Scatterbrained

It's been crazy up in here, so here are some random tidbits for your enjoyment.

* I decided to try out the elliptical at the gym to give my joints a break. After 130+ laps at the indoor track (10 miles) my right leg, which was on the inside lane was a bit sore. It isn't severe pain, but more of a mild pain but the leg feels weak. It starts on the outside of my knee and runs down across to the inside of my ankle. I'm self diagnosing myself with an overuse injury of my IT band. (I actually have no idea, it just sounds good) So I'm trying to back off on the running for a bit to let it heal and decided once I do start training full on again, I need to stick to road running. The track is just too small for doing high mileage and the treadmill is out. I must run differently on the treadmill because that also irritates the outside of my right leg, or what I'm deciding is my IT band, so I tried the elliptical for the first time. I felt a little silly because it took me a minute to realize how to turn it on (you just start moving...the treadmills have an "on" button) and the moving my arms as much as the machine has you do felt odd, but I did 4 miles and felt pretty good, no trouble with my leg. This was 2 days ago. I noticed that my back was sore last night and this morning and I couldn't figure out what the deal was. Until I remembered the elliptical. Now it makes perfect sense. Yep, I'm quick.

* Clara is sick. I think could be strep throat - headache, nausea, sore throat, couch, fever. But I really don't know for sure. It's going around the school apparently. So a doc office visit is in the plans today. I hate when the kids are sick. I don't want them to be miserable, I don't want it to run rampant through the house and get everyone else sick either. I got the call from the school as I was pulling into the parking deck at work for a meeting. At least I hadn't gotten into the building.

* Caleb's new pastime is dumping glasses on the floor. The older kids just can't seem to remember that they need to keep their glasses in the kitchen. When no one is looking, Caleb sneaks over to the table, grabs a full glass of milk (it's always milk, it can never be water) and then we hear the sound of liquid hitting the rug. We thoroughly enjoy it.

* The ornery thing also shook his head at me and told me "NO!" yesterday. We've never actually heard him say the word "no" before. I had run to the bathroom as to avoid a bladder explosion and Caleb must have thought I was abandoning him. So he cried like his heart was broken. I came back, sat down on the couch and said to him "Come here". He looked at me, shook his head and hollered "NO!" at me. *sigh* I'm glad he saved that little first for me. Husband thought it was hysterical.

* I am currently knitting scarf #4. Yes, I learned to knit. I made one for myself, one for a friend and one for Clara. I have camo yarn for scarves for the boys. I'm finally doing ok at not dropping or adding stitches. Maybe in 5 years I'll be up for making something like, say, a hat, or with a pattern. Right now, I'll just finish my scarves.

* Had a girls night out with my mom friends last night. Between the 3 of us we have 13 kids. We get out maybe once a month to the local pub (which is 1 block from my house...the beauty of small towns) In the summer, we get together with the kids, and there are a couple other moms that come sometimes, they have 3 and 4 kids. Only one of the kids is over the age of 10. So when the whole group is together, you need earphones as to avoid permanent hearing loss.

