It sure has been one heck of a wild week! Started out the week by attending a sex toy party. Yeehawww! Do the girls I work with know how to work their sexy! We are a bunch of wild child chicks. Well, what did you expect when you mix alcohol, food, and a sex toy party?
And yes, I bought some.
Next up.........babies galore at work! I literally lost track of how many births I was in over the past few shifts. It's just bam-bam-bam! One after another. One was an unanticipated premature birth where the labor was super precipitous and the kiddo just flew out. Literally rode a huge wave of amniotic fluid (full on in the face of the midwife and doctor at the end of the bed), and I was able to get the baby up on to mom's belly as the midwife and doc worked on wiping the amniotic fluid from their faces. A TON of fluid. Holy heck! Baby was quite stunned, and needed respiratory support and was a NICU admission, of course, due to gestational age. But babe is doing well, the last I heard. The mom was awesome. Totally awesome! She did it with no drugs.
Speaking of natural births, I had another one the day after that. Mom had pitocin augmentation, didn't want any pain medicine or an epidural - and she did it! High five to that mom too! It's just beyond words when I'm present at births where the woman is determined to do it natural, and she does it. Damn! Women are STRONG!
Yet another babe after that. Another first time mom (we seem to be having a lot of primips lately), and she also pushed like a champ! Super short pushing stage! Mom felt like baby was coming OP, but babe turned out to be OA. She had a little bruise on her forehead which tells me she probably was OP, and rotated in time for her birthday to be OA. Those kids do that sometimes. Little buggers!
I haven't caught any babies recently, which is a good thing, because it's kinda frowned on nurses doing the catching. But sometimes they truly come so fast that the nurse ends up catching. Or rather, the baby lands on the bed. Yep, I've done several births like that. Which brings me to my next point........
Keeping the bottom of the birthing bed on. Yeah, I don't like breaking the bed down. That's fine if you need to break it down after the birth to see and do a repair. But for the actual birth? Heck, I personally like knowing that the bed is intact, to catch the baby, just in case he/she shoots out like a cannon at the end. Cause let me tell ya, some kids will do that.
11 comments:
My most recent birth, in February was one of those where the nurse caught the baby. It was her first catch (yes, I asked) and she was luckily there because even though the bed was not broken down, I think the baby would have kept going from my husband's explanation.
I attended a birth last night in which the nurse caught. Of course, the client was the nurse's sister, and she caught on purpose! Primip, augmented at 41 weeks, no epidural, just 29 min of pushing - and 9 lbs 8 oz! Nurse/sister caught the head solo, and then we kind of 4 handed for the shoulders and body because he was a bit of a tight squeeze. Mom was side-lying for the birth, and her sister knelt on the floor at the side of the bed, and I sat on the end of the bed (I rarely break the bed for the same reasons you mentioned.) This experienced nurse has had a few catches before, but they were all really precipitous, so it was fun helping her do one on purpose. Especially for a such a nice chunky baby.
The rest of the week was not so hot, had a true obstetrical disaster with a bad outcome, so participating in this beautiful birth helped a little my current desire to just quit.
As a mom I way prefer the bed not being broken down for quite a few reasons.
As an unmedicated mom I am often deep in transition and having to move and lift my bottom and do this and that so the nurses can break down the bed is at best, distracting.
It makes me feel on display and vulnerable to have my bottom so exposed and 'out there'.
It 'medicalizes' the birth even more.
My current OB doesn't break down the bed, or even turn the 'spotlight' on. He just watched me do my thing and when I said "here he comes' Dr. K met me where I was at...which was in a very awkward sitting position almost hanging off the side of the bed. I had both arms wrapped around my husbands waist. The only thing my OB did was gently push one knee back a little more for the shoulders.
Y'know, there really isn't an "achievement" thing going over whether the mom chooses to have an epidural or not. I'd hate to be a client of yours, with all the push for med-free birth, if I decided to use pain meds. I'm quite sure, from your tone in this blog, that you come across to the patient as extremely judgemental, and would act quite disappointed in the client who doesn't wish to suffer unnecessary pain.
I've had three unmedicated births, mostly because of precipitous labor, and childbirth hurts like hell. There is a reason that they call it labor PAIN.....and the last thing any woman in labor needs is someone with an agenda.
Oh---and btw, if the infant is "stunned" how about checking respiratory status and giving some oxygen/suction/compressions rather than slinging it up on moms tummy? Just saying......
