Thursday, August 20, 2009

Only 2

Only 2 birthdays in the last week :( We've been having babies right and left it seems...I just haven't been involved in them. That makes me sad!!! I want some babies!! It seems like I've had cervidils and antes a lot lately. Boo.

Neither of my birthdays have been terrifically outstanding either. Pretty "run-of-the-mill" almost...for lack of a better word...boring! The first one was a close friend of the doctor...so get this...the doc stood in the room and pushed with her for an hour and a half!! Seriously?! I love this doc, she's great, one of our favorites. But come on. I can think of only a handful of things that can make an L&D nurse feel more useless and a waste of space than standing at the perineum and pushing with the patient the entire time. Makes it even worse when the patients husband is there, and so is her sister...who is a pediatrician. So for an hour and a half I stood in the corner, dumping some astroglide everyonce in a while while doc, patient, husband and sister carried on their own wonderful conversation and the doc did my job!! I was a little sad :( The poor kid crowned for about 20 minutes "stretching". Mom didn't have any major tears...but that poor baby head was bruised and looked horrible!!

2nd birthday was a C/S after pushing for an hour with a kid who wasn't in there straight and a doctor who ran out of patience and a mom who wasn't the hottest pusher. Baby ended up being >9#...the most exciting part of the whole section was the section that happened across the hall at the same time.

We only have 2 OR's, so our rule is not to run them both at the same time (to ward off the emergency walking in). The first time I ever saw them run @ the same time was a couple weeks ago when we had to crash a patient...let's not do that again. Until Monday night. We had just taken my mom back and baby had just come out, when the charge nurse sticks her head in and says that the scrub tech needs to open up the other OR for another case. Huh? When we hear that we suspect emergency, so the scrub tech left to open and prep for the other case and sure enough, pretty soon the other patient came back. After my 2 docs were done closing, they broke scrub and left my OR. So I'm left in a pool of blood, my patient still draped, and the CRNA hanging out at the head. I asked the docs if one of them could do a final count with me and I was told bluntly "we can't. we didn't do the initial count so we can't do the final count." And they walked out.

So now what? I scrubbed in and at least covered the incision. Then counted and thankfully found everything. Then I called out to the desk to see if someone could come back and help me move my patient. My patient was number than a 2X4 and not the smallest mom. So I started cleaning her up by myself and finally the 64yr old charge nurse comes back to help me move out. All the more interesting. So 30min after closing time...we roll out of the OR.

I was NOT a happy camper and when I asked what the emergency was next door...I found out it was a failure to progress section and the doc called it right after I went back for my section. There was no fetal distress, no maternal distress, no fever. No complications, just no cervical change. Then she said that ACOG standards are "30minutes from decision to incision" and insisted that they go back that instant. The charge nurse tried to get her to wait, but she said no. Then they said she could go to the main OR if it was an emergency, but she said no, she wanted to go to our OR's. Seriously?

Thank goodness everything turned out OK, all the instruments, laps, sutures, blades, everything was present and accounted for when I counted and when 2 other people went back and counted. The whole situation made me nervous and a little frustrated. Patience doctors...patience!

Babies today: 1f/1f
Babies total: 58M/70F = 128
Vag:44M/52F = 96
C/S: 14M18F = 32
Babies 'caught' = 2f0.5m

3 comments:

  1. But isn't it worth feeling useless if someone who personally knows/cares about the mom gets to participate in the birth experience and "be there" for her friend? Don't you think it was maybe extra-special for them? Do you think the 20 minutes of perineal stretching was what caused the baby's head to bruise? Yay for intact! The stitches I got for the tear from my first birth (not big or deep, but still) were pretty painful for several weeks. How nice for this mom that she didn't have to contend with that kind of healing!

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  2. Christina...you're totally right that it was the best experience for the patient. It was great to have the doc there and for it to be what was special to the Mom. I felt like a cowgirl before a rodeo though...I spent all the time getting the horse prepped for the show, and then someone else got to ride for the actual rodeo while I sat in the stands. And granted, it was the doctor's patient...but when they are usually so quick to "let us do the work"...it was just totally weird for me not to "get" to do the work!!!

    And yes...I think that it was the 20min of stretching that caused the head to bruise so bad. When up to the ears are sticking out and it won't budge push after push...it looked really, really bad. They even ordered an x-ray because they weren't sure if there was a fracture or not. I felt bad for baby, but I think mom was happy without any perineal tearing. She did get a few "skidmarks" but nothing to crazy!! Yay!

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  3. Wow, scary they didn't count the instruments and then left you there. All for ACOG 30 min decision to incision. Somehow it seems so WRONG!

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