A Superstitious Bunch We Are

I think that all L&D nurses are superstitious. Maybe in other aspects of our lives outside of the hospital we aren't, but when it comes to uttering the "Q" word, or some other blasphemy, the labor gods answer with a hearty "What, quiet, you say? We'll fix that for you right now!" Or have a good hair night and you'll end up in the OR. For example, lets say you have a patient or two, laboring, or a stable pre-term labor, resting, FHR is beautifully reactive and nice progress is being made with the labor patient. But just let someone say "Boy, that's a nice strip" or "Man, we aren't busy, are we?" and watch out! About 30 minutes later, ER will call with 5 laboring patients, one a grand multip needing a repeat c/s and tubal, one of your patients with a beautiful strip will suddenly have a nasty deceleration out of no where, your preterm patient starts contracting and everyone who is laboring delivers at once. That's why we never say the "Q" word. Anyway, this was why I knew I was in for it last night. I was having a good hair night. The 3-11 nurse gave me report on my staged induction patient. Typically, these patients will get a cervical ripening agent, like cytotec or cervidil, and rest most of the night. The evening RN said "She'll be an easy patient for you. Her baby looks fabulous, the couple is very sweet and excited. It'll be a quiet night for you". Uh oh. You just jinxed it. So I go in check on my patient and she is indeed very pleasant, resting, not needing a thing, said she wanted to sleep and would call if she needed anything. OK, so a couple hours later, her baby starts having decels - the late kind. They resolve with appropriate interventions, only to return shortly, her previously nice clear fluid is bloody and baby takes a dip to the 60's for a few minutes - not appropriate behavior for 2 cm. Doc was called, he decided that delivery needed to be now, by c/s. So it's on with the OR cap (thus bye-bye good hair!), and back for a c/s. Nice delivery as far as c-sections go. I did feel like I was moving in slow motion for some reason though. I almost forgot to do a "Time Out" (a patient safety thing where we verify right patient, right procedure, right equipment) and I NEVER forget to do that. But I did remember, no worries. Then we couldn't find a lap sponge for a minute but found it under a towel, one doc tossed a bloody lap sponge in the bucket, but missed and it landed on my shoe, then we couldn't get the darn recovery cart to raise the head of the bed high enough for breastfeeding, so we were creative with pillows. Just minor irritations that had nothing to do with the patient, but made me feel inept for a bit. Anyway, I get her recovered, moved to post-partum and sigh a sigh of relief for a good outcome, happy patient and I'm a happy nurse. While I was back in the OR, the unit filled every labor room! Then, ER calls, another patient, in labor, repeat c/s. It's getting close to end of shift, and I go in to help with the IV start. I'm pretty good with IV's: I'm typically the one who can get it if no one else can. What happens? I blow not 1, but 2 freaking great veins! And my blood work I drew off? Clotted. Quite frustrating, probably wouldn't have been quite as irritating to me (and I'm sure the patient was even more frustrated with me) if I wasn't a hormonal pregnant woman. But, the shift ended, I got my charting done by 8a.m. and went home with crazy hair and slept. So, like I was saying, we are a bit superstitious. Now don't go reading too much into this that I'm complaining, don't like my job, or read any negativity into this post. It's not there, but sometimes it's hard to get tone into a post. I like busy, I love deliveries, I love the unexpected and don't mind mussing my hair with an OR cap, but had that evening shift RN not said the "Q" word, who knows how the night might have gone! One dayshift nurse said I could help my patients out by not brushing my hair before coming in! :) Hope everyone has a great weekend!

18 weeks

This week the wee one is about the size of a bell pepper, according to babycenter.com. Another 2 weeks down! I'm almost at the half-way point, and only 6 weeks from viability! I have a sono in about 2 weeks, so I'm looking forward to that, praying that all the measurements are good and that the baby looks healthy. Would also be nice to find out what sex this wee one is so I can buy some fun clothes. We have most everything else. We just need bottle nipples, diapers, and clothes.

Vital Signs: + 4 lbs from pre-pregnant weight. I'm quite surprised that's all I've gained so far. I figure I'll make up for it in the third trimester. BP 96/56. It seems to catch the tech off-guard every time she takes it. I just explain that I am pretty active and that I (until recently) am a runner. FHR of 156, nice and regular.

Cravings: Potato and cheddar pierogies with butter, Triscuits with cheese and Olive Garden salad

Movement: Yep. Feeling the wee one move everyday, still very sporadic at this point, but he/she is making his/her presence known!

