tag:blogger.com,1999:blog-7085696206433190432024-02-19T21:51:49.873-07:00A Midwife's TaleTales of warm fuzzy feelings, goofy stuff, and a generally crazy and weird journey through life!Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.comBlogger322125tag:blogger.com,1999:blog-708569620643319043.post-26560438065506973262015-04-06T20:27:00.002-07:002015-04-06T20:28:32.517-07:00I'm still here!I swear I have the best intentions. I really want to stay up on blogging but geez, finding time is a struggle.<br />
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Had a really neat birth recently - military and OP. Baby came out successfully but mom had to work hard! I may or may not have accidently poked baby in the eye while trying to determine positioning. Baby had what I call the unicorn hump - molding right where a unicorn horn would be.<br />
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I'm still doing the midwife thing but after a couple really crazy years and a sucky partner, I moved on to a great opportunity that paid better, full benefits, etc. And awesome partners that I can trust and respect. I'm locked in for the long haul I think.<br />
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Getting the itch to go back to school but struggling with what and where. I can't work this crazy kinda call forever. I'm getting old and the years of being on call have definitely taken a toll on my memory. I used to have an awesome memory. Now, I'm all like "can you write that shit down please".<br />
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I got Patricia Harman's new book but haven't had a chance to read it yet. I have no doubt it will be stellar - love her writing! Go get her stuff please!<br />
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<br />Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com0tag:blogger.com,1999:blog-708569620643319043.post-21994651954079560122012-09-03T18:41:00.003-07:002012-09-03T18:43:17.139-07:00Book Review: The Midwife of Hope River by Patricia HarmanOccasionally I get books from <a href="http://us.penguingroup.com/">Penguin</a> to read and review. The books typically involve midwifery in some aspect. I was absolutely delighted at the latest sending! I've read other books by author <a href="http://www.patriciaharman.com/index.htm">Patricia Harman</a>, such as <a href="http://www.patriciaharman.com/the_blue_cotton_gown__a_midwife_s_memoir_71291.htm">The Blue Cotton Gown</a>, and absolutely love her work. Her newest book, The Midwife of Hope River, did not disappoint.<br />
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This fiction piece focuses on Appalachian midwife Patience Murphy. Patience has come to midwifery in a roundabout way, having left her most recent job as a wet nurse, she meets an established midwife in the city. They eventually move to the Appalachians, on the run from political activism resulting in the death of Patience's husband. Here, they find a population in desperate need of midwifery care. In the midst of segregation, depression era conditions, and Patience's own fears and loss, she discovers a new chance at life. She becomes involved in both white and black communities, tending to their childbirth needs, in conditions that I could never imagine working in. She rediscovers a woman's capability and strength to overcome and triumph the harshest conditions, even falling in love again.<br />
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Being a midwife, I found the political climate and conditions shocking. I couldn't imagine having to work under those conditions. This book is easy to read, as Patricia's other books are, and I had to pace myself to not get through it in a couple days! I recommend!Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com6tag:blogger.com,1999:blog-708569620643319043.post-31547675235111060262012-09-03T17:39:00.000-07:002012-09-03T17:39:00.934-07:00The Latest and GreatestHave you missed me? I've missed you. So thought it was high time to write a damn post.<div>
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I'm still plugging away as a midwife. It's been so wonderful to have my passion back for being a midwife. I'm still in the same practice that is much closer to home for me and overall have been very happy. There have been some struggles but I'm overcoming them now that I've been here for over a year. The biggest two struggles have been the large religious population that comes to this practice and a midwife who was specialing lots of the patients.</div>
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Why would the religious crew be a struggle, you ask? Well, I'm not a religious kinda gal. I have a more alternative look about me which doesn't jive with this crowds' look. I just don't fit it in. So, I've had some issues with gaining their trust. But, boy, once they birth with me, I'm their new best friend! LOL. I have mad labor and birth skills and I know it! Just kidding....sorta....</div>
