I was on call a couple nights ago for 12 hours during the night. What I thought was going to be a beautiful birth, turned into a very unpleasant and teeth-grinding experience.
It starts out with finding out I get an awesome nurse whom I really enjoy working with but rarely get to as she is usually charge nurse. So we're thinking that we are gonna have this really nice birth in the evening, then I'll go home and be in my own bed :)
Not so at all!
The patient was a very young primip who I had seen a few times in the office. I felt like we had bonded but then I hadn't seen her in a couple weeks. She has some extenuating circumstances which I really didn't know any details about, in terms of her social system. Anyway, she's in active labor when I get there (the previous midwife had admitted her around 3 or 4 pm, when she was 5cms). She's planning natural childbirth and has a pretty straightforward birth plan. She has two doulas (one of which is one birth away from being a homebirth midwife - which is what she told the nurse). My first moment of unease occurs when I walk in the room to say hello and the doula is right in the patients' face. I can't really establish a connection as the doula doesn't move away at all. Ok. Well, she has a crowd of people around her aside from the doula so I decide to just say hi and head out of there.
I realize it's not about me but about the patient but it still felt weird to not be able to really establish, or re-establish the connection. I'm not used to that. So I just let it go and kinda chill at the nurse's station.
Later, she requests a vag exam - about two hours since the last (the previous midwife had called her 6-7cms). I check and am disappointed to discover that I can't call her any more than 7cms. I offer to break water....she consents to that. I now figure she will zoom along and we'll have a baby soon.
Wrong.
Next exam - 8 (and this is being generous)cms, no descent. Cxns every 5-7 minutes???? WTF??? Now, I am kinda wondering what is going on. Does the patient have a psychological block? She's also starting to fight the labor - won't relax at all...even in the absence of contractions. The family doesn't seem to be on the same page as the patient and doulas. Whatever, I'm totally staying out of it.
An hour later - the patient feels like she needs to push. Exam - no change. Contractions still not very strong and still spaced out. I decide to have the pitocin talk as patient is not tolerating things very well anymore and is getting exhausted. She yells at me. I leave the room without saying a word.
I'm totally pissed. I've never been yelled at by a patient. I have had it with her snottiness (she has been this way with others as well - the nurse, family). I absolutely cannot stand bad behavior in labor - there's no excuse for that.
The patient sends her sister out to let me know I can come talk to her now. Oh really. The sister says she told her that I looked pretty upset when I came out. You don't say. I tell the sister that I will come back a little later when I have chilled out first.
There were no more episodes like that, at least with me.
Eventually the patient agrees to pitocin after trying some other things first. She begins to progress. She gets to complete and pushes for about an hour to deliver her 9 pound baby with a 1st degree tear and some bruising after a mild shoulder dystocia. I then get the third degree about the repair I am doing. Jeez lady, give me a friggin break.
I'm just glad it's over. While we were finishing all this up triage went nuts, with several being my patients. I delivered a baby for another midwife from another practice and one for the doctor she works with. I admitted one very preterm patient for observation and 3 others for labor. People were having to wait in triage to get beds on L&D, with people waiting for eval out in the lobby, including one of my patients who was scheduled for induction but put on hold - however thought she was in labor. She sat out there for an hour screaming. The patient and her husband are pain in the butts and this was pretty typical of her behavior. I knew she was at least 3 cm since she had a foley bulb that came out during the night. She was 5cms when we were finally able to eval her. Then it was time for me to go home ....thank god.
I hugged the oncoming midwife when she got there.
Friday, January 9, 2009
Wednesday, January 7, 2009
Things of interest
After having five straight days off hanging with the kids and my husband I was ready to go back to work! I love them, but jeez they drive me crazy after awhile. You hear the five-year-old constantly hollaring for her brother to come help her with something or another. The 8-year-old just thinks she knows everything! And the 14-year-old grumbles and moans if you ask him to do something like take out the trash, empty the dishwaher etc. It's enough to make you run out of the room screaming....which I did a couple times :)
I have just been in the office since returning to work. I am on call tonight and then all weekend...woo...hoo. I hope it's either feast or famine and not in between :p
I had a young mother in the office the other day who I had to call the crisis intervention line for. She's on her third baby and has a lot of different psychosocial issues. I felt so bad for her, wishing there was a magic wand I could wave and fix it all for her. I don't know what happened after I left as they were there at the office quite late talking with her. I hope they have some good recommendations for her and she will follow through.
I have a patient who looks just like Milla Jovovich! What a trip! I caught her first baby and am now seeing her with this one. Hopefully will catch this one too.
