3 months

Little Caleb is 3 months old already! He is still a very happy, easy going baby that hates to be naked and taking baths. I do hope that he will eventually love his bath time, but for now, he screams every time. We've tried different things, using his baby bathtub, the sink, and I've even gotten in the bathtub myself and brought him with me, hoping that would help, but no. He still hates it. Caleb is sleeping through the night from time to time. Most nights, he falls asleep around 8:30 or 9:00 and will sleep until 3:30-4:30. He'll eat and go back to sleep. It's has been wonderful. He got his 3rd Synagis vaccine a couple days ago and he's up to 10lbs 11oz. It seems so small to me for a 3 month old, but he's growing and I have to remind myself that he started off much smaller than my other kids. He is so close to a full out belly laugh. He smiles that big toothless grin, coos and almost laughs. I can't wait until he finally lets it out! The older kids will get down and talk to him he is just fascinated with them.

As for me, I'm trying to get myself motivated (again) to start running. I had been doing ok for a few weeks, but then I got out of it again. It's just so hard to get out after Husband gets home, drive to the gym and run. I'm 8 lbs from my pre-pregnancy weight but I'm hoping to lose about 20 lbs. I can get into 2 pairs of my jeans, and I should really buy another pair, but in my mind that would be surrendering to those last 8 lbs. They'll come off eventually. I did finally break down a few weeks ago and made an appointment to see the Doc for post-partum depression. It was a very hard phone call/appointment to make. It all started right after delivery. I figured by 6 weeks, my hormones would even out and I'd be fine, but that's when I started feeling even worse. I was irritable. I would lose my temper over little things that I wouldn't have even noticed before. I'd hear myself screeching at the kids and wonder "Who is this woman?" Sleeping was difficult even though I was exhausted and all I wanted to do was lie in bed. That just isn't me. And the crying, oh, the crying all day everyday. I kept thinking "Why can't I handle this? I should be able to handle this". I kept blaming myself for things that went wrong and for Caleb's preterm delivery, even though the rational part of me knew I had no control over that...and then that made me just feel crazier that I could still feel guilty yet know I shouldn't. Then the anxiety started. That tightness in my chest and racing heartbeat and worrying that something was going to happen to Caleb was miserable. At night if he didn't wake up, I was constantly checking to make sure he was breathing. It was a very dark and lonely few weeks. Husband had been on me to call for several weeks and finally I decided that something was wrong and that I needed to be seen. So I go into the appointment and when Doc asked me what was going on, all I did was burst into tears. I realized afterwards that I didn't even tell her everything that was going on, but I think between the tears and the post-partum depression test I took (and failed) was enough. She gave me an antidepressant and I am starting to feel better. She wants me to take it for at least 6 months and then depending on how I feel, I can start to wean myself off of it. I never thought in a million years I would be taking a med for ppd, but it has made a difference: I'm able to sleep at night again, the anxiety is gone and even though I still have days I'm not feeling great, I know in a few more weeks I'll see more improvement (hopefully) because it takes several weeks to get the full benefit. I don't know why I waited as long as I did to go in because its not something you have control over and should never feel ashamed of. We'll see how the next few months go. Hopefully after 6 months my hormones/body will have regulated itself and I can stop taking this medication and still feel like Me.

Happy 3rd Birthday Isaiah!

Three years ago today, Isaiah Edward came into this world, ticked off as all heck, wailing for over an hour after birth (most babies are in a quiet alert stage the first hour, not my darling Isaiah, he cried constantly until I was able to get him on the breast). My only child born at term. He is still our little spit-fire, all boy, rough and tumble. He loves to tackle his big brother and sister and he can't wait until he's big enough to play football. But with as ornery as he is, he can be also be the sweetest little boy, giving his little brother his paci, or giving me a back rub or one of his great big bear hugs. He is starting to be better about sleeping at night. Most nights now he sleeps until 5am, but we do still have nights when he's up once or twice. He just isn't a good sleeper, but thats alright. Most mornings he'll crawl into bed with me and snuggle until we have to get up. Fine by Mommy! Happy Birthday Isaiah!

Isaiah and Caleb

Isaiah lifting weights. Don't worry, they were very light weights!

Love his expressions!

