courtenay_e
03-18-2006, 04:15 PM
Okay, I've posted about this particular client a couple of times lately. She had a version about ten days ago, and then was kept over night the other night b/c her ctx were 4 min apart and she had show...then sent home after she refused pit the next morning.
Here's a bit of back story. Admits to getting pg to "get a guy to stay," and of course, he walked the day he found out. Has no support in the way of family but her 80 yr old grandmother. Works as a dancer at a bar, needs to get back to work asap to support herself and baby. Wanted me to be with her for the birth, but was very upfront about wanting any and all drugs as soon as she walked through the hospital doors. I did my best to educate her about side effects...she listened, considered, and decided on requesting the whole shebang. Nobody she knows but me has delivered without, and she has a total lack of confidence in her body and the process. We practiced relaxation to get her through as long as she could, and there is a tub and shower available in the birthing rooms, so I figured I could use those, as well, until the CNA got there.
Yesterday evening she'd been having ctx four minutes apart consistently for four days, with no cervical change. At all. She was even still posterior, no effacement. Got a call at about six pm that she had just stepped into the shower and she thought her water had broken. She had had an exam yesterday am, so I knew that she was still probably starting from square one. After her water had broken, her ctx were about two minutes apart, and stronger. I advised that she get back into the shower until I could get there, and that we'd go from there...she was still talking calmly through ctx, and watching a comedy central video--and reacting to it. She called me back as I was walking out the door to tell me that she had called the doc, and he wanted to see her at the hosp. So, I met her there instead. When I got there, she had been admitted...there was some meconium in the fluid, or the nurse would have sent her home. She was only fingertip, and still posterior, no effacement. I got her walking around, working on the birthing ball, etc for about an hour. During this time, her ctx continued to be about 2min apart, and were getting harder for her to concentrate through...and the baby's heartrate was not variable at all through the ctx. She stayed right around 155-160...the entire time. Nurse called the doc in, doc put mom on her side, and allowed her to roll every twenty minutes for an hour. Baby didn't seem to like that any better. And after another hour mom still had no cervical change (still in early labor, though, so I wasn't really expecting any)Doc started talking about CPD and failure to progress. I suggested that, as she had just had a version, perhaps the presentation wasn't optimal, and if we could help the baby move a little, maybe she'd be able to put more pressure on the cervix. And also that perhaps she was pinching the cord somewhere, and could we try hands and knees for 20 minutes? He got irritated (of course, god forbid I know anything about my job...), but said "Sure, go do your "doula thing," I'm going to go plan the c-section." Mom freaked out, was asking whether the dad had called or showed up (she'd called him on her way out the door to the hospital). Twenty minutes later, doc came in and suggested c-section. As baby had been in distress, mom hadn't been able to use the plethora of drugs she'd planned on, and while strapped to the bed had been more and more difficult to relax through ctx. I remained calm and steady, and answered all her questions...but saw that when the doc mentioned c-sec, that she seemed to like the idea, after all. She agreed to a section, as the baby hadn't responded to anything we tried to "wake her up." The minute the doctor left the room to prep the OR, she relaxed, the contractions got significantly stronger, the baby's heart rate went totally textbook variable. The doc did the section anyway.
My view on this, as soon as the mom asked where the dad was, was that she was waiting on his arrival to progress. When she realized that he wasn't going to see him there, she gave up and agreed to a section, rather than birthing vaginally with him there. When she came to a resolution to the "problem" of ctx with no coping mechanism she was willing or able to use (c-sec) she relaxed and went with the flow.
Today, she said if she'd had any idea it would hurt this bad, she never would have gone under the knife. :lol I could only sigh quietly and help her deal with the reality of taking care of a newborn by herself with an abdominal incision. The only real upside (besides a healthy baby, of course), was that,though planning to breastfeed up to the onset of labor, when she was rolling into the OR, she decided to bottle feed (maybe the only thing she felt she had under her control?). But, the second she saw/smelled the baby, she opened her gown and put her to the breast. Baby is a great nurser, and they seem to be doing that well!
I feel like I did my best with the circumstances I was given. I spent several hours with her on a few occasions, educating her as to her options and the repercussions of each option. I spent a lot of time with her on the phone. I supported her as best I could during labor, and during the section (1:20 am), and afterward, until the baby had had a few really good nursing sessions. I left when her grandmother got back to the hospital at about 8 o'clock this am. The entire time, the nursing staff was great, and was happy to see her with labor support. The doc was annoying, but I expected that, as he's been that way throughout the whole affair, and I didn't have an attitude with him, I was very calm and professional the entire time. I really was not surprised that the baby had meconium, as she'd had the version, and that is rather stressful...they really had to strong arm her to move her.
I'm glad mostly that baby was okay, and that mom seems to be recovering well, but I'd like to know what tools others may have used, or what you may have done differently to help prevent a section. As the baby seemed to be in valid distress (?) I really don't know what else I could have done, other than force mom to practice more relaxation techniques? :wink Any help would be appreciated. My goal is to do my best to keep the c-sec rate in this world as low as I can, so I'd like to learn from my experiences. I don't want to think that I "failed" her, but if I did, I'd like to learn from it, so that I can more readily help others. Thanks!
