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

Wednesday, November 26, 2008

Get this...

Does this make any sense?

Everyone at work knows I am now a CNM. I've approached each and every provider and asked if they wanted to add a midwife to their roster. Each has said no. One even laughed.

So...clearly they don't want midwives...or me...or both...

But why is it then, that when I called a doctor to the room to check a woman who was clearly fully dilated (an exam is rarely needed for this in an un-epiduralized woman) and ready to push needed me to recheck his exam because she wasn't sure if there was an anterior lip or not?

The patient was fine that I rechecked her, and she was fully and +2 station. What the doctor was feeling was a wrinkle in the fetal scalp. It happened to take me all of 3 seconds to make this determination.

Mind you, this doctor was one of our family practice doctors so perhaps its because she just doesn't have a whole lot of obstetrics in her practice.

But do you see my point?

Monday, November 17, 2008

Another thing not to say to a woman in labor....

I was talking with a woman who told me that she was never going to have anymore children because her last birth experience was so horrifying that she can't even fathom putting herself through such anxiety again.

Her second child was born by c-section and in a different hospital than her first. It was an unplanned emergent c-section that sounds like it was a true stat situation. She had come to the labor floor in active labor, was hooked up to the monitor, an IV and put into a room. She was waiting for the preps for an epidural to be completed when several nurses came running in yelling orders at her to turn to her right, then her left, then on her hands and knees, and an oxygen mask was slapped on her face. She asked what this was all about, and a nurse answered, "You need to just do what we say- change your position because you are strangling your baby! Your baby's heartbeat is down because you are in the wrong position!" Despite the uterine resuscitative methods, the baby's heart rate never returned to a normal rate and she was rushed off to the OR and had her baby. He was vigorous and cried immediately, and she felt so relieved that what she had done did not harm her baby.

When she told me this, I was so saddened by those words. What a horrible thing to say to a woman in labor, leading her to believe that her baby was going to be harmed or even die because she was in the "wrong position". Basically, your baby is in distress because you are doing something wrong! Please!

When she was telling me this, I could see the fear and sadness still in her. Normally I leave my mouth shut when people tell me their birth stories because I don't want to have them feel like I am judging their experience, or challenging their beliefs in a negative way. But I felt so strongly that what was said to her needed to be corrected, I said, "I am so sorry that you had this experience. You didn't do anything wrong, you weren't harming your baby." I explained to her that baby's do drop their heart rates on occasion, sometimes because of a position that causes them to compress their cord, but it's not because the mother was doing something wrong. And sometimes no amount of position change, oxygen, IV fluids, or whatnot can not restore a normal fetal heart rate.

I was curious how long ago this was, since her feelings seemed so raw. "My son is 12," she answered. I would have thought maybe a couple of years at most, given her emotional memory.

Thursday, November 13, 2008

Midwifery in My Dreams

Because, that's the only place I can practice midwifery at this point. Hopefully this will change in the very near future, but it's not looking hopeful.

So my dreams are littered in midwifery. Many times I find myself breastfeeding babies- either my own or some random little one I find awfully cute. One of the most recent was a dream where I was in an office that looked very similar to an office I interviewed in except I had this feeling that we were out in some out of the way wooded area in another state (Indiana, or Illinois maybe...totally random). Suddenly a preceptor I worked with was laying on an office floor and needed assistance giving birth. I helped deliver the baby, a boy with lots of black curly hair, and left the room. The birth part in my dream had this weird focus on providing a lot of counterpressure to the head to preserve the perineum, yet I never inspected the perineum or labia for lacerations after the fact. This was something that panicked me when I was half asleep. How could I forget to assess for lacerations? What if she had some big tear that needed a good repair and I never even bothered to look?