New Year's Chaos

So, it is the last few days of the year, and what does every pregnant family want right now? A birthed baby, of course. Gotta have that tax deduction and there are only a few days between Christmas and New Year's in which to get in all these deliveries so healthcare providers don't get their holiday festivities interrupted.

I hate working this week, but I knew we were going to be slammed, and being on winter break from school, I have the time and need the money.

Last night was a zoo......eight scheduled procedures to come in, not to mention the five triages we had. Three of those stayed and two or them delivered before shift change. Tonight will be no different.....there are seven procedures scheduled and we will be tightly staffed because all those who came in last night will be delivered so half the scheduled staff will be doing postpartum tonight. This will leave just enough nurses to take care of the scheduled procedures.......heaven forbid a triage walk through the door. The powers to be just don't understand that! They fill us up with procedures and make no concession for the women who actually go into labor and just show up.......what? women can actually go into labor on their own? you don't have to schedule their deliveries....grrrrrr!!!

Okay, just had to rant a little.

Hope everyone is gearing up for a great start to the new year! Bring on 2009!!

Unintentional hiatus......catching up

Okay, so I feel like a bit of a slacker. I haven't blogged in two months and I told myself when I started this that I would keep up with it. I have a bad habit of starting something and being all excited about it at first and then, well.....

I must say that ALOT has happened in the past three months. I managed to survive my second term in grad school and again walked away with three A's. I loved the decision making course, it made me really think about how to do a history and the questions to ask and how to put your biases aside to provide proper and thorough care to patients. The nursing theory class, well yuck! I don't enjoy writing papers and that class was nothing but papers! I did enjoy my reproductive physiology course.
The last week of that term I went to Houston, TX to work as part of the disaster relief effort from Hurricane Ike. Yes, I got paid for the stint. If I had the money I would have volunteered my time but I don't. I am a grad student with loans and a family that consists of three children......I have bills, lots of them!
The week I got back from Texas we lost my 23 month old niece. Very long story there, one of which I cannot go in to no matter how badly I want to. Her death was ruled a homicide and the case remains open at this point. The family has had a hard time dealing with this but we will pull through.

So, the third term of school began the first full week of October. I only had two classes this term compared to three classes for the first two terms. I thought this would be a relief to only have to focus on two classes. WRONG!!!!!! This was the worst term I have had in school, any school, EVER!
I took Primary care, which turned out to be a great class. I learned alot and it was by no means easy, but I squeaked by with an A.
I also took Pharmacology. Let's just say, hell on earth! The class was supposed to be a "basic pharmacology" class, to prepare us with basic pharmacology knowledge going into our more advanced midwifery classes. Well, nothing about this class seemed very "basic". I went into this class knowing it would be a challenge and would not be a shining moment for me but, I had no idea. I actually failed the third test in this class, I cried and lamented and lost sleep!!!! Somehow, thanks to the open book quizzes, the alternative med assignment and the extra credit project I managed to barely squeak through with an A, and I mean barely. This had to be the most mind boggling class for me, I just didn't get it. I would study, study and study some more and then take the test and just do horrible....even when I thought I had done well.
I have never been so happy to see a class be finished!

So, this next term I am taking Antepartum, Postpartum/Newborn and a Community assessment class. I have already gotten my Varney's midwifery and have started reading. It's a great book! I already love it! It is such an easy read, almost poetic.

Well, I hope everyone had a Merry Christmas! We sure did! We ate too much, played alot and just enjoyed being with family.

I promise to not go so long without blogging. I think it is a bit therapeutic for me and I should do it more.

Well, in case I don't post again before next Thursday........Happy New Year!!! May you have a prosperous and healthy 2009!!!!!

Help the March of Dimes fight Prematurity!!!!!

Everyone who is concerned about the health of babies needs to be involved in the March of Dimes, they are such a wonderful organization whose only concern is healthy babies.

They have started a campaign called the Petition for Preemies. Join the rest of us fighting for these little ones and sign it!!

Mothers are casting their votes for healthy babies and asking all Americans to join them in signing the March of Dimes 2008 Petition for Preemies. They’re putting public officials – and all Americans – on notice that it’s time to focus on the growing problem of premature birth, the leading cause of newborn death.

Go here to sign the Petition for Preemies
1. We urge the federal government to increase support for prematurity-related research and data collection as recommended by the Institute of Medicine and the Surgeon General’s Conference on the Prevention of Preterm Birth, to:
(a) identify the causes of premature birth;
(b) test strategies for prevention;
(c) improve the care, treatment and outcomes of preterm infants;
(d) and better define and track the problem of premature birth.
2. We urge federal and state policymakers to expand access to health coverage for women of childbearing age and to support smoking cessation programs as part of maternity care.
3. We call on hospitals and health care professionals to voluntarily assess c-sections and inductions that occur prior to 39 weeks gestation to ensure consistency with professional guidelines.
4. We call on businesses to create workplaces that support maternal and infant health. View our 14 recommendations. (workplacecriteria.pdf, 90kb)

A Midwife on a Mission

Ruth Lubic is one amazing woman! I hope I still have this kind of energy and passion at 81 years young.

http://www.cbsnews.com/stories/2008/09/08/eveningnews/main4428250.shtml

Towards the end of the interview the reporter says that Ruth keeps babies out of prenatal care when he means intensive care (NICU).

Abbreviations

Okay, at one time I said I would post a list of abbreviations used in labor and delivery......so here it is and I have included some gyn stuff too.

I'm sure if I have missed anything all my OB friends out there in bloggerland will chime in and add to the list (or make any corrections :)

AB abortion
AP antepartum
MAB - missed abortion
SAB - spontaneous abortion
TAB - therapeutic abortion
EAB - elective abortion
AFP Alpha Fetoprotein
MSAFP - maternal serum alpha-fetoprotein
AMA advanced maternal age
AFI amniotic fluid index
AROM artificial rupture of membranes
BBOW bulging bag of water
BPP biophysical profile
CPD cephalopelvic disproportion
CST contraction stress test
CT chlamydia trachomatous
CVS chorionic villi sampling
D & C dilatation & curettage
D & E dilatation & evacuation
DIC disseminating intravascular coagulopathy
DI/DI dichorionic/diamniotic twins
EDC/EDD estimated date of confinement/estimated date of delivery
EFM electronic fetal monitoring.......cEFM continuous electronic fetal monitoring
EFW estimated fetal weight
EGA estimated gestational age
FAVD forceps assisted vaginal delivery
FHR/FHT fetal heart rate/fetal heart tracing or tone
FLM fetal lung maturity
FSE fetal scalp electrode
FTP failure to progress
GBS group B beta streptococcus
GC gonorrhea
GDM gestational diabetes mellitus
GH gestational hypertension (the most currently correct name for PIH)
GIFT gamete intra-fallopian tube transfer
G_P_ gravida, para (TPAL - term, preterm, abortions, living children)
GTD gestational trophoblastic disease
HCG human chorionic gonadotropin
BHCG - beta human chorionic gonadotropin (usually serum)
UHCG - urinary human chorionic gonadotropin
HELLP hemolysis, elevated liver enzymes, low platelets
HSV herpes simplex virus
IP intrapartum
IUD intrauterine device
IUFD intrauterine fetal death
IUGR intrauterine growth retardation
IUI intrauterine insemination
IUP intrauterine pregnancy
IUPC intrauterine pressure catheter
IVF in vitro fertilization
LDR labor, delivery, recovery (all in one room)
LDRP labor, delivery, recovery, postpartum
LEEP loop electrical excision procedure
LGA large for gestational age
LMP last menstrual period
LOA/LOT/LOP left occiput anterior/left occiput transverse/left occiput posterior
LOF leaking of fluid
LTCS/LVCS low transverse C- section/low vertical C-section
MBU mother/baby unit
MVU Montevideo units
NB newborn
NBN newborn nursery
NICU neonatal intensive care unit
NST non-stress test
NSVD normal spontaneous vaginal delivery
NT nuchal translucency
NTD neural tube defect
OCP oral contraceptive pills
OT occiput transverse
PCOS polycystic ovarian syndrome
PID pelvic inflammatory disease
PIH pregnancy induced hypertension
POC products of conception
POD/PPD post-operative day/postpartum day
PP postpartum
PPH postpartum hemorrhage
PPROM preterm premature rupture of membranes
PROM premature rupture of membranes
PTL preterm labor
PUBS percutaneous umbilical blood sampling
PUPPPS pruritic urticarial papules and plaques of pregnancy
ROA/ROT/ROP right occiput anterior/right occiput transverse/right occiput posterior
ROM rupture of membranes
SGA small for gestational age
SRMC single room maternity care
SROM spontaneous rupture of membranes
STI sexually transmitted transmitted infection
SVE sterile vaginal exam
TOL trial of labor
UC uterine contraction
US ultrasound
VAVD vacuum-assisted vaginal delivery
VBAC vaginal birth after C-section


