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Baby central.... - Nobody wears a white coat any more... — LiveJournal
...a tribute to becoming a doctor.
Baby central....
I've delivered five babies in the last week, or at least five babies have been delivered to patients under my care. One was a patient I inherited from a previous resident (note: when planning a c-section for after you leave, check with the doctor who will be doing said c-section as a courtesy before scheduling), one spontaneous labor that got my clinic cancelled for the afternoon, before we went to c-section at 5 pm. Baby came out like some kind of infant twister, neck extended, head cocked, holding the cord. "No wonder he wouldn't come down..." my attending mused.
Then there was the 2am section while I was working in the ER, and the VBAC (vaginal birth after c-section) that I ran up two flights of stairs for only to arrive as they were putting the infant on the warmer. 90 minutes from arrival in triage to baby delivery, can't beat that.
Four hours after that I'm fielding the answering service call: "Your patient thinks her water broke." And it had, and at 2 am on Saturday we had our baby.
I've had nobody in the hospital since Sunday afternoon and two first-timerd due next week, while I'm going to be in Philly. I was anticipating peace and quiet.
So wrong, I was.

Second-to-last patient of the day. Primip (first pregnancy) due next week. I'm doing the obligatory cervical check and telling her that at 2cm and 80% effaced she had a way to go. "Get-dressed-checkout-slip-outside-the-door..." I went to see the next patient. Before I get through the staffing room my nurse drags me back. "She thinks her water broke."
It had, she was thrilled, and by the time she got across the street to L&D she was contracting away. I signed into a call room, figuring on a 3 or 4 am delivery, and settled in to wait.
5 hours later I barely had the bed broken down in time to catch the baby.

I only have one more patient due this month. Maybe I should call her in and induce her just to get it over with...


16 whispers echo . o O ( ... ) O o . whisper a word
pwwka From: pwwka Date: July 17th, 2008 06:32 pm (UTC) (etched in stone)
Is it true that more children are born in the summer?
ayradyss From: ayradyss Date: July 17th, 2008 07:58 pm (UTC) (etched in stone)
It certainly seems like it.
therealocelot From: therealocelot Date: July 17th, 2008 08:03 pm (UTC) (etched in stone)
The hospital I volunteer at experiences notably higher birth rates June through October, and has been pretty slammed the last few weeks.
ayradyss From: ayradyss Date: July 17th, 2008 08:06 pm (UTC) (etched in stone)
I'll have to look at the baby budget and see.
winktwice From: winktwice Date: July 17th, 2008 08:13 pm (UTC) (etched in stone)
From: broken_onewon1 Date: July 17th, 2008 11:38 pm (UTC) (etched in stone)
It seemed to be the thing to do in the winter. :)
deadrose From: deadrose Date: July 18th, 2008 12:20 am (UTC) (etched in stone)
I was a good one for throwing the docs off-schedule when I was in labor. With my first it was just a matter of being a very efficient pusher :-), with my second, a wandering intern was dragooned into catching, otherwise my husband would have had to do it alone, and by the time my daughter was born I did first contraction to delivery in 2.5 hrs. That seemed like a good place to stop so I wouldn't end up dropping #4 in an aisle at the grocery store.

Was last autumn particularly cold 'round there?
turnberryknkn From: turnberryknkn Date: July 18th, 2008 03:14 am (UTC) (etched in stone)
Know how you feel. Will be joining the on call pediatrics team for the problem deliveries in two week's time.

Now, it's great for training that all of the mothers with potentially critically ill babies are all funneled to us. But I think every night on call with the L&D emergency code pager strapped to my belt adds grey hairs. :-)
ayradyss From: ayradyss Date: July 18th, 2008 03:19 am (UTC) (etched in stone)
Ohhh....code green! Code green!

The siren gives me at least 3 seconds of asystole every time I hear it.
turnberryknkn From: turnberryknkn Date: July 18th, 2008 03:21 am (UTC) (etched in stone)
BTW, I apologize for asking, but I'm confused how your current training works (and I might have missed it while I was on my own previous month deathmarch), regarding the place of the Ob/Gyn training you're doing now -- are you formally finished with your FP residency now?

(If so, congratulations! :-) )
ayradyss From: ayradyss Date: July 18th, 2008 03:22 am (UTC) (etched in stone)
I'll be formally finished on Wednesday :) I'm board-eligible!
From: (Anonymous) Date: July 18th, 2008 01:55 pm (UTC) (etched in stone)

re I only have one more patient due this month.

"Maybe I should call her in and induce her just to get it over with..."

