At least I'm off for a week

The title says it all.

It was a horrid day, again, on L&D. Way too busy, with too few nurses. To top it off, I got (another) taste of lateral (nurse to nurse) verbal violence, again. Twice in two days. From the same person. Problem is, even if I jokingly say something remotely sarcastic to her, she goes off the freaking handle. I seriously think she's got some burnout issues. Or hormonal issues, or something.

I ended up walking away, didn't talk to her the rest of the shift, and just had a little private cry for a few minutes. Then I blew my nose and went on with my day.

Sometimes you cannot make someone happy in the slightest bit. No matter what you do or say, they are angry. They may or may not be angry at you, but they sure can take it out on you. It's not nice, nor professional. And it really pisses me off.

Some days I just want to hide in my patient's room and not have anything to do with any of my co-workers. I'm sure other nurses know what I mean. Sometimes you just have that "clique" of nurses on, and you're the odd one out. No one to commiserate with you, because almost everyone there for that shift is buddy-buddy with each other. Can't get things off your chest to one person, because it will find it's way back to the original person you need to vent about.

Maybe I should just write my nurse manager a nice long letter, explaining the issues. Cause we sure do need to work on breaking up some of this clique-y behavior. It's bringing down morale when one person rips into another person, and there is little to no outlet for the person being ripped into. It truly is verbal lateral violence and abuse.

It's intolerable.

On to the good news, I don't have to see or talk to anyone from work for a full week now! I'm off to Kentucky tomorrow morning (at oh-my-god o'clock in the morning) for my flight to Frontier Bound. YEAH!!!!

I'm almost all packed, and definitely ready to go. Have a great week everyone.

Is it a full moon?

I'd really like to know if it's a full moon. I don't think so. The pregnant women were coming in to L&D in droves today. Not just my shift, but the previous shift, and the shift that followed mine.

Rule out SROM. At least half of them had ruptured membranes.

Rule out labor. Most of them were really in labor.

Rule out preeclampsia. Just why is everyone's blood pressure elevated too?

I had a preterm birth, early 30 weeks, but baby did awesome at delivery. She was screaming her itty bitty lungs off, and was pinker than some fullterm babies. Mom was relieved to have given birth, since we had been trying to keep her pregnant for several days with tocolysis, to no avail, since she ended up breaking through all of the medication. Mom really didn't like the side effects of the medications one bit, and actually wanted to stop all tocolysis completely. It seems that her body made the choice for everyone involved when she kept contracting and dilating.

I also had a rule out labor who I'm sure was in labor, but was still in the early stages of labor (less than 3 cms dilated). She was contracting every 2-3 minutes though, so I'm sure (99.99999% sure!) that she would change her cervix and be admitted.

I was helping out with another preterm gal who was just barely at viability, and was dilating progressively, despite tocolysis. The problem, to compound things, was that she was breech, with the feet coming first. What a disaster that could be if she ruptures her membranes! I really, really hope that we can buy her a couple more days for at least steroids to be given. Even better, a couple of weeks - though I doubt it, with the way she was progressing so quickly. That's so sad too, knowing the poor outcomes (long term) the baby is going to face.

The pregnant women kept rolling in the door as I was leaving. I was so very glad to be leaving too. We were short staffed today, which made it even more difficult to take proper care of all of the laboring women.

Hopefully tomorrow will be better.

If I don't post again tomorrow, I may not be posting until I get back from Frontier Bound. Think of me Monday morning, as I get on a very early flight to Kentucky!!

Weeeeeeeeeeeeeeeeeeeeeeeeee!!

I'll be back!

Happy Turkey Day everyone!

We're eating late this year - probably not til about 6:30pm, so our turkey is still cooking. I also have brownies that my daughter (age 5) helped me make for our dessert. I have a new recipe I threw together for the sweet potatoes....wayyyyyyy too much brown sugar, but we shall see how my stomach reacts to it! The regular potatoes are peeled and ready to be cooked, mashed, buttered, salted. The stuffing is stuffed up inside the bird. (Take THAT bird!) The corn or green beans (not sure which we're doing yet) will be nuked in the microwave. The rolls will be baked to perfection after the bird is done.

Yep, I'd say we're ready to eat dinner. My stomach is growing just thinking about it.

