It is really annoying to walk into a treatment room and have the patient sitting there chatting away on her cell phone, but I will let it slide if gets off as soon as she notices I have come in the room. It is more than annoying if I walk in and then have to wait for her to finish her conversation. I also get rather annoyed when the cell phone rings continuously or beeps continuously for received text messages.
Good grief people! You expect me to respect your time and to see you as promptly as possible, I only ask the same of you. I can get to you quicker if I am not waiting for a patient to get off their cell phone to ask them a question or explain to them the procedure I am about to do.
This has really gotten to the point where I am totally over it!!! Therefore, extreme action must be taken before I totally go off on someone.
We have now posted a sign on the front door to silence cell phones when they are called to the back. The nurses also remind the patients to silence their phones when they are placed in the treatment rooms. Now, when I walk into a room and the patient is on her phone I tell her to notify the nurse when she finishes her conversation and that I am going to see the next patient.
If the cell phones start ringing or beeping about messages received I will ask them once to place it on silent or turn it off otherwise I will walk out of the room.
I have not asked my patients to do anything I don't do myself. I always have my cell phone in my pocket but it is on vibrate. I cannot silence it completely or turn it off because labor and delivery knows to call my phone if they need me quickly. If my phone vibrates I glance at it and only excuse myself to answer it if the caller is the hospital, otherwise I reject the call and the phone goes silent. I don't think I am being unfair, I just want some respect for myself, my time, and the other patients that are waiting.
Wednesday, December 29, 2010
Wednesday, November 24, 2010
Pregnancy.....it'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.
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!
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!
Sunday, August 22, 2010
Moving forward
Okay, so the midwife is finally fully birthed!! I graduated with MSN the first week in June, passed my AMCB boards the first week of July and started a new job the first week of August......now, I wonder what the first week of September will hold?
This blog was totally neglected during the last part of my education simply due to the amount of time I was spending in clinicals and studying for comps and boards. I really didn't want it to turn into a pity party and I was afraid that is what would happen given the amount of stress I was feeling and the precariousness of taking all those exams and then searching for a job! Fortunately that is all behind me now and I can breathe a little easier. I have joined a solo physician in his practice and since he has never had a midwife and I have never been employed as one we are kind of figuring things out as we go. Fortunately, he is a super nice guy and very encouraging. We have a very diverse clientele and I am really enjoying it! Haven't started catching babies yet, the paperwork for credentialing and hospital privileges is ridiculous! It will happen soon enough, just like in every other aspect of this midwifery journey I am learning to be more and more patient. Patience is a wonderful quality to have and I am taking all of this in as a life lesson that will make me a better person and midwife.
On a different note, I have loved summer but it sure has been hot! I am looking so forward to fall, the cool crisp mornings and changing colors of the leaves. What is your favorite season???
This blog was totally neglected during the last part of my education simply due to the amount of time I was spending in clinicals and studying for comps and boards. I really didn't want it to turn into a pity party and I was afraid that is what would happen given the amount of stress I was feeling and the precariousness of taking all those exams and then searching for a job! Fortunately that is all behind me now and I can breathe a little easier. I have joined a solo physician in his practice and since he has never had a midwife and I have never been employed as one we are kind of figuring things out as we go. Fortunately, he is a super nice guy and very encouraging. We have a very diverse clientele and I am really enjoying it! Haven't started catching babies yet, the paperwork for credentialing and hospital privileges is ridiculous! It will happen soon enough, just like in every other aspect of this midwifery journey I am learning to be more and more patient. Patience is a wonderful quality to have and I am taking all of this in as a life lesson that will make me a better person and midwife.
On a different note, I have loved summer but it sure has been hot! I am looking so forward to fall, the cool crisp mornings and changing colors of the leaves. What is your favorite season???
Wednesday, January 13, 2010
Welcome 2010
My first post of 2010.......it's gonna be a good year! If I can get out of the funk I am in, that is.
I am tired, overwhelmed, annoyed, anxious and just plain crabby!
I am finished with my numbers except for deliveries and 10 more new OB visits. The hours are another story....I am in the office 4 days a week but most of the patients want to be induced so I don't get many hours outside of the daily 9-5. So, it seems I am never going to get done!
I have 16 more babies to catch and was cheated out of one last night because the nurse who admitted the laboring woman called the MD on call instead of the midwife on call and the MD did not realize that she was a midwife patient. Grrrrrr!
I have no motivation to write this birth center paper, or finish up my soap notes and turn them in, or do my required forum postings for my clinical classes.
I need to look for a job. I don't even know where to start! I haven't had to job hunt in 10 years........guess I need to start with getting my resume together. Any sure-fire techniques for landing a job with a great practice is welcome!
Again, 2010 is going to be a great year! I am going to repeat that until it sinks in and I get out of this foul mood.
I am tired, overwhelmed, annoyed, anxious and just plain crabby!
I am finished with my numbers except for deliveries and 10 more new OB visits. The hours are another story....I am in the office 4 days a week but most of the patients want to be induced so I don't get many hours outside of the daily 9-5. So, it seems I am never going to get done!
I have 16 more babies to catch and was cheated out of one last night because the nurse who admitted the laboring woman called the MD on call instead of the midwife on call and the MD did not realize that she was a midwife patient. Grrrrrr!
I have no motivation to write this birth center paper, or finish up my soap notes and turn them in, or do my required forum postings for my clinical classes.
I need to look for a job. I don't even know where to start! I haven't had to job hunt in 10 years........guess I need to start with getting my resume together. Any sure-fire techniques for landing a job with a great practice is welcome!
Again, 2010 is going to be a great year! I am going to repeat that until it sinks in and I get out of this foul mood.
Wednesday, December 2, 2009
Catchin' babies
Okay, school requires 40 catches to complete clinicals and so far I have 14.....still have a long way to go.
So here are some stats so far: 6 girls 8 boys, 5 unmedicated births (2 of these were standing with me on my knees) only 4 perineal repairs (none worse than slight 2nd degree), smallest baby was 6#9oz and the largest 8#15oz. There were 7 first time moms, 4 second babies and 3 that are baby #4.
I expect to have more than 20 by the first of the year.....my preceptor has 6 or 7 due between now and then and I am also taking call with another midwife in the practice so that I can get these catches in sooner rather than later!
