I'm home!

I arrived home last evening, after an uneventful two flights. The only interesting points were having one of my carry on bags pulled for a search (darn souvenier of coffee beans in a bourbon bottle is what cause it!), and then finding a love note from TSA agents in my checked bag. Apparently, that one was pulled aside for a special search too. Lucky me!!

Scenes from Kentucky

Click on each picture to enlarge!

Kentucky: Days 2 and 3

It's been a busy days 2 and 3 here in Kentucky for Crossing the Bridge. We've been doing break-out sessions and presenting our power point presentations about our communities and our community health practicum. We've had to create a community intervention project where we can measure short term and long term goals. My project is on postpartum depression - increasing education, awareness, and creating a more structured follow up plan of care. It's interesting to hear about other students' projects and their interventions. I present my power point tomorrow - one of the last people to present their project! Yikes! I would have preferred to have gone sooner, but the order of presentation was pre-selected for us.

This has once again been a very bonding experience, meeting up with my classmates (and friends!) again on campus. Tonight, after a fantastic home-cooked meal (we get those 3x per day!), we dressed up in halloween costumes and build a campfire. We toasted marshmallows and made s'mores. And lots of wine drinking and story telling! It's so spiritual and amazing.....beyond words. I just wish I wasn't so darn tired to fully enjoy the really late night chats in the "Womb Room" in the dorm.

Night night everyone! One more full day left at Frontier, then I'm flying home on Friday.

Kentucky: Day 1

I traveled to Kentucky today via two airline flights. The little metal tubes of death got me safely to my final destination in one piece.

I am sore, aching, and tired. But excited to be here! My dorm room this time is decorated in painted silhouettes of women with a heart for her (pregnant?) belly.

We did our meet and re-greet with each other, and got to reflect on issues that we have come across in the Bridge year. Those issues were duly noted by the director of the Bridge program, and she'll work on addressing those issues.

I'm unpacked, ready for bed, and heading to la-la-land. Will update more tomorrow!

Leaving, on a jet plane......don't know when I'll be back again (ok, be back on Friday!)

It's been fairly busy the past several days. I've switched from evening shifts to day shifts (temporarily), plus I had a full day of observation/clinical in the office with the midwife again. That was pretty awesome actually. I assisted her with an IUD insertion. It went in very quickly and easily! No, I didn't do the insertion - I was more of her "helping hands" handing instruments and such to her. Kinda like what I do now in L&D as a nurse. Felt very familiar, being the assistant. I think this transition from nurse to provider is going to be a little difficult to wrap my mind around.

No days off recently for me. It's just been go-go-go. I started packing for my trip to Frontier last evening. I leave in less then 24 hrs!! WOOHOOOO!!!! YEEE HAWWW!! Kentucky, here I come!!

Working days today. I hope it's a decent day, and we're not as slammed as we have been with laboring women. I did have some fantastic vaginal births in the past several days. Some of the babies were absolutely toddler size!!! The biggest was just shy of 11 lbs. No epidural! Ouch! Mom did awesome!!!! The doc and I were joking yesterday about not having a repeat of such a large baby. Well, spoke too soon. Had one that was (unexpectedly) close to 10 lbs yesterday. A-ma-zing!!!! The power of a woman's body is just out of this world.

Leaving for KY bright and early on Monday morning. I am so super excited about seeing my classmates again!! We're doing what's called "Crossing the Bridge". It's where we finish up our Bridge year and "cross over" into the Master's level curriculum. Technically, we're Bridge students until December, and we've already started our first Master's level course, but it's very symbolic. Plus, we each do presentations on our intervention plan that we formed for our clinical sites. We also will be working on case studies. I <3 case studies! They are an awesome way of learning!

Off to work. Have a great week everyone!

Day two, and so it continues

Day two of the new visiting rules. So far, so good.

Only had two incidents so far on L&D, that I know of. One was when the charge nurse called a scheduled induction patient and was doing so out of courtesy, to inform her about the new visiting policy put in place for the health and safety of pregnant women and their newborns. The woman got very upset, was crying, and her husband took over the phone call. Apparently, the woman wanted her two very young children in the room for the birth, and was upset that no children under 18 could even come in the hospital. The husband sounded like a real control freak and wacko, and was screaming at the charge nurse on the phone. He was saying things like "all you nurses do is sit around and make up bullshit 'rules'!" (Really? It came from the upper echelons in management, not nursing.) The charge nurse tried several diffusing tactics and was very nice and polite about everything - after all, it was a COURTESY call she initiated - it wasn't required or asked of her to call the schedule inductions and let them know about the new visiting policy during the flu season.