Have a great Thanksgiving everyone! This nurse is actually OFF for the holiday - yeeehaww!!!

xoxox

5 more days until Kentucky

Last evening was a bit of a wacky shift. I started out with a young multip being induced for medical reasons - actually, several maternal medical reasons, including active cancer. Such a sad situation with her, but she was so upbeat and ALIVE! Her cancer was in an advanced stage, and her prognosis was poor, but she was actually living her life, and not giving in to the bleakness of her medical situation. I find that absolutely amazing. Unfortunately, she didn't give birth on my shift, however, she had an awesome nurse for her delivery after I left.

I picked up a second laboring woman, just "covering" for another nurse who had to circulate for a c-section. Well, the c-section turned into a much more intricate surgery due to some complications that happened, and a general surgeon was called in to assist. What should have been a 30 minute surgery, turned into a 3 hour major operation. She almost lost her uterus, and did lose part of her bowel, from what I heard.

Anyhow, I kept her laboring woman, who was comfortable with an epidural, for those several hours, until her nurse was able to come back to the floor and take over her care again. This laboring woman, more like a girl, was sweet as can be, albeit very nervous about labor and birth. I spent a lot of time with her, educating her, and trying to put her mind at ease about what her body was going through.

Later on in the shift, things finally did start to slow down a bit, and I was able to catch up on my unit email. I found out that our OB tech are no longer able to unhook patients from the fetal monitor to get up and go to the bathroom. It's all about liability folks! I heard through the grapevine that something happened recently where an OB tech unhooked the patient from the monitor, but the baby needed to stay on continuously, and something bad happened as the outcome. I don't know the details, but it was enough to cause the management to come up with an official statement about OB techs and fetal monitoring. The key thing about the liability is that the nurse is the licensed, trained person responsible for both the mom and baby. The OB tech is working under the RN. If anything happens, it's on the RN for liability. They're trying to eliminate the liability for the OB tech, since she/he is not a licensed person, nor is able to read a fetal monitor strip and know if it's ok for the woman to get up to the bathroom or not.

Years ago, our OB techs used to apply the fetal monitor, but that was taken away from them - liability once again. They are also not allowed to readjust the monitor parts - yep, liability. Basically, they cannot have anything to do with the fetal monitor or it's parts.

I have questions though........how about when we (the RN) teach the patient on how to unhook herself from the monitor to go the bathroom? Is the liability all on the RN? Or does the patient take some responsibility? I believe that ultimately, it is the RN who is liable, since she is the one who is continuously reviewing the EFM monitor strip for decels or non-reassuring fetal status. If the patient should not be getting up to go to the bathroom due to compromising fetal status, chances are very good that the RN is already in the room as it is, doing intrauterine fetal resuscitation maneuvers! (Position changes, oxygen application, IV fluid boluses, etc).

Back to work tonight again. Have a great Turkey Day tomorrow everyone!

5 more days until I leave for Frontier Bound!

I'm still here

I'm still around. Not any new births to talk about. Haven't worked for the past few days, so I've been either relaxing, sleeping, or doing readings for Frontier Bound.

Frontier Bound - in one week I will be in Kentucky! YAHOO! I'm so excited about this new adventure in my life.

When I went in to work today for a meeting, they thought I was supposed to work the 3-11pm shift. Ummm, nope. That would be tomorrow. The charge nurse was sure, because I was on "the list" of nurses for that day that I was working, but when she double checked it against the master schedule, she realized that I was right - I'm not scheduled for today. It looks like it put a crimp into the evening shift staffing, leaving them short staffed. But guess what? Even though I am a good team player, it's not my fault, nor my problem. No one tried to guilt me into staying for the shift either, thank goodness.

I love my job and all, but I had plans for today. Albeit, nothing exciting - just dinner with the family (and more unexpected grocery shopping), some relaxing time, and an early bedtime. But, it was plans nonetheless. I never did get to go shopping for luggage tags that I need for my suitcase, or for a new datebook for 2009. Sometime later this week, I hope to get that done.

I have to get my prescriptions refilled by Saturday, so I have enough of everything for next week while I'm out of the state. Just another thing on my list of things to get done this week in preparation for my going away.

Must remember to remove my old airline tags on my suitcase. I don't want my suitcase to end up in Las Vegas! That was the last place I flew. And gee, it was way back in 2000!

Early bedtime for me, and I promise you some birth stories/patient stories sometime before I leave for Kentucky!

Snow!

We had our first "real" snow here in PA this week! At first, it was pretty exciting to see the beautiful whiteness blanketing everything in sight. But then I had to drive in it.

