Pts that want to have their baby NOW! - page 3
Ok, now I know we've all taken care of pts like this...... Last noc I sent a pt home who was 36w2d......had mild cntx for a day now and was MAD at md and staff because she was sent home (didn't... Read More
Apr 30, '03No, Mimi, those are different babies from various preemie sites on the internet. I guess working in the NICU has changed my perspective a bit- my husband still calls them see-thrus (he's terrified of the NICU!) and says he'd be scared to death to touch a baby that small or sick, but I just fall in love with them as soon as they roll in the door. Wish I could say the same about some of the parents, but of course, it's important to keep an open mind. I'm just huge on patient education, and sometimes, after hearing what some of these moms do to bring on early or convenient delivery, I wish I could reach them BEFORE I meet their babies, you know what I mean?
Apr 30, '03Kristi - I have used these kind of pics before with antepartum patients who "just couldn't stand" the side effects of tocolytics and were demanding to be taken off them and deliver. Patient education as to what your baby will likely look like at birth and what kind of equipment will be hooked up to your baby. NICU nurses are a great backup for this teaching! I figure if a patient is determined to do this, it needs to be a fully informed decision.
Apr 30, '03Originally posted by bagladyrn
Kristi - I have used these kind of pics before with antepartum patients who "just couldn't stand" the side effects of tocolytics and were demanding to be taken off them and deliver. Patient education as to what your baby will likely look like at birth and what kind of equipment will be hooked up to your baby. NICU nurses are a great backup for this teaching! I figure if a patient is determined to do this, it needs to be a fully informed decision.
Apr 30, '03susanmary, i think you are right on the mark. pictures deter some pt's, but not everyone. the "my sister had a baby at 26 weeks that's fine" pt. thinks mostly of herself. i remember one gal who said no way would she have tocolytics. if i am having contractions, it's because "God wants me to have this baby now."
she was approx. 32 weeks gestation and signed out ama. she was having baby #4 at about age 21. of course, she knew everything! some people hear the message. some people just plain do not want to hear it.Last edit by imenid37 on May 1, '03
Apr 30, '03Originally posted by imenid37
to capitalize on the selfishness of some of these moms, i usually tell them that even if the baby is physically ok at 35-36 weeks, they are harder to calm, don't sleep as well, and take longer to feed. then of course the minute they are 37 weeks, they come to the hospital.
Apr 30, '03I just wanna know where these MDs were when I was 5 weeks, yes 5 weeks post term. Had a pelvemetry(sp?) ok that was 14 years ago, might not even do those any more but it indicated the baby was over 10lbs. On Pit three different days, no labor. On day three I told the staff I was not, repeat not leaving that hospital pregnant. Well low and behold as the Doc was coming in to tell me they were setting up for a C/sec I went into labor. 2 hours later, our third and biggest child grace our presence. Yes I was sick of being pregnant, but it didn't last forever. Yes I guess I was a tad over due, but the baby was fine.
I would have loved to have been induced but I had a midwife and she gently reminded me of all the things that have been posted here.
As for the burning question, was I really 5 weeks post term.
Our daughter weighed in at 10lbs, 10oz 24 inches long.
Great advice I see here, keep up the good work.
May 1, '03Hi opalm,
Congratulations on being able to "wait it out" and deliver a healthy baby the old fashioned way!
In answer to your question, it is not likely that you were truly 5 weeks overdue, because the placenta is designed to function for a limited time (40 weeks). After that, its function begins to gradually decline, which is why were are concerned about the well-being of post-dates babies, and whether or not they are receiving adequate nutrition and oxygenation. I can't imagine a placenta functioning adequately at 45 weeks to properly nourish and oxygenate a baby!
It is possible that your dates were off, either due to irregular periods, or a mistaken ultrasound evaluation. I always tell patients to question ultrasound dating of pregnancy that is in discrepancy with the date of their last period. Ultrasound is quite accurate in the first trimester in dating a pregnancy, but far less so in the second and third trimesters when factors such as genetics and nutrition begin to affect the growth rate of the fetus.
At any rate, I can't imagine the mental stress of being so overdue! Glad you had a healthy baby. Nowadays, you would be evaluated with non-stress tests and biophysical profiles to determine the well-being of your over-due baby, and plan an induction, if appropriate.
May 1, '03Hi Jolie,
Each pregnancy went longer and longer, 2weeks late which is still considered on time, the next was 3 weeks 4 days and then the last. Interesting that you mentioned the placenta as during the evaluation afterwards the doc who was called in, had to "show" his students what an "old placenta" looked like. Nothing like being the focus of a lesson when you feel so wonderful!
It was stongly suggested to me that I not consider another pregnancy due to past delivery history and lack of progression with each.
I do know what you are saying concerning ultrasounds. That is my educational background. But I didn't have an ultrasound with my any of my pregnancies.