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What I've noticed about the crowd out here where I live is that, there's definitely this dependency vibe going on. Once they have birthed with you - there can't possibly ever be another midwife who can support them. Hence my partner (now ex-partner as she moved on to another opportunity) specialing so many women. She had been there for quite some time and had built up quite the following. It's crazy, cause they become so dedicated to their midwife. So when my partner moved on, it was hell to try and get some of the women who stayed at my practice to give me a chance (and the other partner - who hasn't worked out very well in terms of fitting with the practice). In fact, there were a few who decided to have the doctor attend them in labor instead of getting to know us two remaining midwives. I don't understand that.....if you truly wanted midwifery care then why would you give that up so easily. Then I realized that for some, it wasn't about midwifery care....it was about having a provider they knew well. I have had to coach myself to not take it personally....considering that many never even met me!</div>
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My current remaining partner hasn't been a big hit....frankly, she was the doctor's choice, not ours. She doesn't even know why she became a midwife....there's no passion or genuine love for midwifery. It's puzzled me more than once. I really like her sense of humor but I think there are some issues with her communication style. I've now found myself being asked frequently to special patients. What a 360! I'm trying not to do it too much but it's hard sometimes saying no. I have a greater appreciation for those struggles with my ex-partner (who I do miss very much even though her leaving has made a huge improvement in my satisfaction with my job). So my current partner is moving away and it will just be me for awhile. I'm excited but nervous as I've never been a solo midwife. I'm hoping it doesn't get too busy and I get too overwhelmed. That could potentially take a toll on my health. We do have someone in mind for replacement but I'm not sure yet if that is going to go through. If it does, it will still take a couple months to get her up and running. I'm totally psyched for this midwife as I think she will be a good fit and I really like her.</div>
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Meanwhile, my old partner is lobbying for me to come join her at her new practice. I'm torn about that. I am so much happier being out in the sun now, instead of in the shadows. Would I really want to put myself back in that position? But on the flip side - her place has health benefits that would be very important to me and my family that my current practice doesn't have. I don't have to worry about a decision now since they aren't ready for a new midwife yet. But when the time comes, that won't be an easy decision to make.</div>
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On the personal side of things.....well, wow - lots of change there as well. As you recall, I have a sick husband - he's doing quite well after having a LVAD (left ventricular assist device) put in earlier this year. There's a whole other blog about all that sort of drama (that blog reveals everything about our real identities so you gotta give me a heads up if you want an invite to that). But he's doing amazing and also still waiting for a heart transplant. Our kids are their usual pesky and lovable selves.</div>
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So, last post for another 8 months? Maybe. Maybe not. We shall see!</div>
Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com0tag:blogger.com,1999:blog-708569620643319043.post-31717551736594630212011-12-09T14:24:00.000-07:002011-12-09T14:24:37.245-07:00Hello? *echo*Hello everyone....still here?<br />
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I've had a lot of changes since I was last here. You already know I switched practices and that continues to have been a great decision. My 'new' practice, aside from small bumps here and there, continues to be great. It's such a nice feeling to work with doctors who actually care about women's choices and aren't jerks if the woman makes a different decision than what is being recommended. It's a great feeling knowing that if I am worried about something that the doc I work with will come in, no questions asked, and evaluate. We did have some drama from the third midwife. After working with us for 2 months she took off and went to our competitors. It was a tough few weeks for me as I felt very betrayed. I struggled to get that damn knife out of my back. But I got to a place where I was able to forgive and reinstate our friendship. <br />
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We have a new midwife that started recently - and she seems to be really working out. She has a sense of humor that is like mine and we have fun working together. I think she will be around for the long term. She's a new grad but has been working for years as a L & D nurse. This wasn't important to me but was important to the doc I work for. We are getting her settled and I am thankful for the extra help cause it has been crazy busy. I had patients come with me to my new practice plus patients already there plus all the great word-of-mouth plus my ties with the birth community. Busy!<br />