Snow and I do not get along when it comes to driving in it.

No, I did not get in another car accident. Thank goodness!

Anyhow, here are a few pictures.....

A day off - whew!

Days 3 and 4 of my 4 day run were busier than the first two days. However, they weren't "runningaroundwithmyhaironfireOMG!" type of busy.

Day 3 - admit a preterm labor at 30ish weeks. Her docs were back and forth on her true due date, and plan of care. Either way, she was preterm, and something needed done for her.

I end up handing her over to another nurse because my other lady needed my attention much more, since she was going au natural with childbirth. She had awesome support partners! Also, she seemed kind of aloof, and seemed to not like the intrusion of nursing staff, so I kept out of her room except for my q 30 minute fetal heart rate checks, and some prn checks for comfort/making sure she wasn't ready to start pushing.

She and I actually started to build some rapport towards the end of the shift, when she was pushing. Since she was able to take little mini-naps between contractions, she was more refreshed and awake for pushing at the very end. I find it so amazing what a woman's body can do! I think the little naps really helped bring her true personality out too. She was more talkative between contractions, and we discussed things like midwifery care versus physician care, natural childbirth versus epidurals, and breastfeeding/skin to skin contact.

Mom ended up pushing out a big baby, with minimal lacerations. I was so happy for her and her husband - they got the birth that they wanted, and were ecstatic to see their new little person in their family.

Anyhow....day 4.

I had another preterm/gestational diabetic woman, on magnesium sulfate. I get so sick of mag sometimes. Those hourly checks, waking her up each time because I have to check her pulse ox and reflexes, these poor ladies never get good sleep.

She was nice and stable, with occasional contractions, so it was a fairly easy evening. Of course, I had occasional meds to give her, and blood glucose levels to check, but all in all, a good evening. I was able to help out with several other nurses and their patients including doing some hard sticks for labs and IV starts. I was able to get them all! WOOHOO! It feels good to get that hard-to-stick vein.



At dinner time, I made the mistake of ordering chinese food with the other nurses, and after just a few bites, I dumped. Oh-my-freaking-stomach!! I haven't had dumping in a while, so this was a slap in the face, thinking I could tolerate chinese food again. I think what triggered it, and I normally do not get these when we order, was the crab rangoon. It's the pastry combined with the fact that it's fried, and the fact that I dipped it in the sweet and sour sauce. BAD BAD GIRL! I tell you, it's strange how I can tolerate one thing, but not something else that is similar. I mean, I can eat dessert without problems. I can occasionally eat a few bites of something that was fried, though I was never a fan of fried food anyway. If I had just stuck to my veggies and beef, I would have been ok. But nooooooooooo......I just had to get crab rangoon!

I spent my dinner break curled up in a ball on the staff lounge couch. It took about an hour until I was feeling back to normal. During that time though, I was nauseous, wanted to vomit, and felt overall like I was going to die. I don't wish dumping syndrome on my worst enemy.

Once it cleared up, like I said, I was feeling back to normal. My stomach felt like it was punched, but that's how I feel for hours after dumping.

By this time, things had slowed down a bit more on L&D, so I was able to just take it easy, and chit-chat with the other nurses, and some of the docs.

And now, today, a day off.

NO MORE CHINESE FOOD!

2 down, 2 to go

Evening shift #1 - have an induction for post dates, on cytotec every 4 hours. Super easy patient. I go home 4 hours early, due to low census.

Evening shift #2 - a steady type of busy, but the unit overall wasn't that busy. My first patient is a rule out preterm labor, who is ruled out and sent home. 2nd patient was in for an external cephalic version, which went off without a hitch! Yeah!! Good baby - now stay vertex! Then I was the 2nd nurse in a c-section for twins, and I took care of one of the babies. Once baby was stabilized, baby care done, and report given, I was off for my dinner break. Last patient of the evening for me (patient #4) was in for SROM, and was only 1cm dilated. Got her up and moving around to get contractions going, but her cervix was unchanged when it was time for me to leave for the evening.

All in all, two GOOD shifts ------ so far! We'll see what Sat and Sun hold.

Work, home, weather - I cover it all!

I did it again! I scheduled myself for four shifts in a row, off one, then three more in a row. Am I crazy or what? I can't do anything to change it now though. Just have to suck it up and deal with it.

