I've said it before, and I'll say it again...

I *LOVE* how much my co-workers can all pull together and help make an emergent situation go off so smoothly, and without any complications.

Yet again, my coworkers have proven to me that we are an awesome bunch of labor and delivery nurses!

A nurse called out for assistance - an emergency was occurring and she needed help. Several of us pitched in, quickly got the patient semi-stabilized and ready for an emergency c-section. Down the hall to the OR we went!

I was in the midst of it all, and wow.......to be on the bed with the patient, doing something to help save a life as we race her down the hall to the OR (argh, how I wish I could say what happened, but I can't....HIPAA and all...)...... anyway. It's just so amazing. I just jumped in, did what needed done, and when it was all over, took a deep breath and smiled for what a great job we ALL did.

Everyone did what was needed, no hesitation, no questions asked. We just DID IT.

A very emergent situation ended very well!

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1.03.01

Sometimes, you just can't predict what will happen

What are the odds that two different potentially catastrophic obstetrical emergencies could happen within just a few days?

It makes me wonder.........

One cord prolapse after SROM, and one spontaneous uterine rupture (no labor), all in a span of just a few days. Seriously! No precipitating factors, and not caused by medical interventions. Just....BOOM!

Wow, wow, wow. I'm constantly amazed at how normal things can turn bad in a moment.

I have honestly only ever seen two uterine ruptures in my 9+ years in OB. Just two! One with no prior uterine incision, one with a prior incision.

Cord prolapse? I can count on one hand how many of those I have witnessed in my years as a nurse.

That's how rare these two events can be. Some nurses never see either event in their career. I'm just so grateful for such fantastic co-workers who pull together in emergencies like these. We can get a baby out in less then 10 minutes, from the time a cord prolapse is discovered. Everyone does their role beautifully.

Best of all? We have some of the most amazing maternal and neonatal outcomes!

I'm so glad to experience not only the good in my job, but also these dire medical and obstetrical emergencies. I believe that these experiences will help me to be the absolute best nurse-midwife I can be in the future.

We need more Dr. Wonderfuls

Over at Navelgazing Midwife she talks a bit about a "Dr. Wonderful" in California (aka, Dr. Robert Biter). Those on the birth circuit have probably been following the latest about Dr. Biter. I'm not going to comment about the particular situations that have been going on with Dr. Biter. Instead, I want to talk about the whole concept of a "Dr. Wonderful".

With all of the negativity that permeates on the blogosphere and elsewhere with doctor bashing, we need to focus on the more positives out there. I'm sure we all have run across a "Dr. Wonderful" in our time. Perhaps he/she isn't the extreme of a "Dr. Wonderful", but they are wonderful nonetheless.

Believe it or not, I work with a few doctors that could be considered close to, if not at, the "Dr. Wonderful" status. I call them midwives in disguise. Why? Because first and foremost, they empathize and listen actively to the women and families that they care for, both in and out of the hospital environment.

There is "Dr. Magic Hands" who can successfully perform an external cephalic version with very high success rates. I literally turned my back for 2 seconds one time, when at the bedside for a version once. When I turned back again, he smiled, looked at me and said "done". WAH?!? Done?!? Yep. That was quite the easy version too. Not all go quite as quickly or as successfully. "Dr. Magic Hands" could do my external cephalic version ANY day. (Not that I will ever have another baby, but I'm sure you know what I mean.)

There is my favorite, very mildly mannered and soft spoken "Dr. Midwife". He has the patience of a saint. This man should have been a midwife - he definitely has his entire heart and soul into serving the women and families who come to him for care. I could tell you dozens of fantastic stories about this man. The hypnobirth mom who labored all day, stalled at an advanced dilitation, and he never once put her on the time clock, or even talked about a c-section for failure to progress. She went on to birth her baby over an intact perineum many hours later.

Or the cord prolapse, where "Dr. Midwife" literally calmed down every single person in the OR, made everyone take 5 seconds to breathe in and out, calm down, focus, and then proceed. Successful stat c-section with excellent apgars of a sudden and unexpected cord prolapse.

Or the woman who, because of her religious beliefs, would not allow a male provider to perform sensitive examinations or see/touch her genitalia. We simply traded places for exams (he acted as the nurse at the head of the bed, while I was performing the exams), and I pretty much delivered the baby, except for the very end of the birth when we traded places quickly for him to catch the rest of the baby (this was pre-agreed to by the patient and her husband as an acceptable solution to their gender beliefs regarding medical care and birth).

Or his general calm demeanor and sensitive nature. His belief that women can and do VBAC successfully. His positive comments to women in labor. His laid back management of labor/birth. Liberal fluid and food intake in labor. I really, truly could go on and on. This is a physician I would LOVE to collaborate with when I am a CNM!

Tell me about some positive stories of your own "Dr. Wonderful"s. We need more positive stories out there.

Frustrations

In light of what has recently happened (that, which I cannot give details about, and I'm very sorry that I can't), I am glad that I am in a position to hopefully see some change come about.

After witnessing obstetrical atrocities in the hospital setting, I am more than ever sure about the path I am taking towards midwifery. Yes, there have been moments where I doubt my entire career as a nurse. There are times where I want to totally get out of labor and delivery. But, after reading about nursing in other clinical areas, and talking to other nurses, I realize: atrocities happen everywhere in medicine & nursing. You cannot escape them.

Better choice then is, since I am already in the hospital system (and the maternal health system), is work towards positive change. Let's face it, the whole maternal care system in the United States need an overhaul. Shall I go through the negatives alphabetically? Or should I just move on and look at what I can do to help change things?

One woman and child at a time. At this point in time, that is all I can do. I can educate and advocate for the women that come under my care. Women that come under my care do so for a very short period of time in their lives. At most, eight hours (or more, if I stay over my shift).

I look around me while at work, and see how every one of us is failing the maternity system. I am frustrated that I can't "fix" everything.

I know I am not the only nurse who feels this way. I KNOW IT!! We get report on all of the women in the unit at shift change. We all mumble the same comments when something that is total BULLSHIT is going on. Yet.........who is brave enough to stand up and say that it's wrong, and it needs changed? Who follows through with making changes?

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Two day inductions that end up as c-sections for "failed induction". Same group of physicians. Repeatedly.

Not fast enough progress in labor. C-section by 6pm.

Pitocin to distress. Stat c-section. (Oh, we are making glorious headway with this one!! We are taking better control, as nurses, in how we "manage" pitocin drips.)

Induction -->pitocin -->epidural -->fetal distress -->c-section.

Too many laboring women to few nurses --> no one-on-one labor coaching.

Denial of VBAC option, or never being offered the option. Even when presenting in active labor and advanced dilation.

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One person at a time. One woman at a time. One birth at a time. Things WILL get better.

Angry, disgusted, appalled

I am angry, disgusted, and appalled right now. I was a witness to something that should have never happened. N-E-V-E-R. Yet, even though I spoke up, several times, my voice and concerns were squashed.

I have gone up the chain of command. Something WILL be done about this.

Times like this, I am disgusted at obstetrics and how we fail women and their babies in our maternity system.

I will say this: I was right and justified in speaking up with my grave concerns about a particular situation. I did a review of literature this morning and found that my knowledge was correct. What happened -- should have NEVER happened.