GYN related abbreviations
AGUS atypical glandular cells of unknown significance
ASCUS atypical squamous cells of unknown significance
BSO bilateral salpingo-oophorectomy
BTL bilateral tubal ligation
CIN cervical intraepithelial neoplasia
EMB endometrial biopsy
ERT estrogen replacement therapy
HGSIL high-grade squamous intraepithelial lesion
HPL human placental lactogen
HPV human papilloma virus
HRT hormone replacement therapy
HSG hysterosalpingogram
LGSIL low grade squamous intraepithelial lesion
TAH total abdominal hysterectomy
TOA tubo-ovarian abscess
TVH total vaginal hysterectomy VAIN vaginal intraepithelial neoplasia
VIN vulvar intraepithelial neoplasia

Tired and unmotivated............

I want to be done with midwifery school......NOW! Sorry for the shouting, just feeling unmotivated and just plain over it right now.
I am stuck. I have been working on a theory paper for a week now and haven't made squat for progress. I am over this paper and over this class! Because I have been so hung up on this stupid paper I haven't done my reading for my other two classes in a week. I think if I can just get this paper out of the way the rest of this class will roll pretty well and I can get the other two classes back in gear.
I am on week 7 of this term, so just five more left before the next term starts. I am in a good place with the reproductive A&P class, just two more tests left to take. The health assessment class is interesting so I can really get caught up on it this weekend pretty easily. Just finding the motivation to pound out the theory paper is my real issue right now.

I am also feeling a bit weepy today....worked last night and didn't make it home in time to see my oldest before he left for his first day of middle school :(
He is attending a local private school that is very big on personal responsibility and independence. I am used to dropping him off at school at 0845 and picking him up at 1530, at a school that is 3 minutes from my house. I used to eat lunch with him at least one day a week.
Now, he gets dropped of by his dad at 0730 and remains at school until his dad picks him up at 1720. He has cross country practice after school, so he is not just "hanging out" until his dad get there, he actually only has 20 minutes from the time cross country ends until his dad gets there. This school is also 30 minutes from my house and the campus is HUGE (like >600 acres huge), so I don't foresee the weekly lunches anymore (esp. not with gas prices the way they are). The school he attends is also a boarding school so there are always students, faculty and many other adults around.....it is a very busy campus.
I can't wait until he gets home today......I want to hear all about his day. I know he's totally loving it! He has been excited for school to start ever since he got his acceptance letter, way back in March!

I am going to go take a quick nap, throw some tacos together for supper and then take the middle child to football practice.

Tonight I am going to work really hard on that paper.......maybe if I type it here I can hold myself to it :)

Not 1, not 2, always 3!

I worked at the big house again last night. Since I've been back I've only worked L&D one shift, all the others I have been down on the HRPU (pronounced harpu) the High-Risk Ante-Partum Unit. I do like the HRPU, usually have about 3-4 patients depending on acuity and once you get everyone their meds and tucked into bed the nights tend to be quiet. Just an FYI, never say the Q word (quiet) on a L&D unit, it is sure to get you many dirty looks.....nurses are a superstitious bunch!
Monday night they put me on L&D, and initially I had two patients. One patient had just delivered so all I needed to do was get her recovered and moved over to mother/baby unit. The other patient was a 27+ weeker who had limited prenatal care and had arrived an hour earlier with her water broke. Well, I ended up having to pass off the fresh delivery because the pre-termer didn't even have an IV going yet.
I got her IV going and gave her; fluids, stadol, antibiotics, steroids (for fetal lung development) and magnesium sulfate (tocolytic, help calm the uterus down so it will quit contracting). Unfortunately, despite our best efforts she delivered shortly after midnight by repeat c/s (baby was breech).....under general anesthesia, because she could/would not sit still for regional block.

We had two other 27 weekers come in and deliver on us that night as well, despite us doing all we could to keep those kiddos in!

Just another example of something every labor nurse knows......bad karma always comes in three's!

It was.......a good night

So last night I worked at the big house.
I came in and picked up a patient who had arrived the evening before for decreased fetal movement. She is being cared for by a CNM I work with frequently at the LDRP hospital.
The baby is reactive but measuring small so the midwife decides to go ahead and induce the next morning. Through the night the mom was having sporadic contractions and occasionally the baby would have a spontaneous deceleration in the heart rate but would recover and look fine. So, they attempted pitocin augmentation. They got the pit started and within fifteen minutes the baby had a seven minute deceleration, so off the pit goes. The mom continued to contract and by about 1:30 yesterday afternoon had made it to three centimeters so the CNM breaks her water and they place internal monitors on baby and the uterus. The continued all day with the spontaneous decelerations lasting anywhere from 3-8 minutes, but in between the baby was beautifully reactive. At 6:15pm the CNM checks mom and she had not changed her cervix so they decide to call in the doc and proceed with c/section since the baby won't tolerate pitocin. The doc is hung up at the LDRP hospital doing a c/section and this one wasn't emergent so we were just going to hang out until he could arrive.
Here's where I come in. Got report and headed in to assess the patient and make sure we were all on the same page and things were in-line to head to the OR once the doc arrives. I am in the room assessing the patient and chatting with the family and having a good time when the baby decides to have another deceleration, down into the 60's......so flip the mommy to her far left side, place O2 by facemask, increase IV fluids.....baby still down but coming up slowly.....vaginal check......9.5cm, just an anterior lip. The CNM comes in (she had been in the lounge on the phone with the doc), baby recovers nicely and we start pushing. Baby handles pushing wondefully and and hour and 20 minutes later we have a girl!!! Oh, I just love it when those kinds of things happen. Baby had a nuchal cord, not tight, but short! BTW, for all you L&D RN's......she had IUPC and MVU's were NEVER adequate......not once!!!!! Women's bodies are simply amazing.
So, I got her recovered and sent to postpartum and was able to sit down and have a nice relaxing dinner and then picked up a triage that had come in with her water broke.
This couple was absolutely wonderful. The mom was undecided on whether or not to go natural so I told her we would just play it by ear...We spent the night walking the halls, sitting on the birth ball and by 0330 she was 3cm and baby had moved down to 0 station (when she came in @MN she was 1cm and baby was high at -3). She spent some time in the shower, which she LOVED! and just did amazingly well. I really spent 95% of my time in that room providing labor support and just enjoying this couple, they were soooo great. At 0700 this am, I did not want to go home.....I wanted to stay with this couple and support them...I wanted to see their sweet little girl be born......I felt like she was really in a groove and I didn't want that disturbed by a new, strange face coming into the room. I feel like it is such an honor and privilege to be allowed to form such an intimate bond with someone and to witness their transformation into parenthood. I just didn't want to leave them......I feel like continuity in care is sooooo important and makes women feel secure and relaxed.
Situations like this keep me motivated to continue with my school work and become a nurse-midwife. If I had been her midwife I could have provided all that support and then stay with her and provide that continuity of care that I feel every woman deserves.

