Today is the first day of the nurse midwifery service - woohoo!!!! I hope that things are going well for the new midwife in the office. I left a welcome note on her desk along with clearing off Dr I Never Chart's charts. I love this doctor but dear god, he's like a dog marking his territory - everywhere he goes he leaves a stack of charts.
I am on call tomorrow for 24 hours and we have a provider meeting as well. Should be interesting - I hear the docs are having issues amongst themselves.
Monday, September 8, 2008
Blogs I like
I'd like to tell you about the blogs I follow...
At your Cervix - Tales of labor and delivery as well as a CNM in the making, also lots of beautiful photography and interesting personal stories. A must Read!
Billybob's Wild Ride - a gentleman who has some very serious health problems along with amazing talent as a graphic artist.
Crass Pollination: an ER Blog - A nurse with extreme attitude who tells fab stories of life in the ER...you won't get this version on Trauma in the ER.
My Labor for Love - a nurse who tells great triage and L&D stories with a nice sarcastic hint of humor (which I love). In fact, she sounds so much like a Nurse at the hospital I sometimes wonder if its her!
N is for Nurse - a blog I just started following today. This nurse is a newbie working L&D. She tells the good and the bad about her struggles as a new nurse. Anyone in nursing and/or midwifery should be able to relate.
Navelgazing Midwife - Tales of a midwife from a more political and activist view
OB/GYN Kenobi - tales from a OB/GYN - I find this interesting because it's neat to get the perspective of the 'other side' - meaning hearing a doctor discuss their adventures.
Sage Femme - Tales of homebirth...love reading her posts and sometimes a little green with envy
The Midlife Midwife - a CNM not doing births but love reading her, sometimes almost poetic, writing about life in the office. I can very much relate to many things she writes.
At your Cervix - Tales of labor and delivery as well as a CNM in the making, also lots of beautiful photography and interesting personal stories. A must Read!
Billybob's Wild Ride - a gentleman who has some very serious health problems along with amazing talent as a graphic artist.
Crass Pollination: an ER Blog - A nurse with extreme attitude who tells fab stories of life in the ER...you won't get this version on Trauma in the ER.
My Labor for Love - a nurse who tells great triage and L&D stories with a nice sarcastic hint of humor (which I love). In fact, she sounds so much like a Nurse at the hospital I sometimes wonder if its her!
N is for Nurse - a blog I just started following today. This nurse is a newbie working L&D. She tells the good and the bad about her struggles as a new nurse. Anyone in nursing and/or midwifery should be able to relate.
Navelgazing Midwife - Tales of a midwife from a more political and activist view
OB/GYN Kenobi - tales from a OB/GYN - I find this interesting because it's neat to get the perspective of the 'other side' - meaning hearing a doctor discuss their adventures.
Sage Femme - Tales of homebirth...love reading her posts and sometimes a little green with envy
The Midlife Midwife - a CNM not doing births but love reading her, sometimes almost poetic, writing about life in the office. I can very much relate to many things she writes.
Sunday, September 7, 2008
Office scheduling
I'd like to take a little time to explain to women how an office schedule works. Now this may not be typical for everyone, it may vary a little from practice to practice. Productivity is key while also trying to maintain quality. This is a nearly impossible task that is only worsens when someone shows up late for their appointment.
The owner of the practice I work at does not want us to re-schedule patients for any reason (including their being late) unless we absolutely have to. We also take walk-ins.
Our time slots for various visits are as follows...
New OB Visit 20 min
New OB visit new to our practice 40min
Return OB visit 10 min
Gyn 20min
New to our office Gyn 40min
Consults 40 min
Postpartum visits - 20min
The doctors have it worse - they get less time for some of those visits. Also keep in mind that some of the time allotted is used by the MA (vitals, restroom, etc).
So, if I have woman booked back to back for various types of visits (which I usually do - my schedule stays pretty full) and say...1/4 show up late (this is probably slightly underestimating) anywhere from 5 to 30 minutes late...guess what happens?
I am a big believer (naturally, I'm a midwife) in quality visits. I want to address everyone's concerns, questions, etc. I want to bond and educate as well. If a woman needs the time and attention, I give it to her. However, if women show up late...it makes it really unfair to them, me, and the other women who showed up on time. Everyone has to wait. I have to be stressed out about how far behind I am. I have to practice the art of getting the quality in there but cutting down on time spent in te room. I work through my lunch every now and then. I stay late, which means sacrificing my time with my family and children.
