Divin' Right In...

Today was my 1st day out of orientation and on my own!  Let's just say the L&D spirits wasted no time in getting my feet wet...


Choose the easiest possible patient right off the bat--a scheduled induction patient---Check!

Start the Pitocin, after all appropriate initial interventions---Check!

Prepare the baby warmer & delivery table ASAP, this is her 4th baby---Check!

Ahh crap, fetal heart tones down to the 50's for 3 minutes---Check!

Rush to the OR for a stat c-section---Check!

Go to the bathroom and check my drawers---Check!

Return to patients room after the c/section false alarm (heart rate up to 120 by the time in
OR)---Check!

Amnioinfusion for the big fat repetitive variables in fetal heart rate---Check!

Scarf down leftover gumbo & a greek yogurt for lunch in a record 7 minutes---Check!

Brush up on my communication skills with low-socioeconomic status patients---Check!

My patient begging me to take her home with me at 3:00 because she doesn't want to "do this anymore" (Literally, sobbing she repeatedly said, "Liiiiiiiiiiiiiiiz, pleeeeeeeease take me home with you!!! My response, "You're pushing this little boy out...like right now! You've got this, girl!!" )---Check!


All in a days work. ;o) Craziness.......

One Crazy Week...

Yes--Very Busy around here lately!! Working on Christmas projects--measuring, cutting, sewing, embellishing, pattern-hunting, etc., reading up on obstetrics, organizing my Black Friday deals & plan of action for the day, squeezing in time with Eric, and chasing around this lil booger over here--who is now WALKING! I know, excuses, excuses...I've slacked on blogging. Darn it!

The new job is keeping me on my toes...reading text books on obstetrics, learning obstetrics-related assessments (these aren't the head-toe assessments that I'm used to!! Bowel sounds? Apparently, nobody cares about bowel sounds in OB! lol), trying to learn the balance & routine that comes with a new job...it's exhausting in itself!! I'm learning how to get a hold of my emotions on this job as well! Those who know me well know that I wear my emotions on my sleeve...er, on my neck & chest (okay, you don't have to know me that well to know this--just sit next to me while I'm eating an orange...or ketchup...or salad dressing...or skittles...or witness me getting frustrated at someone, or embarrassed, or excited, or sad...any fluctuation from normal really--those big ugly red blotches just smother my chest, neck, arms, and face!) So do you think there is ever a day at work that I don't look like a walking glowing red christmas ornament? Nope. But...it's improving :) It's such a high-risk environment...and I'm learning that anything can happen in the blink of an eye. Take this situation for example...my WORST experience in nursing EVER....

WARNING: Don't read this if you're pregnant...that means you Mrs Andrea Howard and Mrs Kayla Rich!! :) I won't use gruesome details, but still....I don't want to stress anyone out!!

