Something oh, so fun and new

Last night, Jacob had his last get together with the baseball team. They had a pizza party and a game of kickball: parents vs kids. I decided I was going to play. OK, so as a kid, I was HORRIBLE at kickball. I could do other sports fine, but I'm just not that coordinated kicking a ball with my feet. But I wanted to play and not sit out. It was fun, but you can only imagine my pregnant butt out there, trying to kick the ball, running the bases. I'm sure it was quite entertaining. One bad thing was my two pairs of black running shorts I planned on wearing were wet in the washer and I knew I need shorts. I haven't bought a pair of real shorts, like jean shorts for years. I pulled out a pair of shorts that I can barely get buttoned not pregnant and put them on, and the buttons were about 1-1.5 inches away from my hips...but that didn't stop me from wearing them. I put on a bella band and went. It actually was comfortable and didn't look bad. So after the game we had pizza, and my stomach just can't handle some foods right now, like pizza. As I was eating it, it was very good but I knew it would be making a reappearance within the hour. Sure enough, we get home, get the kids bathed, and I had to run Jacob out in his towel so I could vomit. Here's the fun part: I vomited...and peed my pants. Yep, my poor pelvic floor has taken a beating and couldn't withstand that much pressure. Sure, at full term if I vomited that would happen, but I'm only freaking 23 weeks. It wasn't good. I hope that isn't a sign of what's to come even after delivery. I told Husband that it's hard to feel sexy when you know you just pissed you pants! Oh well, I can still sneeze without peeing, for now! And I guess it's a small price to pay for another baby, but I'll just have to be a bit more vigilant with those kegels.

My Birth Plan for Delivery #4

I'm not anti-birth plans. Quite the contrary, I think they are a wonderful way for someone to think about how they would like their birth to go. But, there are 2 key points to remember with any birth plan: 1. show your doctor/midwife. and 2. be flexible. In a perfect world, everyone would have the birth they dreamed of, down to every last detail. We all know that sometimes things happen that make that ideal birth unobtainable - prolapsed cord, abruption, too small pelvis, etc. I've seen some very detailed birth plans, some 4 and 5 pages long and invariably, something doesn't go as mom planned and they are unsatisfied with their birth.
It's also a running joke among nurses, at least in the area that I work, that we are more prone to disasters during our births - hemorrhage, prolapse cord, severe pre-eclampsia, etc. Obviously, there isn't probably any truth behind it, but it all goes back to us being superstitious. To ward off those evil vibes, I posted this when I was pregnant with Isaiah, and thought it was still appropriate with this pregnancy, plus I added a few things.

A Labor Nurse's birth plan:

1. I want lots and lots of Magnesium Sulfate.
2. I'd like to have an emergency c-section without anesthesia due to a uterine rupture at my old incision site. (yes, unfortunately, we have done c/s sans anesthesia, luckily not often)
3. If I dont get a emergency c/s and can VBAC, I'd like an episiotomy with a 4th degree extension, please.
3. I also would like to be tethered to the bed for the duration of labor with internal monitoring.
4. I desire lots and lots of cervical checks
5. I also would like my baby taken from me straight away for at least an hour so it interrupts with breastfeeding and bonding.
6. Only internal monitoring for me, baby!

Ok, all kidding aside, I do have a plan for this delivery. Because I know this will be a scheduled c/s this time, I have a few things that I want that will help make the experience the best it can be. If I do go into labor on my own, I get to the hospital and I'm 8cm, I won't be going to the OR - that would be pointless because it is likely that by the time they get everything set up and ready for the c/s, I'll be complete and ready to push. Especially if my water breaks. I may have to argue a bit, and I've jokingly threatened to break my own water with the amniohook (again, just kidding) to prevent going back while in transition. (Really, it was just to get a rise out of one of our new nurses...you should have seen the look on her face because she took me seriously! Ha Ha! Yes, I am evil) But, anyway, that's not likely to happen. So here's what I have planned for my c/s delivery:

1. I will NOT be given any sedative (versed) after the baby is out. Sometimes moms want this, because they don't want to think about being stitched back up and just want to relax. I know what they are doing, and don't care - I don't want to be doped up.

2. I'm still debating in the whole duramorph(astromorph) thing. I probably won't want it and will take a PCA pump instead, even though the pain control isn't as good. A side effect of that wonderful duramorph (really, it works well) is itching. I itched myself into a rash after Clara's delivery and the itching was 10 times worse with Isaiah. I ended up getting 2 doses of Narcan to reverse the effects as I was about to go mad from itching. It's that deep itch all over that you can't get to no matter how much or how hard you scratch. It was horrible. The pain control was nice, and I did have more pain after the narcan, but I'm afraid of how bad it could be this time. I was itching before I even left the OR with Isaiah, and itched for 2 days.