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The nursing staff at the hospitals I deliver at are great, but very different environments. Hardly any idiots at these facilities so very nice to not have those struggles. They have been adjusting to midwifery care for a couple years now but with more midwives coming in and those of us who perhaps practice a little less medical, the staff have had to adjust a bit more but are doing great.<br />
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There's a practice whose docs are notoriously against any midwifery care, now hiring a midwifery service. I guess they got tired of all the transfers to our practice :p It's so hypocritical but yet, the more midwives in the area, the better!<br />
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I've become so lax in my blogging but am going to try to get back with it and get back to visiting other people's blogs! I've missed the blogging community.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com5tag:blogger.com,1999:blog-708569620643319043.post-77376206018499848952011-02-01T08:20:00.002-07:002012-09-03T17:39:37.854-07:00I'm Still a MidwifeWhen I last 'talked' to you guys I was contemplating leaving midwifery and had started to set some plans in motion. I was applying to school to do another specialty.<br />
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Since then, I have switched jobs! I no longer want to leave midwifery anymore :) I have a new position that is considerably closer to my home and far more supportive environment. I'm working with a wonderful midwife I have known for about 4 years. Even better, one of the midwives from the 'old' job will be joining us soon! <br />
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I miss the midwives but absolutely nothing else at my old position. Things had only gotten worse and I was thinking about taking up drinking - haha. I was gonna call it group therapy though.<br />
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I am still planning to pursue an education in another specialty, waiting to hear if I have been accepted. I feel like it's important to have a back up plan :)Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com8tag:blogger.com,1999:blog-708569620643319043.post-22599348556392944052010-10-24T10:58:00.002-07:002010-10-24T11:09:17.264-07:00That Would Be a Good PostI have had many moments where I have thought "Wow, that would make such a great blog post".<br /><br />Like the time when a postpartum nurse called me to let me know that a patient's H&H was 6.something. So I ask for vital signs, previous CBC results, and symptoms the patient was experiencing if any. The nurse had none of these things readily available. Hello! You are my eyes and ears Nurse. You gotta give me some info.<br /><br />So what's been going on? I'm burned out. That's what is going on. I'm so done. I'm tired of my employer and his idiotic and disrespectful management. I left the office an hour early one day (after insuring that someone else would see my last patient if she showed up). Now mind you, leaving early is a once in a blue moon kinda thing. I was informed a couple days later that if I did that again, I would be charged an hour of PTO. This tempts me to keep a running tally of all the times I stay late, work through lunch, come in to help out, etc. What an ass.<br /><br />I am so burned out that I am thinking about leaving midwifery, or at least trying to find aother job. I would rather be a 'medwife' than deal with the struggle I am dealing with now. We are expected to provide the midwifery model of care in a medical environment. I'm so tired of all the fighting the fight and not really getting anywhere.<br /><br />I am going back to school to learn another specaialty cause I am so done. I have worked as a CNM for three years now. I would have never thought I would burn out this fast.<br /><br /><br /><object width="480" height="385"><param name="movie" value="http://www.youtube.com/v/UZd-l_brLf0?fs=1&hl=en_US"><param name="allowFullScreen" value="true"><param name="allowscriptaccess" value="always"><embed src="http://www.youtube.com/v/UZd-l_brLf0?fs=1&hl=en_US" type="application/x-shockwave-flash" allowscriptaccess="always" allowfullscreen="true" width="480" height="385"></embed></object>Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com14tag:blogger.com,1999:blog-708569620643319043.post-56239513357576791602010-08-01T04:52:00.000-07:002010-08-02T04:53:00.423-07:00Ode to the BestieI just gotta say that my BFF rocks. She really pushes my intellectual boundaries all the time. Lovin' it! We are currently reading the same book together so we can discuss it as we move through the book. I've not ever done that and am really enjoying it.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com6tag:blogger.com,1999:blog-708569620643319043.post-55376059167960966362010-08-01T04:00:00.000-07:002010-08-02T04:48:08.616-07:00Can't trust them multipsHad a couple interesting births lately. Both were somewhat complicated with risk factors, which always makes for some <span id="SPELLING_ERROR_0" class="blsp-spelling-error">excitment</span> :p Both were <span id="SPELLING_ERROR_1" class="blsp-spelling-error">multips</span> - one having her 4<span id="SPELLING_ERROR_2" class="blsp-spelling-error">th</span> baby and the other having her 5<span id="SPELLING_ERROR_3" class="blsp-spelling-error">th</span>.