Okay, so, I'm doing way better with happy, uncomplicated births. I've got those down pat. Maybe still a tear-up here or there, but for the most part I try to stay focused on my role as the nurse and I think I'm out of the ooh-my-goodness-I'm-witnessing-a-real-live-birth-right-now mode and into the ooh-my-word-there's-a-million-things-I-need-to-be-charting-right-now mode. Because there are a million things I am responsible for at the time of delivery. Anyhow, this past week I hit a bump in the road...more like a straight-up road block. I'll start by giving a little background on my patient and her husband. This was their first pregnancy & first baby. Her only complication in pregnancy was her diabetes (type I). She was being induced at 37 weeks because she was diabetic and apparently had a narrow pelvis (diabetics typically delivery bigger babies), so to avoid a c-section and to assure that the baby would still be small enough to be delivered vaginally her doctor chose to induce her at 37 weeks if her amnio showed that baby's lungs were developed enough, and obviously they were because they chose to go ahead with the induction. She then labored all day...epidural in place so it wasn't too awful, but we cautioned her to rest & sleep as much as possible, because pushing is very taxing & would require every bit of energy that she could muster up. She disregarded our suggestions. Oh well, maybe her nerves kept her from wanting to rest and instead she called everyone on her cell phone contact list all day. Let me also add that she had a birthplan...a very interesting birthplan at that. She wanted us to withold an epidural even if she was screaming and begging for one... yes, she stated this in writing in her birthplan. The birthplan also stated that she wantetd skin-to-skin after baby was born (great!), to breastfeed quickly after delivery (fantastic!), no male doctors or nurses (um, ok sure!), that if she went into a panic attack it would cause her to bleed more freely so she must be put to sleep immediately (I was so confused at this request, what the heck?), that she wanted her stepmother to cut the baby's cord at delivery (sounds good!), it stated that she had a very strong distrust in medical professionals (uh...yikes?), and many other bizarre requests that I can't recall (two pages worth). But wait Liz, you said she had an epidural all day? Yep, she asked for one...so we gave it to her. Birthplans are not concrete absolutely-must-follow-under-the-law documents...they're simply organized requests that mom would like to share with her obstetrical team. And sometimes birthplans fall through the cracks...you really have to come in focused, determined, mature enough to handle labor pain (with pitocin on board!), and ready to have a baby if you really don't want an epidural with an induction. Let's just skip to the meat & potatoes of the story.... this patient ended up having very poor pushing effort when it came right down to it (perhaps she was worn out from no sleep for 24 hours and chatting it up on the phone all day? We'll never know) and a very large baby...the baby actually got stuck in the birth canal. Her head was out, but her shoulders were stuck behind mom's pubic bone... this is called shoulder dystocia and is the nightmare of ALL nightmares in obstetrics... a stuck baby!!

...Andrea & Kayla, stop reading! I know you're sneaking a read!:).....

.....hemorrhaging can be managed, tearing can be managed, a bad fetal monitor tracing can be managed, but shoulder dystocia's are H-E-L-L. You can get 20 people to your room with a simple phone call to the desk stating "We've got a shoulder!" Bam! Within 10 seconds the room is full and time begins to stand still....literally....the worst feeling about something that I've ever had in my life. Honestly, not even 10 seconds after calling the desk nurses & residents came pouring in the room to help. The room suddenly turned to complete organized chaos. The delivering doc was at the foot of the bed doing her best to pull baby out....like, losing her grip on the slippery baby several times while trying to reach in for an elbow or something. But the sickening part to me was witnessing two big male docs rush in the room and get the footstool out so they could get some leverage on the girl's belly and both of them literally pushing with all-their-might just above this girls pubic bone trying to get baby's shoulder under the bone so she could continue through the birth canal. Mom was screaming, "STOP! YOU GUYS ARE HURTING ME!" over and over. I tried to comfort her during the madness...but really how comforting could I get when two men were practically pouncing on her belly? Most likely they broke baby's collar bone....but it was a necessary evil at that point in time. Broken collar bone vs. asphyxiation? The terror in mom & dad's eyes was probably what got me the most. Can you even imagine how scared they were? The room was so quiet while all of this was happening...eerily quiet...or at least I thought it was. Finally, after what seemed like an eternity, the baby was delivered...3 minutes later.

...I warned you prego chicks! Not a happy story here! I better not hear of either of you going into preterm labor from the panicky state that you've just put yourselves in!!... Listen to the L&D nurse...hehehe.

This cute, chubby, full-term baby was completely floppy & lifeless...and grayish blue. The doctor quickly snipped the cord (or one of the nurses or somebody did, I don't even know, at this point my face was probably looking a lot like the dad's...ghostly white with glassy shocked eyes), the limp baby was rushed over to the warmer and the pediatricians began chest compressions. I think it's different when you're expecting something like this to happen. It was harder on me because the baby was full term. A big full term baby--10 lbs big. Sickening. Baby lived...but still sickening to watch the whole thing unfold. I had to leave the room for a few minutes to regain composure...although I did not let one tear leave my eyes....they were just really clouding my view!!! I came back after a few minutes looking like rudolph...worse than rudolph...I would've been fine with just a red nose, but my whole face, chest, and neck were glowing. BUT, I managed to witness the upside of the disaster....if you want to call it an upside...baby was intubated and whisked away to NICU to be put on a ventilator and mom got geared up for her next journey--safe, uncomplicated recovery.