S/S: I'm still up peeing all night. I do drink all the time because I get this taste in my mouth, almost like cotton-mouth, and I keep trying to get rid of it. Still get a few bouts of nausea, but it's not bad. I am also starting to have a few Braxton-Hicks (boy, I hate that term for some reason) contractions, nothing painful, very sporadic, but they are there. There was one night I noticed them coming about every 5 minutes or so, but by the time I realized they were that frequent, they stopped. With my other pregnancies, I started having these starting at about 22 weeks and they never caused any problem, but this is a bit early. I guess I did have some preterm labor with Isaiah, but I still delivered at term. I did mention it to Doc and they aren't causing any problem, other than worrying me. Part of it I'm sure is I am more focused on the goings on in my uterus this time, and it's my 5th pregnancy so maybe I'm just going to feel the growing/stretching more. I'm also having round ligament pain. I never had that with my other pregnancies until the very end, and I can tell you that I don't care for it at all. There's nothing more annoying (other than leg cramps) than to turn over in bed, half asleep and be assaulted by this sharp shooting pain.

Exercise: I'm no longer running. I had to give that up a little while ago. When I see people out running on a nice day, I'm jealous and wish I could be out there, too, but I'm doing more important things, like gestating. I've been walking, which is nice, too. Really, just chasing after the kids is pretty exhausting. The neighbor kids were all over playing outside yesterday, a total of 6 kids I was trying to keep track of. I was pretty exhausted by the end of the evening, but the kids had fun.






Here's the latest belly pic. Not the greatest shot, but oh well:

Little League Season Begins!

Today Jacob had his first baseball scrimmage game. I haven't been to one of his practices yet, as Husband has taken him every time, so it was fun to get to watch him play. For kids that are 6 & 7, they all did really well! I was also very proud of Jacob. Last year in football, he liked to mess around, not pay attention and didn't seem to care too much. Yeah, there was still some messing around, heck, all of them do, but he seemed to really have fun! They don't keep score or anything, they just run through the line-up and let each kid bat and then change sides, and they just played for about an hour. They also get 6 tries at hitting the ball. Jacob hit the ball every time! He's one of the smaller ones, and I think baseball may be more up his alley than football. Clara was whiny because it was sunny and hot, and Isaiah was a mudball by the time we got home, but it was pretty fun. I always enjoyed the summer baseball feeling and it's even fun watching the kids play and not being a player! I will say that it is a good thing that we get to ease into this sports/activities thing...it's going to take some juggling of schedules once we get all of the kids into their various activities, but it will be fun! I just wish I would have taken my camera to get some pics. Next time!

Deje Vu

Last two shifts that I worked, I had 2 very similar births. Both were multips, with a history of fast labors - very fast labors. They both came in, almost complete. I could tell they were ready to rock as they were wheeled into the room - both were sitting in that tell-all sitting-off-to-the-side position. But they both managed to smile in between contractions. The similarities were many: Same doc, same labor room, same labor nurse (myself), same scrub tech and same nursery nurse and approximately the same time in the morning. Doc managed to get in from home in time to catch the baby - and he is one that takes about 15 minutes to get in. He laughed after the second birth and asked if this was something he should expect from me. I told him "If it were up to me, of course!" All of us in the delivery room had a good laugh. Both moms were very well controlled and even tried not to push so that the doc could get there in time. I'm always amazed when mom's can/are willing to do that when every fiber of their body is telling them to push and their body is pushing against their will. Truly amazing. But they did it, both had beautiful births, quick, less than 2 hours start to finish! and both had beautiful healthy babes that took to breastfeeding like champs! After my dry spell of births, it was nice to have a couple of births just like these!

Control and Everyday Miracles

I see miracles every time I go to work. From every pregnant woman that comes up in labor to every new mom holding her newborn. Sometimes we forget how miraculous pregnancy really is. One egg and one sperm meet under circumstances that have to have perfect timing. They combine, divide over and over and over, perfectly. Each mother's body knows how to nourish this new life, how to keep it safe, and it knows when it's time to start that amazing process called labor that we have yet to completely figure out. The body knows. Then after some time, a new life is here - a newborn baby, and with it's first cry makes it's transition from its amniotic fluid world to an a world where air fills it's lungs.