This is one of the problems with the soaring c-section rate. I think you are trying to be funny but it really isn't since it happens all the time. I had an unnecessary c-section due to a failed induction. I hope you doctors will wake up soon and realize that you are hurting us. My next delivery will be a home birth (my doctor laughed at my wish for a vbac anyway--sums up the obstetrical view of labor and delivery). I am begging you to rethink birth. I don't expect you to post this, I just want you to please think about it. And when you start thinking I am loony for a homebirth, read "Born in the USA" by Dr. Wagner. He is no loony. I wish I could trust doctors to have my best interest in mind, but the evidence is showing malpractice is number one and convenience is two, the baby is somewhere after that and the mother is dead last. You are a new doctor and I hope you will be different.....good luck. Sorry for the rant.
ayradyss From: ayradyss Date: July 18th, 2008 07:46 pm (UTC) (etched in stone)

Re: re I only have one more patient due this month.

Part of my "new mommy" talk at the first OB visit is the discussion of the C-section rates which an OB fellow a few years ago evaluated at our institution. I tell my patients that at 41 weeks if they're not in labor I'll discuss induction, because after 42 weeks there's strong evidence for an increase in sudden fetal demise as well as poor perinatal outcomes (hypoglycemia, shoulder dystocia, etc). I tell them that at 40 weeks they may be begging for it, and then I give them the numbers - 50% unscheduled c-section risk for a primiparous patient induced at term with an unfavorable cervix.
Somewhere around 38 weeks I usually have to repeat the talk. It seems to get through.

VBAC scares me still - but it's an evolving topic. Under the right circumstances, I'm all for it, but a 1-in-20 chance of uterine rupture and possible fetal demise is a statistic I haven't found any studies to counter, so the circumstances have to be very right. And I can't tell you how many times I've gone into a repeat section and seen a uterus so thin I could see right through the muscle tissue.

I have partners who've done home birth of their own children, and we've talked about it at length. With the right plan in place and the right backup support, I don't have a problem with it.

With my laboring moms I have one thing in mind - I intend to have a healthy mother and a healthy baby at the end of it all, and I don't care how I get there. I'll do what's necessary to have two healthy patients at the other side. I'm not particularly worried about malpractice - I feel like I have a good relationship with my patients, and I do the best I can by them, so if it happens, it happens.

And I -am- un-screening this, because I don't know why your voice should be any different from the voices of this generation of physicians.
Do C-sections save lives? Absolutely. Are they overused? Absolutely. But I fear the swing back the other way, to abandonment of hospitals and dismissal of the tools we have to offer. During my own pregnancy I read so much about the horrible and all-pervasive institution of medical delivery - and I simply don't see so much of it where I'm at.
Women come in with birthing plans, and they point to this and that and the other way that they want things done, and all I can do is shrug and say "That's standard policy here. You didn't have to ask for it." And they're so surprised. I don't understand.
From: (Anonymous) Date: July 21st, 2008 01:58 pm (UTC) (etched in stone)

Thank you for responding

And yes--there are good hospitals and doctors. I only ask for you to do more research on VBAC's--if it were a 1 in 20 chance of rupture things would be very different:
10,880 Planned VBACs with one prior scar --0.6%
Source: Miller, D. A., F. G. Diaz, and R. H. Paul.1994. Obstet Gynecol 84 (2): 255-258
And this:
"This risk is thirty times lower than any other unpredictable childbirth emergency such as acute fetal distress, premature separation of the placenta and prolapsed umbilical cord. A 1994 study based on 5733 planned labours after one or more cesareans reported a rupture rate of .8% with no maternal deaths related to uterine rupture (Guide to Effective Care in Pregnancy and Childbirth 1992; Obstetric Gynecology 1994). "

So thank you for agreeing the section rate is too high--help prevent more and promote VBAC. Things will change when this happens. In the meantime, the backlash against doctors and hospitals grows....I think people are really underestimating how much we really do not want these c-sections (except when truly needed of course, about 15% of the time at most).

Good luck to you!

ayradyss From: ayradyss Date: July 21st, 2008 02:13 pm (UTC) (etched in stone)

Re: Thank you for responding

I've asked a number of OB-Gyn's their opinions about VBAC. I've gotten one universal response from those who don't do them - "I had a bad outcome", which is our euphemism for "the baby died".

Can't blame them for being scared to some degree, I suppose.

<3<3<3 for citing references. I'll look at them.
blueeowyn From: blueeowyn Date: July 21st, 2008 07:09 pm (UTC) (etched in stone)

Re: Thank you for responding

My somewhat cynical questions after their comment about the bad result would be:
How many non-VBAC bad results have you seen?
Were there other circumstances that may have been the contributor?
How many VBAC did you see before the bad result?

But I am cynical. My SIL had a section in her first term child (I have no idea why) and the next 2 were scheduled sections (one on Veteran's day in honor of the baby's grandfather having served) and the other was originally scheduled for late June (due July 13) but moved to July 6, and then bumped to July 9 for her convenience (that way she could go to her sister's wedding that she didn't care about missing when she planned her pregnancy for being due at that time ... and her grandmother would be in town to see the baby ... and meet the older ones for the first time).
16 whispers echo . o O ( ... ) O o . whisper a word