Empowering

There's nothing quite like an awesome birth to make you smile. Mom, Dad and Baby all doing well, mom labored like she wanted, got the delivery she so desired. It was very empowering, not only for the patient, but also for the nurse. I love being able to help a mom as she labors and delivers just as she wanted to, even if it was outside the "norm" for a hospital birth. It was just what this labor nurse needed. :)

Still

Yes, I'm still dwelling on Caleb's birth. I don't want to, but the feelings of guilt, anger, sadness, etc are still there. Surprises me a bit, I'll be honest. That whole day leading up to his birth, I knew deep down I needed to be there, as a patient, and that I wouldn't be leaving the hospital pregnant. Another part of me felt silly, since my cervix hadn't changed all day. Then I started feeling ignorant, that I didn't need to be there after I was told "You are just someone who's going to contract. I'm not rushing you back for a c/s unless you make significant change". It was said as if I wanted to be delivered. Which I did not. Not at 34 weeks anyway. Then there are feelings of guilt that I did too much. Since nothing had changed over the 10 weeks I contracted, I kept on going. Maybe pushing with a patient for 3 hours was too much that night. It may not have made any difference, and I know that. Obviously up until then, it didn't cause any problem. I know I didn't cause it. I also feel guilty that I felt vindicated when I kept right on contracting on Mag and especially when my water broke. It was like saying "See? I TOLD you there was something wrong". I know rationally it was probably just going to happen. But the emotional side still creeps up. Caleb is almost 12 weeks and I still cry everyday for no reason. I'm irritable, I'm tired but I don't sleep well. I'm finding it hard to get out and do things, like run, which we all know I really enjoy. I still run the kids all over God's Creation and I do go run when I can, etc because I know I need to. Whenever Caleb goes to the pediatrician for a check-up or his Synagis vaccine, I feel that I let him down because I couldn't stay pregnant. And I know it's all irrational. I think the return to work stirred it up again as I started to hear details of things that were said. I had tried to tell myself that I was just exhausted and not in a right state of mind and that my perception of how I was being perceived was skewed. But each night I've been back, I've heard more and more about it, about things that were said, the eye rolling and attitude. Apparently I had some nerve going and letting my water break in the middle of the night and it was incredulous that I would want Husband there for delivery...Caleb was never in any distress. Ever. I looked at the strip. Never did I think I was being unreasonable. I didn't want to be a pain in the butt. I did look over my record, something I've done with each birth, just because, I guess. I noticed the number of phone calls made to Doc. None of them were at my request. Ok, so I did make one request right after the Mag was started in the morning that I not have to have a catheter and be able to at least drink. But that was it. I hope she didn't think I requested the phone calls be made. I'm not like that. All I wanted to do that night was sleep. I try not to complain (although here I do...it's my outlet) and I try to not be a wimp. When I had my D&C and was in the process of actively miscarrying and in significant pain, when asked, I rated my pain at a 6 and tried to "buck up" and take it. My sister stepped in and made sure they knew I was in a lot of pain and that I try not to complain too much, as she knows me better that anyone, other than Husband. I also laugh when I'm nervous, to keep from crying. Most people know that about me. I hope my nervous laugh that morning wasn't seen as me taking things lightly. I wish my coworkers would stop telling me more about the provider side that night. I might tell them as much this weekend. I was much happier not knowing the details, as the patient. I do have to work with Doc every weekend. I've always worried about what people think about me. I hate that Doc saw me that way - another pain in the ass patient who got her up out of bed in the middle of the night and wanted to wait just a bit to be delivered by c-section until her husband was there. I honestly would have been fine that night waiting until 6 or 7am to be delivered as I hadn't started contracting anymore than I had been all day. I did talk to her at my 6 week appointment. Felt a bit better afterwards, especially about the lack of interventions up until that point. I wouldn't have wanted to be on bedrest, on brethine and off work from 24 weeks on. For 10 weeks, my cervix didn't change. Had I received steroids after the positive fFN, it wouldn't have made much difference because it was about 5 weeks later when he was born. And he was fine anyway. When things picked up and didn't stop with terbutaline or procardia, that's when she ordered the big guns. Had the Mag worked, I would have been on bedrest at the point on. So that part I'm feeling better about and I hope I was able to convey that I never meant to be difficult, that I didn't do anything to purposefully make myself contract and that I never hoped to be delivered at 34 weeks.

I wish I could have a do-over. I'd have Husband stay with me overnight at the hospital and have my mom at the house with the kids, just in case. Heck, I'd go back and stay home from work that night, and maybe, just maybe that would have made a difference. Or maybe not.