Now, I am off for a week! Woo! Hoo! Headed to camp with the church youth group. My oldest is now old enough to be part of the youth group and attend camp. Me, being the protective mother I am.....totally not ready for my kid to be so independent of me! I am going along as a camp cook. He will do his thing while we are there and I will be hanging out in the kitchen, so I am not going to be hovering or bugging him :) I just wanted to be available.....you know, in case he needed a hug from mommy or something. He hasn't ever spent more than a night or two away from home and this is for a whole week, so I wanted to be a little closer than 2.5 hrs away........just in case :)

Groan.........

Here's another one for the "what the h***" archives.
First pregnancy, twins.....both are vertex
Scheduled for primary c-section at 38 weeks.

Choices....or the illusion thereof

Worked last night at the single room maternity care hospital. Not too bad a night except that I started the night in the O.R. and ended the night in the O.R. The O.R. is my least favorite place to be and I always end up there when I'm having a good hair night!!! Never fails.....I even told myself driving to work last night to be prepared to hit the O.R. first thing cause the hair was looking pretty darn good.......and sure enough!!!

The first c/s was distressing for the poor mom because she had been admitted for elective induction on Sunday evening...had cervidil all night, pit started early Monday morning, doc broke her water shortly after pit started.....made it to 5cm by 6pm last evening just to discover the babe was breech!
Now, the nurse that cared for this patient said she thinks the baby must've turned during labor, she only checked her once, about noonish, and is confident it was head she was feeling. This nurse is a good one too and it definitely wouldn't be the first time a baby has flipped during labor.
This patient was being electively induced (doc is on vacation next week) at 38 wks and the babe was barely over 6#. But everyone did well and that baby is sooo cute!!

The midpart of the night was pretty uneventful and then 4am hit! 4am seems to be the witching hour in labor and delivery. That's when it all hits the fan.
We were schedule to have two inductions arrive at 5am and the am scheduled c/s was to be there at 5am also. Well, at 0430 we had a patient, who was scheduled for a c/s later in the week, show up because her water was broke. She had a c/s scheduled because the baby was breech (she wasn't happy...3rd baby, other two were vag deliveries) and much to her excitement when she arrived we scanned her and the baby had turned head down!! So, she was admitted as a labor patient
Not ten minutes after we got her in a room another patient comes in thinking her water broke and has been contracting, so we used some nitrazine and confirmed the leaking of amniotic fluid so I told her she is definitely staying and having a baby today.
I told her I was going to call the doctor and let them know she was here so they could head in and we would get her ready for her repeat c/s unless she was planning to VBAC. This is when she perks up and says she had originally wanted to VBAC but that her doctor didn't think she could birth vaginally because with her first child she never made it past 6cm. After some probing I found out she was electively induced at 39 weeks and after 14 hrs of pit they did a c/s. I explained to her that it was her choice what she wanted to do and she could discuss it further with her doctor but that her body didn't fail her the first time around, the induction did.
So, since she was contracting I checked her cervix and to her surprise found that she was almost 3cm, 80% effaced and the baby was -1 station. Granted, I am no physician but I have had my hand in lots of pelvis' and this girl seemed to have adequate room and her pelvis felt totally normal. I reminded her that she was weeks earlier with this baby and so it would probably be smaller (first was just over 7#!). So, she asked me to ask her doc if she could attempt a TOL when I called him.
I honestly thought this doc wouldn't mind letting her VBAC, he is one of the only ones in this town that is open to it and tends to be so laid back!! So I expressed to him her wishes and let him know she was dilated, contracting every five minutes, baby was well applied and things were looking great. No......not happening, doesn't think her pelvis is adequate.....prep her for c/s, he is on his way. What the h***!!!!!!!!!!!! This girl is 5ft 8inches, not overweight and about to have a baby that ended up being 6# even.......and her pelvis isn't adequate?!
Found out later that this gal has a family member who is an OB in a much larger city with an even higher c/s rate than ours.........think that had anything to do with it, hmmm!

So gals, in my city I have found that if you or anyone you are related to are in the fields of medicine or of law.....you will have a c/s. It's just getting worse, seeing women talked into primary c/s or talked out of VBAC and then finding out her brother is an MD or her aunt is a lawyer.....never fails.

Man, I get wordy!!! Can you tell I talk alot.....need to learn to be more concise!!!!

Well, I think it is time for a nap.....didn't sleep too well when I got home this morning and now I am starting to feel yucky!

Whew.......I survived!

First term........done! I believe I pulled all three A's. Still waiting on grades for two of the classes but I would have to done REALLY bad on the last assignment for each to not receive an A!

Feeling quite proud of myself right about now. I managed to; go to school full-time, work part-time, have three boys playing baseball (two of them play for travel teams-translation; practice or games 6 days a week!), sit on the all-volunteer board for the local youth athletic association (more work than I EVER imagined), and get straight A's. My husband is feeling a bit slighted but totally gets it now that he has seen all the time and work I put into school......just keep reminding him it will all be worth it in the end.

Term recap: Three classes. The Role of Nurse-Midwifery class consisted of two large papers, an oral presentation and a weekend workshop.
Pathophysiology consisted of a short paper and five exams.
Health promotion consisted of ALOT of reading!!!! This class had a 3-5 page essay, a forum assignment, a research assignment, a group project and a really large (15-20page) health management plan.
The big thing that is going to take alot of adjustment is moving from the role of carrying out health care provider orders to thinking like a primary care provider.
One thing about all of these courses: the reading is intense. There is soooooooo much of it, for all the classes!
Very glad that term is over and done with.

Looking forward: Three classes again. Reproductive Anatomy and Physiology.....looks like a fun class. I am looking forward to this one. I know it won't be easy but should hold my interest.
Decision Making in Health Assessment.....learning to think like a primary health care provider. Learning to use critical thinking skills and diagnostic reasoning skills. I should learn alot here!
Theories and Concepts in Primary Care......confession time; I'm not to enthusiastic about this class. Never really liked theory much at all. This will be the class I have a hard time being motivated to work on!

So that is school, as of right now, in a nut-shell.

Just ordered my books....almost $400!!!!!!!!!!!!!!!!!!!! I got lucky last term and only had to buy one book and managed to get it from a student ahead of me for less than half the original price. Well, my good fortune has run out because she got rid of all the books for these classes. I don't mind buying the books for the repro and health assess classes because I intend to keep those but didn't want to fork out the bucks for the theory books. Oh well, maybe I can sell them to someone next term.

Well, next week I am working three days to try and make some $$ before the next term starts. I plan on cutting down to one day a week until I see how these classes are going to play out. I can usually pick up extra shifts but don't want to get overwhelmed by signing up for too many shifts and then get behind in school or be so stressed I take it out on my family.

Now, I think the kids and I will head to a movie since it's cloudy and overcast. Maybe we can get some time in at the pool this week!

Back to where I started.....

Well, I keep getting low census at work so I called the big house (the large tertiary care center with high-risk L&D, where I started out as a nurse) and they are short staffed on night shifts so I am picking up about one shift a week with them. I have worked two nights so far and am loving being back. There are only three nurses left on night shift from 31/2 years ago when I worked there but the night crew is alot of fun. Most of the gals I used to work with have moved on to dayshift, or gone elsewhere. The night shift is a young crew but very nice and welcoming. I am glad I made the decision to "come home".

Frankly, I love working in the single-room maternity care setting and having the normal laboring patients but there is just something about those high-risk patients that keeps you on your toes and makes you keep your critical thinking skills sharp!

I have four patients tonight al l with different problems and levels of acuity. I have done alot of tear wiping and just plain listening tonight. I forgot how intense emotionally some of this can be. I like to bond with my patients and provide them some emotional support as well as nursing care during this time. I hope to make a difference in their experience and help them be as comforted as possible during such a difficult time.

