New year, new beginnings

Happy new year everyone!  Here's to 2014!!

I start solo call time this week, without a 2nd CNM to back me up.  A bit nervous and excited to be on my "own"!  Of course, I'm never really on my own, since I always have a doc on call with me.  As part of my orientation for becoming a CNM, I am doing a fairly intensive residency type of program with my hospital call time.  I run my assessment and thoughts on how to diagnose/treat all triage clients, labor clients, births, etc to my back up MD.  This is to ensure them that I know what I'm doing, am thinking in the right direction for diagnosis/work ups, and am appropriate in my management/treatment plans.  It's very much like what a medical student does in their last year during their clinical rotations, and what beginning OB residents do in their 1st year of training.

I am very grateful for the fact that my back up MDs are within 5 minutes of the hospital, so they are super quick to respond if I need emergency assistance with anything.  The hospital itself is a small community hospital, and is a good distance drive from where I live, so I plan on staying in house for my entire call time.  Of course, there are stores and restaurants close by that I can go shopping/eating if I don't have patients in the hospital.  Like I said, the hospital is a small community hospital.  Our group sees the majority of the patients (there are currently only two OB groups that attend births at this hospital), and our group only does about 40-45 births per month.  So it's very low volume, and low key.  Not what I was used to as an RN at the huge city hospital, where we did a total of at least 300-350 births per month, plus over 1000 outpatient hospital OB patient encounters per month!

I'm sad to say that where I am now, we cannot offer planned VBACs, due to anesthesia not being in house 24/7, which is a requirement.  Of course, my MD partners would *love* to attend VBACs, but their hands are tied by hospital requirements.

I am surprised by some of the outdated policies.....for example: women wanting epidurals in labor are restricted to ice chips/hard candies only (per anesthesia), both pre-epidural and post-epidural.  Anesthesia also requires all women to get a dose of bicitra (a stomach acid neutralizer) pre-epidural placement.  This is usually, in my prior hospital, only a pre-surgical birth requirement (before a spinal is placed for a planned/urgent c-section).  The thought process on giving a stomach acid neutralizer is that is raises the stomach pH to a more alkaline level, so that if the woman vomits, it's less likely to be harmful if it's inhaled into the lungs (Mendelson's syndrome).  However, Mendelson's syndrome is usually associated with general anesthesia, not a regional block.  And, Mendelson's syndrome dates back to studies done in the 1940's and 1960's --- quite outdated in today's day and age!  It's now very rare to see women undergo general anesthesia for c-section births, and even much less aspiration pneumonitis seen in the few that DO receive general!

Since I'm the newbie, I'm treading very lightly, because I know that I cannot be both respected and trusted, as well as be able to change the minds of a large group of anesthesiologists!  I have to earn their respect first.  So, baby steps.

Frustrating?  Yes.  But, this is the life of a brand new baby CNM.