<br /><br />The first lady came in complaining of bleeding. She was contracting with a good bit of uterine irritability. Was only mildly uncomfortable with her contractions. However, there was enough bleeding that it had ran down her leg prior to her arrival. She has a history of substance abuse and has been in treatment for three months. She had only a few visits in the office, poor historian, being confusing when giving her history. She did not have any of her previous babies, but was hoping to 'keep' this one. She didn't have any idea when her last period was so I only had a third trimester ultrasound for dates (which can be off by 3 weeks either way). She had been measuring appropriately for that EDD. Her exam on arrival was 2-3/60/-1. The baby was very active. By her EDD, she was 38 weeks (which means she could be anywhere from 35 to 41 weeks). After watching her for a bit (she was also having the occasional small variable but otherwise had a very reactive strip) then re-checked. She was 3-4/80/-1 with just a small amount of blood on the glove. She continued to be quite comfortable. I decided to just sit on her for the night and admitted for expectant management. I just felt very uncomfortable with sending her home. Her <span id="SPELLING_ERROR_4" class="blsp-spelling-error">UDS</span> was negative <span id="SPELLING_ERROR_5" class="blsp-spelling-error">btw</span>.<br /><br />Eventually, she got uncomfortable and asked for an epidural at 4/90/-1. She <span id="SPELLING_ERROR_6" class="blsp-spelling-error">putzed</span> along. Hours later she was 6/90/-1 so I broke her water figuring we were pretty committed at this point. She continued to have periodic bleeding that was always just a little runnier and heavier than normal show. She progressed to 8<span id="SPELLING_ERROR_7" class="blsp-spelling-error">cms</span> fairly quickly but then kinda stalled out. We flipped her from side to side and she eventually arrived at 10<span id="SPELLING_ERROR_8" class="blsp-spelling-error">cms</span> with no further intervention. She began to push once she was feeling the urge to do so. She took a good half hour to push the baby out and baby came out screaming covered with a small amount of bright red blood. I expected to see evidence of <span id="SPELLING_ERROR_9" class="blsp-spelling-error">abruption</span> on the placenta but none was apparent except for a sort of <span id="SPELLING_ERROR_10" class="blsp-spelling-error">thrombosed</span> vessel at the placental border. Not sure if that was the source of bleeding or what. No lacerations were evident. She was absolutely fine afterwards.<br /><br />The second lady was being watched very closely due to suspected chronic hypertension. She'd had this issue with each pregnancy and a possible <span id="SPELLING_ERROR_11" class="blsp-spelling-error">abruption</span> with one previous pregnancy. She would have elevated <span id="SPELLING_ERROR_12" class="blsp-spelling-error">BPs</span> prior to 20 weeks (which means increased <span id="SPELLING_ERROR_13" class="blsp-spelling-corrected">likelihood</span> of chronic hypertension as <span id="SPELLING_ERROR_14" class="blsp-spelling-error">pre</span>-<span id="SPELLING_ERROR_15" class="blsp-spelling-error">eclampsia</span> doesn't present prior to 20 weeks). We were treating her with medication for her blood pressure. She came in complaining of contractions, just barely shy of full-term (37-42 weeks). She came in requesting an epidural with an exam of 4/50/-3. She got her epidural and then after a few hours went by, no progress had occurred.<br /><br />The head was too high for rupturing her membranes so started <span id="SPELLING_ERROR_16" class="blsp-spelling-error">pitocin</span> instead. I broke her water a couple hours after that, her being 4/80/-2. She took off after that. By 2 hours later she was 9<span id="SPELLING_ERROR_17" class="blsp-spelling-error">cms</span>. We had just enough time to finish a delivery in another room :p<br /><br />When I checked her she was 10<span id="SPELLING_ERROR_18" class="blsp-spelling-error">cms</span> but still very high so even though she was feeling some pressure, I suggested lying on her side (Nurse Crappy was the nurse assigned so you know how that goes!) to let the baby come down on its own. 5 minutes later, it was time. The delivery was great the baby just oozed out on its own. I had dad literally catch. It was awesome to watch!