Tuesday, February 19, 2008

laboring

i just left six hours of watching a first time mother labor. 2cm, 50% and -3 when I arrived. 3cm, 80%, -3 when I left, with membranes ruptured, epidural and foley cath in place. Foley so that when they 'went to the back' it would already be in place. fuck. just go on now, why not?

Pitocin running except when everyone in the nurses station decided those were late decels on the monitor and the nurse stopped the pit and then paged the doc who said start it up again, you can knock it down to 12 milliunits from 18. It wasn't until later that I understood that she had requested to be induced because she was in such misery, 2+ pitting edema, etc etc. and that that's why the pit was running in the first place.

what I don't know if she knows that, to them, to this doc, when she asked to be induced, she was asking for a section. I just don't know if she knows that. I didn't know that. but on my third week on the unit, it surely seems that way...

She was just lying there when I first got there. She was doing it. She was handling the contractions. She was resting between - I realized that I was still in my own stuff about not being able to rest in between, and perhaps more impressed by this than was warranted. But she was all still in the bed, only her face showing the contractions, and every once in a while, her feet would move around restlessly under the sheet.

I realized that I have a romantic, walk the halls idea of labor. The woman shuffles along, periodically stopping and grasping the railing or her support person's arm for 30 seconds and then off they go again. This doesn't happen in hospitals. Does it happen anywhere but in my head? Isn't the best place for a woman at 2cm who wants to keep labor moving to be in motion? In a world without continous monitoring, would I be out walking with this lady? Would we be laying down blankets for her knees and draping her across the birth balls that are all stacked up by the Pyxis mocking me.

On the bottom of last week's lecture notes, I scrawled: Why is the plan to tell the mother to wait as long as possible before coming into the hospital, instead of just NOT strapping her down to the bed on continuous monitoring as soon as she gets there, when we know that we'll end up putting in an IV and an epidural and a urinary cath and maybe narrowly avoiding a c-section? Doesn't this seem ironic when the community health prof defined empowerment as helping a patient or a community regain control of their life or environment? What was the process by which they lost control in the first place? Wouldn't that be a good place to begin with the empowerment interventions?

fuck this.

3 comments:

Emory Student Midwife said...

Welcome to my world of frustration with the current system. My question is if the evidence about what's best for mom during labor is out there -- why aren't we implementing it? Things such as movement, support, intermittent monitoring, etc have been proven to help moms out but we still allow our birth balls to collect dust in the utility closets. I just found out that in the hospital I'm at we have a telemetry where you can monitor mom and baby but mom still has freedom of movement because it transmits the data wirelessly. But no one uses it. Why not?

Are you planning on being an L&D nurse? Midwife?

the robot said...

The Five Year Plan is to work a clinic somewhere for a couple years, and then go back for the MSN FNP.

Someone asked if I thought I would work L&D, and I just snorted. Hell no. I would puff into a little cinder and expire if I had to do this for very long in this environment.

It makes me sad to say that, though, because I wonder if that means that I will just complain my way through this rotation and then roll onto other things, forgetting that there's things here that I'd like to work on changing.

JWJohnsen said...

I'm an RN in Utah, and my wife just had our third baby (and 2nd VBAC). We were terrified - not of the birth, but that my wife would end up on her back in a hospital bed with an IV running because all the idiots at the hospital wouldn't let us have the birth we wanted. We trained for a Bradley birth, and we got what we wanted, but the fact is that the current L&D system is anything but friendly to principles that promote efficient labor and vaginal delivery. Just thought I'd throw in my two cents. Found your blog by clicking on my profession in my profile.