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Monday, March 31, 2008

Would You Like an IUD?

I think because of the level of stress I have been feeling these days I have been experiencing some weird and vivid dreams. The most recent I just had to share; those of you who work in gynecology will get a chuckle. Or maybe you'll be horrified.

I was working as a CNM in my current clinical placement and was seeing a
young girl for an IUD placement. I had briefly reviewed her chart and saw
she had an hCG level of 238. I thought to myself, Well, that's weird
that she's getting an IUD when she is likely pregnant.
But I went
ahead and put in the IUD anyhow. I was surprised at how smoothly it went
in (IUDs are not a strong skill of mine just yet) and was pleased that the young
girl was happy with it. She got up off the exam table and I asked her how
she was feeling.

"Fine," she said. And I noticed that the IUD was sitting on her
tongue. I was baffled at how this could have happened, and briefly thought
that it was too good to be true that it went in so easily. I asked her
again if she felt ok, and she said she did. This time the IUD left her
tongue and slipped into the right place, which, in my dream, was under the
tongue. She left, but I got this terribly nagging feeling that I had done
something very stupid.

I didn't like the hCG level, and on further investigation she was being
followed with hCG levels every 48 hours. It appeared that her levels were
only rising 70 points, not a good sign for a viable pregnancy. I knew that
her pregnancy was unlikely going to continue, IUD or not, but felt like a
complete ass because now it was going to appear that her miscarriage was
completely my fault. I went to my consulting doctor, my gynecologist in
real life, and told her the story. She said not to worry about it, just
about everyone made this mistake, and everything would be ok.

Oh, god, I hope to never make such blundering errors in real practice.

3 comments:

Joyce said...

Another one of those really weird dreams, huh?

Hilary said...

Love it. No, I think that you will never ever ever forget to test someone for pregnancy before inserting an IUD.

I just went to an industry educational seminary on IUDs this week. They confirmed what I had read - they are used for emergency contraception.

Labor Nurse said...

Hilary, only the copper IUD is used for EC. It is 99% effective as EC if inserted within the first 5 days after unprotected intercourse. That's better than Plan B's effectiveness and combined OCP regimens. I didn't know this until I studied contraception several semesters ago. I don't think many people know that an IUD is an option. I think it makes a good option because then the woman has birth control in place.