3. Tubal ligation for me,please. Yes, this is indeed the last baby for us. It is a little sad that this will be my last time pregnant, but there comes a time when you know you are done. We are done. There are times I wonder how in the world I'll handle 4 kids...I can't even fathom 5! So while they are in there, they might as well take those tubes and be done with it. No chance for mistakes, no waiting on a sperm count, and no chance for birth control failure.

4. My baby will not leave the OR (unless need be for health reasons). It is completely possible to do the initial assessment in the OR. The scale is right outside the OR door so they can get the weight. I'm fine with letting him go to the nursery later - I just want to hold him. I bawled like a baby and couldn't figure out why after Isaiah was born. All I can come up with is he had been taken to the nursery per routine until I was settled into recovery and I was the last to hold him. I'm not sure if it was that or not, or just my hormones and tendency to cry anyway. But my plan is to be wheeled out of that OR, barring any complications, holding my baby, skin to skin. Skin to skin may wait until I'm in recovery, but it will happen at some point. I wish we did this more routinely for all c/s patients. Not everyone would want this, but we are working on being more baby friendly. Now watch me be wretching so violently that this can't happen. Oh well, if all goes well, that's my plan, if not, then I'll hold him as soon as I can.

5. Then, once I'm ready to be moved to my post-partum room, then I'll let nursery have him to do his bath. Depending on what's going on in the unit, I may want him to have a Leboyer bath - they like that much more than the standard wipe down under the warmer. We'll see.

Again, I know that things don't always go as planned. I could end up hemorrhaging, feeling like complete crap or the baby may need extra care. But, if it goes anything like my last uncomplicated delivery with Isaiah, it could be a great experience. We'll see how it goes. I plan on talking to the pediatrician to make sure she's comfortable with it - I doubt she'll care. I have a few months before we're really even close to D-day.

Patience

In any line of nursing, you will have your good shifts, and bad shifts, awesome patients who you mesh well with, and then, well, there are those more challenging patients that really test your patience. I was once put through the ringer with probably the most frustrating, challenging patients I've even taken care of. She was pregnant, completely and totally wasted drunk, and in preterm labor. She kept begging me to help her because she was cold and thirsty. But she refused to wear clothes or a gown, kept throwing the blankets off of her and vomiting all over her bed. I can't tell you how many complete bed changes and bed baths I did the night she was in. I've never been threatened so many times with bodily harm (I was pregnant at the time, go figure, but I was never in any real danger, as she was VERY small), cursed at so many times, and just plain abused. Multiple times I had to convince her that she needed to keep her IV in, that she should vomit in the basin, and shouldn't get up and walk down the hall naked. I tried to get her to put a gown on to help keep her warm and she grabbed it, blew her nose on it and threw it at the tech helping me. She purposefully peed and defecated in her bed as I was getting ready to put in her foley catheter...all because I wouldn't give her water, not because she refused the catheter, that she was ok with. She was vomiting - we don't give people more stuff to put in their stomachs when they are vomiting. I developed a real respect for ER staff and psych nurses for having the patience to deal with drunks and people you can't reason with. There were several times I wanted to shake her shoulders and get her to listen...I could have reasoned better with my kids than her I think. It was very, very frustrating. The bad thing was is she was in preterm labor. She did agree to let me do things to stop her contractions. I wasn't ever able to pick up contractions because when she was awake, she never sat still, but oh, she would shriek when she had one. We gave terb, Mag Sulfate and eventually we had to transfer her out to a hospital for higher level of care in case she delivered. Because of inclement weather, she had to go by ambulance...which meant that I had to ride with her. I admitted her right at the start of my shift and arrived back from the transfer 5 minutes before my 12 hour shift ended. I have never been so exhausted mentally as I was that night. But I was able to maintain my cool, and somehow, she seemed to trust me. Well, trusted me more than anyone else. Other nurses came in multiple times during her tantrums and she threw things, hit a couple of them but she never hit me. Eventually, I told everyone else to leave and the patient and I came to an understanding. I'm not saying it ever went smoothly, but she did eventually cooperate with me, and she never actually hit, bit, vomited on me or kicked me like she threatened. I never found out whether or not she delivered preterm or not, but I never saw her again. I just hope she delivered a healthy baby and got the help she needed.

Why?

Working in OB, I've learned that there is one thing that I will never understand. It doesn't make sense to me that someone who cares nothing about their baby, will come in to the hospital, 32 weeks pregnant, completely drunk and high, and they go on to deliver a healthy baby. But at the same time, a perfectly deserving, loving couple can try for a long time, finally become pregnant with that little miracle, only to get the devastating news that it has a condition that isn't compatible with life. One mother does everything she should NOT do: drinking, drugs, horrible diet, etc. The other does everything she can to make sure she is giving her baby the best start: folic acid before conception, prenatal vitamins, excellent diet, etc. And who is it that suffers the loss? I guess I'm not meant to understand and I'm sure God knows what He's doing, but it's really hard to see down here. I know I've talked about this before, but this is one of the most difficult aspects of working in OB.
I joined a group of women who are all due in October. It's been fun to watch others grow and progress along with me. As you maybe guessed, one of the women received devastating news yesterday. I just pray she and her family finds the strength and comfort they need in the many tough days, weeks and months to come.