School only has three weeks left and I still have lots to do. Currently in the middle of two large papers and still have two test to finish in patho. That would be the reason I don't blog much these days...wish I had more time to read others blogs and update more often on mine.
I will do a term recap at the end of this month and update everyone on how the term went and how I did.

Well, time to go put all my gals on NST's (non-stress test) and draw labs.

5 a day....fruits and veggies!

Catching up on some blog reading here and found this neat little post by babymidwyfe. I think it is interesting how foods effect certain parts of the body. This post gives a visual link to foods and body parts....I enjoyed it!

Affirmations from Kneelingwoman

You absolutely must read this post!!!!!!!!!!!!!!!!!!!!!!

But first, take a moment to open your heart and your mind and really listen to what she is saying. This woman puts so very eloquently into words the truth of how so many women are made to feel because of how they choose to parent/birth/breastfeed/bottlefeed/live/love and the list goes on...............

I really love the following from this post:

In the beginning, there was woman.

Before a woman is a mother; she is a woman.

Before a woman is a mother, she is someone's partner and lover.

A woman is more than her mothering; more than her birth and parenting choices.

A woman should be a free agent; encouraged and empowered by her sisters to make her own best choices in all areas.

A woman who gives birth is a mother; regardless of how.

A woman who feeds her child is a good mother; regardless of how.

A woman who takes care of her primary relationship is a good mother because the relationship between the parents' is the foundation for that child's life. Without the example of loving partnership set by the parents; the child has no ability to create or sustain relationships in his own life.

A woman who is honest about her needs and who knows how to get those needs met; is a good mother. A woman who knows her limits, chooses freely, each day, what is needed for that days life, sets an example of flexibility, openness to new ideas and creativity.

Now that you have had a small teaser.....go read the post in its entirety for yourself and ponder the things she says and really take them to heart.

Busy weekend!

Sorry, I've been a slacker. Not much posting lately.....school is very busy!

I just came home from a How to Start a Birth Center workshop over the weekend. I have mixed feelings about attending this workshop. First off, it was GREAT to be with fellow FSMFN students (this workshop is required for NM 601) and to be able to get to know some of those in classes ahead of me.
Secondly, the workshop was very overwhelming, especially for those of us just starting the program. I don't really think this should be required in the first year of school, perhaps requiring students to take it within the 6 months prior to clinical bound, it would be less overwhelming and feel more pertinent to what they are learning and doing at this point in the program.
I did enjoy getting to tour the two birth centers we visited and talking to the midwives that work at those centers. The CNM's for both of these centers practice at their birth center as well as the local hospitals. One of the centers has been in operation for the last 25 years and serves a very rural area, delivering about 120 babies a year. The midwives in this center also deliver about 70 babies per year in the local hospital. The other center has been operating for 17years and also does about 120 deliveries per year in the center. The CNM's in this center also deliver about 165 babies per year in the local hospital, this center is in a very urban area.
It was very eye-opening to see the struggles that birth centers go through to just keep themselves afloat financially. And how difficult it is to stay open with birth being as political as it is. All it takes is a doctor who decides to not back the center anymore to close it down. These two centers have stayed open very successfully and for such a long time because the community is behind them and they have such a good track record the medical community sees the good they do for the people they serve.
I really like this quote by Ruth Lubic, "Remember, the people you serve are your strength"
Another quote I came away from this workshop with really sums up the way I feel about attending births as a midwife, "Imagine you are a midwife. You're assisting at someone else's birth. Do good without show or fuss. Facilitate what is happening rather than what you think ought to happen. When the baby is born, the mothers will rightly say "we did it ourselves"."-Lao Tzu, 5th Century BC

Anyhow, those are just some quick random thoughts about this weekend. I have a big paper due this week and a test. I think next weekend I will pull all this birth center stuff back out, go over it and really try and process my thoughts about the workshop more objectively (right now I am just plain tired!) and do a little soul searching about my own desire to open a birth center. I have always wanted to do as these two centers do and provide women with the option of delivering in the birth center or hospital. I don't think women should be forced to choose a certain type of health care provider based on where they want to give birth, but I'll get into that more at a later time.

Off to snuggle with my Lover and drift off to sleep in his arms

What's up?

What is going on? Where have House of Harris and Minority Midwifery Student gone? Why have you ladies decided to make your blogs private?

I have enjoyed both of those blogs so much and am very saddened by this. I hope it wasn't due to any flack you were getting from others. I just hate that some people who blog their opinions get attacked by others.
Opinions are like arses, everyone has one!
So, why must some people think that it is their duty to attack those who are willing to put themselves out there and voice those opinions. Everyone is entitled to say what they want to say and if you don't like it, go elsewhere! It's their blog! Go get your own blog and voice your opinions there (without the personal attacks please, that is just tacky!)

I am just annoyed today, sorry for the rant

Beautiful Cervix

I love this site, it's a photo journal of a 25 y/o midwifery student who has never given birth. Great for those who are very 'visual' learners. http://mybeautifulcervix.googlepages.com/

First week of school

Wow, the reading in this program is huge!! I knew there would be alot but I think I spent the first three days this week feeling very overwhelmed and like...what on earth have I gotten myself into.
The one sunny spot in the week was some reading for the health promotion class. We had to choose a book from a list we were given and read for pleasure...what a relief. Now, it was for pleasure but had to be read critically because we have to write an essay regarding our cultural awareness and how it has evolved..changed...been more enlightened or whatever based on our readings. I chose the book I Know Why the Caged Bird Sings by Maya Angelou. It was a very easy read...so much that once I picked it up I couldn't put it down and finished it in one day. I recommend it, if you have not read it already. I think I may find another book or two from her to read....when I get some free time.
I am finishing up a one page paper for patho on Systemic Lupus Erythematosus (SLE) and then will prepare to take my first exam next week.
I have some more required reading to do for health promo before I can do the essay but should turn that in next week.
I have barely skimmed the reading for the role class (the role of midwifery and birth centers in America) but need to get on it and start making notecards for my first paper, due in three weeks on the historical development of midwifery. That should be very enlightening.

Work this week was busy. We did have a wonderful natural delivery of a first time mom who birthed a 10# 1oz baby after only actively pushing 4 times. What a woman!!!!!!
Otherwise, it was induction city. Why, oh why can't we just let women go into labor on their own. I'm beginning to hate working Sunday night thru Wednesday night because all we do is admit 7-9 inductions each night, not to mention the ones that actually do come in already in labor or the four that are still laboring when we come onto the shift so we have to get them delivered, recovered and passed off to the postpartum so that we can get the inductions in and started on time (in order to avoid the wrath of certain physicians). Those kind of nights go by quickly but give me no opportunity whatsoever to develop a real rapport with my patients, and that is very disconcerting to me.

Just two more years....just two more years.....it will be sooooo worth the hard work!!!

You too can have a vaginal delivery.

Unintended vaginal deliveries......that seems to be the theme for this week.
We had a patient scheduled for repeat c/s on Tues morning who came in saying she had not slept all night d/t an upset stomach and constipation (this pt is also an MD). The patient kept insisting she really needed to go to the bathroom, she said she just felt sooo bloated and constipated. The monitor showed she was contracting q3 minutes and they were palpating strong, but she kept denying even feeling them. She had only been there about 20 minutes and had refused a vag exam because she didn't think she was in labor. Finally the nurse absolutely insisted on a vag exam to evaluate and let her MD know what was happening. Well, turns out the gal is complete and +2 with a BBOW. She ends up with a precipitous VBAC (RN caught baby) and mom and baby are both doing great.

We had a G1P0 come in on Thursday morning for a scheduled primary elective c/s for suspected macrosomia. Turns out she had SROM a few hours prior to her arrival and since she was already contracting regularly decided that she wanted to attempt to labor and deliver vaginally. She did wonderfully, got an epidural @6cm and once she was complete labored down for about an hour then pushed for 35 minutes to deliver a very robust 9#7oz bundle of joy. Her labor was a total of 12 hours from the time her water broke and she started contracting. Not bad for a primip!
Guess they got the macrosomia right......too bad there isn't a little more trust in the body's ability to birth the baby that it grows.