The other situation was a woman was supposed to come in for observation (preterm, shortened cervix), and when she showed up at the security station at the main entrance with her two young children, she was told that no children under 18 were allowed in the hospital. She was already told this before she left the office on her way to L&D. So she already knew! She said basically "fine then! I'm going home." Ok, whatever. You were advised to come in for observation from the office for your pregnancy problems, but sorry, you need a babysitter. No kids allowed. Period. It's for everyone's safety that these rigid rules were put in force. You may not like the rules, but the rules are there. The nurses cannot change the rules.

We have someone who was delivered emergently who is very sick with possible ARDS (acute respiratory distress syndrome) and who may not survive. So yes, we are starting to see the ramifications of the seriousness of H1N1 in pregnancy and on L&D.

And it's only beginning folks.

Why come to the hospital if you have the flu? There is NOTHING that will be done for you that cannot be done at home. Rest, fluids, tylenol. If you have complications from the flu (difficulty breathing, chest pain, cyanosis, extreme high temps that will not come down), then come in for treatment. But for the love of Pete, if it's the flu - STAY HOME. Do not come and share your germs with everyone else. Hospitals are for people with illnesses and diseases that need medical treatment. They are vulnerable enough as it is.

If you're pregnant and have the flu - call your doctor/midwife for advice on whether you need to come in and be seen. You WILL be screened first by the ER, before coming to L&D for any OB problems. If it's just flu symptoms, you should not be on L&D at all. And believe me, if you are fine obstetrically, you will be turfed back to the ER or home. We don't want to expose anyone else to your germs. Not staff, not patients, not visitors.

I have seen more and more people with masks on in the hospital. Staff and patients. I've taken to wearing a mask during the pushing and birth stage for all births, since I am within 3 feet of the patient for more than 15 minutes. Who knows if the patient will end up sick with flu symptoms in the postpartum period? It's already happened several times. If they get sick within 2-3 days of my being exposed to them within 3 feet for more than 15 minutes, then I have to start on prophylaxis and Tamiflu. Part of the prophylaxis is that now we are being forced to wear a mask for a full 7 days in the workplace after exposure to possible flu - to reduce the risk of us spreading it, if we should happen to come down with it post exposure. (Messed up policy, right? I mean really.....it's improper handwashing that spreads the germs, not necessarily exposure to patients without masks.)

I'm nipping it in the bud and just wearing a mask at all pushing/birth stages. End of discussion. I take the mask off once the birth is over and I'm not constantly at the bedside. Hopefully, if the patient does end up coming down with flu symptoms in postpartum, then I don't have to worry about the BS of wearing a mask for 7 days post exposure.

HAND WASHING - HAND WASHING - HAND WASHING!!

One final thing: wearing a mask in the proper way is important also. Having it hang below your chin does nothing to protect you. This goes out especially to the staff members that I have seen wearing masks like this. I mean, REALLY!

Day one with the new visiting rules

So far, so good. Not nearly as much traffic (people) coming in and out of L&D. Believe me, it gets annoying as $hit when you're constantly hearing people ring the desk, and someone yelling "the door please!". The phones are ringing much, MUCH less. YEAH!

It was so much easier taking care of laboring women when you're not having to trip/jump/bump/"excuse me" around 70 million people in the labor room. Ok, so I exaggerate about 70 million people. But when the "watchers" out-number the actual labor support, then you know it's time to start kicking people out of the room.

So far, people have been very understanding about the reasons for the new rules. I think it's helpful that the powers-that-be changed the "one person" rule to two people for L&D.

I had a very, umm, interesting patient on my shift. Won't go into the finer details, but she was very unique. The highest level of anxiety I have ever seen. I'm willing to bet that she has some sort of underlying disorder/disease related to her mental health status. She tried my patience by the end of the evening.

Her doctor pissed me the hell off though. Listen dude, I *KNOW* what amniotic fluid looks and more importantly SMELLS like. Would you actually listen to me when I'm telling you that your preterm super-grand multip is ruptured and is in rip roaring labor? Don't question it or poo-poo me when I'm trying to tell you, in multiple versions of the english/medical language that she has ruptured her membranes. AND that she is going to deliver her baby post-haste. Dude! My spidey-nurse sense wasn't just tingling......it was ringing loudly enough to cause my ears to explode!

Visiting hours are now posted online!