I have another lady who I have been seeing all through her pregnancy. It's her first baby, and she's due today I think...she's planning natural childbirth and does not want induction at 41 weeks (which is fine). She is open to membrane stripping but her cervix is closed still. I tried to reassure her that the baby knows his birthday but she is miserable with contractions and seemed rather surprised when I mentioned that they will get stronger. She was whining a bit and I felt like telling her to just suck it up. But I couldn't do that as she and her husband are absolutely the sweetest people I have ever met. So I told her to suck it up in a really nice way :)
Well, I have only four hours of office today prior to going on call for just 12 hours. It has been decreed that we midwives must be in the office as much as possible to build our practice...*sigh* But we can't convince the powers that be to give us 20 or even 15 minute time slots for return OB visits. Now we all take however much time we need with each patient, which naturally results in us running behind to varying degrees. So instead of giving us extra time for those visits, the powers-that-be agreed to an extra ten minutes out of every hour as a blocked slot in which to play 'catch-up'. In return we had to add 30 minutes of time to all our office hour shifts AND they took away out emergency only blocked slots - which were rarely used. We got screwed in the end because when I calculated the time out...we are actually working an additional 20 minutes on top of what we were before. It doesn't balance out, that's for sure. And now the office staff that schedules appts will manipulate these blocked slots to where you will be booked two hours straight then get 20 minutes of catch-up time.
I have just been in the office since returning to work. I am on call tonight and then all weekend...woo...hoo. I hope it's either feast or famine and not in between :p
I had a young mother in the office the other day who I had to call the crisis intervention line for. She's on her third baby and has a lot of different psychosocial issues. I felt so bad for her, wishing there was a magic wand I could wave and fix it all for her. I don't know what happened after I left as they were there at the office quite late talking with her. I hope they have some good recommendations for her and she will follow through.
I have a patient who looks just like Milla Jovovich! What a trip! I caught her first baby and am now seeing her with this one. Hopefully will catch this one too.
I have another lady who I have been seeing all through her pregnancy. It's her first baby, and she's due today I think...she's planning natural childbirth and does not want induction at 41 weeks (which is fine). She is open to membrane stripping but her cervix is closed still. I tried to reassure her that the baby knows his birthday but she is miserable with contractions and seemed rather surprised when I mentioned that they will get stronger. She was whining a bit and I felt like telling her to just suck it up. But I couldn't do that as she and her husband are absolutely the sweetest people I have ever met. So I told her to suck it up in a really nice way :)
Well, I have only four hours of office today prior to going on call for just 12 hours. It has been decreed that we midwives must be in the office as much as possible to build our practice...*sigh* But we can't convince the powers that be to give us 20 or even 15 minute time slots for return OB visits. Now we all take however much time we need with each patient, which naturally results in us running behind to varying degrees. So instead of giving us extra time for those visits, the powers-that-be agreed to an extra ten minutes out of every hour as a blocked slot in which to play 'catch-up'. In return we had to add 30 minutes of time to all our office hour shifts AND they took away out emergency only blocked slots - which were rarely used. We got screwed in the end because when I calculated the time out...we are actually working an additional 20 minutes on top of what we were before. It doesn't balance out, that's for sure. And now the office staff that schedules appts will manipulate these blocked slots to where you will be booked two hours straight then get 20 minutes of catch-up time.
Wednesday, December 31, 2008
Retard moment of the week...
I'm in a delivery with terminal bradycardia and yucky decels. Nursery nurse is standing by and I have my labor nurse at the bedside with me. The patient, who speaks no English, is pushing well and delivery will occur before I can get a doc there to vacuum. The head is crowning, the nurse asks me if I will cut an epis to hasten delivery (and this isn't the retard moment). I say no and instead do minimal Ritgen's maneuver.
Head delivers with loop of cord hanging out.
The head is big.
The patient is very small.
I tell the nurse to pull the emergency call light to get some extra help. She then prepares to do suprapubic pressure and McRoberts all by herself as I can tell it will be a tight fit.
Over the intercom "Can I help you?"
Huh? The normal response when the emergency call light goes off is no one answers it...cause nurses are busy rushing into the room.
I say "We need help in here"
"Who would you like?"
Please shoot me now. What the f*** is going on?
I say "nurses"
No one ever comes. So I am totally pissed off and wondering what the hell happened. Fortunately the nurse and I managed the shoulder dystocia, which was mild, and had a good outcome.
Turns out that someone on the postpartum unit answered the call light and never bothered to call back to L&D to let them know or check if there was a problem.
Lovely. Postpartum was told not to answer L&D call lights ever again.
Oh, the patient delivered over an intact perineum - 8 pound baby and her first as well.
Head delivers with loop of cord hanging out.
The head is big.
The patient is very small.