Seeing alot of interesting stuff in the office and really enjoying getting to know the patients and really bonding with some of them......now, just gotta convince the docs in this practice to hire me when I am finished.
Oh, for all of you full scope midwives out there......how many patients do you typically see in the office on an average day? My preceptor usually has 25-30 patients scheduled per day and that number TOTALLY overwhelms me! I do great and feel competent (as competent as a SNM can feel anyway) with about 12-15 and my preceptor is great about making sure I only do as many as I am comfortable doing and not get overwhelmed.
So here are some stats so far: 6 girls 8 boys, 5 unmedicated births (2 of these were standing with me on my knees) only 4 perineal repairs (none worse than slight 2nd degree), smallest baby was 6#9oz and the largest 8#15oz. There were 7 first time moms, 4 second babies and 3 that are baby #4.
I expect to have more than 20 by the first of the year.....my preceptor has 6 or 7 due between now and then and I am also taking call with another midwife in the practice so that I can get these catches in sooner rather than later!
Seeing alot of interesting stuff in the office and really enjoying getting to know the patients and really bonding with some of them......now, just gotta convince the docs in this practice to hire me when I am finished.
Oh, for all of you full scope midwives out there......how many patients do you typically see in the office on an average day? My preceptor usually has 25-30 patients scheduled per day and that number TOTALLY overwhelms me! I do great and feel competent (as competent as a SNM can feel anyway) with about 12-15 and my preceptor is great about making sure I only do as many as I am comfortable doing and not get overwhelmed.
Friday, November 13, 2009
If you can't afford condoms, you can't afford to have sex.
Seriously people!!! EVERYBODY out there has an STI. This has probably been the most eye opening experience of my clinical practicum. I knew STI's were a public health problem but I had no idea it was a freakin epidemic! I have seen patients from age 15-50 with trichomoniasis and even sent a gal to the hospital for some IV antibiotics for severe PID. All of those with trich (except the 15 y/o) were in supposed "monogamous" relationships as was the gal with PID. Gonorrhea and Chlamydia are rampant as well, have treated a 14 y/o for those and she thought it was funny that she had to come in and get a shot for something she caught from having sex........her mom was there laughing right along with her, just disgusting! And don't even get me started on HSV..........
Condoms are not 100% but they sure are better than nothing! And if you can't afford condoms (as a distraught young woman with HSV told me) you most certainly can't afford to be having sex. So don't be an idiot, use condoms and get yourself tested!
Condoms are not 100% but they sure are better than nothing! And if you can't afford condoms (as a distraught young woman with HSV told me) you most certainly can't afford to be having sex. So don't be an idiot, use condoms and get yourself tested!
Tuesday, November 10, 2009
"Catching" up....
Oh wow, have I been busy! I went to Clinical Bound (CB) the first of August and really had a great time! It was fun catching up with some of my classmates and making new friends. The last night of CB was the best. We had dinner at Wendover, the home of Mary Breckenridge and then afterwards were all in a circle and were each given our "hat" or "lap blankets"......the hats are crotched baby boggins given to the midwifery students to give to the first baby they catch, or one they have a special connection to. The NP students are given a hand-made lap blanket to give away to a patient they care for during clinical that is special to them. When giving away our hat or blanket we tell the story of Mary Breckenridge and her vision for healthy moms, babies and families.......
Well, I was given my hat by my preceptor who has been my mentor and encourager in this journey for almost ten years now. Needless to say, it was extremely emotional for the both of us. I don't think there was a dry eye in the room when it was all over.
After CB I came home and finished up my classes and immediately started in the clinical setting. My preceptor let me just observe the first day but the second day put me right to work. I have been in the clinic now for seven weeks and am becoming very comfortable and am completely providing care for the majority of patients that come in with just reassurance and back-up from my preceptor.
I need lots more hours and lots more baby-catching. My preceptor only works two days per week so getting my hours has been difficult but starting last week I am spending two other days a week with one of the other midwives in the practice. I haven't had any problem getting my numbers (FSMFN requires a certain minimum number of each type of office visit, birth, exam etc. as well as a minimum number of clinical hours) since my preceptor sees about 25 patients a day.....that's alot of patients and I am exhausted at the end of each day. I will be in the office four days a week starting next week and will be on call every-other weekend. I am going to like being with two midwives as preceptors.....they both have their strengths and I am learning more than one way to do things, it really is a plus having more than one preceptor.
I need more babies....only have 7 catches so far but my preceptor alone has 8 babies due around Christmas time so December should be a good month for me. My favorite catch so far was catch number 5. My preceptor has been great with pretty much being hands-off and letting me to the catches on my own. She stands there gloved up and ready to assist at any moment but lets me handle it on my own unless I ask for help. Anyway, catch number 5 wasn't even one of our patients, she was one of the other midwives patients (there are 4 mw's in this practice and 3 md's). We were on call on the patient's primary midwife had a migraine so she asked us to care for her. When the patient arrived at the hospital she was 7cm and her water broke. I went to the hospital as soon as the call came. The patient had been in the shower and was in the bathroom leaning on the sink when I arrived. Her doula (whom I have worked with numerous times and consider a friend) was with her as well as her grandmother and two other female friends/relatives (she is a single mom). We remained in the bathroom for a while and then she started feeling pushy.....I checked her cervix and she was complete and +1. I encouraged her to just bend slightly at the knees and bear down during her contractions and go with that urge to push (she was still in the bathroom leaning over the sink). After about 30 minutes of this the baby was visible on the perineum so I asked the patient to just move into the room by the bed when she could to allow more room for the birth. She had no problem with this and went out and leaned forward on the bed. I gloved and positioned myself on my knees behind the patient in preparation to catch the baby. With just a few more pushes a slippery little boy slid into my hands and I handed him to his mother between her legs. This was the first time I had caught in this position and honestly it was a little nerve-racking not having a soft bed underneath her when this kiddo came out. She had two small bilateral labial skid marks that did not need repair. She breastfed wonderfully.
