So, now that I've moved to a new town (got here two days ago, late at night), work has begun! I think I've previously mentioned that I got a job as a midwife in a birth center. I work with one other CNM and several LM/CPMs (licensed midwife/certified professional midwife). The other CNM is out of town for a couple of weeks. So . . .
I was called in yesterday (the day before my official start date) to choose a med & write a prescription for a UTI (urinary tract infection). This client is 4 weeks postpartum, with "allergies to penicillin & sulfa drugs" (and quotation marks because it's really her father's allergy, so she's always avoided them. . . not sure how I feel about that since those meds are often first line choices for many types of infections!), so I gave her ciprofloxacin, which I would not have been able to give if she was still pregnant. Hope it works!
Today, my scheduled client was 14 weeks and complaining of vaginal itching. I diagnosed a yeast infection. Exciting stuff! But I spent quite a bit of time with her, and she felt great about our appointment. When I did her vaginal exam, I didn't use stirrups, - generally my clients love it that I don't use stirrups. :-)
My exciting client of the day was a woman just starting her third trimester who came in complaining of contractions. I just figured it was a UTI or vaginal infection (like yeast or an STD). She peed in a cup for me before her exam, so that I could do a urine culture, and then in the exam room while undressing, had a puddle at her feet. Not pee. So sad. My sterile speculum exam showed lots of obvious pooling of amniotic fluid, fern & nitrazine positive (quick test we can do to confirm that it's amniotic fluid rather than just vaginal mucus), and a baby's head through a dilated cervix - probably 3-4 cm from what I could tell. I could actually see the baby's head moving. Even sadder. After some discussion with her about what to expect, I sent her off to the hospital for an examination there, and hopefully some treatment of her pre-term labor to give her a few days more pregnant. (What is often done is to give medications that reduce contractions, and also give steroids to help the fetal lungs complete development. This helps preemies breathe better at birth). I called the charge nurse at the hospital to let her know that I was sending a client over, and had a great interaction with her. Now I just have my fingers crossed now that the baby is okay! Most likely all will be fine . . . but it will be a stressful beginning for them both.
So, those are my first 3 clients as a CNM! Let me tell you that I left work today with adrenalin PUMPING from my system!!!
