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!

"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......

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.

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.

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.

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."

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!