I understand that many of our clientele may have transportation issues...if the bus is late I totally get that. Maybe babysitting issues...bring them with you - I don't mind (most of the time - like the woman who brought her 3 year old son who kept repeatedly hitting her while she just ignored him - it was all I could do to not turn him over my knee and whack him). Kids are ok - I can work around them most of the time. But don't give me the " I forgot what time my appt was", "I ran into traffic" (for god's sake you know where we live - the friggin' traffic capital in the state!), etc.
Be on time please!!!!! Be considerate. Be early! Sometimes when a woman shows up early I will attempt to get seen early so they don't have to wait. I thank them for being early - I appreciate early and on time.
I hope this helps those on the 'outside' understand a little bit about life on the 'inside' at the office!
The owner of the practice I work at does not want us to re-schedule patients for any reason (including their being late) unless we absolutely have to. We also take walk-ins.
Our time slots for various visits are as follows...
New OB Visit 20 min
New OB visit new to our practice 40min
Return OB visit 10 min
Gyn 20min
New to our office Gyn 40min
Consults 40 min
Postpartum visits - 20min
The doctors have it worse - they get less time for some of those visits. Also keep in mind that some of the time allotted is used by the MA (vitals, restroom, etc).
So, if I have woman booked back to back for various types of visits (which I usually do - my schedule stays pretty full) and say...1/4 show up late (this is probably slightly underestimating) anywhere from 5 to 30 minutes late...guess what happens?
I am a big believer (naturally, I'm a midwife) in quality visits. I want to address everyone's concerns, questions, etc. I want to bond and educate as well. If a woman needs the time and attention, I give it to her. However, if women show up late...it makes it really unfair to them, me, and the other women who showed up on time. Everyone has to wait. I have to be stressed out about how far behind I am. I have to practice the art of getting the quality in there but cutting down on time spent in te room. I work through my lunch every now and then. I stay late, which means sacrificing my time with my family and children.
I understand that many of our clientele may have transportation issues...if the bus is late I totally get that. Maybe babysitting issues...bring them with you - I don't mind (most of the time - like the woman who brought her 3 year old son who kept repeatedly hitting her while she just ignored him - it was all I could do to not turn him over my knee and whack him). Kids are ok - I can work around them most of the time. But don't give me the " I forgot what time my appt was", "I ran into traffic" (for god's sake you know where we live - the friggin' traffic capital in the state!), etc.
Be on time please!!!!! Be considerate. Be early! Sometimes when a woman shows up early I will attempt to get seen early so they don't have to wait. I thank them for being early - I appreciate early and on time.
I hope this helps those on the 'outside' understand a little bit about life on the 'inside' at the office!
Wednesday, September 3, 2008
Judge Judy
I was watching Judge Judy yesterday (yes, I love that crazy old bat). There was a...umm..whatchamacallit.....uh...the person who brings up frivilous lawsuits....what are they called? I'm totally going blank here.
But anyway, she was telling Judge Judy how she worked on and off because of disability. Here's the basic convo (not word for word - I took a little creative license)...
Judge Judy: Why are you on disability?
Lady: I have a medical condition called...(wait for it.....wait.....)...endometriosis.
Judy: How do you support yourself?
Lady: I collect disability and have (been totally scamming the system) for the past two years for this condition. I haven't worked the last three months because of it.
Judge Judy obviously knows nothing about endometriosis because she doesn't rip this lady a new asshole.
I have never heard of anyone getting disability for this condition...even if their insides are falling out and dragging on the ground bleeding (how's that for a visual). Never. My husband with a bad heart and ejection fraction of 10% (borderline transplant list) got turned down for disability...twice. Yet Ms Endometriosis got it....please shoot me now.
But anyway, she was telling Judge Judy how she worked on and off because of disability. Here's the basic convo (not word for word - I took a little creative license)...
Judge Judy: Why are you on disability?
Lady: I have a medical condition called...(wait for it.....wait.....)...endometriosis.
Judy: How do you support yourself?
Lady: I collect disability and have (been totally scamming the system) for the past two years for this condition. I haven't worked the last three months because of it.
Judge Judy obviously knows nothing about endometriosis because she doesn't rip this lady a new asshole.
