The evil drug pitocin - the bane of any woman's existence who desires natural childbirth.
Not so.
Pitocin gets a bad rap. This has happened due to misuse, overuse, whatever. But pitocin can be our friend at times. It can be the difference between a vaginal delivery and a c-section. When used judiciously, pitocin is good.
Now, I know what many will say...pitocin creates such unnatural contractions and makes it harder for woman to have natural childbirth. Granted yes, it is not possible to mimic the brain's pulsatile release of oxytocin. However, if those natural contractions were strong enough (read painful enough) then we wouldn't even be having this conversation.
Others might say what about more natural ways of encouraging stronger contractions...
My thoughts....
1. If you are walking through the woods and see a mushroom, would you pick it and eat it? Probably not, because it could be poisonous. Not everything 'natural' or herbal is safe. I do think herbs have a place in healthcare (after all I want to get a PhD in Naturopathy) but as withany other type of medicine, careful and considerate use. I'm not opposed to the use of blue and black cohosh - but not necessarily comfortable either. Pitocin has a very well researched history. If I have to choose, at this time I'm likely to choose pitocin. Once cohosh goes in there's nothing I can do to control it if it works too well.
2. Nipple stim - yes, go for it...but unless you wanna be brushing the crumbs off for hours, it doesn't seem to be terribly helpful.
3. Walking/positioning, etc - we do all these things to encourage things. This is typically the first line of defense so to speak.
My point is, that I am willing to try different things prior to resorting to pitocin. Pitocin is last resort for many of my ladies.
Thursday, January 22, 2009
Tuesday, January 20, 2009
Ride
I get a call from a patient in the middle of the night because she thinks she might be in labor. I ask her some questions and it certainly sounds like she is in labor. It's her first baby. I tell her to go to the hospital when she is ready, to get checked out. I'm thinking she will be something like 4 or 5 cms and I'll get to not go in since she was planning an epidural. Then she starts mentioning that she and her husband's truck is not running.
Ummm....ok.
Shall I come pick you up?
C'mon, what do you want me to do about it? Call EMS if you have to I guess :( I figure you knew you were pregnant for nine months....you knew labor would happen at some point, right? So, plan a little bit.
Two and a half hours later, she arrives at triage (she found a ride, no EMS). She has advanced dilatation and the baby is breech. Lovely. Guess who got to get up and go first assist?
On the lighter and less crabby side...I had two very nice natural births. One never seemed that uncomfy until right at the very end - wow! The other had a rude awakening. Her first baby came very quickly - because she arrived at the hospital 8cms! They broke her water and she delivered 30 minutes later. This time she was 5cms and with a thick cervix. I warned her that it might not go very quick as she wasn't that active. She wanted me to break her water which I did. After several hours of minimal progress, we started pitocin. It didn't take much - we never got past 5mu/min and I actually had the nurse turning it down once she was active. My plan had been to turn it off so we could hopefully let her finish on her own. But she delivered before that - the pit was on 2mu.
1st baby - 4 hour labor
2nd baby - 10-12 hour labor
Go figure. Mother Nature is a tricky lady!
Ummm....ok.
Shall I come pick you up?
C'mon, what do you want me to do about it? Call EMS if you have to I guess :( I figure you knew you were pregnant for nine months....you knew labor would happen at some point, right? So, plan a little bit.
Two and a half hours later, she arrives at triage (she found a ride, no EMS). She has advanced dilatation and the baby is breech. Lovely. Guess who got to get up and go first assist?
On the lighter and less crabby side...I had two very nice natural births. One never seemed that uncomfy until right at the very end - wow! The other had a rude awakening. Her first baby came very quickly - because she arrived at the hospital 8cms! They broke her water and she delivered 30 minutes later. This time she was 5cms and with a thick cervix. I warned her that it might not go very quick as she wasn't that active. She wanted me to break her water which I did. After several hours of minimal progress, we started pitocin. It didn't take much - we never got past 5mu/min and I actually had the nurse turning it down once she was active. My plan had been to turn it off so we could hopefully let her finish on her own. But she delivered before that - the pit was on 2mu.