Well, I am still taking two didactic classes this term....Advanced Intrapartum and Advanced Women's Health. Next term the only thing I have to do besides clinicals is write my proposal for a birth center. I am really not looking forward to that since I have heard so many other students complain about how much of a pain it is. After I finish my hours I will take about two weeks and study for comprehensive exams and then hopefully within just a couple of weeks take boards......wow, this has really flown by and if things continue to go as planned I will have completed the program and taken boards in 24 months of starting. It really has been a roller-coaster ride but will be worth every sleepless night and the endless hours of studying......
Well, I was given my hat by my preceptor who has been my mentor and encourager in this journey for almost ten years now. Needless to say, it was extremely emotional for the both of us. I don't think there was a dry eye in the room when it was all over.
After CB I came home and finished up my classes and immediately started in the clinical setting. My preceptor let me just observe the first day but the second day put me right to work. I have been in the clinic now for seven weeks and am becoming very comfortable and am completely providing care for the majority of patients that come in with just reassurance and back-up from my preceptor.
I need lots more hours and lots more baby-catching. My preceptor only works two days per week so getting my hours has been difficult but starting last week I am spending two other days a week with one of the other midwives in the practice. I haven't had any problem getting my numbers (FSMFN requires a certain minimum number of each type of office visit, birth, exam etc. as well as a minimum number of clinical hours) since my preceptor sees about 25 patients a day.....that's alot of patients and I am exhausted at the end of each day. I will be in the office four days a week starting next week and will be on call every-other weekend. I am going to like being with two midwives as preceptors.....they both have their strengths and I am learning more than one way to do things, it really is a plus having more than one preceptor.
I need more babies....only have 7 catches so far but my preceptor alone has 8 babies due around Christmas time so December should be a good month for me. My favorite catch so far was catch number 5. My preceptor has been great with pretty much being hands-off and letting me to the catches on my own. She stands there gloved up and ready to assist at any moment but lets me handle it on my own unless I ask for help. Anyway, catch number 5 wasn't even one of our patients, she was one of the other midwives patients (there are 4 mw's in this practice and 3 md's). We were on call on the patient's primary midwife had a migraine so she asked us to care for her. When the patient arrived at the hospital she was 7cm and her water broke. I went to the hospital as soon as the call came. The patient had been in the shower and was in the bathroom leaning on the sink when I arrived. Her doula (whom I have worked with numerous times and consider a friend) was with her as well as her grandmother and two other female friends/relatives (she is a single mom). We remained in the bathroom for a while and then she started feeling pushy.....I checked her cervix and she was complete and +1. I encouraged her to just bend slightly at the knees and bear down during her contractions and go with that urge to push (she was still in the bathroom leaning over the sink). After about 30 minutes of this the baby was visible on the perineum so I asked the patient to just move into the room by the bed when she could to allow more room for the birth. She had no problem with this and went out and leaned forward on the bed. I gloved and positioned myself on my knees behind the patient in preparation to catch the baby. With just a few more pushes a slippery little boy slid into my hands and I handed him to his mother between her legs. This was the first time I had caught in this position and honestly it was a little nerve-racking not having a soft bed underneath her when this kiddo came out. She had two small bilateral labial skid marks that did not need repair. She breastfed wonderfully.
Well, I am still taking two didactic classes this term....Advanced Intrapartum and Advanced Women's Health. Next term the only thing I have to do besides clinicals is write my proposal for a birth center. I am really not looking forward to that since I have heard so many other students complain about how much of a pain it is. After I finish my hours I will take about two weeks and study for comprehensive exams and then hopefully within just a couple of weeks take boards......wow, this has really flown by and if things continue to go as planned I will have completed the program and taken boards in 24 months of starting. It really has been a roller-coaster ride but will be worth every sleepless night and the endless hours of studying......
Sunday, June 14, 2009
If I would quit being a slacker, I wouldn't have to play catch up!
Has it really been since January that I posted last?!! Good grief, I have been slacking terribly with this blog.
Well, honestly not much has changed since January......work is the same, school is kinda the same and the kids are growing by leaps and bounds.....
I managed to finish up the winter term with and A in Postpartum/Newborn an A in Community Assessment and a freakin B in Antepartum. I was so mad about that grade......the only B I have made in the program so far and the only one I plan to make. What makes me mad is that class was not hard but it seemed the instructors just nit-picked everything to death. The tests in that class were absolutely ridiculous! Most tests cover the info you really need to know and leave some of the more obscure stuff alone.....not this class, they expected you to know every minute detail about everything...grrrrrrr!
Okay, so the spring term is actually winding down right now. The intrapartum class has been a breeze and honestly could have easily been completed in 6 weeks but they have absolutely drug this thing out as much as they possibly could.....a bit annoying! Just the final exam left in that class and I am taking it this week. The Women's Health class has been interesting and enjoyable. I am doing well in it and only have the final exam left in this class as well, will probably take it tomorrow or Wednesday. I still have my marketing research paper to finish writing but am giving myself until the 21st to get it written and submitted.....it's just kind of tortorous because it's just alot of plugging in and explaining survey results.
Next term has Advanced Antepartum (same instructors, not really looking forward to it!), Advanced Postpartum/Newborn and Research (yuck!!!!).
On an exciting note, I am attending Clinical Bound this summer and will be starting clinicals the first of October........woo hoo! I can't wait to start putting all the stuff I am learning into practice so it gels in my little head. So, the count down is beginning and my goal is to finish clinicals in February (if not sooner) and hopefully have comps and boards behind me by mid April.
Well, honestly not much has changed since January......work is the same, school is kinda the same and the kids are growing by leaps and bounds.....
I managed to finish up the winter term with and A in Postpartum/Newborn an A in Community Assessment and a freakin B in Antepartum. I was so mad about that grade......the only B I have made in the program so far and the only one I plan to make. What makes me mad is that class was not hard but it seemed the instructors just nit-picked everything to death. The tests in that class were absolutely ridiculous! Most tests cover the info you really need to know and leave some of the more obscure stuff alone.....not this class, they expected you to know every minute detail about everything...grrrrrrr!