So, as you can see, birthplans mean nothing when it comes to delivering a safe, healthy baby--and that is the ultimate goal. Nothing in this delivery went as desired, which happens many times. Moral of the story is...you can't go into child birth and demand that everything goes your way...because it may not...everything went completely opposite from what she demanded in her birthplan (if you would have read the whole birthplan yourself you would have gathered too, that these were demands and not requests). Do you know how many males ended up in her room at delivery!! Yikes!! I hope she wasn't counting!!! Not to be funny about the serious matter...but, for real!! I will also add that no matter how hard I tried to keep my cool during the disaster, you should know that the minute I got in my car after work that night and shut the door the sprinklers went off & I bawled my eyes out the whole way home. A good cry was absolutely necessary. And it felt wonderful.

So, that was the highlight of my week! There is never a dull moment in L&D ... :)

New Job ...

Soooo....for all inquiring minds..... I Love My New Job!!! I'm learning soo much and it's all so very different from what I've spent the past few years doing, but despite the deer-in-headlights feeling I get sometimes from labor & delivery nursing I'm loving my experiences! Really, there is nothing cooler than watching a brand new baby take his first breath of air and let out his first belly wrenching cry!! I mean, wow.... I love it... I can't believe I thought twice about taking the position!! I've seen, ooh I think 4 births now...and don't you know I cried with each one of them. I couldn't help it...it's like, I'm fine until that very moment when baby pops outta mom & it's as if someone opens up the flood gates at that exact moment... the parents are crying, I'm crying, everyone in the room is smiling. :) It's a precious time in life for each person involved...it's life changing for the parents no matter what # child it is, and it's obviously life changing for baby...no more cozy, warm belly to grow in...and it's precious for the nurses and doctors who took part in making it all happen. It's great, I love it. The whole process is a miraculous act of God--pregnancy & labor itself--the more I learn the more miraculous it becomes. :) Granted, I've only seen happy births...I'll have to really really gear myself up for an unhappy delivery. Like the one last week where mom was 20 weeks pregnant with twins and one passed away in utero...so she decided to abort the 2nd baby due to 90% chance that he would pass way as well (I don't know the details as to why 2nd baby would also die). She was induced and had to go through the entire delivery process for both babies...can you imagine? I'm not ready to take on that kind of delivery--I need to get past crying over happy deliveries first!!

I've had 2 just barely teenage patients already...14 &15 years old. Very different to help a laboring adolescent. They revert to about 10 years old and then it becomes nearly impossible to have a decent delivery. It's so sad to me. There are children having babies...and really the babies will be the innocent ones to suffer. 14 year olds don't have the capacity to raise a baby alone. Both girls' boyfriends were at the bedside, but at the first mention of epidural, cervical check, bloody show, or vaginal laceration their eyes glazed over and you would've thought we were speaking Chinese (I guess that's not saying much--many men think we're talking Chinese when these words come up:). They were clueless...as were the girls. All they knew was that they thought they were dying and they wanted to be 'paralyzed from the waist down'. The girl told me "thousands" of girls at her school are pregnant. Thousands? I'm pretty sure there aren't even 1 thousand girls at your high school. It's just scary... apparently girls should be placed on birth control at age 12 these days.

What I have noticed in my short 2 or so weeks on the floor is that nurses and doctors like consistency...meaning, they like every patient to be exactly the same and for everything to go exactly as planned. And they really, really encourage epidurals. Which is fine I suppose, I agree epidurals are miracles, but it seems like if a mom wants anything different, or heaven forbid she brings in a birthplan then the nurses are immediately grumbling that "mom's gonna want to have everything her way" and I'm thinking "well yeah, it's her birthing experience--it should be her choice!" Now granted these nurses have seen it all--like the mom who goes in for an emergency c-section and says, "If anything happens, you save me first not the baby!!" Are You Serious!!?? There are some twisted women out there! OSU happens to serve the highest number of high-risk patients in central Ohio, so consistency is important for safety's sake, but it's nice to get that low-risk mom & baby who can continue to walk the halls & take a hot shower to help progress her labor the natural way rather than relying on oxytocin to do it for her. It's just always interesting in L&D, and I hope to maintain my feelings on pregnancy & childbirth despite the corruption that some oldies (but goodies I'm sure) nurses cast onto me. :)