives have been at this hospital for quite some time (several years) now - you ought to have it figured out by now.
I'm becoming increasingly unhappy with the behavior and care I see from some of the staff. I had a revelation tonight. Perhaps I shouldn't be doing hospital birth anymore. Perhaps I need to be a homebirth midwife! Too bad that's not feasible in the state I live in.
Patient #1 comes in with spontaneous rupture of membranes. She's a multip, contracting every 3 minutes, mildly uncomfortable. The nurse doesn't check her.
Patient #2 comes inwith spontaneous ROM. She's a multip who is VBACing (has had three vag deliveries prior to the section). She's not contracting or complaining of any pain. She's been ruptured for 5 hours. The same nurse checks her.
Does anyone see the illogic behind this? Why wouldn't you check the patient who was contracting regularly and leave the VBAC (especially want expectant management for her!) unchecked since she isn't contracting!!!!!
Please put me out of my misery. I had a temper tantrum about it at the nurses station. One of the nurses tried to use the "well the docs want to know" logic with me. I promptly replied that the nurses ought to friggin know how to approach midwife patients. After all, I've had this very discussion with this nurse (the one who checked the one patient and not the other) in the past. AND we midwives have been at this hospital for quite some time (several years) now - you ought to have it figured out by now.
I'm becoming increasingly unhappy with the behavior and care I see from some of the staff. I had a revelation tonight. Perhaps I shouldn't be doing hospital birth anymore. Perhaps I need to be a homebirth midwife! Too bad that's not feasible in the state I live in.
Saturday, February 6, 2010
Call Gods Suck.
Call just seems to carry with it a black cloud of labors not going smoothly. And I seem to be on call with the same doc every time. Sometimes this is good and sometimes it's a freakin' stressful struggle. I have truly p*ssed off the call gods I guess. Perhaps I tried to plan something for when I was on call? Did I say the Q word one too many times? Did I try to sleep? It really doesn't take much to upset the call gods.
It can be quite advantageous to have this doc on though when you need lots of time for a woman's labor and you don't want to get any grief. Not so advantageous when you really need him to be there due to a crummy strip. He's very laid back :p
It can be quite advantageous to have this doc on though when you need lots of time for a woman's labor and you don't want to get any grief. Not so advantageous when you really need him to be there due to a crummy strip. He's very laid back :p
Favorite phone call
It's 5am....sleeping well....pager goes off and it says "so-and-so, 3 months pregnant, possible UTI".
At 5am. Are you serious????
So I call the patient.
Me: It's the midwife on call, what can I do for you?
Pt: I'm 3 months pregnant and think I have a UTI. Is that normal?
Me: No, why don't you tell me what symptoms you have?
Pt: I just got up to go pee (and so you thought I should be awake too????) and it burned. Hardly anything came out. I also feel crampy.
Me: Sounds like a UTI. What's your pharmacy number and I will call you in an antibiotic.
Pt: Huh?
Me: Your pharmacy phone number?
Pt: What do you mean?
Me: Where do you want me to call in your antibiotics to? (or did you want me to pick them up and bring them to you?)
Pt: Oh, I don't know.
Me: Do you have a phone book you can look it up in?
Pt: *slight tone of exasperation* Yeah, hold on. (right, because I'm totally inconvienencing you)
*Listening to whispered talking with her lovebug as they attempt to find the phone number of a pharmacy by the hospital.*
Pt: Ok the number is xxxxxxxxxx.
Me: Ok, I'll call it in for you. Start that today, blah blah blah.
I call the number and it's a fax machine. Motherf*ck.
Hence me sitting here on my computer griping as I had to boot my computer up and find a damn pharmacy number. Grrr.
At 5am. Are you serious????
So I call the patient.
Me: It's the midwife on call, what can I do for you?
Pt: I'm 3 months pregnant and think I have a UTI. Is that normal?
Me: No, why don't you tell me what symptoms you have?
Pt: I just got up to go pee (and so you thought I should be awake too????) and it burned. Hardly anything came out. I also feel crampy.
Me: Sounds like a UTI. What's your pharmacy number and I will call you in an antibiotic.
Pt: Huh?
Me: Your pharmacy phone number?
Pt: What do you mean?
Me: Where do you want me to call in your antibiotics to? (or did you want me to pick them up and bring them to you?)
Pt: Oh, I don't know.
Me: Do you have a phone book you can look it up in?
Pt: *slight tone of exasperation* Yeah, hold on. (right, because I'm totally inconvienencing you)
*Listening to whispered talking with her lovebug as they attempt to find the phone number of a pharmacy by the hospital.*
Pt: Ok the number is xxxxxxxxxx.
Me: Ok, I'll call it in for you. Start that today, blah blah blah.
I call the number and it's a fax machine. Motherf*ck.
Hence me sitting here on my computer griping as I had to boot my computer up and find a damn pharmacy number. Grrr.
Friday, February 5, 2010
Eh
My BFF was pestering me to blog but I don't have a lot to say at this particular moment....let me see what I can come up with.
