NewFNP's practice includes routine, low-risk office obstetrics. In some ways, it's a really nice practice - moms, babies - what's not to like??
Wednesday, February 18, 2009
Unlike other offices, newFNP's clinic does not have on-site ultrasound. Nor does her site have a family practice MD, an OB/GYN or a certified nurse midwife. Therefore, when newFNP runs up against a concerning finding, she has a few options. She can call the family practice MD at another site, she can consult with Dr. Dual-Ivy-League-Degrees who has some ER OB experience, she can page an attending OB at a nearby hospital or she can call BostonCNM for a telephone consult.
NewFNP wasn't expecting anything unusual with her 37-week primip yesterday. Sure, she was wearing a t-shirt with the phrase "OTHER BITCHES JUST FRONT" emblazoned across her chest in red 200-point font, but other than that, nothing out of the ordinary.
(As an aside, what does that even mean? Does it mean that she is a bitch, but that she in no way fronts? And if she is 100% not fronting, to what does that even refer? NewFNP is very confused.)
As newFNP starting asking her routine prenatal care questions, it came to light that her patient had been seen in the ER for preterm labor a mere six days before. Of course, she did not go to the ER where she is registered nor did she bring paperwork detailing the visit. According to her, she did not receive medications to stop the contractions, she had a normal NST, was observed overnight and then released. She had her paperwork at home, she assured newFNP, and would bring it to her next office visit.
NewFNP proceeded with the exam and was startled when she auscultated distinctly irregular fetal heart tones.
"Why they sound like that," her patient asked. "They was like that in the hospital too."
"What did the doctor say," asked newFNP.
"I dunno. He said it's normal I think," she replied.
Great. Sure, it can be normal. It can be a totally benign finding. Her 24-week level II ultrasound was normal in every way. But a repeat ultrasound or a fetal echocardiogram would provide newFNP with the reassurance she so sorely lacked at that moment.
NewFNP filled out the referral form for a perinatology consult and a repeat ultrasound.
When it comes to prenatal care, newFNP does not front. Whatever that means.