Tuesday, July 27, 2010

I'm Still Such a Sucker Sometimes

Ok, I agreed to an induction for a patient of mine. Totally elective and the wisdom of inducing this particular patient was lost to me until there was no turning back.

I've known this patient for a couple years, as in providing her care during that time. She's a very large lady, close to not being able to get a weight on our office scale (tops out at 350). She's shy about her body and experiences exhaustion towards the end of pregnancy due to the extra load. I don't blame her a bit, or anyone else for that matter, for being miserable in the summer heat at the end of a pregnancy.

So here she is, term, and begging for induction. Her cervix is very favorable - 4/80/-2. It's her 4th baby. I agreed to an AROM induction.

She had a rough time with the last baby - blaming it on the pain meds she opted for with the last baby. She decided she might get an epidural this time if she needed something. Hopefully, things would go smoothly and she would just take off and birth without needing anything.

And of course, that's not how things went. She piddled around for several hours after I broke her water. She finally asked for pitocin to get things going and wanted an epidural. She was 5cms at this point, contracting sporadically. I advised her that if she was sure she wanted the epidural, to do it now so she could maintain the optimal position for it due to her size. Then we used just a 'whiff' of pitocin and she took off.

When I decided to use the pitocin, I figured I had better touch base with the doc on call with me. Which is when it hit me that the wisdom of the induction in a woman this size was not the brightestmove on my part. I felt so stupid for not having given this any thought prior to doing it, or consulting with the doc prior to now. Ugh.

But anyway, he was fine with starting pitocin....although I didn't come out and say I scheduled this. :p I was a chicken. Everything went very quickly with the labor....5 to delivered in about 3 hours (I even shut the pit off when she was freaking out, we were up to only 4mus). She didn't like the epidural either. I think she just doesn't like the transition stuff - gets very panicked and borderline hysterical.

So when I reflect on this experience, it wasn't one of my better labor managements :p


AtYourCervix said...

Live and learn, right?

Pam said...

Just found your blog and LOVE IT!!!!!!!!!! I found it off of AtYourCervix.
OH PLEASE DO NOT MAKE IT PRIVATE!!!! I just love it!!!!!!!!!!

Doula mama Pam

Rochelle said...

I love your blog too. I come here when I start to doubt my ability to be a nurse midwife in a hospital. I will be starting my first semester of nursing school in less than a month and you bring me so much inspiration.