Thursday, January 22, 2009

Work is getting crazy!

I am sooooo freakin tired!!!!

Last night was a total zoo at work! Our unit typically has 165-200 deliveries a month, so we are fairly steady. On the busiest night we will admit 5 or so scheduled procedures and have maybe 3 or 4 triages, that mostly go home. Well, last night we had 10 triages and I think only sent 1 or 2 home and had to call off the scheduled procedures because we had no more nurses and no more rooms! When I left this morning I had just put a laboring patient in the last empty room, the morning's scheduled c-section was being pre-opped in the PACU and we still had one patient being triaged in one of our three triage rooms. I hate to even think of what dayshift is like today!

The one bright spot was a great little couple I had the privilege of laboring. It was their fourth child and she came in to "just get checked" she said she had been having contractions every evening for the last three nights and just wanted to see if they were doing anything, she fully expected me to send her home.....NOT happening. She was 6cm! She was so surprised when I told her, it was great!

She had a wonderful unmedicated birth, two hours after she arrived at the hospital. She didn't get to labor in the shower like we had planned. I was warming up the water for her and getting her towels laid out when she started vomitting (she stood by the bed the whole time leaning over the bedside table) and her water broke, puddling between her legs. This is when she started getting some pressure during the peaks of contractions and we felt it best to hang close to the bed, she really didn't want to move much at this point anyway, it seemed like an insurmountable task to to her to get in and out of the shower at 8cm dilated!

On a less stressful note, I get to spend the evening having dinner with the local CNM's. I really enjoy getting together with these ladies, they are such a wonderful group and always keep me encouraged and pushing forward.

Tuesday, January 20, 2009

Faith and patience.

Okay, the story forthcoming could have had a variety of endings, and here lately we've seen alot of different ones, but this mommy had faith in her body and its ability to birth and it ended just the way she had hoped.

I went into work one evening and was given a patient who had come in early that am for PROM (we seem to be having a run on these the last few months!). When she arrived she refused pitocin, although it had already been four hours since her membranes ruptured and she wasn't having any contractions. The midwife on call for her primary midwife (primary midwife is out of town)was okay with this and told her to do some walking, sit on the birth ball and see if things will get going. Well, by the afternoon not much had happened so the mommy agreed to some pitocin. At this point it had been over 12 hours since ROM and her vag exam was essentially the same as when she had arrived at the hospital that am (thick cervix, fingertip dilated and ballottable fetus....not very promising). At this point the midwife had to consult with the MD on call who came in and check the mommy, got consent for an IUPC and placed it then went on to tell the mommy that they would give her two hours and if she hadn't changed then they needed to have a cesarean section.
After the doc left the room the patient and her husband talked and then told the nurse that they didn't want that doctor to care for them and essentially fired him at that point. So, another midwife in the practice came in to talk to them and discussed the possibility of infection and putting mommy and baby at risk and agreeing with the MD that if things didn't start moving along they would have to consider the possibility of a cesarean. At this point mommy decided she wanted an epidural so the midwife said that was fine and she could have one and instructed the nurse to start the IV fluid bolus, at this point the dad pipes up and says that they want the epidural right now. The midwife tried to explain that it would take a few minutes since she needed the fluids beforehand, dad got a bit huffy and told the midwife to just leave. Well, the midwife did just that and at that point called another MD with the practice and asked him to come in and care for them because they had fired the other MD and she would not care for them at this point.
All of this drama happened within the 30 minutes before my shift began. So, I came in and introduced myself and immediately got the patient in position for her epidural placement. After her epidural they were very calm and got settled in then the new physician came in and spoke with them.....he was wonderful and they liked him immediately. He explained to them how the first stage of labor is the longest and sometimes requires a great deal of patience, and that he was fine with us monitoring her throughout the night, titrating the pitocin as needed and would re-evaluate in the am. But, he was very clear that if she started to get a fever, the baby showed any signs of distress at all or if she had not made significant change by the am that they would have to have a serious discussion about a cesarean. The couple was fine with this and the MD went home to sleep.
She was very comfortable with her epidural, I turned her side to side hourly and checked her vital signs. She had agreed to start some antibiotics to head off any infection so we did that. I monitored the strength of her contractions and actually ended up turning the pitocin down twice during the night. By 1am she was 4cm, and I am pretty sure the baby was straight OP....this would explain the dysfunctional start to labor. We continued with the side to side turnings and by the end of my shift she was 7cm.
After my nap I called to check up on her and found that she birthed her baby vaginally around noon after a very long pushing stage and being ruptured for 36hrs.
Unfortunately, things don't usually turn out this well in this type of situation. Health care providers seem to lack a great amount of patience for a generally slow process and a little bit of faith in how the process works.
I am glad this couple got the type of birth they wanted, I just think the whole situation could have been handled so much better, on both sides.
We seem to be having a run on PROM these days and gals being in labor for a long time before finally giving birth.
Honestly, I have noticed that alot of the health care providers that had gotten away from the weekly in office vag exams starting at 37wks seems to be going back to that.......sad, and I think that has alot to do with PROM.

Tuesday, January 6, 2009

New Research Shows Why Every Week of Pregnancy Counts.......Yes, that includes the last three!!!

So many of us have been saying this for so many years.......

"new research shows that those last weeks of pregnancy are more important than once thought for brain, lung and liver development. And there may be lasting consequences for babies born at 34 to 36 weeks, now called "late preterm."

This article is great. Go and read it in it's entirety at

"The American College of Obstetricians and Gynecologists, the American Academy of Pediatrics and the March of Dimes are now urging obstetricians not to deliver babies before 39 weeks unless there is a medical reason to do so."

The issue now becomes those practitioners that can't stand up to the pressure that parent's place on them to deliver the baby early for convenience. Especially since they've been doing it for years for all their friends. Or those practitioners that like to just 'make up' a medical reason to deliver early...grrrrr!