Wednesday, September 2, 2009
In my line of work, I often hear myself and my fellow nurses repeating a few words. And no, it's not "Push!! Push, push, push!!!!", although, now that I mention it, yes, we do say that a lot, too. However, the phrase I'm referring to is, "If only they knew...", the "they" being the patient. The "knew" being the nurses experience.
What I'm gonna talk about, today, my friends, is a little "induction of labor" lesson. Bear with me (just don't bear down...that's an entirely different lesson in labor).
So many times, we have a sweet young mother...she arrives at the hospital for her induction, laden with books and luggage and cameras and baby bags and snacks and the kitchen sink...not to mention, she's also toting her weary husband, who has just lugged everything up from the parking lot (in one trip, of course). We get her settled in, she, who's all freshly washed, make-uped, pedicured, coiffed...and we begin the induction dance.
Nurse, "Hello, Sweet Young Mother! What brings you in for induction today?"
And, more often than not, we hear...(smiling) "Oh, I dunno! My doctor just said to come today, cuz' she was on call."
Okay, let's digress a bit...a quick lesson in "MD Bucks 101"...no, no, scratch that..."Obstetrician Bucks 101". I'm quite certain nationwide (although I could be wrong, so don't take this for gospel...not that, you know, I ever thought you took anything I say for gospel, just sayin'), or for certain in MN, that OB patients are "a bundle charge". Yes, they charge a bundle (for your little bundle), but that's not what I mean. What I mean is that OB's get x amount of dollars for your prenatal care and y amount of dollars for your delivery.
So, a quick math lesson, x + y = a big bundle of bucks.
As in...your OB may think you are the sweetest, kindest, most normal (and let me tell ya, normal is hard to find!!) patient she's ever had, but, alas, she would love to do your delivery because x + y = more bucks than just x.
As in...if one of your OB's partners does your delivery, your OB just gets x.
So, it is in your OB's pocketbook's best interest to do your delivery.
Okay, now back to our "induction" lesson. But first, let me set something straight. There are plenty of reasons (real reasons) for inductions...baby's not growing, low fluid, high blood pressure, crappy placentas (the list goes on and on) and then there are (insert echo-ey voice here) the other reasons. The "my doctor's going on vacation" or "my ankles are swollen" or "I really want my baby to be born on the second equinox in the month of the butterfly when the wind is blowing from the N-NE", reasons.
And let me be frank (can I be frank with you? Will you still like me? Call me Mama Frank for a bit...), those reasons will set you up for failure. C-section rates for "elective" inductions are sky high...wanna know why?
'Cuz your bod's not quite ready, sweet young mother.
39 week inductions are the "norm" in my hospital. I so wish...I so, so, sooooo wish, that our sweet young mothers were more educated about the induction gig. This whole "lesson" is stemming from my delivery tonight...a (say it together now) sweet young mother requested an induction at 39 weeks (and some odd days)...and, subsequently, squished and squeezed and lodged her baby into such a position that she ended up with a c-section.
Tears, disappointment, infection risks, funky baby heads, and probable repeat c-sections ensued...and all in the name of what?
Discomfort? (Heeelllloooo!!! Welcome to month 9 of pregnancy, my dears!)
Great-aunt Beatrice's Birthday?
I dunno...I can never quite figure out a kind (not snarky) way to ask "Why the heck are you requesting this induction, sweet young mother?"
Now, if we were talkin' bonafide reasons for induction...absolutely.
In fact, often, when there is a "real" reason for induction, things go quickly and smoothly...like Mother Nature realizes that "yes, indeed" it's time for the little bundle to be evicted. No more leeching off it's mama, it's time for this baby to do "this life thing" on it's own. (Aside by me...I once heard a doc (not OB...oops, I just parenthesis-ed within a parenthesis) refer to a "fetus" as a parasite! Half-jokingly, he said..."they just take everything from their host"...kinda funny. Just kinda.)
The real reasons are good and kind and well. Even (I know some people will probably crucify me for this) when you are "post dates". Your "Estimated Date of Confinement" (what a great phrase, huh? *snort*!!) is, indeed, an estimate. But, with recent scientific advancements, like, say the ultrasound, for example...this estimate is a pretty darn good guess. As in, if the Powerball came with ultrasonic guesses, I'd take my chances...frequently.
So, being in the field that I'm in, working at a fairly large teaching hospital, seeing the yuckity yuck that I see...I'd not ever let myself, my bestfriend, or you go more than a week past the "Estimated Date of Confinement"...remember above mentioned "crappy placentas"? Yeah, that's what happens when you go too far past your EDC (that's what we nurses call it)...and baby's don't so much like crappy placentas, and their lungs don't do so well with meconium in them. Which is why I prefer babies on the outside after week 41. But, remember, my word is not gospel, 'k?!!
So, in summary (this is a lesson, afterall!) medical induction...yes!! Convenience induction...no!!! Any questions?
So, my lovely blog friends...with that I leave you this:
"Wise woman once say: Sweet young mothers must know not what is convenient, but what is best."