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.

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