Needless to say, I'm sure I'll have plenty of birth stories/triage stories to tell in the next week.

On the homefront.......

We met with our daughter's Kindergarten teacher last evening. It went pretty well, I'd say. It turns out that her temper and stubborn personality does spill over into the classroom, but not quite as much as it does at home. At home, it's a daily fight with her over something: meals, putting away toys, getting dressed, doing homework, whether she can play outside, watching TV, playing games, etc. She is *so* her father's child - she's got his personality (and mine, I hate to admit) to a "T". Oh, woe is me!

My son is very happy that his father agreed to give me primary physical custody. I think he was genuinely surprised, and I don't blame him - I was surprised too! We'll see how the visitations go.......

The cold weather has hit! It's raining today, and about 45 degrees. However, it feels like we're closer to the freezing point. That rain out there is bitter cold! I would not be surprised if it gets a little icy on the roads when I drive home after work tonight. It feels like we just skipped over the true autumn weather, and are going right into winter. The first snow fall will be here before I know it. I'm not ready for snow! Give me back my warm sunny days!

That is all. Time to eat a snack before going to work.

Joke from a perinatal list

KC Williams teaches AP Government at Santa Fe High School. In one of KC's classes, they were discussing the qualifications to be president of the United States. It was pretty simple.

The candidate must be a natural born citizen, at least 35 years of age.

However, one girl in the class immediately started in on how unfair was the requirement to be a natural born citizen. In short, her opinion was this requirement prevented many capable individuals from becoming president.

KC and the class were just taking it in and letting her rant, but everyone's jaw hit the floor when she wrapped up her argument by stating ... "What makes a natural born citizen any more qualified to lead this country than one born by c-section?"

I'm guessing she didn't get any Advanced Placement credit.

Things went well today

My ex-husband agreed to my having primary physical custody of our son, and he (my ex) will have some visitation. We're doing a follow up conference with the courts in March 2009. I won't get into the nitty gritty details, but there was much debate over things, and he was caught in lies again.

::sigh::

We'll see how things work. My son did get to spend some time with his dad today, and was agreeable to spending time with his dad. So, it's off to a good start. For now.

Dreams/births

I have very vivid dreams, where I'm catching babies. Just last night I had a dream where I had two women in the same labor room, both laboring. One all of a sudden delivered her baby, and I was wiping the birth fluids off of the baby. Then the second woman said "the baby's coming!". I called out for help - "there's no way I can take care of a freshly delivered mom and another mom about to deliver! I need help in here!" But help never came. So, I was alone, bouncing back and forth from each mom and each baby, trying to take care of both of them at the same time.



I've also had dreams where I catch twins. Usually in the dream, the babies come quickly - one, then two - catch 'em quick! Don't get them mixed up!

I guess you could say I really do have the heart of a midwife. Even in my dreams, I'm catching babies!

I never did get to drink my coffee

I was the triage "treat em and street em" queen yesterday. Several r/o preeclampsia patients, and a status post-fall patient as well. I was busy drawing labs, monitoring uteri and babies, assessing pregnant women for s/s of preeclampsia, doing teaching to the women re: plans of care, what preeclampsia is, etc.

Once everyone was situated and sent home, I had some free time where I was without a patient assignment.

La la la la..........you know where this is headed, right?

Just as I sit down with a cup of coffee, in rolls a woman, obviously in active labor. She wants to go to the bathroom first, saying those magical words, "I have to poop!". Hold on sister girl, let me check your cervix first.

10cm/100/0. No bathroom break for you! (Sorry!)

Membranes still intact, but by this time, she's actively pushing. POP! Water breaks. Get the stand-by doc in place, because this woman's doc is on his way in, but will undoubtedly miss the birth.

About 15 minutes after her arrival, she births a healthy baby girl. I was actually hoping that I could catch her baby, but the resident was there, so I didn't get the pleasure of catching.

Baby latched on beautifully, and nursed for a good 45 minutes. Yeah baby! Mom and baby were recovered from the birth and transferred to postpartum just in time for my shift to be over.

Now, that was a very nice way to end a shift.

Abortion/Termination - NOT A DEBATE

First and foremost: this post is not about a debate of whether abortion/termination of pregnancy is right or wrong. IF THERE ARE ANY NEGATIVE OR MEAN COMMENTS, THEY WILL BE DELETED.

Now that I have that said and out of the way.......

