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!

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.

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

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.

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

Busy Playing

I've been quite busy playing this weekend. I went out Friday night with my BFF and was very naughty. We started out with dinner at an awesome modern Hawaiian restaurant. I had 4 vodka martinis. I only knew this because I counted the little olive sticks the next day. I kept the olive sticks for my mother who drinks dirty vodka martinis at home....well not like, all the time....just after work and social events so maybe 6 days a week. but she totally doesn't have a problem. Really. Anyway, she was needing some little sticks for her olives and these ones were pretty darn cool.

Anyway, we ate yummy stuff. I remember eating the abalone calamari which was not fried but grilled I think and was delish! We also had Poke. My BFF didn't care for it as much - I guess it didn't taste like what she remembers from Hawaii. I loved it though so ate it right up. I love Ahi tuna - *drool*. Then she had ribs and I had something, but can't remember what it was. Fish I believe. And there were yummy grilled plantains! We sat by the firepit during this time. We laughed, cried, and had a fabulous time. Or so I'm told.

Next stop on the agenda, after dropping off leftovers in the fridge, was a local coffee shop. It was very cozy and the chick at the counter was very friendly. Very trendy and very gay :) Loved it! I had some coffee and a cookie, tried to sober up a bit. It didn't work. LOL.

Then we headed to the monorail thing, which I haven't ever been on. We rode that for a while, chatting, until the guy in front of us turns around and asks "Are you guys lesbians?" Turns out, Carlos is gay and new to the area. So we bonded with him for awhile and invited him to have a drink with us at some straight sports bar. So martini #5 was had along with some Perrier for hydration. I was starting to slack on water consumption. I don't normally drink this much and will try to drink lots of water and have food.....But I was feeling no pain. In fact, my kneee felt the best it has felt since I hurt it. Woohoo!

We left that bar and parted ways with gay Carlos. I got his email though to stay in touch :) We rode the rail back to where we started, grabbed a car and headed to a gay bar next. In fact it's the same bar I blew out my knee. I wanted to see if anyone remembered me - LOL! No one did. It was dead there but good music (no, I didn't dance.....but really wanted to). I had martinis' #6 and 7. I was ready to head to another gay bar to play pool but my BFF couldn't hang anymore and wanted to crash. Thus ending the night. It was so much fun and I actually remember most of it!

The next day I was just a little tired but had to run some errands with my mom....then game night with BFF, mommy, and stepdaddy. More alcohol....but at a much slower rate.

Today....payback for all that. I am tired! Will head to bed early tonight as I have to go in to help with a breech version in the morning. This will be the second one she's had. The baby flipped back to breech after the first go around. If she flips back to vertex, the plan is to induce her. I'm hoping all is successful. I don't like the idea of the induction but even worse is the idea of a c/s. Keep your fingers crossed.

Peanut

I have been asked occasionally what the 'peanut' is when I reference its use in some of my birth stories. Here's a picture...

They can be found in stores carrying exercise equipment, or online by doing a search for 'peanut-shaped exercise ball'. The kid is not included.

The Good, The Bad...

I had a very tough situation recently (unfortunately I can't go into details here, it's a difficult case to HIPPAize). I felt traumatized by this experience and embarrassed by the care given by staff as well as professionals that were involved. If I felt so bad, I wonder how my patient felt? *sigh* It's a shame when the Bad stuff seems to outshine the Good stuff. And there's far more of the Good stuff.

I had a rockin' waterbirth (oops) recently. I had seen this patient a couple times in the office and enjoyed chatting with her. Her last baby came really fast and she delivered at home, unassisted, then transported to the hospital for a repair. This time she showed up with ruptured membranse and dilated 3cms. She wasn't very uncomfortable and I opted to try and sleep just a little more, until she needed me. An hour later, the nurse calls me to say she's 6cms. Holy sh*t, what the hell was I thinking, going back to sleep?????? I rush up to the hospital and she's in the bed coping well. We get her in the tub and she moans and groans her way through her labor. She feels more pressure and wants to be checked. I check her in the tub and she hasn't changed. I tell her that likely the baby's head just needs to be readjusted and she will finish. I suggest hands and knees in the tub. She goes from side to side for awhile then tells me she has had enough. I ask her if she wants to go home - lol. Finally, she gets up on her knees and leans on the edge of the tub. Booyah. " I gotta push!"

I tell dad to see if he can feel the baby's head when she pushes. He isn't sure....after all, he's only done this once before. I check and can feel the head getting ready to crown. I tell dad - ok, all yours! I watch as the head crowns then briefly assist with maneuvering the shoulders then baby through her legs while having dad lift the baby from her front side into her arms. It was awesome!