1st baby - 4 hour labor
2nd baby - 10-12 hour labor
Go figure. Mother Nature is a tricky lady!
Thursday, January 15, 2009
Call so far today
Another busy day in the life of a CNM.
I am friggin' exhausted.
Yesterday I spent the better part of 16 hours working with a personal patient. Her birth plan could have been a checklist of what was not gonna happen. I finally had to go home in the evening as I was so exhausted with no baby in sight. The other midwife caught the cute kid five hours after I left. Delivery was followed by a retained placenta. I went and saw her today and she and hubby were quite happy. I think she felt that even though things didn't go as she had hoped, she was satisfied that we had tried very hard to make things happen they way she wanted.
Flexibility - key.
So I didn't sleep well last night worrying about her so much. This set me behind in rest for today :p
I had a scheduled c/s to first assist on bright and early. Then a I caught a baby of a young lady who showed up completely dilated - she did great but had a couple smallish tears that wouldn't quite bleeding so had to sew 'em up. I noticed that she had a bit of a rectal prolapse while I was down there, which surprised me in someone so young (19) and hvaing a second baby. Come to find out - her first baby, which was 'delivered' by residents in a teaching hospital, she had a fourth degree laceration. For a 5 and a 1/2 pound baby. WTF?
Then a crash c/s, which I first assisted on as it was my patient :( I hate hate hate to see multips get sectioned with a previous history of vaginal deliveries. But it was a fetal distress kinda thing that had been a problem since she arrived. We tried.
But on the other hand, I have now first assisted 6 times and am feeling much more confident.
Then I sat around waiting on a grand multip to have her baby.
I'm hoping for a very quiet night....please please please!
I am friggin' exhausted.
Yesterday I spent the better part of 16 hours working with a personal patient. Her birth plan could have been a checklist of what was not gonna happen. I finally had to go home in the evening as I was so exhausted with no baby in sight. The other midwife caught the cute kid five hours after I left. Delivery was followed by a retained placenta. I went and saw her today and she and hubby were quite happy. I think she felt that even though things didn't go as she had hoped, she was satisfied that we had tried very hard to make things happen they way she wanted.
Flexibility - key.
So I didn't sleep well last night worrying about her so much. This set me behind in rest for today :p
I had a scheduled c/s to first assist on bright and early. Then a I caught a baby of a young lady who showed up completely dilated - she did great but had a couple smallish tears that wouldn't quite bleeding so had to sew 'em up. I noticed that she had a bit of a rectal prolapse while I was down there, which surprised me in someone so young (19) and hvaing a second baby. Come to find out - her first baby, which was 'delivered' by residents in a teaching hospital, she had a fourth degree laceration. For a 5 and a 1/2 pound baby. WTF?
Then a crash c/s, which I first assisted on as it was my patient :( I hate hate hate to see multips get sectioned with a previous history of vaginal deliveries. But it was a fetal distress kinda thing that had been a problem since she arrived. We tried.
But on the other hand, I have now first assisted 6 times and am feeling much more confident.
Then I sat around waiting on a grand multip to have her baby.
I'm hoping for a very quiet night....please please please!
Duh Moments of the day
1. Said to another midwife by a patient when asked who she was planning to have at her birth for an attendant (midwife or doctor)? "I think I will have a doctor because I'm afraid the midwife will get in the way of my husband supporting me during labor.
- Ok, sunshine - let us know how that one works out!
2. Said to me (numerous times this one occurs) after counseling on 5, 10, 12 pound, etc weight gains in far too short a time..."I don't eat that much".
- Well sweetie, got bad news for ya...you aren't having a baby, you're having an elephant!
3. Said to me after counseling a pregnant patient on smoking cessation - "My last doctor said that smoking was good for keeping the baby from getting too big".
- Please stop procreating
- Ok, sunshine - let us know how that one works out!
2. Said to me (numerous times this one occurs) after counseling on 5, 10, 12 pound, etc weight gains in far too short a time..."I don't eat that much".
- Well sweetie, got bad news for ya...you aren't having a baby, you're having an elephant!
3. Said to me after counseling a pregnant patient on smoking cessation - "My last doctor said that smoking was good for keeping the baby from getting too big".