Small Steps in the Right Direction

The longer I work in labor and delivery, the more I see that there is a need for things to change, especially regarding c-sections. (No, this isnt a post about how there are too many c-sections...that's whole huge post and discussion for another day. Yes, avoiding c-sections altogehter is the best answer, but until we get to that point, there are still many c-sections being done and we need to manage things better until we get to that point) I'll admit, since 4 of my 3 kids were born by c/s, 2 of them preterm and one emergency, it hits a nerve for me. Why is it routine to take babies born by c-section away from their mothers? In certain cases, obviously there isn't a choice, either the mom is too sick or the baby is too sick. What about those non-emergent cases, like a failure to progress, scheduled repeat, or a repeat c-section in labor, or the like? It seems routine that the the baby is born in the OR, taken to a warmer where most the time the pediatrician is in attendance. Baby is held up to mom so she can see her baby, then Dad goes with the nursery nurse, pediatrician and baby to the nursery and the mom is left alone with strangers while they finish the surgery. The baby has already been evaluated and is fine, but stil they go to the nursery. Why? Had my last baby been term, I had already stated that he would not have left the OR. I knew he would be given a good once over by the pediatrician and nursery nurse, so I saw no reason why he should leave. He could hang out in Husbands arms until they were through with me, Husband would give me the baby and I would be wheeled out of the OR into recovery with Caleb skin-to-skin. But, that bonding wasn't able to happen until I was in recovery because he was 34 weeks. And this is where a lot of c-section moms start having trouble. Here they are, sometimes they feel like their body has failed them because they need a c-section. So their baby is delivered through their abdomen, they will have a longer recovery and the baby is taken away from them. They may seem "fine" during the short 2-3 day hospital stay because they have their baby and they do all the typical things new mothers do. But it's not until after they are discharged that the emotional turmoil begins for some. They start to realize they missed out on those first moments. They weren't able to hold their baby for 1-2 hours, in some cases, even longer. Here they carried and loved this child, labored and they are the last to hold the baby. Some women even feel like it was their "punishment" for not being able to deliver vaginally. And these feelings start spinning out of control and when they try to talk about these feelings to others, they are brushed off. "Well, you got a healthy baby. Why are you so upset/sad/angry?". Yes, the most important thing is a healthy mom and a healthy baby, but the birth experience is also very important. I know even for myself, when I tried to talk about my unsettled feelings about Calebs birth, some people look at me like I'm nuts, that I should let it go, "it's been a year plus, just move on". The thing is it's not that easy. Yes, I'm very thankful he was delivered healthy, considering his early gestation, and he is an absolute joy. But, I am still unhappy with the lack of respect I was shown in the day and hours leading up to his birth and during. I was almost denied the option of having Husband there. What would have happened if I hadn't worked in OB? Would I have thought to say "no, if the baby and I are fine I want to wait"? Probably not. That disrespect cut much deeper than the scalpel blade. Those physical scars have healed, but the emotional scars are still a bit tender. But having the opportunity to have Caleb skin-to-skin within an hour of his birth and being able to take him in, to hold him against my chest, eased some of the pain/guilt I was feeling. Ok, back to my main point. Why not keep the baby in the OR with mom? Why can't we keep her child with her, bring him/her to her so she can see, touch and yes, even hold her baby (it is possible) while the docs finish up surgery. Then the baby can go with her to recovery and she will be able to be with her child those first few moments and maybe that will help. I've been doing this lately. I've asked the nursery nurse and pediatrician if the baby can stay in the OR. And I've not met ANY resistance. The results have been awesome. I can't speak to how the moms feel after they are discharged or if it has any effect on possible emotional turmoil they may feel, but in the immediate here and now, they seem happy. They don't lose those first few minutes. They don't watch helplessly as their baby is taken to the nursery even though everything is fine. They get to do skin-to-skin as soon as they are in recovery and guess what? These babies have all nursed great in recovery. Coincidence? Perhaps. It might be a small step in the right direction. Maybe it won't have much impact. Or maybe, just maybe, it will make a world of a difference. It can't hurt to try.

Marathon #2

When I ran the marathon last year, I remember thinking to myself at about mile 20 "never again". I told Husband at I think mile 21 "This sucks. No more marathons". I said over and over again afterwards that "I'm good. I have no need to do that again". Especially that night when I rolled over in bed, forgetting that every muscle in my body was angry and sore and I winced in pain. But a few days later, I started thinking that I wanted to do it again, and train the right way, with adequate time to train. I want to run the entire 26.2 miles, none of this walking the last 6 miles. So, about 1 hour after registration opened on February 1st, I officially registered for my second Chicago Marathon!! I have 246 days to train, as opposed to 2 months. I'm running a half marathon in April, so I've been training. The local community college has an indoor track the public can use so I've been going there to run. For 1 mile, you have to run 13 laps and I just can't keep track of laps because it's monotonous enough running in circles. I can't torment myself with keeping track of laps. Instead, I've been running for a certain amount of time. I know I run at an 11-minute mile pace, so I just estimate how far. Wednesday, I ran for 1hour, 45minutes and it felt good. Plus running at the track, I can make a quick stop at the water fountain, and then get back out to running. Just like I would do during a race. So training is going great, and I'm already excited to be running another marathon this fall. My goal is to finish in 5-5:30 hours. Not a lofty goal at all, but it seems realistic for me. Now, time to get motivated.

