Monday, February 25, 2008

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!!!

Thursday, February 21, 2008

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.

Wednesday, February 13, 2008

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.

Friday, February 8, 2008

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.

Thursday, February 7, 2008

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.

Wednesday, February 6, 2008


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!

Sunday, February 3, 2008


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!