Okay, so the spring term is actually winding down right now. The intrapartum class has been a breeze and honestly could have easily been completed in 6 weeks but they have absolutely drug this thing out as much as they possibly could.....a bit annoying! Just the final exam left in that class and I am taking it this week. The Women's Health class has been interesting and enjoyable. I am doing well in it and only have the final exam left in this class as well, will probably take it tomorrow or Wednesday. I still have my marketing research paper to finish writing but am giving myself until the 21st to get it written and submitted.....it's just kind of tortorous because it's just alot of plugging in and explaining survey results.
Next term has Advanced Antepartum (same instructors, not really looking forward to it!), Advanced Postpartum/Newborn and Research (yuck!!!!).
On an exciting note, I am attending Clinical Bound this summer and will be starting clinicals the first of October........woo hoo! I can't wait to start putting all the stuff I am learning into practice so it gels in my little head. So, the count down is beginning and my goal is to finish clinicals in February (if not sooner) and hopefully have comps and boards behind me by mid April.
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.
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.
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 http://online.wsj.com/article/SB122999215427128537.html
"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."
"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 http://online.wsj.com/article/SB122999215427128537.html
"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!
Monday, December 29, 2008
New Year's Chaos
So, it is the last few days of the year, and what does every pregnant family want right now? A birthed baby, of course. Gotta have that tax deduction and there are only a few days between Christmas and New Year's in which to get in all these deliveries so healthcare providers don't get their holiday festivities interrupted.
I hate working this week, but I knew we were going to be slammed, and being on winter break from school, I have the time and need the money.
Last night was a zoo......eight scheduled procedures to come in, not to mention the five triages we had. Three of those stayed and two or them delivered before shift change. Tonight will be no different.....there are seven procedures scheduled and we will be tightly staffed because all those who came in last night will be delivered so half the scheduled staff will be doing postpartum tonight. This will leave just enough nurses to take care of the scheduled procedures.......heaven forbid a triage walk through the door. The powers to be just don't understand that! They fill us up with procedures and make no concession for the women who actually go into labor and just show up.......what? women can actually go into labor on their own? you don't have to schedule their deliveries....grrrrrr!!!
Okay, just had to rant a little.
Hope everyone is gearing up for a great start to the new year! Bring on 2009!!
I hate working this week, but I knew we were going to be slammed, and being on winter break from school, I have the time and need the money.
Last night was a zoo......eight scheduled procedures to come in, not to mention the five triages we had. Three of those stayed and two or them delivered before shift change. Tonight will be no different.....there are seven procedures scheduled and we will be tightly staffed because all those who came in last night will be delivered so half the scheduled staff will be doing postpartum tonight. This will leave just enough nurses to take care of the scheduled procedures.......heaven forbid a triage walk through the door. The powers to be just don't understand that! They fill us up with procedures and make no concession for the women who actually go into labor and just show up.......what? women can actually go into labor on their own? you don't have to schedule their deliveries....grrrrrr!!!
Okay, just had to rant a little.
Hope everyone is gearing up for a great start to the new year! Bring on 2009!!
Friday, December 26, 2008
Unintentional hiatus......catching up
Okay, so I feel like a bit of a slacker. I haven't blogged in two months and I told myself when I started this that I would keep up with it. I have a bad habit of starting something and being all excited about it at first and then, well.....
I must say that ALOT has happened in the past three months. I managed to survive my second term in grad school and again walked away with three A's. I loved the decision making course, it made me really think about how to do a history and the questions to ask and how to put your biases aside to provide proper and thorough care to patients. The nursing theory class, well yuck! I don't enjoy writing papers and that class was nothing but papers! I did enjoy my reproductive physiology course.
The last week of that term I went to Houston, TX to work as part of the disaster relief effort from Hurricane Ike. Yes, I got paid for the stint. If I had the money I would have volunteered my time but I don't. I am a grad student with loans and a family that consists of three children......I have bills, lots of them!
The week I got back from Texas we lost my 23 month old niece. Very long story there, one of which I cannot go in to no matter how badly I want to. Her death was ruled a homicide and the case remains open at this point. The family has had a hard time dealing with this but we will pull through.
So, the third term of school began the first full week of October. I only had two classes this term compared to three classes for the first two terms. I thought this would be a relief to only have to focus on two classes. WRONG!!!!!! This was the worst term I have had in school, any school, EVER!
I took Primary care, which turned out to be a great class. I learned alot and it was by no means easy, but I squeaked by with an A.
I also took Pharmacology. Let's just say, hell on earth! The class was supposed to be a "basic pharmacology" class, to prepare us with basic pharmacology knowledge going into our more advanced midwifery classes. Well, nothing about this class seemed very "basic". I went into this class knowing it would be a challenge and would not be a shining moment for me but, I had no idea. I actually failed the third test in this class, I cried and lamented and lost sleep!!!! Somehow, thanks to the open book quizzes, the alternative med assignment and the extra credit project I managed to barely squeak through with an A, and I mean barely. This had to be the most mind boggling class for me, I just didn't get it. I would study, study and study some more and then take the test and just do horrible....even when I thought I had done well.
I have never been so happy to see a class be finished!
So, this next term I am taking Antepartum, Postpartum/Newborn and a Community assessment class. I have already gotten my Varney's midwifery and have started reading. It's a great book! I already love it! It is such an easy read, almost poetic.
Well, I hope everyone had a Merry Christmas! We sure did! We ate too much, played alot and just enjoyed being with family.
I promise to not go so long without blogging. I think it is a bit therapeutic for me and I should do it more.
Well, in case I don't post again before next Thursday........Happy New Year!!! May you have a prosperous and healthy 2009!!!!!
I must say that ALOT has happened in the past three months. I managed to survive my second term in grad school and again walked away with three A's. I loved the decision making course, it made me really think about how to do a history and the questions to ask and how to put your biases aside to provide proper and thorough care to patients. The nursing theory class, well yuck! I don't enjoy writing papers and that class was nothing but papers! I did enjoy my reproductive physiology course.
The last week of that term I went to Houston, TX to work as part of the disaster relief effort from Hurricane Ike. Yes, I got paid for the stint. If I had the money I would have volunteered my time but I don't. I am a grad student with loans and a family that consists of three children......I have bills, lots of them!
The week I got back from Texas we lost my 23 month old niece. Very long story there, one of which I cannot go in to no matter how badly I want to. Her death was ruled a homicide and the case remains open at this point. The family has had a hard time dealing with this but we will pull through.