20 Weeks!

I've made it to the half-way point! I can't believe that in another 20 weeks, I'll be holding a new baby! I'm feeling pretty good. I'm feeling quite a bit of movement and Husband was able to feel the baby move for the first time last night. I swear this child likes to do acrobatics on my bladder. It is very reassuring to feel all the movement...although it's just light little kicks and punches now, in a few weeks they'll be much bigger. I had the anatomy US this a.m. and everything looked great! It's such a relief, especially for a paranoid pregnant mommy like me! Heart had four chambers, regular rhythm, 2 functioning kidneys, fluid levels good and the baby is measuring a few days ahead of my due date of 10-27, and more along the lines of the EDC my LMP would have given of 10-22. But there's no need to change the due date at this point. Plus it's a matter of a couple days, so I think it's better to keep it where it's at. Oh, and we were able to see what this little one is....

He was quite willing to show off his goods. The sono tech kept laughing, saying that it seemed he wanted to make sure we knew he was a boy! Even when she was getting profile shots, he was "presenting"! I hope that's not an indication of the future....a 2 year old running around after ripping a diaper off! We're pretty excited. Clara had hoped for a sister, but I think she'll see the benefit of not having a sister - no one taking her clothes, make-up, jewelry, etc. It would have been nice for her to have a sister, but Husband and I didn't care, we just want a healthy baby. We are going to have to sit down and try to come up with a name. We had a hard time coming up with Isaiah's name, so now we are really low on ideas. It has to go with the other kids names, so it's not like we can have some trendy, modern name either. I kind of like Samuel or Caleb, leaning toward Caleb, but Husband isn't sure yet. But he doesn't have any alternatives. The day I ran across Caleb, I called Dr. Sis and asked her to give me a suggestion, without telling her I thought Caleb would be alright, and her suggestion was Caleb. That's a sign to me! We have some time to think about it, and search through more names. Any suggestions would be great though!

8 Years

I can't believe that it's has been 8 years since I walked down the aisle and married my first love! Who would have ever guessed that in 8 years, we'd be where we are today: 3 wonderful children, and 20 weeks to go until our 4th child is born. I'll admit it hasn't always been easy, but I wouldn't change anything and would gladly do it all over again!

Passing Judgement

Being a mom is tough, even without other people looking at you, judging how good of a mother you are. We live in a small town, and our house is on a corner lot...we have a good sized yard, and one of the roads is a main drag in town. It's not a busy highway by any means, but it does get a fair amount of traffic. It does make me nervous...I still don't let Jacob play outside without supervision...call me paranoid. Anyway, there is a old widow 2 house down the road from us and she is one of those old women that always is giving her opinion on what you could do better, that you suck as a mother, that kind of thing. I really try to ignore her but it gets to me sometimes. I don't know if she looks at our yard, which needs a good trimming, we don't have nice landscaping, our house needs painted and we have a gravel parking lot that we are letting weeds take over part of in the hopes that eventually we can have grassm, and thinks we must not take care of our kids. To the contrary...our yard looks like crap because we spend time with our kids. Today I took the kids outside and I was actually trimming the bushes, (something I hope I don't have to do in a few years with 2 sons, possibly son #3 gestating) and Jacob was pulling Clara and Isaiah up and down the sidewalk in the wagon. They were actually behaving. I'm fine with them going down to this widow's driveway and then turning around. Which is what they were doing. I guess maybe she didn't see me and assumed that the horrible mother down the road wasn't watching her children, even though I was just in amongst the forest that lines our porch and could see them. I could run after them and they were within earshot should I need to get their attention. She felt it necessary to walk down the sidewalk with her hands on her hips to see where I was. I just smiled and waved once she realized I was indeed watching my children. It's not necessary for me to follow directly behind them at all times. She then turned around and walked back up to her porch. I swear, it drives me crazy. I know I'm not the only one she does that to, but damn, it's irritating. My kids aren't ever outside unsuperivsed, and like every other mother out there, I do the best I can. There will be times they get away from me, or do something I wish they wouldn't have, but ask any parent whose kids are grown and they'll tell you...it happens, there's not a whole lot you can do but do your best. Time must have clouded her memory of the days of many small children running around. I have half a mind to really give her something to talk about. I think next time she's outside, I'll put on a white tank top and let my belly hang out the bottom, cut off a pair of my jeans so my butt is hanging out the bottom and see if I have a thong I could put on and let the top poke out the waistband, yeah, and I'll leave the top unbuttoned, grab a wine glass, pour grape juice in it, and put an unlit cigarette in my mouth next time I take the kids outside. I'll go outside, holler at the kids, chug down the "wine" and see what she says. I bet she'd be speechless!