We have had a surprising number of vaginal deliveries this week compared to what we usually have when the census is as high as it has been. Hmmm, maybe I need to check our stats for this week. The less time I spend in the OR the happier I am!

Who's your daddy.....

Okay, here's a new one on me.

Gal comes in to have a baby, which she is giving up for adoption (the baby is going to a couple that are somehow distantly related to her). Her husband is with her, only two weeks ago he had kicked her out of his house but is letting her stay with him now. This man is so eager to sign away his rights, his lawyer comes to the hospital within hours of the baby's birth. Except, he wants a DNA test.

Why the DNA test? The gal says it is because they were at a party one night with some friends, got really drunk and passed out. Only, she woke up later with her panties around her ankles and her husband still passed out. She says that a friend of theirs at the party raped her.
Okay, makes sense but then who shows up at the hospital.........the supposed rapist. Demanding a DNA test as well.

Okay, if he's a rapist why is he walking around town and not in a jail cell? And why is he demanding a DNA test? Because according to him they had consentual sex and if that's his baby, he wants it.

The poor adoptive couple, they just want to take the baby and go home.
For this baby's sake I hope it belongs to the husband.

Glad that full moon is gone!!!

Hurting

There are some things I don't think I will ever understand.......but am trying my darndest to be sympathetic to.

We had a gal come in for induction the other night. She was single, young (late teens) and having her first baby. Prior to her arrival her sister and cousin showed up to warn us that she was on her way and that the FOB knows she is coming in and may show up later. This is an issue because there is a history of domestic violence. This man, or rather boy (19), had physically beaten this girl on four separate occasions and the last had just been a couple of weeks ago in which he wailed on her for over two hours and left her in pretty bad shape.
Being in charge that night I did not want any drama so I got a description and called to security to give them a heads up and to stay visible and within shouting distance.
The preggo mama arrived with her mother and a friend. We got her settled into her room and had a nice long chat with her about the situation she was in (after making all the others leave the room) and how she was feeling at this time. She was very concerned for the FOB (huh?!) because now that she lived with her parents and they wouldn't let him anywhere near their house that this would be the only opportunity he would get to care for his child. She wanted him to be at the delivery but none of her family or friends did and they made that very apparent (can't say I blame them).
The patient told us that the FOB was just recently (after this last beating) diagnosed with IED, or Intermittent Explosive Disorder and had just been placed on meds to help with his disease.
We told the patient when said FOB arrived that she was not to be in the room alone with him for even a second at any time, for any reason and she agreed with us that would be best.
Well, the FOB did arrive a few hours later, only he was feeling upset because the patient's family members were staring at him and refused to leave the room with him in there. I was just in shock, this guy sat by her bed and held her hand and she just hung all over him! The patient asked us to come up with a solution because her mother and sister refused to leave the room with him there and he was upset because they were just glaring at him the whole time he was in the room and making him feel uncomfortable. So, we ended up devising a schedule for him to be in the room and her cousin to stay in the room with them while her mother and sisters stayed in the waiting area and then they would switch so the mother and sisters could be with the patient and the FOB and cousin would sit in the waiting room.
I still am totally flabbergasted how this girl, having a baby, was only concerned with the FOB not being treated bad or made to feel bad by her family.
When I left the next morning she was in active labor and had just gotten an epidural. I made sure there was a request for social services consult placed in this girls chart.
I feel for her, and try as I might I don't understand her being overly concerned for this guy. She should be concerned for her own safety, as well as the safety of the child she is about to bring into this world. She had been given an opportunity by her parents (whom she and the baby will go home with) to get on her feet and to make a life for herself and her little girl. I just hope she takes it and doesn't go back to this guy.

This most definitely isn't the first domestic violence situation I have run into but it is the one that has affected me the most and one I don't think I will ever forget.

I have been married for 14 years to one incredible guy, who isn't perfect (although he thinks he is) but neither am I. But I can say with 100% certainty that the first time he hits me will be the last.

Time to.......focus

The mother-in-law came home on Friday and is recovering well. She should get completely back to normal but it will take a while. She is still very slow to respond when you talk with her but that is really the only deficit that she is suffering from.

The weather this weekend was so nice, in the upper 60's-lower 70's until Sunday then it was lower 60's and very blustery. This morning, 30 and SNOWING! The weather around here is so wacky, it's supposed to be in the 70's again by Wed.

I have access to all of my classes (class officially starts April 7) and boy do I have alot of reading to do. I am taking Pathophysiology, Health Promotion and Disease Prevention and The Role of Midwifery and Birth Centers in America.
After looking at the syllabus, Patho is the only class I have tests in, but there are five of them and then one graded assignment.
Health promo has five assignments to complete as well as a health managment plan (that is the big paper for this class).
The Role class has two large papers, a journal assignment and I have to attend a birth center workshop. So, I guess I will be doing alot of writing this term....better get out the ol' APA manual!
I should be studying right now but instead I am perusing blogs and surfing the net. Not a good way to start out the term :) Bad habits are hard to break.

I haven't worked in a week and it has been so nice, but I am back tonight and then off again until next Monday. I really like this one-night-a-week thing, but that won't last long. I'll be back to two nights soon.

Since it is cold outside today, I think we'll be having some soup for supper tonight. Potato soup sounds good and hearty, so off I go to throw some taters in the oven.

To recertify or not recertify......that is the question.

I am trying to decide whether or not to renew my Lamaze certification. It is due in June and right now I am VERY short the required number of CEU's.
Unfortunately, all of the CEU's that I have for my nursing license will not qualify for Lamaze. Over the past couple of years I have take a two AWHONN fetal monitoring courses, STABLES, AWHONN local conferences, all my recerts for ACLS and NRP, and the monthly lunch and learns and mini-conferences put on by the hospital (none of which are normal birth related) that I don't have the resources, time and energy to find normal birth stuff to do.
If I could just pay a fee to recert, I would. It's the CEU's that are killing me, in this area anything normal birth related is pretty much impossible to find, except for the classes I teach.

Unfortunately, I am the only Lamaze certified educator still actively teaching in my city, and I only teach at one facility one night per week. So, I feel that pressure to recert to be able to provide those classes to women who want them. There are a couple of other teachers who will fill in for me if I need but no longer want to teach their own classes. Sadly, there is a certain hostility towards Lamaze by some docs in certain positions in this area. And these docs have made it so difficult to teach they have basically run all of the other teachers off. Therefore, I have had zero luck in convincing anyone I work with or know to look at becoming a Lamaze instructor.
Really, I am feeling pressure both ways. All of my students encourage me to keep teaching and refer others to my classes and I feel the pressure to provide this service to the community. On the other hand, I only teach one night per week because of work, graduate school and I still have young kids and don't want to miss out on their activities. Unfortunately, I see myself teaching less and less the farther I get along in school. Then, when I go into practice I don't see myself wanting to teach classes in the evening after I have been in the office all day.

I think I may recert this year since it is good for three years and re-evaluate once I am out of school and the recert time comes up again. The problem now is finding the CEU's!!!!!! Any suggestions?

Spring break.....and more!

It is spring break, and oh how I love my kids but.......they are driving me crazy!
Until today the weather has not been very cooperative for going outside and doing so we're getting a bit stir crazy.
We went to the mall yesterday and to Sears for a new washer since mine decided to die on Tues. night. The new one is soooo much bigger than the old one, it should really cut down the time I spend washing clothes.

I am gearing up to start my classes on Monday. I am excited to get started but very anxious about the work load. I know that I can handle doing full-time school and working part-time but I have such a tendency to procrastinate. I am really trying to psyche myself out by telling myself how much I am going to learn and trying to get excited about the knowledge I will have and how my skills are going to really expand. But honestly, I am tired of going to school and I just want it to be over with. If I can just get through the next two years and know that time will pass very quickly.

