Ok, I did try to keep this to a short story, but it kinda turned into a novel...
The weekend before Caleb was born was a busy weekend. Clara's birthday was Friday. I had scheduled myself to work Friday night and Sunday night so I'd be off and available for Saturday. It was busy as all heck Friday night - I was in charge and had a full patient load! Then I went home and slept for a few hours before family came to town and we went to a huge apple orchard/pumpkin patch for the day for Clara's bday. They have a TON of stuff for kids there. But I didn't get a lot of sleep. Sunday 9/19 I went to work as usual. I had been a bit uncomfortable all day...had what I called butt cramps and I was just plain uncomfortable. I'd never had that discomfort before, but I figured it was probably just the baby's position, sitting on a nerve or something. And, really, I'd been uncomfortable all pregnancy and so far nothing changed my cervix. So I go on about work and at one point a couple of the other nurses and I thought we'd mess with the nursery nurse that was working. One of them went to the nursery and told her "Mary, get ready for a c/s. Nurse Lochia's water broke and she's only 34 weeks!" Yeah, yeah, we nurses have a sick sense of humor, but it was all in good fun! We all had a good laugh. Little did I know what was in store 24 hours later. Anyway, I push with this patient for 3 hours and she finally delivers. I had started getting really uncomfortable, not with clear cut contractions, but my back was killing me, I felt like I could faint and vomit, and my uterus was just sooo tight, it actually felt like it could pop. I told the charge nurse after the baby delivered, that I was not feeling well at all and needed to rest for a bit after it was all said and done. So delivery done, patient taken care of, and I run to the bathroom to vomit. I also took a brethine, hoping that would help with the tightness in my uterus. I felt a bit better after vomiting, but I notice I'm passing pink mucus. I sat down with a huge glass of water, ate my sandwich and finished my charting, but still wasn't feeling good at all. Finally, after much debate, we decided I needed to clock out and become a patient around 4am. I was contracting pretty frequently, cervix was 2cm, soft, but thick, but it was easy to reach. I really thought a few shots of terbutaline would do the trick. So I called Husband, told him I was a patient, that I'd gt a couple doses of terb and probably go home and probably wouldn't be working that night. Two shots in, I'm still contracting, and my pulse is 130 so they have to hold the 3rd dose. By now, it's 7am and my doc comes to see me. She said that when my pulse slows, I'd get that 3rd dose. If that didn't work, then she'd give me a dose of procardia to see if that helped. If that didn't work, then she'd have to start me on Magnesium Sulfate since I was only 34 weeks. I know some hospitals go ahead and let you deliver at 34 weeks, but in this area, we stop labor at that point. I knew from experience as a L&D nurse that if 2 doses of terb didn't slow the contractions, then the 3rd wouldn't and the procardia probably wouldn't either. Got the third dose and no change in contractions. I get the procardia and you guessed it, no change. By now my pulse was 150 and I felt like complete crap. At this point, I know what's coming: Mag. My IV is started and they draw labs, do a GBS culture and I get a 6g bolus of Magnesium sulfate and then the maintenance rate is 2g an hour. Can I just say Mag sucks. I tell patients that all the time when I start Mag but until you experience it, you just can't understand. It feels like fire in your veins, in makes you nauseated, and hot. I did ok with the bolus, though. Finally, the contractions start spacing out. I begged to not have the foley catheter...doc said fine but I had to use the bedpan and was not allowed anything to eat or drink...just in case. After about an hour on 2mg of mag, the contractions pick up again so I had to have the catheter put in to keep my bladder empty. I'm a baby and I hate catheters. They ended up bumping the mag to 2.5g/hour then to 3 g/hour. At 3g and hour, I felt like crap...again. Double vision, felt weak, and out of it. Finally, they slowed again, cervix still unchanged, thankfully. When they increased the Mag to 3 g, I started to have a bit of a melt down. I started worrying about the baby - I see 34 weekers born all the time and they almost always have problems. yeah, in the long run, they do fine, but initially, they have problems breathing, sometimes need to be ventilated and given surfactant, which my hospital doesn't do, they get transferred to another hospital with a big NICU. They also have problems with their blood sugar, keeping their temp up, weight, etc. Plus my daughter was 36 weeks and had respiratory issues, so I started freaking out. I called DH and he came to the hospital...I texted my sister, my due date buddy in my due date club I'm in, and talked with my coworkers, trying to calm my nerves. The kids pediatrician even came by when she saw my name on the board and that was nice...she could make a dead person feel better she's so soothing and reassuring. They were all reassuring, but I don't remember the babies that do well...I remember the ones who don't do well. Finally, after my "moment" I got myself together and I knew really needed to turn the labor nurse part of me off. Doc ordered a cocktail of meds that will help with pain/nausea/and will make people sleepy, Nubaine and Phenergan, since I had been up since Sunday a.m and it is now Monday at 3pm she wanted me to sleep. I didn't want this cocktail because I didn't' want to be anymore out of it than I already was on the Mag. I was seeing double and couldn't think straight. That combo of Nubain and Phenergan did not help at all with my mental