Miracles

*L&D unit, wee morning hours, mom presents in labor.

Mom: This child is my miracle baby

Nurselochia: Yeah?

Mom: Absolutely. We tried for year for a baby. Finally we had our daughter and we were on top of the world. But we wanted her to have a sibling. Someone to share life with. And we felt like our family wasn't quite complete. We wanted another child. So we tried, and tried and finally we got pregnant. Then I lost it. So we tried again. And again I lost the baby. This happened 3 times and I finally told my husband that I would try one more time. But if I miscarried another child, I couldn't do it again. We gave it another go. And I was happy but terrified when that second line came up. We waited until I was about 8 weeks to see the doc. We went in, both of us on edge and Doc did a sono to verify that I was pregnant. We saw the baby...but there was no heartbeat. No blood flow to the baby. We were devastated. Doc suggested we go home and give my body time to naturally miscarry. He wanted to see me back in a week just to check on me and we'd go from there if nothing was happening. I didn't want a D&C. So we went home and cried and started praying that God would allow my body to do what it had done with the 3 prior losses. But nothing happened. We went back a week later and saw Doc. He did another sono to see if anything was starting to happen, and the look on his face told me nothing had. He looked at me and said "I don't know how to tell you this..." and I interrupted "I know, I can tell nothing is happening". He said "No, that's not it at all. Here, look here". So I looked at the screen and there was this little flickering where there hadn't been a week ago". Doc said "See? This baby is alive. I don't understand it, but look at that!" And here we are, 40 weeks and I'm going to get to hold this little boy that I thought I'd never have!


I wasn't sure why her doc would have done another sonogram after the initial but I've never worked in an office before and that early pregnancy stuff I'm not so good with. I thought maybe she didn't quite understand everything, maybe she had been too early to see a heartbeat and that's why her doc wanted to recheck in a week. I also knew at 8weeks there should be a heartbeat. I also had no reason to doubt her. It just seemed so unlikely. I was skeptical until I looked at her prenatal record the office sent over. And right there, documented in this pregnancy history just as she had told me. "IUP at 8w. No cardiac activity noted." And then an entry that estimated gestation to be 9 weeks with a healthy heartbeat, followed by a long list of appointments that outlined her prenatal care, and verified that her dates were absolutely correct. Her doc affirmed her story at delivery. Maybe there was a more logical explaination as to what happened. Maybe they just "missed" the heartbeat, etc. But I choose to believe that they didn't miss anything, that this truly was a miracle. Why question something that had such a positive outcome? There wasn't a dry eye in the L&D department that night. A prayer was said as this little boy entered the world screaming and healthy. Very much full of life.

Who says God doesn't perform miracles?

One sign it's the end of a busy, busy night.

On one particularly busy, crazy night, I had a patient who we were watching for labor. She had an IV running for no other reason than to have it in "just in case she went into labor" and she decided wanted to get up and walk the halls. I saline locked her IV and just attached the end of the tubing to another port on the IV line, above the IV pump. She got up, walked for awhile and then decided she was ready to lay down. I flush her saline lock. About that time, I was called out of the room to go to the ER for a patient who came in by ambulance who was crowning. I quickly turn my pump back on, and make a mad dash to the ER where got the pleasure of catching a baby down in the ambulance bay while the ER staff stood as far away as possible. (They don't do labor...we don't do traumas. We have an understanding). Exhilarating. Anyway, I go in to check on my other patient who had been up walking, who was now asleep, and I'm surprised to see the IV bag looks suspiciously as full as it was when she went back to bed.* I use my clinical skills and I realized why...I never hooked the tubing back up to the saline lock. The fluid was just cycling through the pump, thus explaining why my bag volume looked the same...because it was. *Dumb* Thankfully, it was change of shift.

