Okay, the story forthcoming could have had a variety of endings, and here lately we've seen alot of different ones, but this mommy had faith in her body and its ability to birth and it ended just the way she had hoped.
I went into work one evening and was given a patient who had come in early that am for PROM (we seem to be having a run on these the last few months!). When she arrived she refused pitocin, although it had already been four hours since her membranes ruptured and she wasn't having any contractions. The midwife on call for her primary midwife (primary midwife is out of town)was okay with this and told her to do some walking, sit on the birth ball and see if things will get going. Well, by the afternoon not much had happened so the mommy agreed to some pitocin. At this point it had been over 12 hours since ROM and her vag exam was essentially the same as when she had arrived at the hospital that am (thick cervix, fingertip dilated and ballottable fetus....not very promising). At this point the midwife had to consult with the MD on call who came in and check the mommy, got consent for an IUPC and placed it then went on to tell the mommy that they would give her two hours and if she hadn't changed then they needed to have a cesarean section.
After the doc left the room the patient and her husband talked and then told the nurse that they didn't want that doctor to care for them and essentially fired him at that point. So, another midwife in the practice came in to talk to them and discussed the possibility of infection and putting mommy and baby at risk and agreeing with the MD that if things didn't start moving along they would have to consider the possibility of a cesarean. At this point mommy decided she wanted an epidural so the midwife said that was fine and she could have one and instructed the nurse to start the IV fluid bolus, at this point the dad pipes up and says that they want the epidural right now. The midwife tried to explain that it would take a few minutes since she needed the fluids beforehand, dad got a bit huffy and told the midwife to just leave. Well, the midwife did just that and at that point called another MD with the practice and asked him to come in and care for them because they had fired the other MD and she would not care for them at this point.
All of this drama happened within the 30 minutes before my shift began. So, I came in and introduced myself and immediately got the patient in position for her epidural placement. After her epidural they were very calm and got settled in then the new physician came in and spoke with them.....he was wonderful and they liked him immediately. He explained to them how the first stage of labor is the longest and sometimes requires a great deal of patience, and that he was fine with us monitoring her throughout the night, titrating the pitocin as needed and would re-evaluate in the am. But, he was very clear that if she started to get a fever, the baby showed any signs of distress at all or if she had not made significant change by the am that they would have to have a serious discussion about a cesarean. The couple was fine with this and the MD went home to sleep.
She was very comfortable with her epidural, I turned her side to side hourly and checked her vital signs. She had agreed to start some antibiotics to head off any infection so we did that. I monitored the strength of her contractions and actually ended up turning the pitocin down twice during the night. By 1am she was 4cm, and I am pretty sure the baby was straight OP....this would explain the dysfunctional start to labor. We continued with the side to side turnings and by the end of my shift she was 7cm.
After my nap I called to check up on her and found that she birthed her baby vaginally around noon after a very long pushing stage and being ruptured for 36hrs.
Unfortunately, things don't usually turn out this well in this type of situation. Health care providers seem to lack a great amount of patience for a generally slow process and a little bit of faith in how the process works.
I am glad this couple got the type of birth they wanted, I just think the whole situation could have been handled so much better, on both sides.
We seem to be having a run on PROM these days and gals being in labor for a long time before finally giving birth.
Honestly, I have noticed that alot of the health care providers that had gotten away from the weekly in office vag exams starting at 37wks seems to be going back to that.......sad, and I think that has alot to do with PROM.
Tuesday, January 20, 2009
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
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