Sometimes things aren't always so "perfect". Sometimes the timing of the sperm and egg meeting is perfect, but fertilization doesn't happen. Or it occurs but it doesn't divide just the way it should. Or the woman's body starts labor a bit too soon, or there is a complication that threatens the life of the unborn baby. We have technology to fight it. We have IVF, IUI, progesterone, clomid and many other meds to try to help pregnancy be achieved. We have cerclages to help keep a shortening cervix from opening. We have terbutaline and Magnesium Sulfate to try and stop preterm labor. We also try to prevent seizure and lower blood pressure from pre-eclampsia with medications, including Mag Sulfate. We have vacuums, forceps and operating rooms for when something just isn't going like we want and we need to get the baby delivered. Sometimes we are successful in controlling mother nature/playing God. Sometimes we are not. Sometimes God/mother nature/whatever being you believe in, lets us know that WE are not in control at all. Sometimes it is revealed that the baby has birth defects that are incompatible with life. Sometimes we can perform surgery to correct this...sometimes there is nothing we can do. We can put a mom on bedrest, start her on blood pressure medicine, Magnesium Sulfate to prevent seizures...but she still seizes. We can do NST's and ultrasounds and biophysical profiles to assure ourselves that the baby is doing fine...and then mom notices no movement and the baby has died. Sometimes we can use all the medications we have to stop preterm labor, put mom on bedrest with her head below her heart to prevent the weight of the baby from putting pressure on her cervix, we can place a stitch in the cervix to try and stop it from opening...and she still delivers prematurely. We can fertilize an egg outside of the mother's body and implant it into her uterus, hoping it takes root in her uterus, and it does...then she miscarries. Or we can use every for of fertility treatment we have over and over but she never becomes pregnant. We can rush a mom back for an emergency c-section when her baby's heartrate plummets to dangerously low levels...and the baby doesn't survive. We have ventilators, machines, meds, surgery, etc. - all sorts of life saving measures that can help a 24 week baby survive outside it's mother's womb. Sometimes that baby grows into a healthy adult. Other times it has severe disabilities...or we are unable to sustain it's small body outside of it's mother's body. Again, another reminder: We are not in control. For all we try to do, we can't control everything. But we try.

But in these instances when we do all that we know how to do and still can't stop mother nature, we can still see the beauty and the wonder of something we have no control over. We see it through tears when a perfect 20 week baby is born into his parents arms much too prematurely to survive outside the womb. We see how perfectly that sperm and egg combined and divided to make such tiny fingers, toes, hair, fingernails, a beating heart. We are astounded it when fights, and lives for a couple minutes, sometimes hours. We can see it in the infant born with anomalies that will prevent it from living outside of the womb, and notice how perfect her eyes and nose are formed, how her skin is flawless and see that baby grasp it's parents fingers in it's few moments it has on this earth. At 12 weeks and even earlier, we can see on ultrasound the baby moving and taking in it's amniotic environment.

But thankfully, the majority of the time, a full term, mature baby is born healthy into the arms of his parents, not needing any intervention from us. We aren't in control. The baby develops, labor will ensue and a baby is born. Regardless of us. He cries, he nurses, he grows into an adult that someday may have a child of his own. From one egg and one sperm, a human is formed. Just an everyday miracle.

16 weeks

16 weeks. According to babycenter.com, the baby is about the size of an avocado. Some days it feels like this pregnancy is crawling, but most of the time, it seems like it's going so quickly. I know that doesn't make a whole lot of sense, but in my head it does. It's been fun so far keeping track of what's been going on - I didn't do any of this with my first two kids, and I did some with Isaiah, but just not to this extent and I didn't' take belly pics this early. It'll be a nice record since this will be my last. I'm feeling more and more certain that I am in fact feeling a little bit of movement. It's only happened a couple of times and it's very light. I would have probably missed it if I hadn't been sitting still. We finally told the kids the other night. We figured they would probably figure it out before too long, or someone would say something to them. We wanted to make sure they heard it from us. They were pretty excited for awhile, then they got off on another topic pretty quickly. Jacob and Isaiah will share a room, and right now, Jacob is pretty excited and started talking about how he wants it decorated, etc. Kids. Seems like my belly has started to pop out more in the last few days. I'm not huge (yet) but it's definitely growing. Isaiah came up to me last night, reached up, rubbed my belly and said "baby". It was pretty cure. So even he sort of gets it, although when this baby does come, it's going to rock his world. He'll be the one we really have jealousy issues with. Lately I've noticed that it's not all that comfortable sleeping on my back anymore because I can just feel the weight of my uterus in my abdomen. Oh well, I'm a side sleeper anyway. I'm still up several times a night to pee - and I have a feeling that won't ever let up. We've decided we are in fact going to want to know what this little one is. I thought a few times that we might wait, but we really aren't very patient when it comes to these things.

We'll here's the belly, at 16 weeks:

