Sunday, March 28, 2010

Shoulders. Oh fuck.

So I had my first days back in the hospital post-H1N1 on Friday & Saturday. But let me briefly recap the last couple weeks in bullets. Forgive me.

  • Caught 4 babies with my Manwife preceptor. One natural mama in hands-knees. Very difficult to do your appropriate perineal support & hand maneuvers upside down. But a definite learning experience. One pre-termer who didn't breathe & had to get intubated at BS. We were so busy this day. Literally ran nonstop all day long. Had 15 mins of down time to inhale some food.
  • Caught 2 babies with awesome Midwife H. One first thing in the morning. I love that.
  • Went home for the weekend. My flight got delayed for 5+ hrs. I rented a car for super cheap. Saw B. Saw my family. Caught the crud (later identified as H1N1.)
Alright, you are thusly brought back up to speed. Friday I was with Midwife A. We weren't super busy which seems to always happen with her. Most significantly, I had my first shoulder dystocia. Super scary. It wasn't a bad one...resolved in 60 seconds, but still something I haven't seen enough of to feel comfortable managing. Midwife A stepped in as soon as the baby's head started turtling; we did McRoberts, suprapubic pressure, and Midwife A delivered the posterior arm which gave enough room for the rest of the baby to be delivered. And she was a tiny thing (7ish...) to be causing so much commotion. It turned out well but scared the shit out of me. Lesson to be learned: a shoulder dystocia can happen to anyone at anytime with any size baby. Duly noted universe, I got the message. So we only had that one delivery.

Yesterday I was with Midwife Ratched. I think that I'm growing on her because she actually seemed okay with me rather than exceptionally annoyed at my mere presence. So I'm taking that as a good thing. We were rather busy yesterday. We had a lot of people coming through triage, including people actually in labor. Woo. I will admit I got super excited when vertex/vertex twins came in contracting. Sigh. Not in labor though. Better luck next time. I gave up one of my deliveries to the dad. He wanted to catch the baby. So he did. It was cute. We did two other deliveries and neither were particularly easy or straight-forward. One had FHTs down in the 80s-90s...making me super uncomfortable. Mom was just not moving baby as quickly as needed. Midwife Ratched had to step in w/the modified (aka not-in-your-butt) Ritgen. It worked...baby was OP and had a double nuchal. Ahhhh it's all so clear now. Second delivery was also not super easy...it all turned out okay in the end; but I was still terrified there would be shoulders. There wasn't...phew.

So lets do the math 11+2+1+2= 16

I am starting to feel comfortable in my clinical setting. Less awkward and more take-charge. I feel like the midwives collectively have been giving me more and more responsibility. Charting, writing H&Ps, progress notes, delivery notes, orders, etc. is a lot easier than it had been. I don't have to write drafts of my notes or stare at prenatal records blankly cos I don't know where any of the information is. I also feel like I'm starting to be on the same page as my preceptors. And actually knowing the answers to their question of: What do you think we should do with this pt? And having my answer match theirs. Using my clinical acumen to work through a vague CC of abdominal pain.

As far as my personal life goes, a lot has been happening. As my life is more and more midwifery, I feel less like my personal life belongs here in this blog. Maybe I'll feel comfortable sharing soon.

5 comments:

cjones88 said...

I have really enjoyed your blog. I've been reading it for the past few months. I want to know how do you like the education and training you are currently receiving.

Student Nurse Midwife said...

Cjoness88,

Thanks for commenting & reading. When I came to midwifery, I really came from a natural, more holistic place. The midwifery I'm learning in my program can be holistic but does really train us to be able to work in a hospital setting, with the technology, as well as in other settings such as birth centers. A lot of my classmates are in birth centers. A downfall to solely getting your training there is low delivery volume and you may not see/do things that you really need to see/do for boards & graduation.

As I am growing as a midwife, I am learning where I feel comfortable. I have seen some emergent situations where I was very much glad to be in the hospital with my MD close at hand. But I've also seen super healthy normal births that could have easily taken place elsewhere. I think it's just a balance.

Right now I'm happy with my practice. The midwives do all of the vaginal deliveries and our practice is very large, seeing a lot of patients both in the office and in the hospital. Right now, numbers are key. The more you see, the better you get. I'm happy to be exposed to all sorts of things.

Finally, I think being in the hospital setting may be a great place for me to advocate for change. Realistically, most women do deliver in hospitals. And if you want to affect change, I think it should start there. As a student, I don't have a lot of say or authority yet. But improving the care that is available to women is something I'm constantly thinking about.

Chakeeta said...

I just want some advice and insight on what to expect. I got accepted for the fall semester and I am super excited. But I do know that moving to a new place, school and all the other stress is going to be a handful

Student Nurse Midwife said...

Chakeeta,

What program are you going into this fall?

Chakeeta said...

I will be in the bsn/msn segue in midwifery at emory