We have had some issues come up on L&D regarding abortions/terminations of pregnancy. We are trying to more clearly define what it is. We do not term 2nd trimester abortions on L&D as "abortions" per se, but rather as "elective terminations of pregnancy." We rarely do them on my L&D unit, but they are still done. Thus, we need a very clear cut policy/statement about them.

What we do now:

• Each nurse signs a form stating either:

1. I will take any termination patient.
2. I will only take terminations if the mother's life is at risk.
3. I will only take terminations for fetal anomalies incompatible with life.
4. I will not take any terminations.

The majority of our nurses will do #1, 2 or 3. A few nurses have chosen #4.

In order to keep the peace and not open a debate, I will not state which number I signed.

Now, the issue at hand is - if a woman is inevitably going to deliver, and the fetus is non-viable (before 24 weeks), however, the fetus is still alive, is it a termination of pregnancy/abortion if the nurse needs to add medication to continue the natural course of the labor? (Pitocin, cytotec, prostin, etc)

This recently came up at work, and it's created a lot of arguments back and forth, on both sides of the issue.

On one side: it's being humane to add the medication, to keep the delivery process moving, when delivery is going to happen no matter if we intervene or not. (ex: fully dilated, membranes ruptured, fetal parts presenting, fetus still with a heart beat.) The woman could potentially become septic and very sick if we do not intervene. We're trying to prevent her from becoming sick, by not prolonging the inevitable.

On the other side: by adding an oxytocic medication, and the nurse having to physically administer the medication, this is now not an inevitable delivery caused by nature, but rather, it's now an elective termination of pregnancy. The nurse objects to giving the medication, because she feels that it goes against her moral standards to purposely aid in the delivery of a non-viable fetus, while the fetus still has a heart beat.



As you can see, we need improved clarity on what is and what is not a termination of pregnancy/elective abortion. We have tried to find a clear cut definition, but have not come up with something yet.

We do currently have a policy statement that further addresses the nurse's role in termination of pregnancy:

• A nurse may not refuse to care for any patient if it is an emergency situation, even if the care rendered goes against any moral, religious, or personal belief system.

So, we are back to the issue again. When is care deemed emergency care? Who decides if it is an emergency or not? I can think of several situations where it can be argued either way - emergency or non-emergency.



(On another note: there will always be nurses on my unit who will care for a woman having a termination of pregnancy/elective abortion. I want to make it clear that someone, whoever can render the best care to her, will be assigned to that patient. Not having a nurse assigned to care for this particular patient is not the issue at hand. We have a large enough unit, with plenty of nursing staff available.)

Birth story #2 - my son

I was pregnant with my 2nd child, my son, when I was 18. I was newly married, and we were living in a tiny one bedroom studio apartment. Way too small for a couple, a toddler and a newborn. But I digress......

I went to a full 42 weeks with my 2nd pregnancy. I had hypertension in the last several weeks, and was on modified bedrest. I was going buggy, being inside all the time, so I headed out to the grocery store at about 10 pm, the day before I was 42 weeks. Looking back, it was probably my little burst of energy ("nesting") before labor started. I felt this need to buy oodles of groceries.

I got home, with my toddler, and her dad was due to come home from working 2nd shift soon. We were all tucked into bed, when the contractions started at 1 am. I let my husband sleep for a few hours, but by 5 am, I couldn't wait anymore. I woke him up, got our daughter ready to go to grandma's, called the doctor, called grandma to let her know we were coming, and out the door we went. Contractions by this time were definitely picking up, and I waited on our apartment building door step for my husband to bring the car around. It was getting harder to walk with the contractions.

We dropped our daughter off with grandma, then timed the contractions a bit while at grandma's house. They seemed to be spacing out. UGH!!! I was tempted to not go to the hospital, because they seemed like they were going away. We ended up going in to L&D around 6 am.

I was hooked up to the monitor and checked - 4cms! Yeah! I was staying. I was also a patient of the clinic service, so I saw the whole gamut of residents, attendings, students, etc. They also broke my water (AROM) when they checked my cervix -- without my consent. But, being 18 yrs old, I didn't know better than to say to them to not breake it. Being 42 weeks, I had meconium in the fluid. The docs told me about how the baby would not cry at birth, due to needing to intubate him right away, and suction him out to prevent him from breathing in the meconium. Of course, I was scared then. However, my nurse was wonderful! She told me that meconium happens a lot, don't be worried, it will be ok. She was awesome at soothing my concerns.