The mental stress was due to everyone calling asking if I had delivered the baby and being so large. I am only 5'4" and weighed 127 at the beginning of my pregnancy. I refused to get on the scale once I crossed over 200lbs. No, no gestational diabetes either just big babies that were very content hanging out.
Boy does that seem like a lifetime ago.
Bottom line, I still think the plan of leaving them in utero as long as possible avoids so many problems.
May 1, '03I had my offspring well before I trained as a Midwife so I have had the perspective from both sides. Our first stuck it out to a 42 week pregnancy and, boy, was my wife sick of being pregnant and did I hear about it. Then daughter took her time coming with a 28 hour labour.
At the time I would have wanted an earlier delivery and a shorter labour but, thankfully, we have a good local doc. who would not hear of interference in an otherwise healthy pregnancy. Since training I have seen prem babies and all that can go wrong and would much rather overcook than under cook. (I look at her 6ft hieght now and wonder where that tiny bundle went).
I agree that an exposure to a Special Care Nursery might adjust the thinking of some people but keep in mind it is the MEDICAL staff who go along with the early inductions and the high number of early C sections that abound in Western society; forget about education for the masses, lets educate doctors.
May 2, '03opalm's message made me think. All three of my babies were exactly 11 days overdue. This was twenty years ago. I can't tell you the number of younger women who tell me their docs say that's too long to go over, if they don't go into labor within a few days of their due date, their doc means to induce them.
What the heck is that???? I know they have all this technology but sometimes babies ARE NOT the age they think they are, etc. I just don't understand it. Is it for the mom's sake, for the doc malpractice paranoia, what is the reason for all this induction, c/sec stuff that seems so rampant nowadays???
May 2, '03Somebody here had a good tagline:
Never trust a 35-weeker.
So true. Any time less than 38 weeks I worry. ANYtime. I have seen 37-weekers crump cause they were NOT ready to breathe and could not maintain temps and blood sugars steadily. All we can do is educate these people and really give them a good visual of what NICU life is all about and the disabilities that may ensue from being born too soon.
Then when their babies are born too early, they can sue as as in the case above.
Sad. What can I say?
May 2, '03We are in the age of "social inductions", I've seen at least one of the patients everyone is talking about. The most recent was a 16yo who came to ER at 36 weeks after she had some bloody show. Her whole extended family was with her and they were put out that she was not in labor. They kept asking "when is she going to have the baby?" I jokingly said anytime between now and 6 weeks. They were mad, her mother even said, "they had to break my water before she was born". All this was coming from a middle-class family of a 16 year old!!!! She did finally deliver, quickly at 38 weeks.
I wish people would just realize, for all the technology available, God or Mother Nature still knows best.
Aug 21, '04Quote from NICU_NurseBravo NICU nurse--so sad but so true!Perhaps you should send these moms to ME (or your nearest NICU!) for a nice little tour and visual 'demo' of what REALLY happens when their babies are born before they should be. I'd be more than happy to show them what THEIR baby would look like with an ETT stuffed down their throat, an NGT crammed in their tiny nostril, hooked up to a ventilator or surrounded by a wall of equipment and cords. These are the same mothers who I will meet on my unit who will inevitably be frustrated that their babies can't breathe on their own, can't come home early like their momma's sister's best friend's baby did, can't even go home at their original due date because he/she's developed an infection that may never have happened if they'd never been exposed to the nasty germs inside an NICU. Maybe show them pictures of a baby who had to have her little foot amputated after developing osteomyelitis because she had to be stuck for an IV so many times because the doctors wouldn't place a central line and somehow along the way got a wayward IV needle jammed into her tibia that no one knew about until it was too late. I'd be delighted to introduce them to a cute little 36 weeker who was fed to much too soon and ended up with necrotizing enterocolitis, who perfed and needed to have her rotten, dead intestines cut out and has a beautiful little ostomy bag that her mother can't stand to look at or touch. Maybe after that, we can take them to the developmental clinic so they can see a couple of babies who suffered from severe grade IV IVH's and now have cerebral palsy and will need serious medical care for the rest of their lives. Think your hospital can arrange something like that? I'd jump on board in a heartbeat.
Sorry. It's kind of morbid, but I will NEVER for the life of me understand what these women are thinking sometimes. God/Mother Nature designed pregnancy to last nine months FOR A REASON, you know? Now, suddenly, with technology at their fingertips, some of these people think anything that happens can be conveniently and quickly fixed with a little TLC and maybe a few expensive pieces of equipment. We have moms all the time who come in after taking 'home remedies' (and I'm phrasing that gently) to have their babies early because someone told them that, yeah, the baby might be vented for a few days but after that it'll be okay and they'll get to to take the baby home earlier. I guess this just touched a nerve. Sorry, again. Had a bad night.