So, the third term of school began the first full week of October. I only had two classes this term compared to three classes for the first two terms. I thought this would be a relief to only have to focus on two classes. WRONG!!!!!! This was the worst term I have had in school, any school, EVER!
I took Primary care, which turned out to be a great class. I learned alot and it was by no means easy, but I squeaked by with an A.
I also took Pharmacology. Let's just say, hell on earth! The class was supposed to be a "basic pharmacology" class, to prepare us with basic pharmacology knowledge going into our more advanced midwifery classes. Well, nothing about this class seemed very "basic". I went into this class knowing it would be a challenge and would not be a shining moment for me but, I had no idea. I actually failed the third test in this class, I cried and lamented and lost sleep!!!! Somehow, thanks to the open book quizzes, the alternative med assignment and the extra credit project I managed to barely squeak through with an A, and I mean barely. This had to be the most mind boggling class for me, I just didn't get it. I would study, study and study some more and then take the test and just do horrible....even when I thought I had done well.
I have never been so happy to see a class be finished!
So, this next term I am taking Antepartum, Postpartum/Newborn and a Community assessment class. I have already gotten my Varney's midwifery and have started reading. It's a great book! I already love it! It is such an easy read, almost poetic.
Well, I hope everyone had a Merry Christmas! We sure did! We ate too much, played alot and just enjoyed being with family.
I promise to not go so long without blogging. I think it is a bit therapeutic for me and I should do it more.
Well, in case I don't post again before next Thursday........Happy New Year!!! May you have a prosperous and healthy 2009!!!!!
Saturday, October 25, 2008
Help the March of Dimes fight Prematurity!!!!!
Everyone who is concerned about the health of babies needs to be involved in the March of Dimes, they are such a wonderful organization whose only concern is healthy babies.
They have started a campaign called the Petition for Preemies. Join the rest of us fighting for these little ones and sign it!!
Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials – and all Americans – on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.
Go here to sign the Petition for Preemies
1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
(a) identify the causes of premature birth;
(b) test strategies for prevention;
(c) improve the care, treatment and outcomes of preterm infants;
(d) and better define and track the problem of premature birth.
2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.
4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)
They have started a campaign called the Petition for Preemies. Join the rest of us fighting for these little ones and sign it!!
Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials – and all Americans – on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.
Go here to sign the Petition for Preemies
1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
(a) identify the causes of premature birth;
(b) test strategies for prevention;
(c) improve the care, treatment and outcomes of preterm infants;
(d) and better define and track the problem of premature birth.
2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.
4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)
Tuesday, September 9, 2008
A Midwife on a Mission
Ruth Lubic is one amazing woman! I hope I still have this kind of energy and passion at 81 years young.
http://www.cbsnews.com/stories/2008/09/08/eveningnews/main4428250.shtml
Towards the end of the interview the reporter says that Ruth keeps babies out of prenatal care when he means intensive care (NICU).
http://www.cbsnews.com/stories/2008/09/08/eveningnews/main4428250.shtml
Towards the end of the interview the reporter says that Ruth keeps babies out of prenatal care when he means intensive care (NICU).
Tuesday, September 2, 2008
Abbreviations
Okay, at one time I said I would post a list of abbreviations used in labor and delivery......so here it is and I have included some gyn stuff too.
I'm sure if I have missed anything all my OB friends out there in bloggerland will chime in and add to the list (or make any corrections :)
AB abortion
AP antepartum
MAB - missed abortion
SAB - spontaneous abortion
TAB - therapeutic abortion
EAB - elective abortion
AFP Alpha Fetoprotein
MSAFP - maternal serum alpha-fetoprotein
AMA advanced maternal age
AFI amniotic fluid index
AROM artificial rupture of membranes
BBOW bulging bag of water
BPP biophysical profile
CPD cephalopelvic disproportion
CST contraction stress test
CT chlamydia trachomatous
CVS chorionic villi sampling
D & C dilatation & curettage
D & E dilatation & evacuation
DIC disseminating intravascular coagulopathy
DI/DI dichorionic/diamniotic twins
EDC/EDD estimated date of confinement/estimated date of delivery
EFM electronic fetal monitoring.......cEFM continuous electronic fetal monitoring
EFW estimated fetal weight
EGA estimated gestational age
FAVD forceps assisted vaginal delivery
FHR/FHT fetal heart rate/fetal heart tracing or tone
FLM fetal lung maturity
FSE fetal scalp electrode
FTP failure to progress
GBS group B beta streptococcus
GC gonorrhea
GDM gestational diabetes mellitus
GH gestational hypertension (the most currently correct name for PIH)
GIFT gamete intra-fallopian tube transfer
G_P_ gravida, para (TPAL - term, preterm, abortions, living children)
GTD gestational trophoblastic disease
HCG human chorionic gonadotropin
BHCG - beta human chorionic gonadotropin (usually serum)
UHCG - urinary human chorionic gonadotropin
HELLP hemolysis, elevated liver enzymes, low platelets
HSV herpes simplex virus
IP intrapartum
IUD intrauterine device
IUFD intrauterine fetal death
IUGR intrauterine growth retardation
IUI intrauterine insemination
IUP intrauterine pregnancy
IUPC intrauterine pressure catheter
IVF in vitro fertilization
LDR labor, delivery, recovery (all in one room)
LDRP labor, delivery, recovery, postpartum
LEEP loop electrical excision procedure
LGA large for gestational age
LMP last menstrual period
LOA/LOT/LOP left occiput anterior/left occiput transverse/left occiput posterior
