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

Sunday, November 22, 2009

Multip End Point

This morning I get an email from an old friend who is pregnant with her fourth child. This pregnancy was more challenging than her others, with more aches and pains, preterm contractions, questionable blood pressure issues, and then a few episodes of premature rupture of membranes. Everything has always turned out fine whenever she went in for an evaluation, whether at her doctor's office or the labor and delivery triage unit. Her most recent labor and delivery triage visit prompted a nurse to say to upon arrival, "Oh, I would have thought you would have delivered by now!" This made my friend feel a bit like a multip she should have been able to know exactly the right times to actually present for triage evaluation or have had something requiring her to stay instead of being discharged still pregnant.

Her previous three babies were all delivered between 36 and 37 weeks after spontaneous rupture of membranes and a fairly quick spontaneous onset of labor shortly after. So at 36 weeks we were all waiting for her water to break. And she reached 37 weeks. During the 37th week, she went in for several evaluations of varying concerns, all panning out just fine. She was feeling quite anxious at this point, given that she had never gone past 37 weeks.

And then 38 weeks...

Now, at just 39 weeks, and still chugging along, she tells me that she is going in for induction tomorrow. Just because. The reason her doctor gave her was basically a "What the're a multip and your cervix is 2 centimeters dilated and I know you want this over with."

And you know how I read this? "ACOG says it's ok to induce at 39 weeks, you've had 3 normal vaginal deliveries without problems, your Bishop score is favorable, and we are sick of you calling us everyday and I am on call tomorrow."

Why do I think this? Because my friend reports that her doctor had said it was fine for labors to be induced once a woman reaches 39 weeks in all women; that her doctor's office staff have said to her that she "got the award for the most phone calls from a multip ever", and he said routinely started checking her cervix at 37 weeks to see if she was "ripe" should she ever need an induction. Oh, and when she requested to postpone the offered induction by one day for childcare reasons, the doctor said it couldn't be done because he wasn't on call that day and it would just be better for all involved if she came in when he was there.

Now, I am not sure if my friend sees it this way, as she was delighted to be able to have an end point to her pregnancy that has been an anxiety provoking experience for months.

And it gets better...the reason my friend contacted me to discuss her induction was because the doctor ended her visit with saying, "Well, this all should go fine, but I think your baby is big so you might end up with a c-section."


Sunday, November 8, 2009

Days Off

I have been finding my days off, be it a true day off or post call day, go by so quickly that they aren't enough. I feel the need to sleep in late, yet if I do I feel like I've cut off so much of my time off. I dread the sun going down and the need to start dinner because it means the day is coming to a close.

I fantasize about having chosen a different path in life. Like, had I stuck to writing like I wanted to when I was a kid and through most of high school, perhaps I could have been writing for money and not need to be awake at 24 hour intervals once or twice a week. I could have structured my day around going to the gym, running errands, and just flat out getting shit done so nothing ever feels like it is hanging over my head for days or weeks at a time. Like the tub would get cleaned even before the algae or mold or whatever that stuff is that seems to find it's way onto the tub walls.

Or perhaps I should have been fine with mediocrity and stayed a bedside labor nurse. I could do a few shifts a week, and go home with nothing following me like following up on labs, making sure someone shows up for their very important lab work because you think you might be dealing with an early ectopic pregnancy, or second guess that the meds you just started on someone was the right choice. I'd not be expected at every single freaking departmental meeting despite the fact I'd not gotten more than 15 minutes of sleep on my call shift and all I want to do is go home and curl up in my bed. Instead, if I worked through the night I could have just given report by morning and gone home.

But, that's not what I wanted. I keep reminding myself of this, even on my days off.