Social inductions
Labour can be pushed. We can prod it on if it is slow, we can try to start it if it hasn't started. It isn't the ideal scenario. Labours will generally go better if allowed to progress on their own. A labour that is pushed has more chance of ending in major surgery, not to mention other interventions like epidural, instrumental delivery (forceps, vacuum), and being confined to bed (or at least, confined to the fetal monitor).
So we make a practice of not offering induction unless there is a medical indication for it. We don't offer inductions for being overdue until they are overdue at least 10 days (2 weeks is the maximum our College will allow us to allow a woman overdue), or if there is a fetal indication such as IntraUterine Growth Restriction, or Oligohydramnios, etc.
Before neighbour midwife went off call, she was giving me report on all the cases she had that I was backup for. One of them was a mom having her fourth baby, who also had 5 foster children. She was due Wednesday, but was requesting to be induced for a couple reasons - childcare was difficult to arrange at the last minute, her last baby was born in 45 minutes as an unplanned home birth, and she was wanting a hospital birth, but above all she was ready to be done (as every mom is close to their due date!). These are all not medical reasons for induction: they are social reasons. Good ones perhaps (you be the judge), but social nonetheless. She also thought (despite what ultrasounds early in the pregnancy stated) that she was at least a week overdue based on conception date. So neighbour midwife had arranged an OB consult for that evening to get an induction arranged for Monday when she would be back on call.
That evening about 8:00 I get a page: Going to General Hospital to be induced. Pls call. Great. She had seen the OB, he had checked her and said why not tonight? She said sure. (note the childcare arranged at the last minute!). The OB wanted to maintain care but allowed me the courtesy catch. If it would have been my client, I would have taken greater measures to resume care (we can induce, the OB just has to order it), but since this woman a)wasn't my client, b)was requesting an on-demand labour and c) WAS STARTING THIS AT NIGHT (!), I admit to feeling a little bit like I couldn't care less. I had all these women due and she was demanding labour and at the same time putting us out for it! So if her result was going to be to have a stranger manage care, I wasn't going to quibble. (Am I a bad person?!)
The induction went very well. I hung out with the nursing staff, having a great time, and now an then hung out with her (she had good support, and when the nurse was in there coaching her, I didn't want to step on toes), and when it came time to deliver, I delivered, and the OB stayed at the door! That baby came out COVERED in vernix [definition: cheesy white substance that coats baby before they are due] - She wasn't overdue at all! (also her foot creases only went part-way down her foot, another sign of being early). So I got home at 6am, praying fervently that no one else would go into labour. Thankfully no one did, and I got rest.
Next time I'm not cutting my fingernails. Sheesh.
So we make a practice of not offering induction unless there is a medical indication for it. We don't offer inductions for being overdue until they are overdue at least 10 days (2 weeks is the maximum our College will allow us to allow a woman overdue), or if there is a fetal indication such as IntraUterine Growth Restriction, or Oligohydramnios, etc.
Before neighbour midwife went off call, she was giving me report on all the cases she had that I was backup for. One of them was a mom having her fourth baby, who also had 5 foster children. She was due Wednesday, but was requesting to be induced for a couple reasons - childcare was difficult to arrange at the last minute, her last baby was born in 45 minutes as an unplanned home birth, and she was wanting a hospital birth, but above all she was ready to be done (as every mom is close to their due date!). These are all not medical reasons for induction: they are social reasons. Good ones perhaps (you be the judge), but social nonetheless. She also thought (despite what ultrasounds early in the pregnancy stated) that she was at least a week overdue based on conception date. So neighbour midwife had arranged an OB consult for that evening to get an induction arranged for Monday when she would be back on call.
That evening about 8:00 I get a page: Going to General Hospital to be induced. Pls call. Great. She had seen the OB, he had checked her and said why not tonight? She said sure. (note the childcare arranged at the last minute!). The OB wanted to maintain care but allowed me the courtesy catch. If it would have been my client, I would have taken greater measures to resume care (we can induce, the OB just has to order it), but since this woman a)wasn't my client, b)was requesting an on-demand labour and c) WAS STARTING THIS AT NIGHT (!), I admit to feeling a little bit like I couldn't care less. I had all these women due and she was demanding labour and at the same time putting us out for it! So if her result was going to be to have a stranger manage care, I wasn't going to quibble. (Am I a bad person?!)
The induction went very well. I hung out with the nursing staff, having a great time, and now an then hung out with her (she had good support, and when the nurse was in there coaching her, I didn't want to step on toes), and when it came time to deliver, I delivered, and the OB stayed at the door! That baby came out COVERED in vernix [definition: cheesy white substance that coats baby before they are due] - She wasn't overdue at all! (also her foot creases only went part-way down her foot, another sign of being early). So I got home at 6am, praying fervently that no one else would go into labour. Thankfully no one did, and I got rest.
Next time I'm not cutting my fingernails. Sheesh.
posted by Stork at 9:38 AM
1 Comments:
Yeah! Come on baby! I hear your frustrations, sister!
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