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.