I get very frustrated when people (esp. family) call you about something medical and then basically ignore everything you just said and do it their own way. Case in point: My mother-in-law is showing symptoms of a mild stroke that probably happened on Monday evening although no-one who had contact with her on Monday evening and Tuesday put the symptoms together and realized it until Wed. morning. When I was called and asked what I thought it was I told them it sounded like a TIA and to get her to the hospital ASAP.
My in-laws live in a very rural area and the only hospital is a satellite facility off of our large tertiary care center. Anyway, I told them to take her straight down to the large hospital (40min away) and to skip the satellite facility, there wasn't much they could do for her there except IV, labs and get her transferred (which would take FOREVER). I knew that the large hospital was on divert and would not take transfers but if she came in through the ED she would get cared for (the large hospital also has the only local accredited stroke center and has some incredible neurologist on staff).
Did they listen? Of course not, they stopped at the satellite facility instead of driving 40min more to the large hospital. Needless to say, they didn't do much except IV, labs and paperwork to get her transferred (this all took a total of 5hrs before she was transferred). And of course the large hospital was on divert so they took her to another local hospital, who took another 3 hrs to get her into a room.
My poor father-in-law is soooo frustrated at how slow everything has been at this facility that she is at. They ran an MRI on her first thing this morning but said they won't read it until tomorrow. What the..........?!!!!! And she has yet to be seen by a neurologist.
I am trying to just be sympathetic and help them understand the medical lingo and tests and such when I just want to scream, WHY DIDN'T YOU LISTEN TO ME IN THE FIRST PLACE!!!
Please, don't call me for advice and then don't even bother to take it. No, I'm not right 100% of the time, but dang it 99% is pretty freakin good! :)

Now, off to Hobby Lobby after some lunch. Gotta get the munchkins outta the house before I pull my hair out, or lock myself in a closet!

Spring is in the air

Oh I really have spring fever! The weather today was glorious!!!! Sunny and 70 degrees, just the way I like it. I hope we have seen the last of winter and this trend continues. My boys are playing in a baseball tournament this weekend and it looks like the weather is going to be perfect for baseball, not to hot and not to cold.

We had such a nice shift at work last night. Came in to only postpartum patients, discharged two couplets and then admitted four inductions, one c/s scheduled for this early am and then one triage who came in with SROM. So, overall it was a pretty laid back evening. I got to spend some time chatting with the gals and cuddling babies in the nursery. Those nights are so welcome when we have them because they are so few and far between.

I am taking three classes this first term that starts in April and have just been able to get online and access the syllabus for each course. I have my books and am currently working on de-cluttering my office and getting it set up and ready. Hopefully this weekend I will have it all cleaned out and set up so that I can get a jump start on my reading assignments while I am excited and motivated.

Frontier has really taken into consideration the isolation that is so common to online learning and that can be very detrimental to the learner. During orientation we were divided by specialty and then subdivided according to geographical location so that you could really get to know people that are close enough to you to perhaps actually get together outside of Hyden. My group is already planning to meet up for a weekend in May and because there are three of us in my group that are full-time and all taking the same classes we are setting up chat times and study groups. I honestly think that is going to be the greatest help in keeping me motivated and moving through this program at a pace that I am comfortable with and will get me to my destination in the amount of time I desire. Again, more kudos for Frontier and really having it all together!

Catching up

My blog has been totally neglected the past few weeks..sorry.

I had the best time at my graduate school orientation. I spent the week meeting new people, making new friends and learning about this journey I am embarking on. It was so overwhelming at times but I really felt confirmed during that week that I am on the right path and that midwifery is truly my calling.
I have to say that the Frontier School of Midwifery and Family Nursing has it all together!! It is an incredible program, operated by incredible women, and I am very excited and proud to be a part of that school and will be a part of its rich history.
Of course, by the end of the week I was incredibly homesick and really missing my boys. Baseball season is about to be in full swing and with all three of the boys playing ball it is going to be one busy spring! I love to watch my boys play ball, because they love it so much and they are good little ball players.

I worked two shifts last week and taught an all-day Lamaze class on Saturday. I was in charge on Tuesday night and triage was hopping. It seemed everyone kept coming in with SROM, so most of them were keepers. We did have one girl who came in not in labor and not ruptured. She had called her physicians answering service and told them she was having pressure so they sent her to triage. We got her gowned and on the fetal monitor and began asking her history. It turns out she was not having contractions, nor was her water broke so definitely not in labor. She had been to the doctor a few days before and her physician had done a vaginal exam and told her that the baby had 'moved down' and was 'much lower' than at her last check. Evidently, after this visit she told either a friend or family member what the physician had said and this well-meaning person told her she needed to go to the hospital because she could--"suffocate her baby if it stayed that low for to long" Needless to say, there was a lot of education going on before discharging this gal to home.
My last Lamaze series class had five couples in it. One of the couples gave birth after the second week of class so that left us with four. One couple had a scheduled primary c/s for macrosomia at 38+5 weeks because mom was gestational diabetic, I wasn't really surprised knowing how persuasive this particular physician can be but I really did think they would at least attempt an induction first. Anyway, the baby was 8#2oz--not really macrosomic in my book.
Another couple gave birth with epidural anesthesia but had a great experience, baby was 8#14oz. The interesting thing about this couple is the mom said they were going to try again in two years and she said she would call me when she got pregnant because she thinks she would like to really try and go natural next time. That is really neat because she never had any intention of even attempting a natural delivery this time.
The last two couples to birth both had spontaneous, natural labor and birth experiences. Both of these moms called me afterwards to tell me their birth stories. They both were so overjoyed at their experiences and the fact that they were able to go into labor on their own and work through the process of childbirth without any drugs. Just to hear the pride and joy in their voices when they expressed how glad they are they gave their babies the best start possible. One of the moms expressed how incredible it was to feel the baby come out of her body and how she is so glad she did not dull that experience with numbing medication. Those types of stories keep me teaching! BTW, one of those babies weighed 7#12oz and the other was 8#14oz!

It's a busy week coming up. I am scheduled to work; Tues, Thur and Sat. night. and my boys have a ball tournament next weekend so I'll be busy working the concession stands in between watching their games.

Classes for school do not officially start until the first week in April but I should have access to the readings and assignments week after next so that I can hopefully get a head start on things. Fortunately I have a friend who is just ahead of me in the program and I am getting my books for these first classes from her on Tuesday, that will help save a few bucks.

Be sure and check out some of the blogs on my blogroll, there are some very interesting conversations happening surrounding midwifery. Unfortunately, I just don't have the brain cells these days to get into all of that. I do have very strong opinions about the topics that are popping up, but right now I am just going to prepare my mind for some higher learning and focus on being a good student, sumptuous wife, and rockin' mom.

Hi Ho! Hi Ho! It's off to school I go...

Darn it!!! I can't sleep! Partly anxiety, partly excitement. You see, tomorrow morning (well, today now) I leave for my midwifery school orientation. I am so excited to finally be getting started! But, I am soooo anxious. There are 50 people in my class (only 19 of them are MW students, the rest are NP and WHNP students) and I don't know any of them.
So, I am going to a strange place (5 hours north of my home) to spend four days with a bunch of strangers. And after looking at the weather channel it's going to be cold, and you know how much I dislike being cold!!! It looks like we may get a little snow while we are there, I kind of hope so. If it's going to be cold anyway, it might as well snow.
I will try and update this week if I get a chance, otherwise it will be the weekend.
Keep me in your prayers!
Oh, pray for my husband and boys this week too. It will be the first time I have been away and left daddy in charge for this amount of time!!!

Random rambling

I really dislike cold weather...and today, it's cold. I know some of you nor'easterners will be like 'what the..' This girl is wacko, 42 degress is not cold. Well, for me it is. I am as far north as I ever have any intention of going and would really like to be a bit farther south!

