labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Wednesday, May 21, 2008

The Bulb Syringe

My most recent clinical shift was a nightmare. I don't even know where to begin, but there is one thing that sticks out above the rest, and it is so innocuous that it makes no sense. Between multiple laboring women with so many compounding issues (like untreated STIs or domestic violence or multiple substance abuse issues) that were overwhelming, the pushy physicians who kept making their way into see our laboring women when they were not needed (and ultimately deciding one needed a c-section...which she did, but this physician was talking c-section well before there was an indication for one), and a preceptor who could not have been bothered with me, it's a bulb syringe that is pissing me off.

You see, one of the laboring women went very quickly and my preceptor was not available when delivery was imminent. So another midwife from a different practice offered to do the delivery. Phew, I wasn't going to be alone! But...perhaps I should have been. I quickly glove up and get together my supplies, which is not a whole heck of a lot. And so I stand and am ready to catch this baby when the midwife says, "Where is your bulb syringe?" and plops it into my placenta basin. I said nothing, thinking maybe she just likes having it handy. I usually leave it on the delivery table that is at the foot of the bed because I have never needed it. Not to mention my understanding was that evidence shows that normal newborn transition rarely requires assistance in clearing the airway, even when meconium is present when the baby is vigorous.

The head delivers and the midwife shoves the bulb syringe in my hand. "Suction! Suction!" she barks. I was stunned. Suctioning on the perineum? Did we time warp here? And, so like her minion I suction. Barely. The position the baby and mom were at allowed me to make it look like I was suctioning that baby good, but in fact I wasn't exactly doing nearly what she was expecting.

The rest of the birth didn't exactly go as I would have hoped (for me at least, the mom was fine) because this midwife just kept barking orders at me like I was an idiot. I kept my mouth shut and did the things I needed to do, and having attended a fair amount of deliveries at this point have come into a few ways of doing things of which she criticized profusely. It was so frustrating. Moments like these make me wish I was independent, yet I quickly remember that I don't feel quite ready and to pull in the reins.


amy said...

She was out of line barking commands at you like that. No one learns well with that kind of environment so don't beat yourself up about it. Keep in mind that you only have to jump hoops for so long and that observing all these different provider's styles will help develop what you do (or DON'T DO! :)) in many cases.

frectis said...

I can empathize. I found myself doing things the way the assisting midwife would do them, rather than the way I was taught or have adapted my own practice. I was always pissed afterward too because I realized I was doing things her way for HER comfort. How much longer until you're a GNM?

Molly said...

Cringe. It's rather comforting, though, that you're out there anyway, supporting laboring women and figuring out how you want to practice. So thanks :)

Anonymous said...

I wonder if there is any way you could talk to the midwife at some point to question why she made some of the reccommendations? I'd be super-nice about it...approach her with something like "I realized when I was working with you the other day that you do things somewhat differently than I've been taught, and I want to expose myself to different points of view, so I wanted to pick your brain and find out why you do some things. For example, I have been taught that suctioning a baby is usually not necessary, but you wanted me to suction on the perineum. Have you seen problems when suctioning is not done?"

And so on...

BTW...I agree with you that I've read the suctioning is usually not necessary. Only my first daughter--who had meconium--was suctioned, and I've since read a couple of studies that find that process to be pretty much useless.

Sounds frustrating though. Even if she thought you weren't doing things correctly, she could have quietly said in your ear "I think you need to suction the baby" while pressing the bulb into your hand.


Sarah said...

How much older was the other midwife? Does she practice "old school" medicine? Even though I'm a medic and not an RN I've run "differences" in treatment based on how/when the provider was taught.

As for the suctioning, and granted we deliver in emergent situations, we are trained to suction w/ bulb syringe as soon as the head clears and to use a meconium aspirator/suction if any meconium is present. Obviously, very differnt teachings.