She also told me - let's order you a good breakfast tray - you're going to be hungry after you have this baby! She started checking off all of these foods for me on a menu.....I was like...."I won't be that hungry", but she insisted on this huge breakfast. They would hold the tray for me for after my delivery. (Sure enough, I did dig in when they brought me the tray after the birth - I loved my nurse!!!)

I had one decel, and she turned me to my side. No more decels after that, as far as I know. I was, however, having tons of rectal pressure and pain with contractions, and in between my contractions. I asked for an enema this time, thinking that it would help with the rectal pain. It didn't help. But it did empty me out! I recall the doctor saying just how much stool I had, when he checked me....he said it over and over......it was embarassing actually, and I wish he would just shut up. Anyhow, the enema took care of that.

When I was back to the bed, I was checked again - 7cms! Woohoo! I asked for pain medication, and got something in a shot in my hip. Don't know what. Probably demerol like my first pregnancy. (This was 1992 - demerol was used still).

About 45 minutes later, I'm begging for more drugs. Nope, too soon, and moving too fast. Still hooked up to the fetal monitor continously, and in the bed. Probably the worst place to be with continued back labor!

I started involuntary pushing around 8cm, and the doc kept admonishing me to not push. Heck man, I couldn't stop it. It was insane how my body just pushed. There was NO way I could stop it. After the doc leaves the room, my wonderful nurse tells me - don't fight it, just go with what your body is doing. (I loved my nurse!)

I got to a lip - don't recall the time. Such awful back pain!! I must have had 3 or 4 different docs/students/residents try and push that lip back as I pushed. I screamed. It was worse pain than contractions. I begged my husband to not let anyone touch me anymore. They finally backed off.

I probably pushed for about 30-45 minutes (???), but I don't know how long exactly. I had a much nicer resident doctor for the actual birth (Dr KC, a sweet Indian woman), with her nasty OB attending over her shoulder (the one who kept saying how much stool I had in my rectum....jerk). He made her cut an episiotomy (to the side - my husband told me later that I started to tear, so they cut along the tear). I got local again at some point. Out my son came! 9:43 am. Nuchal cord x 1. No crying. They rushed him to the warmer, where the NICU staff was waiting. I held my breath as I waited for them to say he was ok.

Finally...........a lusty cry! Relief!!!!

My placenta wasn't even delivered, before I asked when I could get up and walk. Looking back, I had to laugh at that. They all reminded me - your placenta isn't even out yet. Ok then......

Got a shot of pit in my hip, which cramped me up something wicked. Baby boy was weighed - 7 lbs 5 oz - my biggest baby! - and wrapped and handed to me.

I was so sore from that episiotomy/laceration. I walked funny for a good week.

My son was an awesome nurser, right from the beginning. I don't remember my first feed with him, but he was exclusively nursed for the first 4 months of life. Never had a problem with breastfeeding, latching, etc.

Now, he's 16 yrs old, and taller than me. Amazing how fast they grow up!

Sweet!

I received my reimbursement check in the mail today from the child support that was deducted from my last paycheck, and was intercepted after I got the order stopped earlier this week at the Domestic Relations Office.

SWEET!!!

For the first time in a verrrrrrrrrrrrrry long time, my next paycheck will be my full check. No more support! WOOHOO!

To top it off, I found out the official amount that I have additionally overpaid in support - $1034 and some change. The only way I can get it back is if I file for child support against my ex husband.

I'm very tempted to file.

However, we have our custody modification conference next week, and in order to get my ex-husband to agree to how my son and I want his custody to be, I may have to pull the child support card out - as in, I won't file for support if he agrees to giving me full physical custody of our son. (Which our son wants - long story as to why, and highly personal, so I won't get into it here. Just know that we have very good reasons.)

::giggle:: I'll actually see my paychecks being in the four digits, instead of my "normal" upper level three digits.

More good news - my son is doing very well in his junior year of high school. I had a parent-teacher conference tonight. I'm so proud of how well he's doing! If only I could convince him to turn in ALL homework assignments, he'd be getting even better grades........

It's been quite a week for twins

We have had numerous twin gestation moms on L&D in the past week. Thankfully, all but one set have stayed gestating!

