Wednesday, January 19, 2011

A Day In The Life Of Dr. Justin Case

Written by Birth Sense,

Dr. Justin Case 
Meet Dr. Justin Case.  Handsome, personable, and a recent graduate of one of the top OB residency programs in the country.  He immediately developed a huge following of patients who loved his friendly banter in the exam room.  Women appreciated the fact that he promised them a family-centered birth, and his support of patient rights.

When it came down to delivery day, however, it seemed that all of his promises evaporated.  Rhonda had been thrilled to find a provider who was willing to accept her birth plan.  Things didn’t start off the way she’d planned. 
Rhonda woke up early in the morning to her water breaking.  The fluid was clear, she didn’t have group B strep, and she knew her baby had dropped into the pelvis, head first, a week ago.  She wasn’t having contractions, and so she wanted to stay home until contractions began.  She called Dr. Case.  and told him what her plan was.

“Well, Rhonda,” Dr. Case began.  “I’d like you to come on in to the hospital just in case you might develop an infection.”  Rhonda, trusting her doctor’s opinion, came in to the hospital.  There, the nurse started an IV, even though it was not on her birth plan.  “It’s just in case you should bleed too much after delivery; then we can give you medication immediately.  It’s what Dr. Case wants”. 

Next, it was the continual fetal monitor.  Rhonda wanted to walk around, trying to stimulate contractions.  Dr. Case had different ideas.  “I want you to be on the monitor, just in case there’s a problem with the umbilical cord proplapsing, since your water’s broken.”

Dr. Case also wanted to do a vaginal exam to check Rhonda’s dilation.  Rhonda knew that this would increase her risk of infection and asked him to wait, but Dr. Case told her that it was important to do this exam just in case the baby might have turned breech since her last exam.

Next, Dr. Case wanted to give Rhonda a pill called Cytotec, which was supposed to help “ripen” the cervix.  Rhonda reminded him that she wanted to wait and let contractions begin on their own, but Dr. Case told her that it was really important to get labor going just in case an infection might develop. 

The nurse was having a hard time monitoring Rhonda’s contractions after she got the Cytotec, so Dr. Case put in an intrauterine pressure catheter, to measure the intensity of contractions, just in case they got too frequent or strong, she could be given medication to stop them.

A short while after getting the medication, the baby’s heart rate had a decrease in variability.  Rhonda knew that this could be a normal sleep cycle of the baby, but Dr. Case decided it was important to put in an internal fetal monitor, just in case the decrease in variability indicated fetal distress. 

Now Rhonda’s contractions were becoming painful.  She wanted to get into the jacuzzi and let the warm water jets pound on her back, but Dr. Case said it was better to stay in bed so that she could be monitored, just in case there was any problem.  Rhonda found the bed to be the most painful place to endure contractions, and soon requested something for pain.  She got an epidural and was comfortable within a short time. 

A couple of hours after the epidural, Rhonda developed a fever.  She had no signs of a uterine infection, but Dr. Case ordered an antibiotics just in case she had an infection.  Dr. Case didn’t think her contractions were as strong as they should be.  Rhonda knew that first babies often take longer than the average labor is thought to last, and asked for more time to dilate.  But Dr. Case thought it prudent to give her pitocin just in case there was a problem with the labor, so that it wouldn’t go on too long.

Soon after receiving the pitocin, the baby had some deep drops in the heart rate.  Rhonda was moved from side to side, a difficult undertaking considering that her legs were dead weight and she had a half dozen wires coming out of her and connected to her.  The position changes did no good, and Dr. Case came in to talk to her about a c-section.  By this time, the baby’s heart rate had recovered, and Rhonda begged to turn the pitocin off and try laboring a little longer on her own.  Dr. Case demurred, stating that he felt safer doing the c-section just in case there was a cord wrapped around the baby’s neck.  He didn’t want Rhonda’s baby to have to ride the little school bus someday!

Rhonda reluctantly signed the papers consenting for the c-section.  During the surgery, she begged to be allowed to hold her baby, but was told it was not permitted, just in case she might accidentally touch the sterile surgical drapes.  Rhonda’s baby weighed 8 1/2 pounds, and was given a bottle against her wishes, just in case the baby might have low blood sugar.  Formula was recommended for supplementation, just in case of jaundice developing, and vitamin K just in case the baby might develop a bleeding problem.  Eye drops were given just in case Rhonda’s husband had been fooling around behind her back and given her a sexually transmitted disease.  Pitocin was run through her IV for four hours after delivery, just in case she might bleed too much, and the nurses rubbed her uterus painfully every fifteen minutes just in case it might not be as contracted as they liked. 

Rhonda’s baby was taken to the nursery because his lungs sounded a little wet, and the nurse wanted to keep an eye on him just in case he developed breathing problems.  Rhonda lay in her bed, her arms aching to hold her baby.

And at the end of the day, Dr. Justin Case went home, sat in his recliner, and smiled with satisfaction at the thought of another healthy baby brought safely into the world.

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