<br /><br />So you would think that women who have had several babies would just spit those kids out. but not always! In fact, once you get up into 5,6, or more kids, the possibility of complications and labor <span id="SPELLING_ERROR_19" class="blsp-spelling-error">dystocia</span> increases :pCiarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com1tag:blogger.com,1999:blog-708569620643319043.post-55427622359592836052010-07-29T19:30:00.000-07:002010-07-29T19:34:21.516-07:00Jacuzzi Tub RationaleI admitted a patient with ruptured membranes, first baby, early labor in the middle of the night one night. I wasn't heading in yet to do labor support as the woman was very early in the labor still...but she was laboring. I left orders for expectant management and to call me when she was a little further along. Apparently the nurse didn't want the woman to get in the tub until I arrived because the head was very low in her pelvis. That's the best rationale I have ever heard to not allow a patient to get a tub. Really? Really.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com3tag:blogger.com,1999:blog-708569620643319043.post-9997329218083212032010-07-27T14:10:00.000-07:002010-07-27T14:11:02.441-07:00I'm Still Such a Sucker SometimesOk, 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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.<br /><br />So when I reflect on this experience, it wasn't one of my better labor managements :pCiarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com3tag:blogger.com,1999:blog-708569620643319043.post-23926526048542584542010-07-26T18:18:00.003-07:002010-07-26T18:32:44.859-07:00OMGYou guys make me wanna cry. The comments from the previous post are so wonderful. It makes me not want to give up up on public blogging. Will ruminate about it a bit more.<br /><br />I had a beautiful birth recently. This little momma was having her first baby. I had met her only at a birth class recently. She came in in labor, was about 4cms, changing to 5cms after walking for an hour. She was contracting very regularly and mildly uncomfortable. She was kinda chilling in the tub, walking around, not doing a whole lot. After a few hours had gone by, I suggested checking her cervix with the possibility of breaking her water or sending her home if she wasn't changing. Unfortunately, she had not changed and did not want to go home. She agreed to getting her water broke, which we did.<br /><br />Since she was fairly comfy I decided to head over to the office to see a few patients. I knew the patient would have the nurse call me when she needed me to be with her. About two hours later she was ready for me. The nurse had said that she didn't want to do anything like the tub or the birth ball. She was very opposed to moving, which was fine! I just sat with her. Finally, she seemed to be losing focus, crying instead. She asked me for something for the pain. I told her, let's check your cervix, if you are close then you just keep doing what you are doing. If not, then we'll discuss the options. <br /><br />Woohoo - she was 8-9cms! So I encouraged her to get in the tub which she agreed to. However, she was unable to sit and felt better standing. She began to get more vocal after a few minutes of standing in the bathroom. Then I saw the first little pushes as she involuntarily beared (or bore down? That sounds weird too) down. Then she says "I feel something!"<br /><br />She climbs into the bed and pushes, totally spontaneous, and I see a little bit of the head. Now, she was -1 station before she stood up! Woohoo - gravity rocks. She pushed her baby out in ten minutes flat :)Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com1tag:blogger.com,1999:blog-708569620643319043.post-8119378997162999642010-07-25T19:51:00.002-07:002010-07-25T19:53:49.856-07:00PrivateI've been thinking about making this blog private for a while now. I talk about personal stuff on here that's pretty specific so worry that someone will figure out who I am. I think if I made this blog private, I would no longer have that stress about it. I also want to eliminate some people's desire to debate the things I say. That's not what my blog is about. It's the one place I have where I can say whatever I want and don't have to discuss the research, etc. <br /><br />So what do you think?Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com23tag:blogger.com,1999:blog-708569620643319043.post-42702605935160873162010-07-24T10:47:00.002-07:002010-07-24T10:49:18.814-07:00I Want a Healthy, Natural Childbirth...This was said in the same appointment that the women also said she would try, but wasn't promising, she wouldn't gain 70 pounds with this pregnancy like the previous ones. Uh, ok.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com9tag:blogger.com,1999:blog-708569620643319043.post-41820871035508572552010-07-22T06:21:00.002-07:002010-07-22T06:29:41.376-07:00Nurse Crappy at Her FinestI was told by Nurse Crappy that one of the docs I work with asked her to grab a midwife if she saw one to break his patient's water. The patient is a multip being induced because she's been 5cms for a couple weeks now. Um, ok. He's gonna be in surgery for awhile. So I go break the lady's water (with her consent of course) and get a ton of fluid. I tell Nurse Crappy "She's still 5cms but I think she's gonna go fast". I head to the OR to first assist on a scheduled section. We're just getting ready to get the baby out when Nurse Crappy comes in and says the other doctor's patient is now a rim and very pushy. Can you please come because the other doctor is in a gyn surgery and can't make it? <br /><br />I tell Nurse Crappy - I'm in surgery as you might be able to see, and can't come either. (Perhaps the other doctor should have thought about the wisdom of breaking a mulitp's water when you won't be readily available) I tell her she better get a resident to come stand by.