Day 5: Diabetes and Pregnancy

Today was another very early morning with appointments starting at 7:30 a.m. again. I was with the last of the three midwives, Jonalea, or Jon for short. She was very good about explaining as much as she could to me and always asking if I had any questions. There was also a new RN who started at the office today who will be with the Mercy Midwives for about six months and is working towards graduating from the Frontier Nursing University to become a midwife.

The first patient of the day has two days until her due date, but she is a diabetic (insulin-dependent, not gestational), so it is recommended that the baby be born by the due date or else it runs the risk of getting too big. This is from extra sugar from the mom that gets passed through the placenta to the baby, whereas normally it would exit the body in the urine. She had an NST done to make sure everything was normal, and Jon explained what exactly they look for in the graph to classify the baby as healthy. It is a 20-minute long test, and there should be quite a bit of variability in the heart rate with an average of around 130 BPM. Jon also looks for at least three spikes to around 150 BPM for about 15 seconds within the 20 minutes. The NST also monitors contractions, and the graph showed that she was having small regular contractions every five to seven minutes. Here is an example of what an NST graph looks like:

The top line shows the heart rate, and as can be seen, there are the three spikes that last for a duration of 15 seconds or more, which is a very good sign. There are no major dips, which is also a good sign because it shows that the baby is getting enough oxygen from the placenta. The bottom line records any contractions, but there doesn't seem to be anything significant in this test. 

Jon also explained the Bishop score to me, which is a score that measures the softness of the cervix, how far down the cervix is, and how dialated it is. The patient got a score of eight, which is the most favorable score and shows that she is very close to being in labor. If she does not go into labor tonight, the plan is for her to go to the hospital tomorrow at 9:00 to get induced because of her diabetes and her approaching due date. The Mercy Midwives generally like to stay away from inductions unless medically necessary, but this is a situation in which it could become medically necessary because of the risk that comes with exceeding the due date.

I was able to get a hold of the Mercy Midwives' statistics for births today. Although they are from 2000-2001, I was told that their numbers haven't changed much in 15 years.

The area-wide rate for cesarean sections has gone up to about 33% since 2001, but the Mercy Midwives' rate has stayed very similar. 

Irma came into the office today for a little bit even though she was not seeing patients, and she said that she was at the hospital most of the night delivering the baby that was due yesterday and had come in for an NST! She said that it was a very healthy, beautiful baby. We are still working on finding a mom who will allow me to be at her birth, but I'm learning that there will be no shortage of births in the next two weeks, so there is plenty of time at this point.