Follow Your Gut

I spent the night trying to get a woman into labor who, on paper, had been augmented for post dates but who, in reality, was a TOLAC (her first was a c-section and then she had a successful VBAC a few years ago) who had started prenatal care at 19 wks and was only seen in the office 5 times since then. So, it’s been worse, right? And we actually got her GBS status (negative) somewhere in those 5 visits. Anyway, she was 41 wks by that 19 wk US and decidedly not in labor when I got to L and D.

She was reported to me as “favorable” at 2/50/-3 which I wouldn’t call supremely ripe as I gave her a bishop’s score of 5. She was “contracting” but her ctx were almost undetectable by the patient. But hey, she was on the floor, pit had been started, she was a multip and I had already prepared to be up all night. She finally changed to 3 and proceeded to an epidural. And like so many of my patients, had some rest and 4 hours later she was 8 and 100 with a BBOW.

I also ended up admitting a multip (a G6P2022 to be exact) who called me around 4am c/o irregular contractions since 3am. No bleeding, no LOF, no HA, +FM… I’m like: Call me back when the contractions are regular, like every 5-10 minutes for an hour. “Really?” She says. “But I really think I’m in labor!”

“I think you might be in labor too! That’s great. Call me back.”

I barely finished my telephone note on her when I get a phone call from our answering service. It was the same pt. Calling back less than 15 minutes later reporting 2 painful contractions since we had spoken last.

I mean, is this me? Is it my practice? Is it just people? What the fuck is up with that?

I call her back. “You didn’t make it the full hour, huh?” I said trying to mask my annoyance.

“No.”

“So, tell me what’s going on.”

“Well, it’s just these contractions! They keep coming and coming! I just keep having them! And man they hurt so much!”

I checked the number against her chart. Yep, same woman who has supposedly had 2 other children vaginally.

“Well, you’re in labor, honey.” I said a little softer. “You’re supposed to have contractions. And it’s supposed to hurt.”

“But I’m nauseous and getting all hot and these contractions keep coming!”

“All normal. You’re doing great.”

“But…”

“Are you saying you would like to come in and be evaluated?”

“Yes!”

“Okay, come on in.”

I just don’t get it. When someone has been in labor before, not once but twice (!), why do they always seem so surprised with the pain of contractions, or, actually, with just simply the contractions themselves?? What are people preparing for during those 40 weeks? No seriously, tell me! I am at a loss here. I probably get at least one report like this every night I’m on call. I understand the fear. I understand the sense of feeling out of control. I even understand the somewhat misguided feeling that the hospital is a better place for women to be than their own homes when they are in labor. But surprise? Complete and utter surprise than contractions just, well, happen? (I smell a bumper sticker here…) I do not get that. So, she got to triage, she was 5/100 and high. I admitted her and she decided she wanted an epidural before I had a chance to say anesthesia.

And then it was 7am. Glorious oh glorious 7am. This is the time I start to write my last notes, do my rounds on my patients, say goodbye, let them know who the next midwife will be…it gives me a sense that morning has broken and my own warm bed is in the very near future.

I gave report on these two patients and the CNM who was on call for the day told me she had three inductions scheduled in addition to these two patients I just left her. “Well,” I said, “I do think these two will probably go. Both are in pretty good labor now.”

“You never know.” She said back to me. “You just never know. You think these multips will go and then you are surprised. They stall or something happens…You just never know.”

“Yeah, I guess you’re right.” I said “But, I don’t know. They might.”

“You just never know.”

The on call midwife and the pp rounder started chatting as I was getting my coat on. They were talking about 2 recent IUFDs we had in our practice. Both 3^rd trimester. In one situation the MD wanted the patient to come in for a f/u NST after 1 episode of decreased fetal movement for which she had been evaluated and it was found to be benign. The doc just wanted to run another strip.

“Just because she ‘had that feeling’” The midwife said.

“Oh yes.” The other midwife said “That ‘feeling’. You have to follow your gut. You have to follow your intuition. That thing that keeps you up at night. You have to listen to it.”

Now hold on. I thought I just had a good feeling about these 2 multips headed into some nice active labor and possibly second stage. And I got shot down. I got the “you never know” response. But why sometimes, usually in hindsight I might add, do you get the “you just have to follow your gut” response. There are so many problems I have with this. Besides the glaring hypocrisy here, I think sometimes your “gut” is so wrapped up in feeling scared that it is difficult to “know” what the truth is. I also do not believe you can ever tell what the future holds. I also do not believe that because that doctor wanted the patient to have that NST and the pt refused and the baby was without a heartbeat the following week, that that doctor somehow had a 6^th sense about the fetus’ wellbeing. Or maybe it’s just that I don’t feel that I have that intuition (yet?) so I don’t even want it to exist.

But here is something I do know: I left the hospital, walked into the parking garage and just 3 cars away from mine was a blue station wagon with the license plate “BELLY”. I rolled my eyes, might have uttered a tiny “ew” as I passed and knew in an instant that that must be the car of a fellow midwife. I mean look, she followed her gut, right? And look where it got her.