I tell the nurse to pull the emergency call light to get some extra help. She then prepares to do suprapubic pressure and McRoberts all by herself as I can tell it will be a tight fit.
Over the intercom "Can I help you?"
Huh? The normal response when the emergency call light goes off is no one answers it...cause nurses are busy rushing into the room.
I say "We need help in here"
"Who would you like?"
Please shoot me now. What the f*** is going on?
I say "nurses"
No one ever comes. So I am totally pissed off and wondering what the hell happened. Fortunately the nurse and I managed the shoulder dystocia, which was mild, and had a good outcome.
Turns out that someone on the postpartum unit answered the call light and never bothered to call back to L&D to let them know or check if there was a problem.
Lovely. Postpartum was told not to answer L&D call lights ever again.
Oh, the patient delivered over an intact perineum - 8 pound baby and her first as well.
Catch-up
I hope everyone has been enjoying their holidays - Happy New Year's!
We had a great Christmas, lots of family time. Very relaxing just sitting around the fireplace, playing Wii, etc. Christmas dinner, courtesy of my husband, was excellent!
I was on call yesterday and aside from being very busy in the office, it was pretty laid back. I had a Burmese lady who I had never met that came in and had her baby in the late morning. It's really so frustrating when there is a language barrier. It becomes very difficult to make a connection with someone. It really makes me realize how important language is to us. At least with hispanic women I can speak a few words.
Aggravating things in the office this past couple weeks...
1. On Monday I saw at least 6 pregnant women who were dehydrated. Drink ladies drink!
2. Yesterday, the trend of the day was spotting/bleeding in the first trimester. One lady went to the hospital the weekend before Christmas, when she was about 12 weeks. She went even though the midwife on call advised her to stay home and wait until Monday unless, of course, worsening of symptoms occurred. Well, the patient tells me it wasn't convinient (I never can get the spelling right on this word) since she had to work Monday and she just wanted some piece of mind. What she wanted was an ultrasound! The hospital did this whole work up and everything was completely normal. Go figure. As I listened to her talk about it was easier to go to the hospital then wait and come to our office a day later, I kept thinking "well, it's not easier when I have to pay the bill for people who take advantage of their free medical care". Grrr....I once had a patient tell me, when I was a L&D nurse, after I said that I wanted to get the last little bit out of her IV bag..."oh, that's no big deal, I don't have to pay for it anyway". I actually told her "well I do" but I don't think she got it.
3. Spotting on and off for four days at 6 weeks pregnant....a family member asks for an ultrasound.....um, no.
Anyway, that's enough being snarky....these things sometimes get frustrating though. Plus, it's a really bad time of the month this month for me with PMDD. I've got one nerve left and everyone wants to step on it!!!!
I'm off for the next five days so plan to get some stuff done around the house, chill, watch movies, and of course, catch up on blogging!
We had a great Christmas, lots of family time. Very relaxing just sitting around the fireplace, playing Wii, etc. Christmas dinner, courtesy of my husband, was excellent!
I was on call yesterday and aside from being very busy in the office, it was pretty laid back. I had a Burmese lady who I had never met that came in and had her baby in the late morning. It's really so frustrating when there is a language barrier. It becomes very difficult to make a connection with someone. It really makes me realize how important language is to us. At least with hispanic women I can speak a few words.
Aggravating things in the office this past couple weeks...
1. On Monday I saw at least 6 pregnant women who were dehydrated. Drink ladies drink!
2. Yesterday, the trend of the day was spotting/bleeding in the first trimester. One lady went to the hospital the weekend before Christmas, when she was about 12 weeks. She went even though the midwife on call advised her to stay home and wait until Monday unless, of course, worsening of symptoms occurred. Well, the patient tells me it wasn't convinient (I never can get the spelling right on this word) since she had to work Monday and she just wanted some piece of mind. What she wanted was an ultrasound! The hospital did this whole work up and everything was completely normal. Go figure. As I listened to her talk about it was easier to go to the hospital then wait and come to our office a day later, I kept thinking "well, it's not easier when I have to pay the bill for people who take advantage of their free medical care". Grrr....I once had a patient tell me, when I was a L&D nurse, after I said that I wanted to get the last little bit out of her IV bag..."oh, that's no big deal, I don't have to pay for it anyway". I actually told her "well I do" but I don't think she got it.
3. Spotting on and off for four days at 6 weeks pregnant....a family member asks for an ultrasound.....um, no.
Anyway, that's enough being snarky....these things sometimes get frustrating though. Plus, it's a really bad time of the month this month for me with PMDD. I've got one nerve left and everyone wants to step on it!!!!
I'm off for the next five days so plan to get some stuff done around the house, chill, watch movies, and of course, catch up on blogging!
