Monday, May 17, 2010

Stop Living In the Past

I have a patient who is living in her obstetrical past. She is a wonderful woman, very intelligent, with a pleasant sense of humor. I very much enjoy seeing her prenatally. But...

She's living in the past as far as labor and birth is concerned. No matter what I say to her, she can't seem to move out of the past. I would love and appreciate some words of wisdom on how to handle this!

Her second baby came rather precipitously after laboring all day and only being slightly dilated when the midwife checked her. So the midwife goes home. The patient delivers 90 minutes later unattended. Was the midwife correct in her assessment of cervical dilation or did the patient really gor from almost nothing to delivered in 90 minutes? I don't know.

Her third baby was a long torturtous back labor and pushing out of an OP (posterior) baby. She very much hopes to avoid that again (I don't blame her!). So, every week at the office I feel for the baby's position via Leopolds.....and the remains OA. I tell her this, showing her exactly where the baby's parts are, etc. Still she is fixated on the fear of an OP labor and birth.

She came in recently for a cervical check due to contracting all day. She does not love close to the hospital at all. She's worried that if she cmes in she will just get sent home and the same thing will happen as baby #2 because these contractions feel the same way. I reassure her that the nurses don't decide when she gets to go home, and that I won't send her home without waiting for a bit. Turns out false alarm....

What do I say to her?

I hate It When...

I hate it when...

  • water breaks prior to the onset of labor
  • onset of labor doesn't occur by 24 hours out from rupture of membranes
  • it's momma's first baby and her cervix is unfavorable

It frustrates me when...

  • I call to give the oncoming midwife report and she appears to have an attitude of 'I can't believe you are leaving anything for me other than a perfectly normal spontaneous labor'
  • I don't ever moan and groan to the preceding midwife about what I get 'left' but it happens to me
  • patients call on weekends about minor gyn problems - really, it can wait a few more hours until the office opens!

I love it when...

  • things go smoothly and no intervention is necessary
  • a baby is born vaginally
  • I can leave the board clear for the oncoming midwife

Saturday, May 15, 2010

Transplant Evaluation and stuff

My husband has been doing well considering. Energy level has improved to slightly above zilch :p

We are waiting on word from the transplant coordinator regarding dates for the 4-5 day intensive evaluation. I suspect this is something we will do a lot of....waiting.

Otherwise, not much else going on. We've been debating about cancelling our family vaca this summer. We finally decided to see if we could get a refund on airfare - keep your fingers crossed. It was decided that if we could get that money back then we would do a local vaca instead. But now with the week off I will need for the eval, may just cancel the vaca altogether and instead make the eval week a vaca. I would not need to be there every day and so could take the kids to do things. Then spend the evenings and weekend doing some fun stuff as a family - of course allowing for some naps for him! I just want to conserve my PTO.

We're trying to figure out what he should do this fall for school. It's no longer feasible for him to continue the program he was in due to the physical aspects. I suggested another course of action - do another program, just take one class a semester in somthing fun...ya know, for sh*ts and giggles to keep his mind occupied but not run up a lot of student loan debt.

As the medical bills are starting to roll in, I am anxiously awaiting the decision on his disability paperwork. The website says a decision has been made but we have to wait for snailmail to find out what the decision was :( I'm hoping the eval will be scheduled by the end of the month as the insurance deductible is almost completed for him - would then only add about $300 in medical bills to what I am currently dealing with. If it happens after June 1st then the deductible starts over again....$3000. Keep your fingers crossed.

Cesarean Scar

I'm so woefully behind on blogging and reading blogs but will make a valiant attempt at 'catching up' on the blogosphere. While I was off tending to family, etc Navelgazing Midwife started up a new website - I bow to her amazing skills and intuitive nature!

I like this website as it gives women another chance to share their stories about birth and cesareans. It brings a human face to the numbers and statistics.

Favorite 'duh' moment of the day

It's 4am. The pager goes off.

Nurse - I have a patient who came in for r/o labor. She was 2cms when she got here (ok, it's her first baby - just send her home at this point!) so I had her walk. I recehcked her and she was 3cms. So I sent her back out to walk and will re-check her in 30 minutes. What do you want me to do with her?

Me - I suppose recheck her in 30 minutes and send her home if she hasn't changed, otherwise page me back (thinking, 'wow, you could have made this a one wake-up episode if you ahd just waited the thirty damn minutes then woke me up!).

1 hour later....the pager goes off.

Nurse - She's 3-4cms now.

Me - jeezus, send her home already - tell her to come back when they are closer together and stronger (which should have been the plan when she came in at 2cms).

Nurse - Can I offer her something to help her sleep?

Me - Sure....we could have done that 2 hours ago.
I posted this cuz I think it's incredibly interesting and fascinating....

Diaper Free on Peaceful Parenting shows us a new eco-friendly and green way to live.

I don't know if I believe this or not but wow - just think of the trees we could be saving...not to mention money!

h/t to Kathy at Woman to Woman CBE