TOBP

Forty weeks is a long time to be pregnant.  Granted, 40 weeks is “term,” although the phrase “term pregnancy” actually refers to any gestation between 37 and 42 weeks.  (Yes, ladies, that means if you delivered anywhere between 37 or 41 6/7 weeks, you were not “early” or “late.”  You were “at term.”)  Many women understandably become anxious for their pregnancy to end, and quite a few of them present to the L&D floor thinking they may be in labor.  “Active labor” has some very specific definitions, however, and the obstetricians (OBs) generally won’t admit a woman to the hospital for delivery unless she’s in active labor or has had some other reason for admission.  The OBs end up doing a lot of labor checks on women who aren’t actually in labor but are, as the OBs like to say, “TOBP” (tired of being pregnant).  Most TOBPs will grumble and go home when told they’re not in active labor.  Some of them try to trick the OBs into admitting them, though, as if the OBs haven’t seen all these tricks before.

One thing TOBPs commonly do to get themselves admitted is to mess with the tocometer, the device that monitors uterine contractions.  The tocometer is placed on the abdomen and works by sensing how easily the skin can be indented; this decreases during uterine contraction.  A normal uterine contraction should produce a tocometer strip that looks like this:

TOBPs have figured out that the OBs are looking for contractions as one of their criteria for diagnosis of “active labor.”  Some of the more clever ones (well, they think they’re being clever) try to fake it by pressing the tocometer into their belly when nobody’s looking.  Problem is, it’s nearly impossible to simulate the gradual uterine tension changes that result from a real contraction, and the tocometer strip generally turns out looking something like this:

Doctors and nurses aren’t fools, though, and we know what’s up when we see that sort of tracing.  The nurses watch the toco strips from the nurses’ station, and they’ll often go check on the patient during one such “contraction” so they can catch them in the act.  The nurses typically say something benign like “You need to keep a bit more still, sweetie, or our monitors won’t work right.”  But the patients know what they’re really saying: You got busted.  We’re not as dumb as you seem to think we are.

The OBs will also watch the tracings from their work room and chuckle when they see those tracings.  They call that pattern a “Bart Simpson” for reasons that should be fairly obvious.  When they approach the patient, though, they tend to be a little more direct: “You need to stop pressing that thing onto your belly.  It messes up the readings.”

Some patients will get embarrassed at having been caught, but some try to argue about it.  They deny what we all knew they were doing and insist that their “contractions” are real.  The OBs tend to stand their ground, though, and let the ladies know that a real contraction looks different from a simulated one.  Those ladies get sent home, just like all the others who aren’t in active labor.

We laugh about that kind of stuff together, of course.  We’re human and we like sharing funny stories with each other just as much as the next guy.  We try not to let things like that make us too cynical.  But we still want to ask a lot of folks, “Do we really look stupid to you?”  Instead, we just shake our heads and move on.  (And then we post it on our blogs.)