-VISIT OUR OTHER FORUMS- OB-GYN-L Ultrasound Ultrasound History Fibroid Forum Physicians-in-Training Tech Talk OBSTET-L (portuguese) OBGIN-L (spanish) Nursing

Re: Practice Philosophy From: Len2976@aol.com Tue Apr 24 20:07:52 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Zach Newton: "Re: Osteoporosis" Previous message: Larry Glazerman: "Re: Osteoporosis" OB and CNM practice philosophies may differ, but we often work well as a team. Often he would not manage situations as we do, but he is very accepting of our decisions. One difference is when we start encouraging our patients to push. As I've mentioned before, I work in a (3) CNM, (1) OB private practice. We deliver 50-60 per month. We all communicate well and I think there is a great deal of mutual trust on all sides. Today I had a patient in labor that I'm sure most of you can identify with (30 y/o, G1, M.D.). Pregnancy had been significant for macrosomia. Induction of labor had been discussed by one of my colleagues, but she declined. Anyway she presented today (39 6/7) in spontaneous labor. She made excellent progress (4cm to full dilation in 4 hrs.), and she opted for an epidural at 6 cms. As an aside, my OB backup was "in-house," as this is his surgury day. At this time (Cx. fully dilated, +1 station, ROT) since her legs were still a little heavy and she had no urge to push, I let her rest. FHTs were reassuring. Usually I find that by the time the patient has the urge to bear down the head is +3 station and she pushed only a few minutes. Unfortuanately, this wasn't the case here (whenever you take care of a friend and want everything "smooth"--watch out). Anyway, she finally started pushing, and after 2 1/2 hours (pitocin started, positions changed, squatted, etc.), she was tiring and it was obvious she had at least another 30" of pushing left. She requested "help" either by vacume or forceps. My OB's response (which I totally understand)--"Oh yes--I really want to do an instrumental delivery on a pediatrician!" Anyway, we encouraged her to continue to push, but got her ready as he very SLOWLY made his way down to the room. In fact, so slowly that she was delivering spontaneously as he arrived! Baby's weight--10 #, 1 oz! Apgars great! Patient and family happy and so were we. Lenora McCall, CNM Next message: Zach Newton: "Re: Osteoporosis" Previous message: Larry Glazerman: "Re: Osteoporosis"

Return to

Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Sun Nov 2 04:41:48 2008

The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.