Challenge

I like a challenge. And that was just what I got with a patient the other night. She was a very young teen mother with an entourage of equally young, demanding young women. I usually do very well with the young mothers. I'm not sure why, but somehow they seem to put their trust in me and I'm able to help them through the labor/delivery process. This mother was a challenge. Normally a mild mannered, shy girl according to her father, labor brought out "the worst" in her (her parents words, not mine). Yes, labor will do that. I'm used to that: cursing, yelling, screaming, grabbing, flailing arms and legs (I draw the line at kicking, hitting and biting, and yes, someone has tried to bite me, and one patient tried to kick me when I was 28 weeks pregnant with Isaiah because I wouldn't "Give her a c-section") She cursed, moaned, waved her support people off with her hands and was just downright hateful to everyone. Her mother was in tears by the end of the night from the stress and abuse she received at the hands of her daughter. The hard part was trying to figure out just what she wanted. She didn't want me in the room supporting her. She would shoo her support people out of the room then yell at them for leaving. She didn't want anyone talking, touching her, rubbing her back, etc. But she was on the call light all the time and in between, her friends were out at the desk, saying that she needed me NOW. No problem, that's what I'm there for. But after awhile, it became a bit tiresome. She rolled her eyes at every single suggestion I made to help her become more comfortable. She didn't want any pain, but didn't want an epidural. I gave her pain medication, but that only goes so far and after awhile, doesn't do a whole heck of a lot. And it was her friends that seemed to have the hardest time with the contractions. At one point, one of them made a trip (one of many) to the desk and asked with a very degrading tone if the patient could have pain medicine yet. So I go in the room and talk with the patient, who tells me she didn't want any pain medicine right now. The only thing I did that she seemed to like was give her warm packs and ice packs. Now these packs I had to make myself. For the warm packs, I would get a chux (disposable, absorbant, water-proof liner) put a towel in the middle, pour hot water from the coffee pot on the towel, wrap the chux pad around it, tape it and place it in a cloth girdle and taped the ends closed, so it wouldn't be too hot against her skin. For the ice packs, I double bagged crushed ice, placed two bags in a cloth girdle and taped the ends together. She liked those. Only problem - they won't last 12 hours. So I made them multiple times and she became angry when they weren't hot/cold. I explained to her and her friends that it would take a couple minutes for me to make them. Did that stop her friends from coming to the desk, giving me dirty looks, demanding to know what took me so long? No. I finally put them together in her room so her friends could see the process. I was in and out of that room only God knows how many times. I don't mind being busy, I like supporting women in labor, and I have spent an entire 12 hour shift in a room with the patient while she labored, but nothing I did seemed to be what this mom wanted. I am very patient and understanding, but I can only take so much abuse. I was frazzled and exhausted by the time change of shift came. In the end, I hope I gave her the support she wanted and needed. I did my best. Hope it was good enough.

A whole lot of nothin' goin' on

I've noticed a lack in my posts about labor and delivery. It's nothing intentional, I've just been a little preoccupied with the little one growing in my uterus. Another reason is we haven't been as busy as we used to be. Some of it I'm sure is the economy. People aren't having babies right now because they are unemployed or the job outlook isn't like it used to be. A lot of it I think is politics. There have been a lot of changes that have taken place since last fall and I think our patient census is down because of all the politics. But, we are starting to get into the busy season - we always have had a boom of babies starting the end of May through September. Hopefully that will be the case this year as well. Sure, I've had my share of patients but lately, I have spent most weekends as charge nurse, so I don't have a patient load. I've had an induction or prepped a scheduled c/s here or there, but really, that's the extent of it. I'm having birth withdrawal syndrome!

Pregnancy-wise, this little one wants to make sure I don't forget it's in there growing. I feel pretty good most of the time, still tired. I was ready for bed last night at 7:30. I did get quite a bit done yesterday. Got Jacob off to school, washed and folded 4 loads of laundry (which are still sitting in the baskets, but they're folded and clean), got groceries with all 3 kids in tow, and had to buy Jacob baseball pants, socks and cleats. In between all of that, I had my 3rd migraine this pregnancy. Yep, they're back. They started when I was pregnant with Isaiah, and really, I don't get a bad headache, just an annoying ache that doesn't last but a couple hours. It's the aura that drives me completely crazy. I know it's all hormone related, but it's obnoxious. I very rarely have them outside of pregnancy. Hopefully, they'll follow the same pattern as they did with Isaiah - several in the first 20 weeks, then they were less frequent after that, with a couple here and there in the first few months post-partum. On a much more positive note, I think I might have felt that first movement, or quickening. It seems a bit on the early side, but it felt like two little pops in my lower abdomen that felt just a bit different than the gas that moves it's way around. I can't be completely sure though. I felt the other kids at 16 weeks, so I'm fairly close to that. Fifteen weeks just seems early, but then again, this is my 4th baby, I'm relatively thin, and I remember what that first little flutter feels like. Soon enough, I'm sure he/she will be jabbing my insides and dancing on my bladder. We're still debating names...don't have anything for a boy and just a couple for a girl. If this is a boy, we're in trouble - we'll really have to buckle down and come up with something. And it could be that we are getting ready to be discharged home with the baby before we have decided on something!

Inernational Doula Month

Who doesn't like to win jewelry? I'm a big sucker when it comes to jewelry.



This is International Doula Month and Nicole over at Bellies and Babies has a post on her blog about a jewelry giveaway in honor of this month. The jewelry is woman-inspired and really is very beautiful. I especially like the "Blooming belly" piece.



Go on over and check it out!