<br /><br />They get a midwife who's in the office seeing patients to come over as well, which she misses the delivery (but the resident was there for the delivery at least - I wouldn't trust Nurse Crappy to get a patient a glass of water, let alone catch the baby).Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com2tag:blogger.com,1999:blog-708569620643319043.post-87066344470624323332010-07-22T06:11:00.003-07:002010-07-22T06:21:20.099-07:00I'm a Mini-Resident or Let Me Be Your B*tchI was recently on postpartum during call doing rounds. The postpartum nurse (she normally works in the nursery) asks me if I will be seeing a patient who was sectioned over the weekend. I let her know that we don't do post-op rounds, the docs do their own (it's a hospital by-law kinda thing).<br /><br />7 hours later...<br /><br />She calls me at the office and says...<br /><br />"No one ever came to see this patient and she wants to go home. I called Dr S0-and-So who said that no one ever asked him to see that patient. I then called the doctor she was assigned under who seemed rather perturbed and told me to have you come see her, discharge her, and give her an Rx for vicodin."<br /><br />Me?<br /><br />Of course, I get ticked off. I'm at the office seeing patients. I have no reason to go back to the hospital. I'm not his b*tch. So I call him and ask what's going on with this patient.<br /><br />He informs me that he knew she was there because he rounded on her yesterday, but forgot to see her today. Was I still at the hospital? I tell him no, I am in the office seeing patients and have no plans to go back to the hopsital. He says "well ok, just thought if you were there you could see her. I'll call her in a Rx then." Ok then!<br /><br />I had already broken the water of his patient earlier in the day at his request. Gotta draw the line somewhere :pCiarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com0tag:blogger.com,1999:blog-708569620643319043.post-20245525966006636472010-07-17T12:27:00.003-07:002010-07-17T13:37:16.944-07:00Dah-da-da - Nurse Crappy returnsIt's been a really long time since I have even seen Nurse Crappy, let alone had to be torutred...uh, I mean, work with her. Oh, but ye gods decided to smite me with her crappy nursing skills and personality recently.<br /><br />So here's the scoop, I had a patient who was being induced due to gestational diabetes controlled by meds. Oh but wait, I forgot, gestational diabetes doesn't exist. How could I forget such an important point. You might be asking "what the heck are you talking about?" right about now. I guess there are some people out there in the blogosphere talking about how gestational diabetes and preeclampsia do not exist. Or if a mother can't cure herself, then it's her own fault. The sheer idiocy that exists in the world scares me sometimes. I'm not really sure how these people function in the real world....or perhaps thy live in Idiot Land only. I dunno...but I digress...<br /><br />So the patient is getting some cytotec (geez, please don't start - I like cytotec and Henci "Nutcake" Goer be damned). That happens through the night. Then first thing in the morning I get a call from Nurse Crappy. She informs me that the patient has had her 3 doses of cytotec, is feeling a little crampy, and what would I like to do now? Uh. The order I wrote says give one dose of cytotec and can repeat up to 3 more doses. Nurse Crappy says "Oh, well night shift RN (who's kinda a nervous bunny) said it was just three doses." I'm thinking (but I don't say it, Bestie will be proud of me) Oh well, good thing you did a chart review hunh? What I actually say is allow the patient to go for a walk, shower, etc then put the final dose in. <br /><br />About 45 minutes later...<br /><br />Nurse Crappy calls to inform me that the patient is crying and contracting every two minutes so she held the cytotec dose (thank god for small miracles - she can do the right thing occasionally). She requests orders for pain meds, and wants to know what I want done with her. Well, did you check her? Of course not. Nurse Crappy is a firm believer of always doing the opposite of what I want when it comes to cervical exams. If a patient's water has been broke for 24 hours and wants no intervention then she'll check her to satisfy everyone's curiousity. But if the patient is intact and you're calling me to make some decisions regarding the plan of care, well hell, who needs that exam as part of the database for making decisions). Oh, and the baby looks good when she's able to trace it....that would hold up in court really well Nurse Crappy.<br /><br />So the exam has changed, I'm hoping the patient is kicking into labor with no further intervention required (pitocin) so suggest she try putting her in the jacuzzi tub before giving any pain meds. She's not really active yet so not time for me to be there quite yet. Nurse Crappy acts like that's an amazingly novel idea. 30 minutes goes by and Nurse Crappy calls me again. The patient enjoyed the tub and is much calmer now. But she also feels like the contractions of gotten milder. And the contractions have spaced out so I tell Nurse Crappy to give her the final dose.