I was irritated this morning when I received a page from a nurse, wanting to know when I was going to round. Basically, when I get there was my response. She claimed the patient was antsy to go (not a delivered patient but an antepartum patient). While that might possibly be true, this particular nurse is well-known for shoving patients out the door as soon as she can. When I am on call for the weekend (and starting early to boot), with no office hours and no patients laboring....I'm gonna round when it's damn well convenient for me! It's not like I live close to the hospital and can just whip by. :pppp
I recently had a run-in with another midwife. I was having a rough night - was up all night and the labor ended in a c/section unfortunately. I had been notified of a patient 'out there' who was 6cms but not in labor. Uh ok. She was a primip and had gotten checked in the office and wanted to go home as contractions had fizzled. She came back that night to get checked again. Nothing had changed and her contractions once again fizzled out. I started to wonder if she had some subconscious stuff going on about the hospital environment. She wanted to go home which was fine with me. She calls me about 2am (waking me from the best 45 minutes of sleep ever) and kinda wants to come back and just be admitted. Ok, sure, whatever. She's 8cms now and contracting about every 5minutes. But they aren't very strong - she's totally relaxed and barely breathing with them when she has one. We discuss options - she wants to try to get some sleep then will be ready consider AROM if labor hasn't progressed. She sleeps for about two hours, then her water breaks spontaneously. Woohoo! By this time, I have 45 minutes of my call left and I am feeling like sh*t. I call the oncoming midwife and ask her to be here at 7. She says, 'well it won't be quite 7 cuz you didn't give me enough time to shower and drive there'....blah blah blah is all I'm hearing. I say 'well, I'm not staying, she's not doing anything' but then I say 'nevermind, I won't leave until I see the whites of your eyes'.
So she arrives shortly after 7....the patient has been in the shower most of that time while I sit at the nurses station looking like a zombie. I give the midwife report and can tell she's perturbed about something. I ask what's wrong? She tells me she's disappointed that I would really leave a patient who was 8cms. I was so mad....I told her that I hadn't left had I? But that the patient isn't doing anything. She totally madfe a snap judgement without knowing the full situation. We go into the room where the patient is fresh out of the shower and very comfortable. She's smiling and chatting. Tells us the contractions seem to have petered out again. The other midwife says 'you're not in labor' and laughs. In my head I'm thinking "see? see??????". I was offended that she thought I would even leave a patient who was transitioning. This patient was 8cms but wasn't in labor. Really.
Anyway, the patient ended up delivering like 8 hours later :pppppppppppp
I was irritated this morning when I received a page from a nurse, wanting to know when I was going to round. Basically, when I get there was my response. She claimed the patient was antsy to go (not a delivered patient but an antepartum patient). While that might possibly be true, this particular nurse is well-known for shoving patients out the door as soon as she can. When I am on call for the weekend (and starting early to boot), with no office hours and no patients laboring....I'm gonna round when it's damn well convenient for me! It's not like I live close to the hospital and can just whip by. :pppp
I recently had a run-in with another midwife. I was having a rough night - was up all night and the labor ended in a c/section unfortunately. I had been notified of a patient 'out there' who was 6cms but not in labor. Uh ok. She was a primip and had gotten checked in the office and wanted to go home as contractions had fizzled. She came back that night to get checked again. Nothing had changed and her contractions once again fizzled out. I started to wonder if she had some subconscious stuff going on about the hospital environment. She wanted to go home which was fine with me. She calls me about 2am (waking me from the best 45 minutes of sleep ever) and kinda wants to come back and just be admitted. Ok, sure, whatever. She's 8cms now and contracting about every 5minutes. But they aren't very strong - she's totally relaxed and barely breathing with them when she has one. We discuss options - she wants to try to get some sleep then will be ready consider AROM if labor hasn't progressed. She sleeps for about two hours, then her water breaks spontaneously. Woohoo! By this time, I have 45 minutes of my call left and I am feeling like sh*t. I call the oncoming midwife and ask her to be here at 7. She says, 'well it won't be quite 7 cuz you didn't give me enough time to shower and drive there'....blah blah blah is all I'm hearing. I say 'well, I'm not staying, she's not doing anything' but then I say 'nevermind, I won't leave until I see the whites of your eyes'.
So she arrives shortly after 7....the patient has been in the shower most of that time while I sit at the nurses station looking like a zombie. I give the midwife report and can tell she's perturbed about something. I ask what's wrong? She tells me she's disappointed that I would really leave a patient who was 8cms. I was so mad....I told her that I hadn't left had I? But that the patient isn't doing anything. She totally madfe a snap judgement without knowing the full situation. We go into the room where the patient is fresh out of the shower and very comfortable. She's smiling and chatting. Tells us the contractions seem to have petered out again. The other midwife says 'you're not in labor' and laughs. In my head I'm thinking "see? see??????". I was offended that she thought I would even leave a patient who was transitioning. This patient was 8cms but wasn't in labor. Really.
Anyway, the patient ended up delivering like 8 hours later :pppppppppppp
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