- Please stop procreating
Tuesday, January 13, 2009
An update
So I recently posted on An Unpleasant Experience and wanted to give you the update. One of the other midwives rounded on her the next day and she was absolutely thrilled with her birth experience and me. She told the midwife that I was great!
It's interesting how differently the perspectives can be.
It's interesting how differently the perspectives can be.
G7P5
I forgot to tell you about one of those births from this weekend...
This woman was a term patient who came in with contractions and appeared to be quite uncomfortable with them. This would be her 6th baby and another VBAC for her. :)
Her vag exam was closed/80/-2. Hmm, ok....but she has a history of fast labors and is contracting regularly. So she walks for a couple hours. Now she's 1-2/80/-2. Ok....well, let's let her walk another hour and just keep an eye on her.
Now normally, I would have sent the woman home when we discovered she was closed....but it is her 6th baby, and she looks sooooo uncomfy.
Afetr another hour she's 2-3/80/-2. Hmmm.....ok, go home. Come back when you are complete (which is what she would inevitably do - with me being at home when it happens). I go talk to her, planning to send her home, but am really just bothered by how much pain she seems to be in. It doesn't match where she is in labor. So I check her just to be sure...
She's now 3-4/100/-2, 15 minutes after the nurse had checked her. Ok, maybe we'll just keep her then.
An hour later, she's 8/100/-2 with a BBOW.
Less than an hour after that we had a baby. Wow.
This woman was a term patient who came in with contractions and appeared to be quite uncomfortable with them. This would be her 6th baby and another VBAC for her. :)
Her vag exam was closed/80/-2. Hmm, ok....but she has a history of fast labors and is contracting regularly. So she walks for a couple hours. Now she's 1-2/80/-2. Ok....well, let's let her walk another hour and just keep an eye on her.
Now normally, I would have sent the woman home when we discovered she was closed....but it is her 6th baby, and she looks sooooo uncomfy.
Afetr another hour she's 2-3/80/-2. Hmmm.....ok, go home. Come back when you are complete (which is what she would inevitably do - with me being at home when it happens). I go talk to her, planning to send her home, but am really just bothered by how much pain she seems to be in. It doesn't match where she is in labor. So I check her just to be sure...
She's now 3-4/100/-2, 15 minutes after the nurse had checked her. Ok, maybe we'll just keep her then.
An hour later, she's 8/100/-2 with a BBOW.
Less than an hour after that we had a baby. Wow.
L&D Rules
I found this and thought I would share....labor and delivery nurses will get it...everyone else, maybe not. This is a joke!
Rules of the Labor and Delivery area
1. Don't ask me if my wheel can tell you if you got knocked up on the 15thor 16th. That's too damn close to have 2 different partners anyway.Just suffer for 8 more months, assuming the father is not the one it should be. For real. I get asked when a patient may have conceived from time to time. Usually it's related to being sure who the FOB is
2. Bed rest does not include walking around Walmart or running by the mall topick up something. I'm gonna start handing out this instruction when I have to put someone on bedrest!
3. Don't come in the middle of the night because you've been throwing up for a week and then ask me to get you something to eat.
4. Breathing hard and faking to your family like you're having contractions WON'T open up your cervix.
5. Tears and rolling around in the bed also will NOT open your cervix.
6. Doing sit ups while in the bed to make the monitor "go up"also... WILL NOT open your cervix.
7. Until your cervix is opening, don't plan on staying.
8. If you fight with your boyfriend and need a little TLC... go to his mother's house, not the labor room.
9. If you are there with someone in labor, don't try to read the strip and tell me what's going on. You don't know the difference between a fart and a contraction and you'll likely just piss me off and delay your loved one getting pain medication or her epidural.
10. When I ask the patient a question, that's who I want the answer from... OK? I don't need her mother to tell me when she had sex last....