We did a c/section for one set a few days ago because she broke through her cerclage, and then continued to labor and dilate, despite aggressive tocolytic therapy. Unfortunately, the babies were not in optimal position to continue on and be born vaginally, so she had a c/section. These twins were still premature, so they went right over to the NICU, and will stay there for several more weeks. Hang in there little ones! You're off to a great start!

I feel like the tocolytic queen lately. Almost every time I go in to work, I have someone one magnesium sulfate, terbutaline, procardia or indocin. Or a combination of two or more of those medications. Magnesium sulfate requires hourly rounding, where I check her vital signs (blood pressure mainly), deep tendon reflexes (no rest for the weary pregnant woman on Magnesium - sorry!), pulse ox saturation, urine output, fluid intake, checking pump settings, etc. Every four hours I'm doing a full body physical, including the all important lung sounds. Magnesium can lead to fluid imbalances where you retain the extra fluid in your lungs, called pulmonary edema, and can happen quickly in a pregnant woman. Not so nice for the woman when it happens to her.

Indocin hosts another set of difficulties. It should only be given for a short period of time, due to the side effects of: reducing the amount of amniotic fluid (oligohydramnios), and premature closure of the ductus arteriosis in the fetus. Neither of which are good for the baby!

Terbutaline can raise your heartrate, sometimes uncomfortably so that we have to stop giving you terbutaline all together.

Procardia is the least offensive of the tocolytic agents. At most, it may cause some facial flushing, or feeling a little tight in the chest, but it goes away. Procardia can be taken for not only preterm labor, but also for hypertension (it's indended use among the non-pregnant population!).

Birth story, child #1

As requested, this will be post #1 of 3, with my own birth stories. Enjoy!

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I was pregnant at age 15 with my first child, many moons ago (1989). I was a junior in high school. My labor started out as mild contractions around 11pm, one week before my due date. I didn't think much of it, because it honestly didn't hurt that much. So, I went to bed.

The next morning, I was still having mild, irregular contractions, but wasn't hurting any more than the previous evening, so I went to school. I made it through 2 class periods before I decided to call the doctor. They, of course, told me to come in to L&D to be checked. When I arrived, I was about 1.5 cms. They sent me home, since my contractions were mild and irregular. I spent the rest of the day on the couch, eating light foods, and timing my contractions.

They picked up more in frequency, so I headed back to L&D later that evening. This time I was 2cm. I was given a sleeping pill to try to sleep, while staying on observation on L&D overnight. They kept me on the fetal monitor while I tried to sleep, but I never did sleep. The contractions got stronger, and closer together.

I called for my nurse to check me around 2am, because they were hurting much more. I must have made some cervical change, because they started setting up for my delivery! I got a shave prep, and an enema prep. Some time in there I got a shot of Demerol, at my request. It didn't feel like it did much for the pain.

The doc broke my water when I was 9.5 cms.

By 6am, I was 10cm, and started pushing. Apparently, I was a crappy pusher. With no epidural. No drugs at this point. Not much of an urge to push either. I remember pushing with my face for most of the time. I remember falling asleep while my legs were in the stirrups too - everyone watching and waiting for me to push. I think my contractions stopped for a period of time (20-30 minutes??), but then started again. The doctor cut a mediolateral episiotomy. I felt her shoulders pop out and poof! There she was! 6 lb 5 oz baby girl, born at 8:13 am. I *think* they injected me with local before her head was born, because I don't remember feeling much pain/burning with her head, compared to my second and third births.

I had an awesome student nurse named Jennifer who was helping hold one of my legs, and my boyfriend (now my ex-husband) was holding my other leg.

I got very sick after my daughter was born. My temperature shot up to 104-105, and I thought I was going to die. My parish priest came by and blessed me. In my haze, I thought it was Last Rites, but he was just coming by to bless me. They kept me on L&D for a few hours, started antibiotics, and took my daughter to the nursery while I worked on getting over whatever it was that hit me after delivery. They never did tell me what it was. Looking back, I don't think it was chorioamnionitis, because my membranes were intact until I was 9.5 cms. I never had a fever during labor either. I recall having a vaginal culture done when I was on postpartum, but I have no clue what they tested for, or what they found.

I was on IV antibiotics for several days, and went home on oral antibiotics. My fever cleared up within 24 hrs. I tried breastfeeing my daughter, but wasn't successful. Also, no one showed me how to breastfeed, and I got discouraged quickly, and the bottles of formula were too easily available in the hospital.

My daughter is now almost 19 years old, and is a freshman in college!

