These last few times on call, I have been super busy. Last night was no different. I came on to a full board. But only two “laboring” patients. I use quotes because the doc on call decided to admit both patients when neither were really laboring. Ah well…I did their admission orders and H&Ps anyway. Rule numero uno: don’t keep ladies that aren’t in labor.
And then the night just kept getting better and better. Basically I had 4 additional admissions…all primips…all in labor. Real labor. One PIH, had to start magnesium. She progressed well and I caught her baby. One lady came in “complete” and I broke her water and we regressed to 7cm. Also, her baby hated everything. Hated AROM — prolonged decel, doc at bedside. Hated pushing, decels. Hated contrxns. Her strip definitely gave me some new gray hairs. I was pulling out all of my tricks. Pushing side-lying, every third contraction. After several consults w the doc, ended up being a vac-assist. Despite a terrible looking strip, her baby did well…excellent Apgars, vigorous, and cord gases wnl. Phew. Another one, extremely limited PNC, oligo. I caught her baby too.
Neither of my two “labor” admissions from earlier did much of anything. So had to AROM, start pitocin. One of them delivered right before shift change. Nurses gave me sass about their plan of care. Nurses gave me sass about my terrible strip. And one nurse in particular really gave me some attitude about AROMing a different patient. A busy night is hard enough without sassy nurses. Admissions steady throughout the night. Now up to 6 laboring primips. Doc who absolutely hates me coming on in the morning and I’m terrified what he’s going to think of this mess of a board I’m dealing with.
Then the icing on the cake? 25wker s/p cerclage. Greeeaaatttt. Came in w vague complaints. My little gut voice encouraged me to sterile spec her where I discovered a bulgy bag and amniotic fluid. PPROM. Admitted her. Consulted w the doc. Rule number two: listen to your internal voice.
So by the shift change, between my doc and myself, we have delivered almost everyone except one. One of my original not super labor-y patients who puttered along all night. And, yes, I did get chewed out for her management. (“So you’re telling me..this pt has been here 12hrs and hasn’t done much of anything…yada yada yada”) But I was too tired to care. Still am. I hope she delivers for him today. What a night…