*no harm was done, before someone blasts me. Fluid was a *just because* order, so we'd have the line in if she went into labor and I was given "permission" to saline lock her if she got up and walked. I could have left her IV site saline locked or hooked fluid back up, and she was a little on the dehydrated side and I figured the fluid wouldn't hurt her.

High risk or Homebirth?

I've decided that I'm a schizophrenic labor nurse. Let me explain. I love high risk OB. I like having to be extra vigilant, looking for subtle changes in a patients condition. I even like when a patients condition means they need delivered RIGHT NOW and we have to get her ready immediately to deliver. Now, before anyone blasts me for hoping for emergencies (which I don't), lets look at what I really mean by that. If an ICU nurse says she likes taking care of her patients, does that mean she hopes for people to be critically ill? No. Emergencies in obstetrics do and will happen. Do you want a nurse who loathes taking care of emergencies, or someone who likes it? I would want someone who doesn't mind because she knows how to handle herself and take care of the woman, not forgetting that there's a scared mother there. I always pray before coming on shift that there are NO emergencies, but I'm ready if one should happen. At the same time, the more high risk patients I care for, the more I want to take care of someone with minimal or no interventions. A nice all natural birth. A mom who comes in at the end of labor just ready to push her baby out...no time for anything but to catch the baby. Love that! My attitude toward home birth has changed drastically during my time as a labor and delivery nurse. When I first started in OB, I couldn't imagine why anyone would want to deliver at home. Now, I understand. At times, I wish I could get out of the hospital setting with continuous monitoring, epidurals, hospital policies, etc and support women birthing their children at home. Just to get back to good ole' fashioned birthing of babies. Maybe I'm glorifying it a bit, but it just sounds like fun. The woman surrounded by the comforts of home and friends/family. See what I mean? How can I like high risk AND think attending a home birth or a no intervention birth at a birthing center? I guess it comes down to the fact that I just like taking care of pregnant women. The majority of the time, there's no need for all the interventions. But I also see that there are times that interventions are necessary to ensure the health of mom and baby. So, there you have it. I'm a labor nurse who enjoys high risk OB but would love to support women in an out of hospital setting as they have their babies.

Work, running, life

Long time, no blogging. It's been a little busy around here and I'm finding that juggling 4 kids, 3 in school, activities, work and all the extra meetings I've been going to, and running...really just life in general has made it hard to keep up. We're only a few months away from moving into our new building at work and we're working very hard to make sure we're ready. It's been pretty slow at work because the other hospital opened it's new birthing center about a month or so ago. It really stinks that we've been slow because I'm craving deliveries and every time the phone rings, we hope it's ER. More often than not, it's the other hospital, calling for prenatal records for patients who have gone over there for the new building but had initially planned to come to us. We're fairly certain once we open, it'll swing back because everyone wants the "new", but right now, we're able to do one on one care, which is every nurses dream. Anyway, with it being slow, it's also allowing us to work on the process of going from a LDR to a LDRP. I have concerns. I just don't know how it's going to flow, how we're going to know what's going on in the department, but part of it is I haven't taken a tour of the new building. I figure I'll wait a month or two when all they'll really be doing is putting in finishing touches and I'll be able to visualize the department. It's just going to be different and it will take some getting used to. We'll adapt because we're a pretty flexible staff and we're already making big strides in the right direction. We now are doing skin-to-skin with almost every delivery (unless mom doesn't want to or the baby needs some extra stimulation), I'm on a tachysystole group and we're working on developing standing orders for how to deal with tachysystole, either spontaneous or pitocin-induced tachysystole. Along with this, we will have a pitocin checklist that must be filled out prior to starting pitocin and thankfully, we have good support from the physicians so far.

Outside of work, I've been running, working towards my next race. I had been debating on whether I should run a half marathon or a full marathon in April. I've decided that I just don't have the motivation to run in the cold, so I'll just be doing a half marathon. Ok, so I know that sounds ridiculous, "just" a half. I am running the marathon again next October and I already have my training plan. My hope is that I can really train properly and shave off a decent amount of time. I *think* I may be able to finish in 5 hours if I really start working slowly towards that goal now. But even just finishing in 5:30 or 5:45 would be fine. We'll see where the next 11 months take me.