We spent the long President's day weekend in Myrtle Beach and I must say what a great weekend it was! My two oldest ran the Myrtle Beach 5k on Friday night and my husband did the Myrtle Beach marathon on Saturday morning. I have to say, my husband has run marathons all over the country and this one is, hands down, his favorite. And as a spectator I have to say it is very easy to navigate and be able to see your runners at different spots. This was our fourth year going to MB for this run and we plan on doing it every year.

The picture is my husband and my three boys--ages 11, 9 & 3.5 on the beach

I worked on Tuesday night and it was chaos. We walked in to a very busy unit, but do-able. Then, the triages just kept pouring in. I think we ended up admitting ten patients that night and delivering two of them---leaving 8 in labor for dayshift to contend with. I came in to a c/s in the OR, so I got her recovered then passed off to pick up a 10pm cervidil induction and a midnight pit induction. So I stayed busy myself with my patients and trying to help out where I could. By the time I left on Wed. morning ALL 23 LDRP rooms were full, all 3 triage rooms had laboring pt's in them and we were triaging a gal in the PACU (post-anesthesia care unit)--of all places. All of our mother/baby nurses had four couplets and all the labor gals had two apiece.

I had wanted to call work and check up on them last night but was just too tired and went to bed about 7pm. They only had 6 pt's going home yesterday, which would have gotten all the pt's out of triage and into rooms but still had a noon c/s to come in, and there is always one or two sent over from offices during the day so it will be interesting to see how they handled the 6 scheduled procedures that were supposed to come in last night. I'm so very glad I don't go back in until Friday night!!!!

Well, I leave for my orientation to graduate school on Monday. I still have to finish a novel and a computer class before I get there. I will be gone the week, getting back home sometime Friday afternoon. So, I have lots to do before then. Get the house and kids ready for the week without me and make sure all everyting is done and caught up so my Love doesn't stress out too much with me gone.

Happy Birthday Jewel!

Remember how in a previous post I said that I am a firm believer that things happen for a reason. Well, the following story is just another one of those instances.
I work nights, because I love nightshift and because I then don't have to deal with babysitting issues for my three-year-old. Well, we have had quite the rash of new hires and a bunch of gals are coming off orientation making night shift full to overflowing with nurses wanting to work (very unusual, we are usually begging and pleading for help) and I happen to work PRN (very flexible, only required to work four shifts in each six week period) which means when our census is low and they have to call off nurses they call the PRN off first (we are not given benefits therefore our rate of pay is much higher than the FT and PT gals).

I was scheduled to work on Tuesday night but when I was there on Monday I took a look at the census and what we had scheduled to come in and since I was the only PRN person scheduled to work Tuesday night there was a 99% chance I was going to get called off. Well, as I was complaining about needing to work one of the ANM's asked if I could pull day-shift on Tuesday instead since there were alot of procedures scheduled and staffing was tight. Well, I did some calling around and got a friend who could drop-off and get the kiddos from school for me on Tuesday so I said 'yes' to working day-shift.

When I arrived Tuesday morning my lovely charge nurse said I had an assignment that is right up my alley, mommy having her third baby and has gone unmedicated every time. Yeah!! Just the kind I like. So I found my nurse to get report from and we sat down in the lounge. When she told me the patient's name and age I asked if she knew the husband's name and she said 'yes, it is xxxx'. Well, lo and behold I know this gal! I was actually her doula for the birth of her first daughter six years ago, but with her second daughter three years ago I had to recommend a fellow doula because I was pregnant and working full-time and didn't feel I could make the commitment. Okay, so when I walked into the room S just looked at me and the biggest smile came across her face. When I told S I was going to be her nurse she told me that she and her mom had been praying for the past few days that I would be there and be able to take care of her. This patient and her family are deeply religious people with such good hearts and souls, I just adore them.

Well, the circumstances just get better. She was being induced on her father's birthday (he is always present at the births of his granddaughters) not only because it was his birthday but because her midwife's husband has cancer and they were leaving on Wednesday morning to go to a larger city for her husband to have surgery and she would not be working for six weeks. Well, S really wanted her midwife to deliver instead of the physicians in that practice.

So after some catching up with one another S tells me that her grandmother (her dad's mom) had just passed away a week ago and they were naming this baby after her but had not told any of their family that.

On with the story: She had come in at midnight and had cervidil placed and I was to remove it at 0730 and start her on pitocin at 0800. When she arrived she was already 3cm. I pulled the cervidil at 0730 and checked her, she was now 4cm. She asked if her midwife was going to come break her water and I told her I would call the midwife and update her on the cervical change and see what she had planned. The midwife said to go ahead and start pitocin she would be there about 0845 and would break water if S wanted her to. So I start the pitocin @ 0800 (I love this midwife, she starts low and goes slow!!), midwife comes in at 0845 and breaks her water, she is still 4cm. S did so great, she stayed up and ambulating around the room. I had put her on the telemetry monitors so she could walk around and we could still keep up with baby. Well, it wasn't very long when S said the contractions had really picked up in intensity (they were already about 3min apart prior to starting pitocin) so @0925 I turned off the pitocin to see if her body would just go with it, and it sure did (btw, once I turned on the pitocin I never did increase the dosage). She alternated between standing and swaying her hips and sitting in the rocking chair. She requested a vaginal exam at 1000 and was 6cm and the baby had really moved down into the pelvis (was -2 when CNM broke water and was now 0 station) and her cervix was now 100% effaced.

S seemed to be getting discouraged and kept asking me how much longer so of course I just stayed at her side encouraging her. Her mom and dad arrived about this time and were wonderfully supportive to her (when her mother came in the room and saw me she just said "thank you God for answering my prayer").
For those wondering, what about the husband, he was very verbally supportive but the poor man doesn't deal well with the intensity of childbirth so I had him just sit on the couch for the most part, fetch ice chips and cold wash cloths and he was at S head during the actual birth (he came very close to passing out during the birth of their first child and I didn't want a repeat)but that was the limit of his ability to provide labor support. S continued laboring beautifully by rocking and swaying and moaning with contractions. Since the pitocin was off I had heplocked her IV so she was no longer burdened down by any wires or tubes connecting her to anything. At about 1100 she requested another exam and she was 7cm, after sitting through a few contractions she then got back up and really started pacing the room and standing on her tip-toes (at this point I started getting flashbacks to her first birth where she did the exact same thing when she hit transition). So I asked her how she was feeling and if she had any pressure. She told me only with peak of contractions she got the tiniest hint of fullness in her pelvis. I took this opportunity to leave the room to go call the midwife to head this way. While I was out at the nurses station paging the midwife and making a note in her chart, S's husband calls out and says to come to the room so I ran down to the room while hollering at the charge nurse to get me a midwife and a delivery cart. When I walked into the room S just very calmly looked at me and said "it's time". So I ask her if she would sit on the bed and I could check to see if there was any cervix left, there was a small anterior lip but it slid back over the baby's head during the next contraction (it's about 1125 at this point). S told me she was at the point where she could not stop herself from pushing, so I told her to just do short grunts with the contractions instead of long sustained pushes to give the midwife a few more minutes to make it. S was sooooo in control it was just beautiful to watch as the baby moved down and started to crown. The midwife came into the room and put on her gloves (the tech had brought in the delivery cart and set it up) and S pushed so beautifully with the next two contractions and birthed her beautiful "Jewel" into this world @1137 on Feb. 12th, 2008.

What a wonderful day and a beautiful birth! I so enjoyed being with this family and watching it grow and S was so sweet. We joked about how the midwife almost missed it all (she was in the room a total of 3 minutes before the baby was born) and I almost had to catch. S just looked at me sweetly and said, "you know I would have been just fine with you catching my baby". I could not have been paid a higher compliment by a more sincere, genuine person.

Some would call it luck, others coincidence. But, I have absolutely no doubt in my mind that I was supposed to be there at that birth. S has always had a special place in my heart since I had attended the birth of her first daughter and now I have been privileged to witness the birth of her last daughter, her grandmother's namesake.