<br /><br />More on this later...Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com2tag:blogger.com,1999:blog-708569620643319043.post-27008533183993310022010-05-17T14:03:00.002-07:002010-05-17T14:13:31.276-07:00Stop Living In the PastI 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...<br /><br />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!<br /><br />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.<br /><br />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.<br /><br />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....<br /><br />What do I say to her?Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com9tag:blogger.com,1999:blog-708569620643319043.post-70219036771546011412010-05-17T13:57:00.002-07:002010-05-17T14:03:30.228-07:00I hate It When...I hate it when...<br /><br /><ul><li>water breaks prior to the onset of labor</li><li>onset of labor doesn't occur by 24 hours out from rupture of membranes</li><li>it's momma's first baby and her cervix is unfavorable</li></ul><p>It frustrates me when...</p><ul><li>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'</li><li>I don't ever moan and groan to the preceding midwife about what I get 'left' but it happens to me </li><li>patients call on weekends about minor gyn problems - really, it can wait a few more hours until the office opens!</li></ul><p>I love it when...</p><ul><li>things go smoothly and no intervention is necessary</li><li>a baby is born vaginally</li><li>I can leave the board clear for the oncoming midwife</li></ul>Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com5tag:blogger.com,1999:blog-708569620643319043.post-29812908853028853552010-05-15T09:37:00.003-07:002010-05-15T09:47:27.606-07:00Transplant Evaluation and stuffMy husband has been doing well considering. Energy level has improved to slightly above zilch :p <br /><br />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.<br /><br />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.<br /><br />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.<br /><br />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.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com1tag:blogger.com,1999:blog-708569620643319043.post-16452467126291175032010-05-15T09:33:00.003-07:002010-05-15T09:37:31.391-07:00Cesarean ScarI'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 <a href="http://navelgazingmidwife.squarespace.com/">Navelgazing Midwife</a> started up a new website - <a href="http://www.cesareanscar.com/">CesareanScar.com</a>. I bow to her amazing skills and intuitive nature!<br /><br />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.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com0tag:blogger.com,1999:blog-708569620643319043.post-14568965964062017412010-05-15T09:26:00.003-07:002010-05-15T09:33:12.561-07:00Favorite 'duh' moment of the dayIt's 4am. The pager goes off.<br /><br />Nurse - I have a patient who came in for r/o labor. She was 2cms when she got here (<span style="color:#000099;">ok, it's her first baby - just send her home at this point!) </span><span style="color:#000000;">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?</span><br /><br />Me - I suppose recheck her in 30 minutes and send her home if she hasn't changed, otherwise page me back <span style="color:#000099;">(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!)</span><span style="color:#000000;">.</span><br /><br />1 hour later....the pager goes off.<br /><br />Nurse - She's 3-4cms now.<br /><br />Me - jeezus, send her home already - tell her to come back when they are closer together and stronger (<span style="color:#000099;">which should have been the plan when she came in at 2cms)</span><span style="color:#000000;">.</span><br /><br />Nurse - Can I offer her something to help her sleep?<br /><br />Me - Sure....we could have done that 2 hours ago.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com2tag:blogger.com,1999:blog-708569620643319043.post-27198876466542138992010-05-15T09:23:00.003-07:002010-05-15T09:26:44.330-07:00I posted this cuz I think it's incredibly interesting and fascinating....<br /><br /><a href="http://www.drmomma.org/2010/03/diaper-free-video.html">Diaper Free </a>on <a href="http://www.drmomma.org/">Peaceful Parenting</a> shows us a new eco-friendly and green way to live.<br /><br />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!<br /><br />h/t to Kathy at <a href="http://womantowomancbe.wordpress.com/">Woman to Woman CBE</a>Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com1tag:blogger.com,1999:blog-708569620643319043.post-15781126250277998282010-04-28T17:12:00.003-07:002010-04-28T17:20:05.453-07:00Latest Adventures of Nurse CrappySo yet again, I have p*ssed someone off and gotten the worst nurse there - Nurse Crappy. <br /><br />Even one of the docs I was doing a section with (their patient, not mine) was ready to bang her head against the wall. This doc is one of the nicest most patient docs ever. But Nurse Crappy can do that to you.