Monday, December 15, 2008
The weekend
The weekend on call was not too bad. I had three babies and those were all convinently (sp) during the day. I spent my nights at home in my own bed. I even got to go to the office Christmas party.
One thing of note...
About midnight last night, just as I had fallen asleep, I got another call from the triage nurse at the hospital. Apparently the doctor on call for the weekend (from another practice) had asked her to see if I would come in for a delivery on a doctor patient that had just come in and gone from 4 cms to 6 cms while in triage.
Uh....no.
I like this doctor and have caught babies for her in the past so she wouldn't need to come in....but that was when I was already there! I'm not getting out of my warm bed in the middle of the night for a doctor patient whom I have never met!
I had dental work done this morning - oh joy. But damn that nitrous oxide is good stuff!
One thing of note...
About midnight last night, just as I had fallen asleep, I got another call from the triage nurse at the hospital. Apparently the doctor on call for the weekend (from another practice) had asked her to see if I would come in for a delivery on a doctor patient that had just come in and gone from 4 cms to 6 cms while in triage.
Uh....no.
I like this doctor and have caught babies for her in the past so she wouldn't need to come in....but that was when I was already there! I'm not getting out of my warm bed in the middle of the night for a doctor patient whom I have never met!
I had dental work done this morning - oh joy. But damn that nitrous oxide is good stuff!
Friday, December 12, 2008
Lack of writing
I haven't been blogging much - just very tired and a wee bit overwhelmed with holiday stuff. So I have given myself permission to blog only when I feel like it :) Things may be a bit slow over the next couple weeks in that case.
Vegas was fabulous fun but we made a deposit instead of a withdrawal :p I discovered single-deck blackjack and loved it. I actually made some of our losses back playing that. The odds are supposed to be better anyway with single deck.
Work is busy busy - haven't been on call since before leaving for Vegas but start call tonight until Monday morning. My first weekend....I'm a little nervous.
I'm having a hard time in the office with some of my ladies - there are several that I have been seeing almost exclusively and feel so very bonded with. So then I am telling them I will try to be there for their delivery. I shouldn't be doing this so much though - it can take up a lot of personal time and my girls are always disappointed when I have to leave for a baby :( I feel very torn.
Vegas was fabulous fun but we made a deposit instead of a withdrawal :p I discovered single-deck blackjack and loved it. I actually made some of our losses back playing that. The odds are supposed to be better anyway with single deck.
Work is busy busy - haven't been on call since before leaving for Vegas but start call tonight until Monday morning. My first weekend....I'm a little nervous.
I'm having a hard time in the office with some of my ladies - there are several that I have been seeing almost exclusively and feel so very bonded with. So then I am telling them I will try to be there for their delivery. I shouldn't be doing this so much though - it can take up a lot of personal time and my girls are always disappointed when I have to leave for a baby :( I feel very torn.
Saturday, December 6, 2008
Busy busy busy
Been busy around here...
I missed three of four deliveries this past week! #1 came in complete and pushing (and it was her 6th baby - she had her legs crossed when she came up in the wheelchair...or so the nurse told me :) #2 happened as I was coming out of the OR from first assisting. I missed #3 by half a minute - got stuck in traffic due to an accident between the hospital and my office (and she came in 9cm, second baby). *sigh*
Finally finished decorating for Christmas today and am exhausted.
We leave for Vegas tomorrow (my husband and I) for a couple nights so will catch up more later in the week!
Oh, and read a couple good books I would recommend if you like to read memoirs.
Playing Catch by Sarah Urang - totally my type of personality, funny, irreverent, check it out!
A Midwife's Story by Penny Armstrong, etc - I love reading about the Amish culture/lifestyle. I came close to taking a job in this area - it's absolutely gorgeous!
Currently reading Brisngr...
I missed three of four deliveries this past week! #1 came in complete and pushing (and it was her 6th baby - she had her legs crossed when she came up in the wheelchair...or so the nurse told me :) #2 happened as I was coming out of the OR from first assisting. I missed #3 by half a minute - got stuck in traffic due to an accident between the hospital and my office (and she came in 9cm, second baby). *sigh*
Finally finished decorating for Christmas today and am exhausted.
We leave for Vegas tomorrow (my husband and I) for a couple nights so will catch up more later in the week!
Oh, and read a couple good books I would recommend if you like to read memoirs.
Playing Catch by Sarah Urang - totally my type of personality, funny, irreverent, check it out!
A Midwife's Story by Penny Armstrong, etc - I love reading about the Amish culture/lifestyle. I came close to taking a job in this area - it's absolutely gorgeous!
Currently reading Brisngr...
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