Never, ever underestimate how important a woman's labor/birth is and how much that will affect her days, weeks, months, even years down the road.

Chart Review

Documentation on labor flowsheet (nurse documentation):
SROM @2:10 am, clear fluid, nitrazine positive . FHR 155,
reactive. Contractions every 5-10 minutes, (no change from prior entries). Mag Sulfate rate 2.5mg/hr.
3:25 am entry: EFM discontinued, patient taken to OR suite #1. FHR 150, reactive, contractions every 5-10 minutes, no vaginal bleeding. Mag Sulfate dc/d.


History & Physical:
IUP (intrauterine pregnancy) at 34 5/7 weeks, preterm labor. Gravida 5, Para 3, Prior c/s X 2. No response to terbutaline or procardia. Magnesium Sulfate protocol initiated.
PROM @ 34.5 weeks.

Progress note entry @ 3:30 am
Patient refused to go to OR until spouse present.


Hmm, sounds kind of silly to me to document on the patients chart that refusal. The patient is stable, baby is stable, doesn't appear anything changed after the patient water broke, and it is documented as such. Doesn't sound like such an unreasonable request of a patient in L&D to have her spouse present when she is delivered, since the baby was fine and there were no signs of uterine rupture. Especially since the time of SROM was only 1.5 hours prior to the time the patient was taken back for a c-section. I'm sure the patient would have consented to immediate surgery without her spouse should it have been necessary. I understand the need to document our backsides, but really? I've not seen this documented unless there was an issue that the baby wasn't tolerating labor or there were signs of a problem. Doesn't seem too necessary in this case.

This patient was very tearful, worried about a preterm delivery, hadn't wanted to deliver preterm. Not a case of tired of being pregnant. Not a patient who refused care just to refuse care. This was just a mom who wanted her husband there when their last child was delivered and really thought that her request to wait until her husband was present before going back for delivery wouldn't be a big deal. Her husband had been home, taking care of their other children and he was there in her room within about 1 hour. She would have consented to a c-section with no anesthesia, in the labor room, without her spouse, if it had been necessary.

I'm perfectly fine with that documentation on my chart. ;)

Hi-Ho, Hi-Ho, It's Back to Work I Go

I went back to work this past Sunday night, something I was dreading. I got used to being home with the kids and although I was going stir crazy being at home, I didn't want to go back to work. I'm not sure why but going back to work after maternity leave got harder with each kid. But, anyway, I went back to work Sunday night, only did an 8 hour shift, and had just a few tears as I left. Thank goodness it was a slow night. We actually had plenty of labor nurses (which is surprising) so I was only going to have 1 patient, the midnight induction. So I had about an hour to get ready, try to remember my passwords to everything. Thankfully, I was able to log into the 2 charting systems we use, one for the fetal monitor and the one for meds. But I couldn't log into my email or into the Omnicell, the machine that dispenses medications. And it wasn't because I forgot my password. Apparently they had disabled my user id and of course, being a Sunday night, no one was there to fix it. It was fabulous. The charge nurse was able to give me a temporary id and password so I could function, but it was a pain in the arse. It becomes almost mindless when you log into different things so when you have to change a password or, in my case, have some funky user id, it slows you down. As for my work email, the guy in IS who can usually fix anything with the computer couldn't figure out what the problem was with my email. So who knows when that will be fixed. Beyond the technical difficulties, the night wasn't too bad. The midnight induction was a no show, but I did admit one patient. Like I said, it was a slow night. I felt just "off" going through the millions of questions we ask when someone comes in. I had no problems with the assessment/hands on stuff, like the IV, cervical exam, reading the monitor, but it was more in my organization, my routine. It's a bit hard to explain, but I just felt like I had been gone for 10 weeks. Monday night was much better. I felt like I was back to my old self, well, maybe 95% back to normal. I think this weekend I'll feel "back".

Caleb did just fine with my return to work, sleeping through the night for the first time Sunday night and again on Monday. Lucky Husband. Of course last night, since Mommy was home, Caleb was up quite a bit. Figures, right? A friend of mine, who has 5 kids, calls it survival mode. They know Mom isn't there so they figure they might as well sleep.





On a completely different note, I want to take just a minute to remember my stillborn niece Mirabel. She would have been 7 years old today. My SIL and BIL have been actively trying to conceive for the past year without success. I finally talked her into making an appointment to see her physician. Today I pray they are able to conceive again soon. My thoughts are with them today as they remember...she may be gone, but not forgotten.