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Birth stories #2 and 3 will be written another day. So, stay tuned!!

Good news on the homefront

At last, some good news on the homefront regarding some of my legal issues with my ex-husband. I am officially, as of today, no longer paying him child support! YEAH! About time too, since our son has resided with me since June.

Next week is a custody modification conference, where I hope to have primary physical custody formalized through the courts. It's not as easy as it sounds however, because my ex-husband will more than likely try and fight it. He has used our children as his pawns for money (child support) since I left him many years ago. I have been through countless attorneys, court hearings, conferences, etc. I have cried more tears over custody issues and battles than I care to admit.

But, finally, it looks like things are winding down.

Our oldest child is a freshman in college, and on her own. Our son is a junior in high school, and is adamant about living with me, and living his life the way he wants to live it. (Finally! He speaks up for himself!)

As for my youngest child, her dad is not my ex-husband. My partner now is her daddy. Thank goodness for that! The custody/support issues with my ex have been a big source of strain and stress in my relationship with my partner. You don't know what a huge burden it feels like has been lifted off of our shoulders.

I think we may, finally, be able to start saving for a house of our own. We're definitely going to be breathing much easier with our finances now.

Cerclage

I had a woman yesterday that needed a cerclage for cervical shortening. I hadn't circulated for a rescue cerclage in several years, I realized pretty quickly. Thankfully, our OB tech set up the instrument table in the OR for the procedure. I still felt like I was floundering around when the doc was asking for miscellaneous things that weren't set up on the table. Ugh! To make things more complicated, we do cerclages in our lesser used OR, so it's a pain in the buttocks to try to find instruments/laps/sutures/gloves, etc. I ended up having the OB tech come back and help me find what was needed, because the doc was getting pissy because I couldn't find things quick enough for his tastes. (Bite me!)

I swear, you have to do things multiple times, and often, to keep the skills up, or you forget! I hated feeling like an idiot, floundering about, trying to find the instruments and extra hucks towels. UGH!! I hate that feeling!

Day shift - ugh

So, for a change (ugh), I worked two day shifts this week. Whose crazy idea was that? Oh yeah. Mine. All so I could take my child out trick or treating last night.

Well, day shift #1 - up way too early in the morning. Some ungodly hour where it's still dark out. Do you know how cold it is at that early morning time? Whoa baby! Get in to work, and it's not that busy of a day to start out. I get assigned to two ladies. One had her baby the day before, and was on magnesium post delivery for preeclampsia. The second woman was having twins, on magnesium for preterm labor, and was 29-ish weeks. Both stable. However, it did make for a long day, doing hourly mag checks (reflexes, lung sounds, pulse ox, emptying foleys, assessing for PES s/s on the delivered mom, plus regular basic activities of daily living.) Helped out on some births too in my time between hourly rounds. I ate too much food too. That's the problem with work - ANY shift in the hospital - the constant availability of food and the subsequent grazing all day/eve/night.

Day shift #2 - up at ungodly o'clock again. Still cold outside. Still dark on my way in. Feeling hungover, but didn't drink any alcohol the night before. It's Halloween today! You know what that means - FOOD GALORE! Any reason to bring food in for an impromptu party at work. I was a good girl and brought in veggies and dip. I'm assigned to a laboring woman, having baby #1. She was just recently admitted, and was going to get some pitocin to help move her labor along. Contractions on admission were piddly, and she had ruptured membranes, plus she wanted to just "get the show on the road". Okie dokie. Get pitocin started, get antiobiotics going for +GBS, and before I could blink, she was ready for an epidural. Get her comfy, and encourage her to nap. Cause goodness knows, her nurse would love a nap right about now. I settle for a cup of coffee instead. Run down to the pharmacy to pick up a med for another nurse's patient (a controlled substance, so a tech is not allowed to pick it up). Come back up, graze at some of the food spread out in the break room. My lady is moving right along nicely with her dilation.....3.....5........6........8......time for me to head to lunch. Recheck my lady....10/+3! Time to push! Midwife comes in, and my patient rather quickly becomes a new momma! YEAH!! I'm so proud (and surprised!) at how wonderful of a pusher she was. Evening shift comes on, as I'm finishing up most of her recovery time, and I sign out to the next nurse.

By the way, I did collapse on the couch at home after working both days. Day shift...whew! I never did really feel like I woke up until about 10-11am on each day.

Working evenings the next two nights. YEAH!!