Tuesday, March 2, 2010

4+3=7

I was trying to be a good nurse-midwifery student and put my pt encounters in this god-awful tracking program that they mandate we use. I hate the program. It's not user-friendly, has weird quirks, and is really annoying. Equally aggravating are the brand new sets of ICD9/CPT codes I've got to commit to memory because they're almost completely different for intrapartum than antepartum. The search function sucks so basically I have to keep a cheat-sheet of ICD9/CPT codes that I use. Using these codes helps also keep track of your pt encounters by type (ie. prenatal visit vs. intrapartum delivery.) So I had been trekking through all of my recent pt encounters and I notice that the program has set my default information incorrectly and there is no way to go back and mass-correct. So I have to go back case by case and update the correct information. Gr. *sigh* I digress.

I had a very productive two days in the hospital. Friday I worked with Midwife Ratched who happens to hate my guts. When we came on there was a pt about to deliver and she took my easy multip vaginal delivery first thing in the morning. The nerve! So I was slightly miffed about that. We did end up admitting another pt in pretty good labor later on. Midwife R was a little less possessive and let me manage this woman's labor, push with her, and catch the baby (baby #4 for me!) Unfortunately, both MR and the doc on call were there for the delivery, ordering me to cut an epis. Little autonomy and two-against-one, I did as told. But I don't feel really awesome and midwife-y about it. MR & I did the repair together and all was well. I do have to have at least one to graduate so I got that out of the way.

I ended up coming in on Saturday as well. Talked to MR in the morning (before she went home) to see if it was busy and we had two multips in active labor. Rock on. Midwife H came on who I really like. She's super chill, very friendly and very much hands on with me. She challenges me and really facilitates learning. I've worked with her in the office several times, so I knew she'd be fun on the weekend. Plus I was interested to see the different dynamic when a) the office is closed b) there are no inductions c) docs aren't in-house hovering over your shoulder. I got to postpartum round on the pts who delivered the day before which was pretty cool as well. In addition to our pts, we admitted a drop-in with no prenatal care, contracting @ 4-5cm with a questionable EGA. Then babies came from all directions -- I caught baby #5 at 11a, baby #6 at noon, and baby #7 at 245p. No episiotomies but a second-degree laceration that I repaired pretty darn well. Turns out questionable EGA baby Dubowitzed to post-dates IUGR. The other fun thing that happened was when I was doing a vaginal exam on a pt in labor...felt the cervix, then the baby's head, then ran my finger along the head trying to determine position/sutures when I felt fingernails. Baby had its hand by its head. After feeling the fingernails for a couple seconds, baby got annoyed and balled its hand into a fist and moved it away from me.

And then yesterday I was back in the office with none other than my fav Midwife R. Boo. It's not as exciting when I've had a pretty awesome time in the hospital. But...it has to be done. I still haven't seen any pt from the office in the hospital, but I might. Who knows. Anyway...I've got some case studies to work on for tomorrow's class.

2 comments:

Iris said...

Wow, congrats on your 7 births so far!! And that is soo neat about feeling the baby's fingernails, whoa! :)

Student Nurse Midwife said...

It was neat and very odd. Pt ended up w/a CS cos the baby's arm actually was in the way of the head coming down. We thought that might happen.