Wednesday, April 28, 2010

The Exorcist

I had the privilege of witnessing a scene from the Exorcist recently - minus the vomiting of split pea soup :p

This particular patient was a really nice lady that showed up wanting to VBAC. Unfortunately she was barely dilated and her water had broke. I always hate it when that happens because even though we can be pretty liberal with time constraints, it still creates a sensation of pressure for everyone involved - the midwife, the patient and her family, the nursing staff, etc. This lady was very much wanting not only a successful VBAC but a very natural experience as well. I was able to accomodate this up to a certain point. The plan was to leave her be to ambulate, do nipple stim, etc in the hopes of increasing the little bit of labor she was having. Her labor appeared very prodromalish (is this a word?) to me. I was a little concerned but kept that to myself. I gave her a peptalk (inlcuding a discussion about previous c/s baggage and letting it go) and everyone was on board with the POC (plan of care). Under no circumstances did she want an epidural. I've heard that before and usually dread hearing it. It inevitably sets a woman up for guilt IMO, if she decides, once she's in the heat of the moment, to get an epidural.

Fastforward several hours later.

The patient and myself are both ready to move to the next step as labor hasn't seemed to progress. The POC is a nap with a narcotic to help her sleep for a bit then on to pitocin. I head off to get some dinner and chill for a bit. I get a call from the nurse who says the patient woke up from the nap feeling like things were different and that she felt herself dilating. She doesn't want pitocin and thinks that the birth will be sooner rather than later. Ok. Stranger things have happened so I head back to the hospital.

She feels like she needs to push. I check her - *sigh* disappointment for all, she's progressed a little but still in the latent phase of labor in terms of dilation. She falls back to sleep. I head out to try and get some sleep myself - feeling really tired as all the husband health stuff is taking its toll on my autoimmune issues.

Once we hit the 18 hour mark, the patient and everyone are in agreement with re-evaluating her cervix. Nothing has changed, so now we start pitocin. I tell the nurse to call me when she gets active and I will come back.

2 hours later...

The nurse calls to let me know the patient is demanding my presence at her bedside...WTF? She also wants more narcotics. I, being a little irritated with this demand for me to be at her bedside, fall back asleep. I know, not very nice or mature of me....was also really feeling tired. A little more time goes by and the nurse calls again to let me know the patient wants to know where I am at. Has she called her doula to come? Nope. But I better get my a$$ up there ASAP. Apparently she called out on the call light screaming. Now she wants an epidural. She's now 4cms. And the pit was shut off at the patient's demand. I head in and arrive as she is signing the consent for the epidural. She looks so exhausted but not really seeing the behavior from her that the nurse was describing to me. Of course, the relationship between the provider and patient is different from the patient and nurse relationship frequently. She absolutely wants the epidural so we go with it.

Once the epidural is in, mom is sound asleep, pit re-started, and baby looks good, I go home to bed with 4 hours of call left. The oncoming midwife caught her baby just over 4 hours later. I'm very happy that she was successful in VBACing....but I feel worried that she may not be happy with her birth experience. *sigh*

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