LOF leaking of fluid
LTCS/LVCS low transverse C- section/low vertical C-section
MBU mother/baby unit
MVU Montevideo units
NB newborn
NBN newborn nursery
NICU neonatal intensive care unit
NST non-stress test
NSVD normal spontaneous vaginal delivery
NT nuchal translucency
NTD neural tube defect
OCP oral contraceptive pills
OT occiput transverse
PCOS polycystic ovarian syndrome
PID pelvic inflammatory disease
PIH pregnancy induced hypertension
POC products of conception
POD/PPD post-operative day/postpartum day
PP postpartum
PPH postpartum hemorrhage
PPROM preterm premature rupture of membranes
PROM premature rupture of membranes
PTL preterm labor
PUBS percutaneous umbilical blood sampling
PUPPPS pruritic urticarial papules and plaques of pregnancy
ROA/ROT/ROP right occiput anterior/right occiput transverse/right occiput posterior
ROM rupture of membranes
SGA small for gestational age
SRMC single room maternity care
SROM spontaneous rupture of membranes
STI sexually transmitted transmitted infection
SVE sterile vaginal exam
TOL trial of labor
UC uterine contraction
US ultrasound
VAVD vacuum-assisted vaginal delivery
VBAC vaginal birth after C-section
GYN related abbreviations
AGUS atypical glandular cells of unknown significance
ASCUS atypical squamous cells of unknown significance
BSO bilateral salpingo-oophorectomy
BTL bilateral tubal ligation
CIN cervical intraepithelial neoplasia
EMB endometrial biopsy
ERT estrogen replacement therapy
HGSIL high-grade squamous intraepithelial lesion
HPL human placental lactogen
HPV human papilloma virus
HRT hormone replacement therapy
HSG hysterosalpingogram
LGSIL low grade squamous intraepithelial lesion
TAH total abdominal hysterectomy
TOA tubo-ovarian abscess
TVH total vaginal hysterectomy VAIN vaginal intraepithelial neoplasia
VIN vulvar intraepithelial neoplasia
I'm sure if I have missed anything all my OB friends out there in bloggerland will chime in and add to the list (or make any corrections :)
AB abortion
AP antepartum
MAB - missed abortion
SAB - spontaneous abortion
TAB - therapeutic abortion
EAB - elective abortion
AFP Alpha Fetoprotein
MSAFP - maternal serum alpha-fetoprotein
AMA advanced maternal age
AFI amniotic fluid index
AROM artificial rupture of membranes
BBOW bulging bag of water
BPP biophysical profile
CPD cephalopelvic disproportion
CST contraction stress test
CT chlamydia trachomatous
CVS chorionic villi sampling
D & C dilatation & curettage
D & E dilatation & evacuation
DIC disseminating intravascular coagulopathy
DI/DI dichorionic/diamniotic twins
EDC/EDD estimated date of confinement/estimated date of delivery
EFM electronic fetal monitoring.......cEFM continuous electronic fetal monitoring
EFW estimated fetal weight
EGA estimated gestational age
FAVD forceps assisted vaginal delivery
FHR/FHT fetal heart rate/fetal heart tracing or tone
FLM fetal lung maturity
FSE fetal scalp electrode
FTP failure to progress
GBS group B beta streptococcus
GC gonorrhea
GDM gestational diabetes mellitus
GH gestational hypertension (the most currently correct name for PIH)
GIFT gamete intra-fallopian tube transfer
G_P_ gravida, para (TPAL - term, preterm, abortions, living children)
GTD gestational trophoblastic disease
HCG human chorionic gonadotropin
BHCG - beta human chorionic gonadotropin (usually serum)
UHCG - urinary human chorionic gonadotropin
HELLP hemolysis, elevated liver enzymes, low platelets
HSV herpes simplex virus
IP intrapartum
IUD intrauterine device
IUFD intrauterine fetal death
IUGR intrauterine growth retardation
IUI intrauterine insemination
IUP intrauterine pregnancy
IUPC intrauterine pressure catheter
IVF in vitro fertilization
LDR labor, delivery, recovery (all in one room)
LDRP labor, delivery, recovery, postpartum
LEEP loop electrical excision procedure
LGA large for gestational age
LMP last menstrual period
LOA/LOT/LOP left occiput anterior/left occiput transverse/left occiput posterior
LOF leaking of fluid
LTCS/LVCS low transverse C- section/low vertical C-section
MBU mother/baby unit
MVU Montevideo units
NB newborn
NBN newborn nursery
NICU neonatal intensive care unit
NST non-stress test
NSVD normal spontaneous vaginal delivery
NT nuchal translucency
NTD neural tube defect
OCP oral contraceptive pills
OT occiput transverse
PCOS polycystic ovarian syndrome
PID pelvic inflammatory disease
PIH pregnancy induced hypertension
POC products of conception
POD/PPD post-operative day/postpartum day
PP postpartum
PPH postpartum hemorrhage
PPROM preterm premature rupture of membranes
PROM premature rupture of membranes
PTL preterm labor
PUBS percutaneous umbilical blood sampling
PUPPPS pruritic urticarial papules and plaques of pregnancy
ROA/ROT/ROP right occiput anterior/right occiput transverse/right occiput posterior
ROM rupture of membranes
SGA small for gestational age
SRMC single room maternity care
SROM spontaneous rupture of membranes
STI sexually transmitted transmitted infection
SVE sterile vaginal exam
TOL trial of labor
UC uterine contraction
US ultrasound
VAVD vacuum-assisted vaginal delivery
VBAC vaginal birth after C-section
GYN related abbreviations
AGUS atypical glandular cells of unknown significance
ASCUS atypical squamous cells of unknown significance
BSO bilateral salpingo-oophorectomy
BTL bilateral tubal ligation
CIN cervical intraepithelial neoplasia
EMB endometrial biopsy
ERT estrogen replacement therapy
HGSIL high-grade squamous intraepithelial lesion
HPL human placental lactogen
HPV human papilloma virus
HRT hormone replacement therapy
HSG hysterosalpingogram
LGSIL low grade squamous intraepithelial lesion
TAH total abdominal hysterectomy
TOA tubo-ovarian abscess
TVH total vaginal hysterectomy VAIN vaginal intraepithelial neoplasia
VIN vulvar intraepithelial neoplasia
Monday, August 18, 2008
Tired and unmotivated............
I want to be done with midwifery school......NOW! Sorry for the shouting, just feeling unmotivated and just plain over it right now.
I am stuck. I have been working on a theory paper for a week now and haven't made squat for progress. I am over this paper and over this class! Because I have been so hung up on this stupid paper I haven't done my reading for my other two classes in a week. I think if I can just get this paper out of the way the rest of this class will roll pretty well and I can get the other two classes back in gear.