I have never heard of anyone getting disability for this condition...even if their insides are falling out and dragging on the ground bleeding (how's that for a visual). Never. My husband with a bad heart and ejection fraction of 10% (borderline transplant list) got turned down for disability...twice. Yet Ms Endometriosis got it....please shoot me now.
New hours
I'm starting these new hours that I so suckerishly agreed to. Seems I am the only one who said they would be willing to do late hours, come in late and stay late. So today will be the first day of that 12-7. So far it's kinda cool because I am sitting here in my pajamas (didn't want to inspire too many visual images so will leave out the description) blogging and checking out other peoples' blogs. Will let you know how it goes.
Monday, September 1, 2008
Beautiful birth
Had a beautiful birth the other day. This was a gravida 2 para 1 lady that I had been seeing since about 20 weeks. She and her husband are just the sweetest people. She had been struggling with a lot of prodromal labor. We had also been following her closely throughout her pregnancy because of a history of preterm labor and birth. I told her that if she made it to term she would probably go overdue! Seems like if a woman makes it to term that will inevitably be what happens :p
She went into the office for a labor check and was 5cm dilated so the midwife sent her over to me. The funny thing is she was scheduled for induction of labor that evening. She would have been put on hold since L&D was so busy. Anyway, she came over and wanted to walk for awhile so she did that. After about half an hour she wanted to try the whirlpool but didn't really like that. That was a surprise as most women enjoy the tub during labor. She tried the birth ball but didn't get as good of relief as she did with just sitting on the toilet. But she was embarrassed to sit on the toilet. I told her to go for it if that's what worked for her. So she's sitting on the toilet for awhile when she tells me she needs to be push and wants to be checked. So I check her and she just has an anterior lip (this is a way of saying she's 9.5cm) but really needs to push. So I try to break her water but can't quit snag the membranes - must have been the bag of steel! But it popped on its own a minute later. The lip went away and she pushed. She really was very well focused and delivered her son a few minutes later with just a small tear. She did such an amazing job. All told, she was at the hospital for only an hour and a half.
It's kinda funny because there was another lady scheduled for induction who came in during the night in labor. This lady delivered four minutes after the other one. Needless to say I missed the delivery but got to do the placenta - woohoo. Then she's apologizing to me for not being able to stop delivering until I got there (we had a family practice resident who caught the baby)! I told her not to apologize - she had to do what her body was telling her to do! I just think that's funny that sometimes women will apologize for delivering before you can get there.
She went into the office for a labor check and was 5cm dilated so the midwife sent her over to me. The funny thing is she was scheduled for induction of labor that evening. She would have been put on hold since L&D was so busy. Anyway, she came over and wanted to walk for awhile so she did that. After about half an hour she wanted to try the whirlpool but didn't really like that. That was a surprise as most women enjoy the tub during labor. She tried the birth ball but didn't get as good of relief as she did with just sitting on the toilet. But she was embarrassed to sit on the toilet. I told her to go for it if that's what worked for her. So she's sitting on the toilet for awhile when she tells me she needs to be push and wants to be checked. So I check her and she just has an anterior lip (this is a way of saying she's 9.5cm) but really needs to push. So I try to break her water but can't quit snag the membranes - must have been the bag of steel! But it popped on its own a minute later. The lip went away and she pushed. She really was very well focused and delivered her son a few minutes later with just a small tear. She did such an amazing job. All told, she was at the hospital for only an hour and a half.
It's kinda funny because there was another lady scheduled for induction who came in during the night in labor. This lady delivered four minutes after the other one. Needless to say I missed the delivery but got to do the placenta - woohoo. Then she's apologizing to me for not being able to stop delivering until I got there (we had a family practice resident who caught the baby)! I told her not to apologize - she had to do what her body was telling her to do! I just think that's funny that sometimes women will apologize for delivering before you can get there.
Flippant remarks
I was reading my last post and now feel bad for making a flippant remark about the 26 weeker. I don't want to go into detail here about it but she had a bad outcome a couple days later. While I am not responsible I still feel bad. So the lesson of the day is if you feel like something is wrong, don't hesitate to call and go to triage if you are that concerned.
Thursday, August 21, 2008
Update
Well, I went and did it again...been so busy I went and disappeared on everyone.
Thoughts for today
1. Just because the baby is not moving every hour at 26 weeks, please don't come to triage more than once a day!
2. Please don't wait until 2am to call me and ask me if it's normal for your legs and feet to be swollen at 38 weeks - I'm not going to induce you because of it and certainly not at 2 in the morning.