Fuzzy - I do not have an agenda. I am an advocate of whatever the woman wants for her birth. The only things that I am opposed to are inductions for no medical reason, and primary elective c/s for no medical reason.
Beyond that, I will educate and advocate for whatever pain relief method the woman is desiring. I do not 'push an agenda' or my opinion on her.
Sometimes though, I have to use my nursing judgment and withhold narcotic pain medication if it's so close to the birth time. Narcotic pain medications given within 1 hr of the birth will often lead to respiratory depression and apnea in the neonate. Then guess what? I have to resuscitate the baby, give narcan, and sometimes the baby is admitted to the NICU.
An epidural given right before the birth (which I have participated in several times), usually leads to a precipitous birth before the epidural can give pain relief.
In either of those two situations, where birth is imminent, and the woman is wanting pain relief, I try to explain why it would be detrimental to the baby, or would be ineffective, and I support her with good coaching and verbal support through the birth.
Your last comment about the infant being stunned: this was not a normal situation. This was a very premature infant who had immature lungs and was not breathing. This baby needed more support than what I could do at the bedside. Plain and simple. Getting the baby up on the mother was the best place for me to start resuscitation, in the physical environment that I was in at that time.
DoctorJen - don't quit!! we need lots of docs like you!! perhaps a week in Hawaii instead? :)
I second what Nicole said! We need more docs like you Jen!
Sounds like a busy and pretty cool week! I really enjoy your blog, but I have to say that the "women are strong"/"mom was awesome" because they opted to go nonmedicated is kind of off-putting to me. Is birth less incredible or mom less awesome or strong when she has pain relief?
Paula
You seem like an awesome nurse. If you and I lived in the same metro area, I'd consider switching health plans to be at your hospital and timing an induction so you could be my nurse (but only if I had a good Bishop's score!). I melted when you wrote about how you talk to your patients as they're being rushed into an emergency C-section. I know you want what's best for women, for them to be comfortable and supported before/during/after labor.
That being said, I think the issue is that by complimenting only women who choose unmedicated birth, you're implying that you think women who choose pain relief are less worthy. If only women who go unmedicated are strong, then others must be weak. I'm not saying that's what you think, but that's what it looks like.
I agree with you that sometimes pain relief is not medically indicated. If I'm in labor and the nurse explains that an epidural so early could stall my dilation, or an epidural so late wouldn't take effect in time, or that narcotics so close to birth could harm my child, then I'm fine with that. But women who choose to go without pain relief otherwise shouldn't be judged, explicitly or implicitly, for doing so. And I've been picking up on some implicit judgement lately.
I know you're hanging around with the ICAN folks. I agree that VBAC should be encouraged where safe, and that primary elective C-sections should be discouraged. However, ICAN folks often make ridiculous, blanket statements like "epidurals cause C-sections!" Well, maybe sometimes they can stall out labor, requiring a section. But I also have friends for whom an epidural prevented a C-section due to maternal exhaustion. Having adequate pain relief allowed these women to rest up through their slow labor so they had energy to push.
I'm just saying that when the only women you praise are those who go natural, some women may think, "Oh, nurses think I'm a wimp if I want meds. Maybe they won't treat me as well unless I suck it up." I know that's not true. I'd hate for women who don't want to experience pain to suffer through it because they're worried they'll receive substandard care if they choose an epidural.
I gave birth to twins a month ago (my third and fourth children). When the nurse asked if I wanted to do a practice push, I laughed and told her that, for me, there is no such thing as a practice push and I wasn't going to be pushing until the doc came in to do the catching. Baby A was out in 2 pushes, Baby B was born 9 minutes later.
I did have an epidural, mostly because the on-call doc had hands the size of polar bear paws and if he'd needed to do a breech extraction, I didn't want to feel it. As it was, he had to go in midway up his forearm to break B's water... I am very glad I didn't feel that.
My birth story is on my blog in a ridiculous five-part saga. It's long because I wrote it for my babies to read it when they're older and I didn't want to forget the little details.
Thank God the nurse didn't break the bed down with baby #4,#5,or #6 because I had all of these quickly and #4 did bounce on the bed! So appreciate the extra space. The midwife with #7 actually had me in a mostly sitting up position with my feet on the lowered part of the bed, not broken away but lowered. It was different, it felt like a "princess throne" and she called it that.
Blessings!
Dawn
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