Wednesday, November 24, 2010's not about you

I understand the discomforts of pregnancy. I have had three term pregnancies myself. I had morning sickness with all three, it became worse with each pregnancy. The third pregnancy I vomitted every single day, give or take a half dozen during the whole 9 months, until I finally birthed my bouncing baby boy. I started having Braxton Hicks contractions by 24 weeks with all of my pregnancies. I had heartburn, so bad it would make me vomit and keep me from sleeping at night. I had sciatica with my third pregnancy so bad there were days I couldn't get out of bed by myself. I worked as a labor and delivery nurse and worked 8-hr shifts until four days before I went into labor. By the time I went into labor with my babies I was just plain miserable and so happy to be in labor!

I understand how you are feeling! I know what if feels like to have a complete and total meltdown because you just don't think you "can do it any longer". But, please do not ask me to induce your labor at 36 weeks for any of the above reasons. I will not do it. If there is no clear medical indication that the baby would be better off out of the womb than in it, I will not induce your labor before 39 weeks, period. I am sorry that it makes you mad at me. I am sorry that you think I just don't understand, when I do.

You are pregnant. It is no longer about you. It is about the little baby that you are carrying in your womb. It is about the baby that has no decision in what nutrients it is fed or what drugs it is exposed to. It is about the baby that may not be ready for the outside world. I am sorry for your discomfort and I will give you many suggestions to help make these last few weeks as comfortable as they can be for you, your health and happiness are a priority for me. My other priority is your baby.

My goal is for this baby to be as healthy as she can be and to come into this world with all systems developed and matured so that she has the best possible start in life.
It has been proven that the baby's brain at 35 weeks is just two-thirds of its weight at 39-40 weeks. Also, babies born before they should are at increased risk for breathing problems, temperature instability and difficulty feeding. The "estimated due date" is simply that, an estimate. Women have differing cycles and not everyone ovulates on the same schedule. Therefore, although we say you are 37 weeks your baby may really only be 35 weeks. If your baby arrives at 34-36 weeks it is five times more likely to die within the first week of life. It is three times more likely to die within the first year of life. And, it is more likely to exhibit some long-term problems with speech, coordination, learning and behavior. In pregnancy, every week counts. I encourage you to take some time to explore the March of Dimes website and see how serious prematurity really is.

So, I will listen to you! I will sympathize with you! And, I will give you every suggestion I can possibly come up with to help you get through these last few weeks of pregnancy. However, I will not induce your labor without a clear medical indication.

Saturday, November 20, 2010

Finally catching babies!

Since I started my new job in August I have only been doing office work while waiting for the credentialing process to run its course. It really has been a blessing that I wasn't taking call and delivering babies while still getting accustomed to the office culture. I think I would have been completely overwhelmed.
There are two healthcare organizations in the area that I will be catching babies in their facilities. One is a private organization and I was just given notice last week that I have been approved temporary privileges until their board of governors meets in January to make everything official. The other organization is public and has two facilities either of which my patients can choose to give birth at. I have been reassured that as long as the Medical Director signs off on my application before December 1st, I will be granted privileges then. The private organization has not made any requirements for my privileges but the public facility requires my first 25 catches to be observed by my "supervising" physician. It's funny because the same physicians are on the OB committees at both facilities and basically interchange as Medical Directors for the facilities but have these different requirements.

So, I caught my first baby as a CNM two evenings ago. It was a twin delivery and baby B was frank breach so my physician was right there with me. I caught baby A quickly and easily, he was 6#3oz and came out screaming. Baby B never did move into a vertex position so my physician basically did that delivery with the help of some Piper forceps. Both babies are so incredibly cute and doing very well.

I am on call this weekend and have just sent a mom to the hospital for a labor check so baby #2 could be well on his way!