Friday, March 26, 2010

One Down...Nine (?) To Go.

First term of school officially over.
GPA intact and improved.
How the hell it happened? I have no clue.

Onwards and upwards.

Tuesday, March 23, 2010

Sunday, March 21, 2010

The RockStar Delivery of Tiberius Achaemenes

Yesterday, I pushed with a Mum going natural from 0715am until delivery at 1134am.

Let me repeat, Mum was au naturale without so much as a Tylenol from the time her labor started (1730pm on the 19th) until she got a pudendal block for the forceps at 1130 on the 20th.

And she didn't even want the pudendal! We had to coerce/strongly encourage her to take it. 
And once the forceps were on, I'm pretty sure she was glad she got whatever little relief from the pudendal that she did. (A pudendal block is an intra-vaginal injection of anesthetic that supposedly numbs the perineum, vulva and vagina.)

She had a doula, who was (thankfully) awesome. 
But have mercy. 
I needed a doula, too. Someone to tell me to "keep breathing" and offering me water.
And maybe the Doula needed a Doula.
Over four hours of pushing, and we were all exhausted.

GooberDoc, who is not her primary but is just on call for the group wants the patient to have pitocin to increase the frequency of her contractions. The patient (literally) growled at him. 
Granted, in GooberDoc's defense, she did need at least a sniff of pit. Her contractions were 2-7 minutes apart, and this was after two hours of pushing already. 

Outside the room, GooberDoc says to me, "If she is so fucking crazy that she wants to do this her way, I'll let her keep going... It doesn't hurt me at all." (Side note: this is how he earned the title of "GooberDoc.")
Perhaps you should've been a dentist,
or a dermatologist.

Nothing perturbs me quite like a male doctor making some borderline (or even over borderline) comment about my gender, and expecting me to agree, or laugh along with their asinine comments.
It's the equivalent of telling a "black joke" to a black girl, and expecting her to giggle, just because you're sharing

Anyway, RockStar Mum had a tiny first degree (so GooberDoc is good with the forceps) and a gorgeous, gorgeous, baby boy.
 Tiberius Achaemenes isn't his real name, by the way.
But I am thoroughly convinced that it should've been.

Saturday, March 13, 2010


Today was a triumph.
I fought for my patient and we won.

She was dead set against an epidural, and had gone natural with her first baby, over 17 years prior.
When I got report, I was told she was a medical induction for pregnancy-induced hypertension (high blood pressure). She had come in the night before, at only a centimeter or two, and the Doc had broken her water. Since then, she had progressed slowly to four centimeters, and at the last exam (@0630), she was finally seven centimeters.
So I went down to meet her, and it was just her and baby-daddy in the room, and she was side-lying in the bed. (Let me say now, that this is one of my pet peeves. Women in labor should be UP! Using gravity to its fullest advantages.)
I asked her how she was feeling, she said not so great, since they wouldn't let her out of the bed, and her hips were "killing her" from lying down so long. She said the night nurse had made her use the bedpan because her blood pressures were "so high" that she was afraid getting up and down to the bathroom would only increase them. Her blood pressures were running 140s-150s systolic, with diastolic within normal limits. (Normal BP is considered 120/80. The newest guidelines actually state 120/70. Fluctuation is normal, though, and this is only a guideline.)
So this is were I got a little pissed. Well, yeah, she's putzed along all night, because we stalled out her effing labor by making her lay in one of two positions and not letting her MOVE!
Ignorance gets my Irish up.
So we got her up to a rocking chair at bedside and she was much happier after that.
This was all at around 7:00am.
Doc shows up at 7:30, and checks her cervix. She's only 4 centimeters. He recommends an epidural so we can go ballistic with her pitocin (a med used to induce or augment labor). He didn't say "ballistic" but that's exactly what he meant. He also told her to start thinking of a cesarean section. He then proceeded to blindside me by announcing to the patient and baby-daddy that their nurse (moi) is an "anti-epiduralist."
He sarcastically asked if I had any suggestions, to which I stammered something about moving around more...I know, I know. I dropped the ball.
He and I left the room. As soon as the door was closed, I mimed kicking his shins. He feigned shock.
I told him that it wasn't fair of him to put me on the spot like that, in front of a patient that needs to trust me. He said that he had given me an opportunity, and I hadn't taken it. I got irritated, (i.e. grew a set) and told him that it wasn't like he would've actually taken my suggestions as he obviously just wanted his patient epiduralized anyway.
He again, feigned shock.
He asked me why I am so "anti-epidural."
I told him that it's because: we give the epidural, then the catheter into her bladder because she can no longer safely get out of the bed to urinate. This is a risk for infection. Then her labor will slow, so we have to intervene, to augment her labor even more. Then we stress her baby, or her uterus, so we have to give a med for that. Or we just take the big leap, call her a "Failure to progress" or a "Fetal Distress" and back she goes for a cesarean section. In a nutshell, epidural = more interventions = cesarean section likelihood increases drastically.
He rolled his eyes. But! I tell him, the literature supports these findings!!! And I have personally given this very doctor the printed research articles that show this. Because I am a Grade A Dork.
(But you can't argue with college kids that have access to online article databases. I can find the article to support my claim that the sky is in fact green, if I want to.)
Okay, he says. You've got an hour. If there is at least one centimeter of change in one hour, you can keep doing it your way. No cervical change in an hour, she gets the epidural.
Fine, I say, shall we synchronize watches? He rolls his eyes.
We go back into the room where the patient is sobbing and saying, "But why do I have to get an epidural? I know I can do it naturally. I've done it before." He tells her to stop crying, that her nurse "went to bat for her." I grin at her. He wants me to check her cervix, so we can both agree on what 4 centimeters is for this patient (This is because cervical exams are rather subjective. What I call 5cms, someone else may call 4cms, or even 6cms. The only two checks we all agree on are "Closed," or 0cms, and "Complete," or 10cms.).
I check her, we agree, he leaves.
We get to work.
The baby, of course, starts with the variables as soon as I get ready to put her on telemetry monitors so she can walk around the unit. (Variables mean the baby's heartbeat is having small decelerations with the contractions.)
I switch to plan B, the birth ball. I put her on that, and for the next hour, she huffs and puffs her way to a true 6cms. This was at 0850. The variables came back, so I left her in the bed, on her side with some O2, while I went to call Doc to let him know she was progressing. She was hurting, but still pretty well in control.
At the desk, she starts having deeper, more often variables (as most people involved with labor/birth can tell you, for a mum going naturally, this usually means the baby is moving down F-A-S-T). I ran back to check her. She is now 7cms. I tell a nurse standing by to tell the unit secretary to call the Doc. She does. I don't leave the room because I know I'm about to need to catch a baby...
Doc gets transferred to my phone (we carry unit cell phones), and I can hear that he is driving. He says he is about 13 minutes away. I tell him he is clearly not going to make it. Mum shouts that the baby is coming, and she is trying not to push.
The head comes out anyway. I drop my phone (with Doc still on it), sit down on the bed, and deliver Mum's baby. Mum's first words as she delivers:
"Oh my God! My Baby!!! Laura, we DID it!!! Camera! Camera! Is somebody taking pictures!?"

I felt so validated in the profession that I have chosen.
Doc congratulated me, and told me that I should be proud for a job well done.
I didn't gloat.
But I'm pretty sure I was glowing.
And maybe next time, he'll read one of those articles I gave him.