<br /><br />My BFF joked that she ran into Nurse Crappy in the cafeteria and asked her to not kill my patient today. That had me laughing at least.<br /><br />But I have to be nice. There's been a b*tchfest recently about us midwives on the part of some of the nursing staff. I can't bark orders at intellectually challenged nurses anymore. I have to mentor them instead. F*cking p*sses me off. I don't see my job as being about educating and mentoring the nursing staff - don't get me wrong, will do this with those I like and those that are interested in that from us - but it's not my job to focus on nursing staff development. Seriously - that's what the nursing educator is for. Not really sure what she does. But theoretically that's her job. I see my job as protecting my patients from those who are lazy or incompetent. It gets old....hence the 'barking' of orders.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com2tag:blogger.com,1999:blog-708569620643319043.post-50651170418066422452010-04-28T16:46:00.002-07:002010-04-28T17:11:42.601-07:00The ExorcistI had the privilege of witnessing a scene from the Exorcist recently - minus the vomiting of split pea soup :p<br /><br />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.<br /><br />Fastforward several hours later. <br /><br />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.<br /><br />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.<br /><br />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.<br /><br />2 hours later...<br /><br />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.<br /><br />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*Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com0tag:blogger.com,1999:blog-708569620643319043.post-82773734193616537302010-04-26T18:19:00.003-07:002010-04-26T18:44:52.398-07:00Holy Cow - Babies Galore!I have been so crazy busy lately! Let me update you first on my husband's status...<br /><br />I brought him home (yep, he's still surviving on that 5%!) after 8 days in the hospital. He and I were both getting a little stir crazy. It was finally decided that he didn't meet the requirements for the three lead pacemaker. Both the nephrologist and the internal med doc said "He needs a heart". Well, thanks for that newsflash :P The cardiologist who really wanted the pacemaker pretty much bowed out once it was decided that the pacemaker wasn't gonna help. The 'winning' cardiologist ended up discharging him home after putting him on a new beta-blocker (sotolol - go ahead look it up.....it'll scare the crap out of ya). He had been having lots of PVCs and had 2-3 runs of V-tach (non-sustained). He didn't have any awareness of the V-tach episodes as they weren't fast enought to trigger his AICD nor did they last more than 24 seconds. Nice. As if anxiety levels weren't slightly elevated already. He was to follow up the following week and the transplant route is now under way. We got an information packet from the transplant program and the newest leg of the adventure begins. Currently waiting on insurance authorization to proceed with scheduling the appointment for the consult. He's been in much better spirits since coming home. No coughing and down about 34 pounds total. I'm still not used to his new look - skinny :p<br /><br />I have been on call a lot due to another midwife being out of town. I have caught so many babies in such a short time that some of the labors and births have blended together a little :( I was on call for my weekend and broke my previous record of 7 babies in a weekend! I got about 3 hours of sleep in a 41 hour period of time...and not all in a row! Everyone that came in wanted to have natural childbirth. I was so exhausted that I started hoping women would get epidurals so I could sleep. But then of course, I felt guilty for thinking that. But it was really the sleep-deprivation speaking. If I recall correctly, I had something like 4 epidurals, 1 IV pain med labor, and 4 natural childbirths. <br /><br />Two of the women were ladies I had seen a lot of in the office so it was extra special to get to catch their babies. One lady had a history of vacuum assisted birth with her first child and very much wanted to avoid it this time. She did! But it was getting to be a close call. In fact I had called the doc on call to come in to stand by vacuum. In the meantime, she got riled up and pushed her baby out about the time he arrived. I was very happy for her...and the baby was almost half a pound bigger than her first! I don't know if she just reached a point where she had a psychological block and couldn't get past it initially or what. <br /><br />The other lady was having her first baby and had a beautiful natural childbirth - one of those ones where everything goes smoothly and damn near perfectly. Love it!<br /><br />I've had some more births since that weekend...lots of fun and interesting births but can't remember much right now :p I think I have a touch of stress, busyness, and maybe some fibro fog going on :p I need to try and blog more often before i forget details I guess. We'll see what I can do.Ciarinhttp://www.blogger.com/profile/01265859556543021100noreply@blogger.com1