BTW, just for CYA, I have S permission to share this story fully with all names and details included but I have chosen to leave out their names and certain other details. So yes, I am in full HIPPAA compliance.

Teaching...and more teaching

Well, it has been a busy few days. I started out on Saturday teaching one of those all-day Lamaze classes. You know, the ones where I try and cram in one 7-hr session the info that I usually teach in a 5-week/12-hr series (but I'll rant more on that at a later date).
Side-note: Ladies if you have any intention of having an unmedicated labor and birth do NOT take one of these classes, take the 5/6 week series classes. These classes always get so hung up on talking about interventions and asking so many questions about those (because most of these students have no intention of laboring without an epidural and think that there is no problem in "planning" your baby's birthday), it leaves very little time to teach any real hands on labor support and comfort techniques.

Then on Monday I taught a labor support class for nurses that I have developed for our unit. Our unit has recently undergone an expansion both physically and in staffing, so we have lots of nurses that are new to labor and birth. I have developed this class to teach our nurses how to really care for our mommies by being very hands on and informative and providing real labor support for them and their families.
Originally management had decided that this class would be mandatory for all nurses with less than two years labor experience and optional for the more seasoned gals. Well, I had the first class back in December and had a couple of experienced (one with 20+ years in labor) nurses in that class. Well, after they went back to the unit exclaiming how you "can teach an old dog new tricks" and how much they enjoyed the class it became mandatory for the newer gals and highly suggested for the rest. This class I had on Monday consisted of 13 nurses (5 of which had 15+ years labor experience) and we had so much fun. I had originally limited the class to 10 participants because it is hands on and requires participation but made an exception to this one because most were very experienced. I have been so encouraged at the positive comments that are being made about this class and I really think alot of the girls are learning some good ideas and I hope to see our patients really reap the benefits of this class very soon.
I also worked on Tuesday during day shift (night shift is my usual and I work nights for very good reasons) and was very busy, but the adventures of this day will come in a different post.
Then on Tuesday night I attended a dinner/educational session sponsored by a certain pharmaceutical company about their medication that is used to treat bipolar depression. It was very informative and interesting and it was held at a restaurant that I wouldn't normally just go to for dinner (very expensive, the type you go to for an anniversary dinner or special occasion) and the food was great! Got home late and the kiddos were already in bed so I had some nice quiet time with my love catching up on things we haven't had time to discuss in the last few days.

Sooner than planned

I started this blog to chronicle my journey through midwifery school. Well, seems that journey is going to begin sooner than I had originally planned. I had applied for the midwifery class beginning in March and was headed for orientation March 10th. Then I got an email the other day asking if I would be interested in attending the February orientation since they had one spot left open.
Well, I discussed it with my husband and he agreed that if I could get the childcare issues taken care of then 'why not, just get it going!' So, I am headed off for four days of orientation in TWO WEEKS!!! And believe me, there is alot to do between now and then. But, I am sooooo excited to get things moving.

A little information can go a long way....

Okay docs, if you're not going to "let" your patients take my Lamaze classes (I have been told they are then coming back and asking too many questions) then give them some idea of what to expect when they come in for their induction. Case in point; 18 y/o primagravida shows up @0115 am for her elective induction. Along with her she brings FOB, her mother, his mother and numerous other assorted family members for a total of about 15 people. The issue I have with this is that three of those people were kids (not her kids or his kids, just niece and nephews) the girl about 10 and two boys probably 4 and 6. At 0115 in the morning, you have got to be kidding!!!!! Did they not tell this girl the baby wouldn't be here for 10..12..18 hours or longer? No, they told her "come on in today and we'll have a baby" and "the baby is really low, you're going to go fast".
It really saddens me to see the insurmountable number of women who come in to have a baby that haven't bothered to; read a book, take a class, or even ask their physician about how this is going to happen and what it takes to birth a baby.
Some classic examples of birth ignorance (and I mean that as in 'lack of knowledge', not derogatory) are the grandmas that have shown up right when their daughter's arrive for her induction and then the shock that overcomes them after they ask you how long this will take and you tell them you hope their daughter has given birth by the time you come back for your shift this evening! But aren't inductions supposed to make it all go faster! My goodness things are supposed to go swiftly and easily in theses days of technology, it's not like it was back when they had babies! (sarcasem intended)
Or the primagravida who pushes twice and then gets upset that you haven't called the doctor yet, they might miss the delivery!!! And you have to explain to them (as kindly and gently as possible) that they may push for as little as 30 minutes and as long as a few hours and that the doctor will not arrive until the very end.
Please! please! Just give them the basics; the average length of labor and pushing, that they have to have an IV to get....pitocin..epidural...nubain..etc. I always feel like the bad guy when I have to give them a "reality check" after their physician has made it all sound so quick and easy. So ladies, please educate yourself and don't rely on someone else to take care of it all. It will really cut down on the anxiety if you at least know what we are going to do to you before you get there for us to do it!

But I guess as long as shows like Baby Story are out there some people will think that is all the education and preparation they need.

Networking

Well last night I attended a meeting, at one of our local fine eating establishments, that consisted of the local CNM's and WHNP's. I knew just about everyone there and met a few very fine ladies that I had not known previously. Athough there has always been a very strong presence of CNM's in this area I do believe that we are going to see it growing bigger and stronger over the next 5-10 years and I am very excited about that. It was great to get together with women who tend to be on the same page regarding birth and women's health. I really enjoyed myself and look forward to attending these meetings in the future.

The rest of the story....

I am a firm believer that things happen the way they do for a reason. Some people call it luck, I choose to believe in Divine intervention.
My Lamaze student gave birth by cesarean on Sunday afternoon. After making slow progress the MD requested the nurse place an IUPC (an internal pressure catheter placed inside the uterus to measure the strength of the contractions). During this placement the baby had a few significant decelerations and after a slow recovery became extremely tachycardic. So the decision was made to proceed with a cesarean section. My student had been laboring without an epidural so was able to have a spinal placed for the cesarean. It turns out there was a velamentous cord . It seems that when the doctor ruptured her membranes he just got the forebag and the placement of the IUPC got the rest. I'm just grateful that it turned out the way it did, honestly it could have been alot worse after the doctor ruptured the membranes because the tear in the amniotic sac could have torn the vessels and caused the baby to be exsanguinated in a matter of seconds. Mother and baby are both doing very well and baby breastfeeds like a champ!!
Another reason why amniotomy should not be used routinely!

aaarrrgghhhhhhh!!!!

Okay, so one of my Lamaze students was due on Friday. She called me that afternoon after having and appt. with her MD (whom I generally enjoy working with) to tell me he wanted her at the hospital the following morning for induction since she was now "postdates". She had called to see if I would be working this weekend and be able to take care of her, well unfortunately my husband is out of town this weekend and I am not scheduled to work.
Sooo, they used cytotec on her all day yesterday, to no avail of course. Then, switched over to cervidil last night, only she accidentally pulled it out after just a few hours while going to the bathroom. So, more cytotec through the night.
I just spoke with her and they started her Pitocin this morning and her MD came in and broke her water, he told her she was 2cm at that time and her nurse just checked her and said she is still 2cm and the baby is still high (her primary nurse is a good friend of mine and says her pelvis is roomy and the baby doesn't feel too big, so she is trying all the tricks she can think of to help her get moving).
I just have that awful sinking feeling in my gut that this is not going to end the way she wanted it to. She originally wanted to have an unmedicated birth but at this point says she will take an epidural if that's what it takes to get her through the pit induced contractions and be able to birth vaginally. Her husband is with her and is such a good support for her and she has a doula as well. At this point I am really just being in prayer for her and hoping things turn out well.
Why, why, why? Postdates?!!!! Seriously now!

New Beginnnings

Please be patient, this blog is currently being born. Hopefully over the next few weeks I will get all of this blogging stuff figured out and there will be some resemblence of order to my site. Thank you and visit again soon.