I am on week 7 of this term, so just five more left before the next term starts. I am in a good place with the reproductive A&P class, just two more tests left to take. The health assessment class is interesting so I can really get caught up on it this weekend pretty easily. Just finding the motivation to pound out the theory paper is my real issue right now.
I am also feeling a bit weepy today....worked last night and didn't make it home in time to see my oldest before he left for his first day of middle school :(
He is attending a local private school that is very big on personal responsibility and independence. I am used to dropping him off at school at 0845 and picking him up at 1530, at a school that is 3 minutes from my house. I used to eat lunch with him at least one day a week.
Now, he gets dropped of by his dad at 0730 and remains at school until his dad picks him up at 1720. He has cross country practice after school, so he is not just "hanging out" until his dad get there, he actually only has 20 minutes from the time cross country ends until his dad gets there. This school is also 30 minutes from my house and the campus is HUGE (like >600 acres huge), so I don't foresee the weekly lunches anymore (esp. not with gas prices the way they are). The school he attends is also a boarding school so there are always students, faculty and many other adults around.....it is a very busy campus.
I can't wait until he gets home today......I want to hear all about his day. I know he's totally loving it! He has been excited for school to start ever since he got his acceptance letter, way back in March!
I am going to go take a quick nap, throw some tacos together for supper and then take the middle child to football practice.
Tonight I am going to work really hard on that paper.......maybe if I type it here I can hold myself to it :)
I am stuck. I have been working on a theory paper for a week now and haven't made squat for progress. I am over this paper and over this class! Because I have been so hung up on this stupid paper I haven't done my reading for my other two classes in a week. I think if I can just get this paper out of the way the rest of this class will roll pretty well and I can get the other two classes back in gear.
I am on week 7 of this term, so just five more left before the next term starts. I am in a good place with the reproductive A&P class, just two more tests left to take. The health assessment class is interesting so I can really get caught up on it this weekend pretty easily. Just finding the motivation to pound out the theory paper is my real issue right now.
I am also feeling a bit weepy today....worked last night and didn't make it home in time to see my oldest before he left for his first day of middle school :(
He is attending a local private school that is very big on personal responsibility and independence. I am used to dropping him off at school at 0845 and picking him up at 1530, at a school that is 3 minutes from my house. I used to eat lunch with him at least one day a week.
Now, he gets dropped of by his dad at 0730 and remains at school until his dad picks him up at 1720. He has cross country practice after school, so he is not just "hanging out" until his dad get there, he actually only has 20 minutes from the time cross country ends until his dad gets there. This school is also 30 minutes from my house and the campus is HUGE (like >600 acres huge), so I don't foresee the weekly lunches anymore (esp. not with gas prices the way they are). The school he attends is also a boarding school so there are always students, faculty and many other adults around.....it is a very busy campus.
I can't wait until he gets home today......I want to hear all about his day. I know he's totally loving it! He has been excited for school to start ever since he got his acceptance letter, way back in March!
I am going to go take a quick nap, throw some tacos together for supper and then take the middle child to football practice.
Tonight I am going to work really hard on that paper.......maybe if I type it here I can hold myself to it :)
Wednesday, August 13, 2008
Not 1, not 2, always 3!
I worked at the big house again last night. Since I've been back I've only worked L&D one shift, all the others I have been down on the HRPU (pronounced harpu) the High-Risk Ante-Partum Unit. I do like the HRPU, usually have about 3-4 patients depending on acuity and once you get everyone their meds and tucked into bed the nights tend to be quiet. Just an FYI, never say the Q word (quiet) on a L&D unit, it is sure to get you many dirty looks.....nurses are a superstitious bunch!
Monday night they put me on L&D, and initially I had two patients. One patient had just delivered so all I needed to do was get her recovered and moved over to mother/baby unit. The other patient was a 27+ weeker who had limited prenatal care and had arrived an hour earlier with her water broke. Well, I ended up having to pass off the fresh delivery because the pre-termer didn't even have an IV going yet.
I got her IV going and gave her; fluids, stadol, antibiotics, steroids (for fetal lung development) and magnesium sulfate (tocolytic, help calm the uterus down so it will quit contracting). Unfortunately, despite our best efforts she delivered shortly after midnight by repeat c/s (baby was breech).....under general anesthesia, because she could/would not sit still for regional block.
We had two other 27 weekers come in and deliver on us that night as well, despite us doing all we could to keep those kiddos in!
Just another example of something every labor nurse knows......bad karma always comes in three's!
Monday night they put me on L&D, and initially I had two patients. One patient had just delivered so all I needed to do was get her recovered and moved over to mother/baby unit. The other patient was a 27+ weeker who had limited prenatal care and had arrived an hour earlier with her water broke. Well, I ended up having to pass off the fresh delivery because the pre-termer didn't even have an IV going yet.
I got her IV going and gave her; fluids, stadol, antibiotics, steroids (for fetal lung development) and magnesium sulfate (tocolytic, help calm the uterus down so it will quit contracting). Unfortunately, despite our best efforts she delivered shortly after midnight by repeat c/s (baby was breech).....under general anesthesia, because she could/would not sit still for regional block.
We had two other 27 weekers come in and deliver on us that night as well, despite us doing all we could to keep those kiddos in!
Just another example of something every labor nurse knows......bad karma always comes in three's!
Saturday, July 12, 2008
It was.......a good night
So last night I worked at the big house.
I came in and picked up a patient who had arrived the evening before for decreased fetal movement. She is being cared for by a CNM I work with frequently at the LDRP hospital.
The baby is reactive but measuring small so the midwife decides to go ahead and induce the next morning. Through the night the mom was having sporadic contractions and occasionally the baby would have a spontaneous deceleration in the heart rate but would recover and look fine. So, they attempted pitocin augmentation. They got the pit started and within fifteen minutes the baby had a seven minute deceleration, so off the pit goes. The mom continued to contract and by about 1:30 yesterday afternoon had made it to three centimeters so the CNM breaks her water and they place internal monitors on baby and the uterus. The continued all day with the spontaneous decelerations lasting anywhere from 3-8 minutes, but in between the baby was beautifully reactive. At 6:15pm the CNM checks mom and she had not changed her cervix so they decide to call in the doc and proceed with c/section since the baby won't tolerate pitocin. The doc is hung up at the LDRP hospital doing a c/section and this one wasn't emergent so we were just going to hang out until he could arrive.