It's official! The visiting hours have changed as of today, and are posted on the hospital's website as follows:

*Starting Monday, October 26*

Our patients’ and staff's health and safety is our number one priority at XXXXXX. With the increase in flu this year, we have changed our visitation and treatment guidelines at XXXXXX and XXXXXX Hospitals. Please see the new guidelines and separate policy for maternity and pediatric patients below.

• If you have cold or flu-like symptoms (fever, congestion, sneezing, cough), do not visit patients in the hospital

• Visitors under 18 years of age can not visit the hospital during the flu season

• Only patients' immediate family may visit during their hospital stay

• Visiting hours during the flu season have been limited to 3-8 p.m. daily; you must register at the main lobby information desk before visiting with your family member

Maternity and Pediatric Patients

• Labor and Delivery Floor: only two people are allowed (with no switching) during labor and delivery

• Maternity Floor (postpartum): one significant other allowed (person who has the infant bracelet with no switching) 24/7

• Neonatal Intensive Care Unit (NICU): parents or parent and significant other only

• No vendors, staff friends, no tours

Remember to wash your hands regularly. Antibacterial hand sanitizer is available in the main lobbies, emergency department lobbies, patient rooms and nursing stations. Frequent hand washing will help prevent the spread of the flu to our patients, staff and visitors.

We're all tired of hearing about swine flu

More and more, we've been hearing about H1N1 (swine flu, if you've been in a cave for the last 6 months). A few more diagnosed cases in staff at work. Yeah, ok, whatever. It's the freaking flu! Wash your hands, drink fluids, take tylenol, and stay the heck at home.

But no. What is the hospital doing now? Two brand spanking new shiny trailers are being placed outside of the ER entrance. One trailer will be for registration and triage, and the other will be for treatment of all suspected flu patients. Why come to the hospital if you have the flu people? Unless you are blue, can't breathe, or are immuno-compromised, you are best off keeping your germs at home. REALLY!!!!

Because of the "increase in potential swine flu patients" coming into the hospital, we are also starting a new, much stricter visitation policy.

• No children under age 18 may enter, unless they are a patient
• Visitors are restricted to immediate family only
• Visitation hours are only from 3pm to 8pm.
• Everyone is screened at the front desk before entering the hospital
• If you have a cough or fever, or any other sign of the flu, you may not visit

In addition to those rules, the Women's Health/Maternity/L&D/NICU/Peds units will implement the following:

• One and only one person may accompany the patient.
  
• That one person will NOT be able to switch off with another person.
• No visitors on L&D, Maternity, Peds, NICU, Women's Health other than the primary visitor/support person.

Get out your bulletproof vests fellow nurses. We're going to need them. We work in a major inner city. We've already had 15 murders this year in the city itself. There will be more. Count on it.

Hopefully, HOPEFULLY, we will finally get some better security in place at the hospital for everyone's safety. This is going to get very ugly people. Very, very ugly.

Edited to add:

I forgot to mention that doulas are NOT going to be considered the "one support person". So, if your husband is your support person, and you have a doula, BOTH may come with you. However, those are the ONLY people allowed with you your entire stay on L&D and postpartum.

Unfortunately, I don't see many doulas at all on the unit. I wish we had more doulas with the laboring women!

Also, the visiting hours are for the areas of the hospital that are not part of Women's Health, L&D, postpartum, NICU. We will still have 24/7 visitation for the primary support person.

When is it too late to get my epidural?

I am asked this question almost daily.

When is it too late to get an epidural for labor?

• When the baby is crowning ::grin::
• If your labor is moving so quickly that sitting you up for placement of an epidural for 15 minutes means the baby will be born during those 15 minutes.
• If you have had a baby before, and you have a history of rapid transition. It will probably go fast again.
  
• It all really depends on the situation and the person!

As you can see, there really is no "magical" number of dilation in any of my answers. I'm very sorry that I cannot give a definitive answer to this question. To put it very simply, each woman is different. Each labor is different.

Many, many women ask for an epidural or something for pain during transition, I have noticed in my 8+ years as an L&D nurse. Transition is hard, fast and furious for many women. This is when the pain really can intensify, and those inner feelings scream out "I can't do this anymore!!!" and "I need drugs!!!!". I know it's no consolation when you are in the throes of transition, but these responses are normal! Unfortunately, things might be moving too quickly to be able to get medication or an epidural by this point. It's not always the case, but sometimes it's true.

(This post was spurred by a recent birth with a multip who was moving too fast in her labor to get an epidural. 10 minutes after sitting her up higher in the bed, she birthed her baby - sans epidural.)