3. Please don't send over a patient to the hospital as a direct admit without calling the person on call to give them a heads up!
Ok, just a recent glimpse into my life lately :p
So, great changes are a afoot in midwife land. We have a new midwife starting soon and will be able to go back to a midwifery service again - yah!!!!! I anticipate this will alleviate some of the stresses and strain of dealing with my fav doctor. I haven't been working with him much lately but have still accumulated some fun stories for you.
Story #1
The patient I am seeing is 37 weeks, has been seeing Dr I'm Scared of Big Babies throughout her pregnancy. She wants a second opinion. She had a vaginal delivery with her first baby (who was 7lbs 8 ozs), c/s with her second for breech. Now she wants to VBAC but is scheduled for c/s the following week because the baby is 'big' (89th percentil by US the previous week). So I have the VBAC, big baby discussion with her. She decides she wants to give it a try. I tell her I believe she can do it. Outcome - we induced at 40.4 weeks, I estimated 9 lbs, she delivered VAGINALLY a 8 and a half pound handsome little boy. I told her to go see Dr I'm Scared for the postpartum visit - just kidding!
Story #2
I called in at 5:45 am to see if I needed to be there at 7am when I start call. Was told there was a 'midwife' pt there who was 7cm. I decided to come on in a touch early since Dr I'm Scared was there waiting for another delivery. Unfortunately I did not make it there on time (I live a fair distance away) and missed the delivery by five minutes. The doctor came out a little later and asked to talk to me. He wanted to vent about 'midwife' patients and how this patient was 'uncooperative' because she didn't want to lie on her back to deliver, among other things. *snicker* I tried to explain to him that patients aren't difficult and uncooperative just because they don't do as they are told like good little children.
I really actually like this Dr personally - just professionally he makes me cringe. Doesn't even let dads cut cords and god forbid if a dad wanted to help catch the baby. I think there is something terribly romantic and special about having a dad's hands be the first to touch the baby.
Ok, enough for now....gonna go look at other people's blogs and I promise I will try to post a little more often!
Thoughts for today
1. Just because the baby is not moving every hour at 26 weeks, please don't come to triage more than once a day!
2. Please don't wait until 2am to call me and ask me if it's normal for your legs and feet to be swollen at 38 weeks - I'm not going to induce you because of it and certainly not at 2 in the morning.
3. Please don't send over a patient to the hospital as a direct admit without calling the person on call to give them a heads up!
Ok, just a recent glimpse into my life lately :p
So, great changes are a afoot in midwife land. We have a new midwife starting soon and will be able to go back to a midwifery service again - yah!!!!! I anticipate this will alleviate some of the stresses and strain of dealing with my fav doctor. I haven't been working with him much lately but have still accumulated some fun stories for you.
Story #1
The patient I am seeing is 37 weeks, has been seeing Dr I'm Scared of Big Babies throughout her pregnancy. She wants a second opinion. She had a vaginal delivery with her first baby (who was 7lbs 8 ozs), c/s with her second for breech. Now she wants to VBAC but is scheduled for c/s the following week because the baby is 'big' (89th percentil by US the previous week). So I have the VBAC, big baby discussion with her. She decides she wants to give it a try. I tell her I believe she can do it. Outcome - we induced at 40.4 weeks, I estimated 9 lbs, she delivered VAGINALLY a 8 and a half pound handsome little boy. I told her to go see Dr I'm Scared for the postpartum visit - just kidding!
Story #2
I called in at 5:45 am to see if I needed to be there at 7am when I start call. Was told there was a 'midwife' pt there who was 7cm. I decided to come on in a touch early since Dr I'm Scared was there waiting for another delivery. Unfortunately I did not make it there on time (I live a fair distance away) and missed the delivery by five minutes. The doctor came out a little later and asked to talk to me. He wanted to vent about 'midwife' patients and how this patient was 'uncooperative' because she didn't want to lie on her back to deliver, among other things. *snicker* I tried to explain to him that patients aren't difficult and uncooperative just because they don't do as they are told like good little children.
I really actually like this Dr personally - just professionally he makes me cringe. Doesn't even let dads cut cords and god forbid if a dad wanted to help catch the baby. I think there is something terribly romantic and special about having a dad's hands be the first to touch the baby.
Ok, enough for now....gonna go look at other people's blogs and I promise I will try to post a little more often!
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