Here's where I come in. Got report and headed in to assess the patient and make sure we were all on the same page and things were in-line to head to the OR once the doc arrives. I am in the room assessing the patient and chatting with the family and having a good time when the baby decides to have another deceleration, down into the 60's......so flip the mommy to her far left side, place O2 by facemask, increase IV fluids.....baby still down but coming up slowly.....vaginal check......9.5cm, just an anterior lip. The CNM comes in (she had been in the lounge on the phone with the doc), baby recovers nicely and we start pushing. Baby handles pushing wondefully and and hour and 20 minutes later we have a girl!!! Oh, I just love it when those kinds of things happen. Baby had a nuchal cord, not tight, but short! BTW, for all you L&D RN's......she had IUPC and MVU's were NEVER adequate......not once!!!!! Women's bodies are simply amazing.
So, I got her recovered and sent to postpartum and was able to sit down and have a nice relaxing dinner and then picked up a triage that had come in with her water broke.
This couple was absolutely wonderful. The mom was undecided on whether or not to go natural so I told her we would just play it by ear...We spent the night walking the halls, sitting on the birth ball and by 0330 she was 3cm and baby had moved down to 0 station (when she came in @MN she was 1cm and baby was high at -3). She spent some time in the shower, which she LOVED! and just did amazingly well. I really spent 95% of my time in that room providing labor support and just enjoying this couple, they were soooo great. At 0700 this am, I did not want to go home.....I wanted to stay with this couple and support them...I wanted to see their sweet little girl be born......I felt like she was really in a groove and I didn't want that disturbed by a new, strange face coming into the room. I feel like it is such an honor and privilege to be allowed to form such an intimate bond with someone and to witness their transformation into parenthood. I just didn't want to leave them......I feel like continuity in care is sooooo important and makes women feel secure and relaxed.
Situations like this keep me motivated to continue with my school work and become a nurse-midwife. If I had been her midwife I could have provided all that support and then stay with her and provide that continuity of care that I feel every woman deserves.
Now, I am off for a week! Woo! Hoo! Headed to camp with the church youth group. My oldest is now old enough to be part of the youth group and attend camp. Me, being the protective mother I am.....totally not ready for my kid to be so independent of me! I am going along as a camp cook. He will do his thing while we are there and I will be hanging out in the kitchen, so I am not going to be hovering or bugging him :) I just wanted to be available.....you know, in case he needed a hug from mommy or something. He hasn't ever spent more than a night or two away from home and this is for a whole week, so I wanted to be a little closer than 2.5 hrs away........just in case :)
I came in and picked up a patient who had arrived the evening before for decreased fetal movement. She is being cared for by a CNM I work with frequently at the LDRP hospital.
The baby is reactive but measuring small so the midwife decides to go ahead and induce the next morning. Through the night the mom was having sporadic contractions and occasionally the baby would have a spontaneous deceleration in the heart rate but would recover and look fine. So, they attempted pitocin augmentation. They got the pit started and within fifteen minutes the baby had a seven minute deceleration, so off the pit goes. The mom continued to contract and by about 1:30 yesterday afternoon had made it to three centimeters so the CNM breaks her water and they place internal monitors on baby and the uterus. The continued all day with the spontaneous decelerations lasting anywhere from 3-8 minutes, but in between the baby was beautifully reactive. At 6:15pm the CNM checks mom and she had not changed her cervix so they decide to call in the doc and proceed with c/section since the baby won't tolerate pitocin. The doc is hung up at the LDRP hospital doing a c/section and this one wasn't emergent so we were just going to hang out until he could arrive.
Here's where I come in. Got report and headed in to assess the patient and make sure we were all on the same page and things were in-line to head to the OR once the doc arrives. I am in the room assessing the patient and chatting with the family and having a good time when the baby decides to have another deceleration, down into the 60's......so flip the mommy to her far left side, place O2 by facemask, increase IV fluids.....baby still down but coming up slowly.....vaginal check......9.5cm, just an anterior lip. The CNM comes in (she had been in the lounge on the phone with the doc), baby recovers nicely and we start pushing. Baby handles pushing wondefully and and hour and 20 minutes later we have a girl!!! Oh, I just love it when those kinds of things happen. Baby had a nuchal cord, not tight, but short! BTW, for all you L&D RN's......she had IUPC and MVU's were NEVER adequate......not once!!!!! Women's bodies are simply amazing.
So, I got her recovered and sent to postpartum and was able to sit down and have a nice relaxing dinner and then picked up a triage that had come in with her water broke.
This couple was absolutely wonderful. The mom was undecided on whether or not to go natural so I told her we would just play it by ear...We spent the night walking the halls, sitting on the birth ball and by 0330 she was 3cm and baby had moved down to 0 station (when she came in @MN she was 1cm and baby was high at -3). She spent some time in the shower, which she LOVED! and just did amazingly well. I really spent 95% of my time in that room providing labor support and just enjoying this couple, they were soooo great. At 0700 this am, I did not want to go home.....I wanted to stay with this couple and support them...I wanted to see their sweet little girl be born......I felt like she was really in a groove and I didn't want that disturbed by a new, strange face coming into the room. I feel like it is such an honor and privilege to be allowed to form such an intimate bond with someone and to witness their transformation into parenthood. I just didn't want to leave them......I feel like continuity in care is sooooo important and makes women feel secure and relaxed.
Situations like this keep me motivated to continue with my school work and become a nurse-midwife. If I had been her midwife I could have provided all that support and then stay with her and provide that continuity of care that I feel every woman deserves.
Now, I am off for a week! Woo! Hoo! Headed to camp with the church youth group. My oldest is now old enough to be part of the youth group and attend camp. Me, being the protective mother I am.....totally not ready for my kid to be so independent of me! I am going along as a camp cook. He will do his thing while we are there and I will be hanging out in the kitchen, so I am not going to be hovering or bugging him :) I just wanted to be available.....you know, in case he needed a hug from mommy or something. He hasn't ever spent more than a night or two away from home and this is for a whole week, so I wanted to be a little closer than 2.5 hrs away........just in case :)
Subscribe to:
Posts (Atom)