Tuesday, July 1, 2008

Choices....or the illusion thereof

Worked last night at the single room maternity care hospital. Not too bad a night except that I started the night in the O.R. and ended the night in the O.R. The O.R. is my least favorite place to be and I always end up there when I'm having a good hair night!!! Never fails.....I even told myself driving to work last night to be prepared to hit the O.R. first thing cause the hair was looking pretty darn good.......and sure enough!!!

The first c/s was distressing for the poor mom because she had been admitted for elective induction on Sunday evening...had cervidil all night, pit started early Monday morning, doc broke her water shortly after pit started.....made it to 5cm by 6pm last evening just to discover the babe was breech!
Now, the nurse that cared for this patient said she thinks the baby must've turned during labor, she only checked her once, about noonish, and is confident it was head she was feeling. This nurse is a good one too and it definitely wouldn't be the first time a baby has flipped during labor.
This patient was being electively induced (doc is on vacation next week) at 38 wks and the babe was barely over 6#. But everyone did well and that baby is sooo cute!!

The midpart of the night was pretty uneventful and then 4am hit! 4am seems to be the witching hour in labor and delivery. That's when it all hits the fan.
We were schedule to have two inductions arrive at 5am and the am scheduled c/s was to be there at 5am also. Well, at 0430 we had a patient, who was scheduled for a c/s later in the week, show up because her water was broke. She had a c/s scheduled because the baby was breech (she wasn't happy...3rd baby, other two were vag deliveries) and much to her excitement when she arrived we scanned her and the baby had turned head down!! So, she was admitted as a labor patient
Not ten minutes after we got her in a room another patient comes in thinking her water broke and has been contracting, so we used some nitrazine and confirmed the leaking of amniotic fluid so I told her she is definitely staying and having a baby today.
I told her I was going to call the doctor and let them know she was here so they could head in and we would get her ready for her repeat c/s unless she was planning to VBAC. This is when she perks up and says she had originally wanted to VBAC but that her doctor didn't think she could birth vaginally because with her first child she never made it past 6cm. After some probing I found out she was electively induced at 39 weeks and after 14 hrs of pit they did a c/s. I explained to her that it was her choice what she wanted to do and she could discuss it further with her doctor but that her body didn't fail her the first time around, the induction did.
So, since she was contracting I checked her cervix and to her surprise found that she was almost 3cm, 80% effaced and the baby was -1 station. Granted, I am no physician but I have had my hand in lots of pelvis' and this girl seemed to have adequate room and her pelvis felt totally normal. I reminded her that she was weeks earlier with this baby and so it would probably be smaller (first was just over 7#!). So, she asked me to ask her doc if she could attempt a TOL when I called him.
I honestly thought this doc wouldn't mind letting her VBAC, he is one of the only ones in this town that is open to it and tends to be so laid back!! So I expressed to him her wishes and let him know she was dilated, contracting every five minutes, baby was well applied and things were looking great. No......not happening, doesn't think her pelvis is adequate.....prep her for c/s, he is on his way. What the h***!!!!!!!!!!!! This girl is 5ft 8inches, not overweight and about to have a baby that ended up being 6# even.......and her pelvis isn't adequate?!
Found out later that this gal has a family member who is an OB in a much larger city with an even higher c/s rate than ours.........think that had anything to do with it, hmmm!

So gals, in my city I have found that if you or anyone you are related to are in the fields of medicine or of law.....you will have a c/s. It's just getting worse, seeing women talked into primary c/s or talked out of VBAC and then finding out her brother is an MD or her aunt is a lawyer.....never fails.

Man, I get wordy!!! Can you tell I talk alot.....need to learn to be more concise!!!!

Well, I think it is time for a nap.....didn't sleep too well when I got home this morning and now I am starting to feel yucky!


Apple said...

Perhaps it will be irresponsible but I would "forget" to call that Dr. if another VBAC hopeful...coerced c/s momma comes in again. Geez what arrogance.

And maybe the key to having a good night is to just roll out of bed throw the hair in a bun and call it good enough hehe :-D

RN2CNM said...

As much as I would like to do that most times....it is our hospital policy that a physician is required to be in-house if we have a VBAC patient laboring. So we have to notify them as soon as the patient arrives so they can come in and be available.

You know, I think I will try that next time...just pull the hair up and be done with it....maybe I'll have a night full of patients fore-going epidurals, delivering natural and having all midwives in attendance. Oh well, one can dream!