OB-GYN-L Messages for November, 2004: Re: CNM Cases

Re: CNM Cases

From:

Stmidwife@aol.com

Sun Nov 28 10:41:05 2004

In a message dated 11/28/04 6:21:04 AM Pacific Standard Time, ob-gyn-l@obgyn.net writes:

> This patient presented on a Monday AM:
>
> Yesterday, a 36 year old or so 41w2d primigravida presented in early
> labor at around 8 AM. She was 2 cm per the CNM, and refused any
> monitoring other than an occasional fetoscope*, didn't allow blood > work,
> and basically sat in L and D all day. At 0300 today, SROM occurred. > She
> was 4 cm. at 8 AM, and 4 cm. at 5 PM, and, when I last heard at 6 > PM,
> she literally walked out of the L and D unit, and hasn't been seen
> since.
>
> Left Tuesday late PM, and eventually delivered at home on Friday AM, > and
> told the CNM via phone the following Monday that she just needed a
> change of environment, and all was well. After she left Tuesday 5 PM, > I
> sent a dismissal letter out Wednesday AM.
>

We give out a 3-4 page article on GBS prior to testing and ask clients if they have read it prior to even testing. It seems to help with the lack of knowledge and increase awareness of the risks associated.

>
> Monday 30 YO P0010 at 33w6d, CNM patient with long birth plan ("If
> extraction is necessary, request gentler methods other than
> forceps/vaccuum extractor") and a chiropractor, presents with SROM/no
> labor/1 cm/70%/vertex.
>
> Saw in the office, and explained need to do GBS culture and cover, and
> expectant management planned.
>
> After the exam, and after she dressed OTW to the hospital, she asked > "Do
> I have to get antibiotics? I have no symptoms of GBS. Can I wait > until
> I have a fever or something?"
>
> I can live with patients who are in left field, but this was out of > left
> field from the stadium NEXT DOOR. Where, or where are they getting
> their information.
>

I have had the people who have run Bradley for the entire US come to my birth center twice for births. They are reasonable people. The instructors do have a set cirrocumuli but they also sometimes have their own opinions or experiences they throw into classes. I think that the best way to address these issues is to provide your own handouts, information and discussion during appts. I have noticed patterns with certain instructors and when I know that my clients have those instructors, I try and fill in the gaps and get the clients the correct information.

> I am hoping that our CNMs can meet with certain instructors (I believe
> they're Bradley) and clear the air/set guidelines/work out compromises
> and information.
>
> BTW, she went into labor overnight and just got an epidural. When I
> asked her how she was doing with pain, the HUSBAND said fine. I > looked
> him in the eye and said nicely, "I didn't ask you. She is my > patient,"
> and then I asked her again.
>

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