11. This day and time, if a patient is between the ages of 37 and 42... she has had approximatley 2-5 partners. If she is between the ages of 28-36, the average is 7. If she is in her early to mid twenties, then her age is how many partners she's had... If she is a teenager, then "too numerous to count" applies. (and she has had, or currently has chlamydia or trich)
12. Open your damn legs. If you were a virgin, you wouldn't be here.
13. Shave that sh*t. If we wanted a trip to the jungle... we'd go there.
14. Clean your ass before you come in. Unless you have the umbilical cordhanging out, are in a serious accident, or are bleeding profusely, take time towash it up a bit... it's going to be on display. (Why do you think I like to get women in the tub? JK)
15. You'd better be nice to your nurse. She, not the physician, decides when you get pain medication... There is such a thing as placebo. We can also make you wait the entire 2 hours... adding 45 minutes for our convenience... or we can give it to you 15 minutes early.... it's all in your attitude.
16. The fewer visitors you have in with you... the better mood your nurse will be in.
17. Get rid of that one "know it all" visitor before it's toolate. She can ruin the entire experience for you by pissing me off.
18. If this is your 6th baby, either get the epidural before you come in, or don't plan on one.
19. Don't blame us when you're baby can't say it's own name when it's 5. Chances are, it was the cocaine you snorted in the parking lot,just before you were rushed in abrupting.
20. If your pulse is 50 when you come in... from all the downers you'vebeen downing... chances are your baby will be several bricks shy of a full load. It's your fault, not ours.
21. When I ask you if you smoke... you should include marijuana in that answer.Other things that should be included are, hashish, crack, meth, and any otherillegal drug that you may have smoked. Nicotine is the least harmful of all thecrap you could smoke...dummy.
22. Don't bitch at us because your baby has to stay in the hospital until it's 2 months old, weaning off of Methadone or Morphine. Regardless of what the bullshit clinic says to you.... Methadone is NOT healthy for babies.
23. If you call us and say you're bleeding profusely, then I'd bettersee some blood when you come in. Do you know how many people we notify for shit like that!
24. Hard labor doesn't just stop with 1 bag of IV fluids. We know a fakerwhen we hydrate one.
25. If you're an addict, we already have a preconceived notion about you,and we probably don't like you. Nothing personal... it's just the way itis. You chose that life... now live it.
26. Regardless of the fact that your neighbor's sister's aunt had ababy at 30 weeks and it is perfect... that does NOT mean we're going to letyou have yours at 30 weeks.
27. Your neighbor's sister's aunts baby likely had to stay in thehospital for 6 weeks, and could possibly have problems that you're not awareof... dumb dumb.
28. You'd better tell us if you're on narcotics... trust me......We'll know soon enough, because our drug of choice is Stadol.... HA HA.
29. If you have track marks on your arm, "NO YOU CAN NOT GO OUT AND SMOKE" with your IV. What do you think we are, Stupid?
30. Don't scream. We hate screamers. It get's on our nerves and we just sit at the desk looking at each other and grinning and making faces. It'snot to your advantage.
31. If you don't have custody of your 3 other kids, chances are youwon't go home with this one either. We ARE calling Social Services.That's our job.
32. If the baby's dad is in jail, and he's still your boyfriend, we automatically assume "birds of a feather flock together".
Rules of the Labor and Delivery area
1. Don't ask me if my wheel can tell you if you got knocked up on the 15thor 16th. That's too damn close to have 2 different partners anyway.Just suffer for 8 more months, assuming the father is not the one it should be. For real. I get asked when a patient may have conceived from time to time. Usually it's related to being sure who the FOB is
2. Bed rest does not include walking around Walmart or running by the mall topick up something. I'm gonna start handing out this instruction when I have to put someone on bedrest!
3. Don't come in the middle of the night because you've been throwing up for a week and then ask me to get you something to eat.
4. Breathing hard and faking to your family like you're having contractions WON'T open up your cervix.
5. Tears and rolling around in the bed also will NOT open your cervix.
6. Doing sit ups while in the bed to make the monitor "go up"also... WILL NOT open your cervix.
7. Until your cervix is opening, don't plan on staying.
8. If you fight with your boyfriend and need a little TLC... go to his mother's house, not the labor room.
9. If you are there with someone in labor, don't try to read the strip and tell me what's going on. You don't know the difference between a fart and a contraction and you'll likely just piss me off and delay your loved one getting pain medication or her epidural.
