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Re: Practice Philosophy From: Anna Meenan, MD (annam@uic.edu) Tue May 1 00:19:58 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Joanne Bulley: "Re: GYN: recurrent abnormal paps" Previous message: u.f.steinhart, md: "tetracyclines in early pregnancy" At Tue, 24 Apr 2001, Len2976@aol.com wrote: > >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 Amazing. Except for the epidural and the extra 1 oz of baby weight, you've described my first labor exactly, Lenora. My doc did the "rattle the forceps" maneuver instead of the "slow walk to the delivery room" maneuver, but the result was essentially the same. Excellent 10-lb baby after 3 hrs of pushing. We docs don't know how to do labor without causing trouble I guess. -- Anna Meenan, MD Next message: Joanne Bulley: "Re: GYN: recurrent abnormal paps" Previous message: u.f.steinhart, md: "tetracyclines in early pregnancy"

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