Here's a bit of back story. Admits to getting pg to "get a guy to stay," and of course, he walked the day he found out. Has no support in the way of family but her 80 yr old grandmother. Works as a dancer at a bar, needs to get back to work asap to support herself and baby. Wanted me to be with her for the birth, but was very upfront about wanting any and all drugs as soon as she walked through the hospital doors. I did my best to educate her about side effects...she listened, considered, and decided on requesting the whole shebang. Nobody she knows but me has delivered without, and she has a total lack of confidence in her body and the process. We practiced relaxation to get her through as long as she could, and there is a tub and shower available in the birthing rooms, so I figured I could use those, as well, until the CNA got there.
Yesterday evening she'd been having ctx four minutes apart consistently for four days, with no cervical change. At all. She was even still posterior, no effacement. Got a call at about six pm that she had just stepped into the shower and she thought her water had broken. She had had an exam yesterday am, so I knew that she was still probably starting from square one. After her water had broken, her ctx were about two minutes apart, and stronger. I advised that she get back into the shower until I could get there, and that we'd go from there...she was still talking calmly through ctx, and watching a comedy central video--and reacting to it. She called me back as I was walking out the door to tell me that she had called the doc, and he wanted to see her at the hosp. So, I met her there instead. When I got there, she had been admitted...there was some meconium in the fluid, or the nurse would have sent her home. She was only fingertip, and still posterior, no effacement. I got her walking around, working on the birthing ball, etc for about an hour. During this time, her ctx continued to be about 2min apart, and were getting harder for her to concentrate through...and the baby's heartrate was not variable at all through the ctx. She stayed right around 155-160...the entire time. Nurse called the doc in, doc put mom on her side, and allowed her to roll every twenty minutes for an hour. Baby didn't seem to like that any better. And after another hour mom still had no cervical change (still in early labor, though, so I wasn't really expecting any)Doc started talking about CPD and failure to progress. I suggested that, as she had just had a version, perhaps the presentation wasn't optimal, and if we could help the baby move a little, maybe she'd be able to put more pressure on the cervix. And also that perhaps she was pinching the cord somewhere, and could we try hands and knees for 20 minutes? He got irritated (of course, god forbid I know anything about my job...), but said "Sure, go do your "doula thing," I'm going to go plan the c-section." Mom freaked out, was asking whether the dad had called or showed up (she'd called him on her way out the door to the hospital). Twenty minutes later, doc came in and suggested c-section. As baby had been in distress, mom hadn't been able to use the plethora of drugs she'd planned on, and while strapped to the bed had been more and more difficult to relax through ctx. I remained calm and steady, and answered all her questions...but saw that when the doc mentioned c-sec, that she seemed to like the idea, after all. She agreed to a section, as the baby hadn't responded to anything we tried to "wake her up." The minute the doctor left the room to prep the OR, she relaxed, the contractions got significantly stronger, the baby's heart rate went totally textbook variable. The doc did the section anyway.
My view on this, as soon as the mom asked where the dad was, was that she was waiting on his arrival to progress. When she realized that he wasn't going to see him there, she gave up and agreed to a section, rather than birthing vaginally with him there. When she came to a resolution to the "problem" of ctx with no coping mechanism she was willing or able to use (c-sec) she relaxed and went with the flow.
Today, she said if she'd had any idea it would hurt this bad, she never would have gone under the knife. :lol I could only sigh quietly and help her deal with the reality of taking care of a newborn by herself with an abdominal incision. The only real upside (besides a healthy baby, of course), was that,though planning to breastfeed up to the onset of labor, when she was rolling into the OR, she decided to bottle feed (maybe the only thing she felt she had under her control?). But, the second she saw/smelled the baby, she opened her gown and put her to the breast. Baby is a great nurser, and they seem to be doing that well!
I feel like I did my best with the circumstances I was given. I spent several hours with her on a few occasions, educating her as to her options and the repercussions of each option. I spent a lot of time with her on the phone. I supported her as best I could during labor, and during the section (1:20 am), and afterward, until the baby had had a few really good nursing sessions. I left when her grandmother got back to the hospital at about 8 o'clock this am. The entire time, the nursing staff was great, and was happy to see her with labor support. The doc was annoying, but I expected that, as he's been that way throughout the whole affair, and I didn't have an attitude with him, I was very calm and professional the entire time. I really was not surprised that the baby had meconium, as she'd had the version, and that is rather stressful...they really had to strong arm her to move her.
I'm glad mostly that baby was okay, and that mom seems to be recovering well, but I'd like to know what tools others may have used, or what you may have done differently to help prevent a section. As the baby seemed to be in valid distress (?) I really don't know what else I could have done, other than force mom to practice more relaxation techniques? :wink Any help would be appreciated. My goal is to do my best to keep the c-sec rate in this world as low as I can, so I'd like to learn from my experiences. I don't want to think that I "failed" her, but if I did, I'd like to learn from it, so that I can more readily help others. Thanks!