10. When I ask the patient a question, that's who I want the answer from... OK? I don't need her mother to tell me when she had sex last....
11. This day and time, if a patient is between the ages of 37 and 42... she has had approximatley 2-5 partners. If she is between the ages of 28-36, the average is 7. If she is in her early to mid twenties, then her age is how many partners she's had... If she is a teenager, then "too numerous to count" applies. (and she has had, or currently has chlamydia or trich)
12. Open your damn legs. If you were a virgin, you wouldn't be here.
13. Shave that sh*t. If we wanted a trip to the jungle... we'd go there.
14. Clean your ass before you come in. Unless you have the umbilical cordhanging out, are in a serious accident, or are bleeding profusely, take time towash it up a bit... it's going to be on display. (Why do you think I like to get women in the tub? JK)
15. You'd better be nice to your nurse. She, not the physician, decides when you get pain medication... There is such a thing as placebo. We can also make you wait the entire 2 hours... adding 45 minutes for our convenience... or we can give it to you 15 minutes early.... it's all in your attitude.
16. The fewer visitors you have in with you... the better mood your nurse will be in.
17. Get rid of that one "know it all" visitor before it's toolate. She can ruin the entire experience for you by pissing me off.
18. If this is your 6th baby, either get the epidural before you come in, or don't plan on one.
19. Don't blame us when you're baby can't say it's own name when it's 5. Chances are, it was the cocaine you snorted in the parking lot,just before you were rushed in abrupting.
20. If your pulse is 50 when you come in... from all the downers you'vebeen downing... chances are your baby will be several bricks shy of a full load. It's your fault, not ours.
21. When I ask you if you smoke... you should include marijuana in that answer.Other things that should be included are, hashish, crack, meth, and any otherillegal drug that you may have smoked. Nicotine is the least harmful of all thecrap you could smoke...dummy.
22. Don't bitch at us because your baby has to stay in the hospital until it's 2 months old, weaning off of Methadone or Morphine. Regardless of what the bullshit clinic says to you.... Methadone is NOT healthy for babies.
23. If you call us and say you're bleeding profusely, then I'd bettersee some blood when you come in. Do you know how many people we notify for shit like that!
24. Hard labor doesn't just stop with 1 bag of IV fluids. We know a fakerwhen we hydrate one.
25. If you're an addict, we already have a preconceived notion about you,and we probably don't like you. Nothing personal... it's just the way itis. You chose that life... now live it.
26. Regardless of the fact that your neighbor's sister's aunt had ababy at 30 weeks and it is perfect... that does NOT mean we're going to letyou have yours at 30 weeks.
27. Your neighbor's sister's aunts baby likely had to stay in thehospital for 6 weeks, and could possibly have problems that you're not awareof... dumb dumb.
28. You'd better tell us if you're on narcotics... trust me......We'll know soon enough, because our drug of choice is Stadol.... HA HA.
29. If you have track marks on your arm, "NO YOU CAN NOT GO OUT AND SMOKE" with your IV. What do you think we are, Stupid?
30. Don't scream. We hate screamers. It get's on our nerves and we just sit at the desk looking at each other and grinning and making faces. It'snot to your advantage.
31. If you don't have custody of your 3 other kids, chances are youwon't go home with this one either. We ARE calling Social Services.That's our job.
32. If the baby's dad is in jail, and he's still your boyfriend, we automatically assume "birds of a feather flock together".
Monday, January 12, 2009
The weekend
The weekend consisted of four straightforward births, tons of pages (I was tempted to take a sledgehammer to my pager), one pretermer on mag, and an admit for hydration related to a stomach virus.
I received two calls early this morning regarding postpartum (2 weeks) back and abdominal pain and the other early pregnancy with diarrhea, having traveled out of the country recently. Both calls came back to back three hours before the office opened. After determining that neither seemed life threatening, I instructed them to call the office for an appointment. Grrr.
I received two calls early this morning regarding postpartum (2 weeks) back and abdominal pain and the other early pregnancy with diarrhea, having traveled out of the country recently. Both calls came back to back three hours before the office opened. After determining that neither seemed life threatening, I instructed them to call the office for an appointment. Grrr.
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