Please silence your cell phones

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.

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.

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!

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???

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.

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.

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!