clarity. From about 2:30pm on, I was out of it. It was like I was in a daze...not able to really sleep, but I couldn't keep my eyes open, couldn't focus to even form questions that made sense, couldn't hit the numbers on my phone. Around I think 4pm, my doc came to see me again...this time I felt like she really didn't think I needed to be there, kept saying "It's your 4th baby, your cervix hasn't changed, you were contracting every 2 minutes at your last appointment and you're probably just someone who contracts. When they hurt, then we are concerned. I'm not going to rush you back for a c/s unless your cervix changes". This pissed me off. Ok, first I was uncomfortable, and that was why I was admitted. Second, I know I contract all the time and when they didn't hurt, I didn't worry about it. Third, the very LAST thing I wanted to be was delivered. I'd been just fine with carrying until the end of October, I don't care how uncomfortable I was. I don't know if it was because I wasn't quite with it, but my coworker taking care of me told me she was just trying to reassure me that she didn't think I would have to be delivered. So I tried to relax. I sent Husband home to take care of the kids and said I'd call if anything happened. The rest of the evening was uneventful. I was in and out of poor sleep, and around 1am, my coworker came to give me another round of the Nubain/Phenergan and the ampicillin I had been getting every 4 hours. My WBC count was 15 - we see an increase in WBC when women come in in labor, or if there is an infection of course. Fifteen minutes later, I notice my underwear was wet. "Ok", I thought "maybe it was the KY Jelly oozing out from the cervical checks, or maybe the catheter was leaking". I took my underwear off, it was covered in mucus, but I had been losing mucus all day. Over the next hour, I finally realized that it was probably amniotic fluid I kept feeling and the pad under me was wet. I considered not saying anything right away...I had just been doped up with drugs, I wanted to sleep and the last thing I wanted was to be drugged out when my baby was born. Plus, I worried about how he would come out b/c of the drugs, but reason won over and I called my nurse. Sure enough, it was amniotic fluid, not that either one of us had any doubts. So I called my DH...and he didn't answer. "Ok", I figured maybe he was in the bathroom. I called 7 times and he didn't answer and I was furious! How could he not have his phone next to him! I had called my mom and she was on her way, but she is 1 hour drive away. My charge nurse actually called another coworker of ours who lives a block from me...she was still awake and she walked to my house to wake DH. About the time she knocked on the door, I got a hold of him- he had been trying to get Isaiah back to sleep. In the mean time, my RN called my doc, told her my water broke and that I wouldn't be going back to the OR until DH was there. My doc, (this ticks me off), wanted to make sure it was documented that I was "refusing" to go to the OR until my husband was there. Baby was fine, I was fine, so I don't know what her problem was. I think it was just the middle of the night thing - she had said half-jokingly earlier that she didn't want to see me at 2-3 in the a.m., and this phone call was at 2:30. It still irritates me, but whatever. Husband gets there very quickly, they also called in my pediatrician (who wasn't on call) and the favorite anesthesiologist (also wasn't on call) and they came in for me. It was really, really nice that they came in for me! I had no idea how weak I was from the mag, but I couldn't even stand up to get myself into the wheelchair. That was an odd feeling, not being able to hold my own weight up. So they help me into the chair, and off we went to the OR. I've been through a c/s before and I've seen hundreds, but when it's me, I'm still scared to death when it's me. I get prepped, draped and again, they ask if I want to go through with the tubal ligation or wait until later. I wanted it done then. At 3:47 a.m little Caleb Dean was born with a hearty cry before his body was even delivered! He did great, as I have bragged already! His apgars were 9 and 9, and he was 6lbs 1 oz, 18 1/4 in long. He was beautiful and looked just like my firstborn - full head of dark hair too! I got to cuddle him a bit before they took him to the nursery for a complete evaluation. He checked out great in the nursery, never needed oxygen. He just didn't seem to realize he was preterm! I finally got to hold him in recovery and he looked like he might nurse so I figured we'd try. I didn't have much hope he would because 1. it's hard to breastfeed on the recovery cart and 2. he was early and they don't always know how to suck. I laid him on my chest and he latched right on. I was amazed! I was laying down, and here is my little 34 weeker nursing better than my other kids did! The rest of our stay was uneventful - he still nurses like a champ, his temps were always good, his weight was fairly stable and although he was a bit jaundiced, he is fine now. He came home on time! with a biliblanket to help bring his bilirubin down, but the next day it was down enough we didn't need it anymore!
I recovered well. The duramorph they put in the spinal for pain control (a form of morphine) always made me itch like a madwoman, so they only gave me half a dose. I still ended up itching myself into a rash. I ended up with a narcan drip to reverse the effect of the duramorph - that also took away the pain control and I then was in quite a bit of pain, but some toradol and fentanyl did the trick. The pain was good and the itching was gone. I don't think the anesthesiologist believed my itching was as bad as they had said until he saw me in the hall - then he went to town trying to figure out what to do for me and we tried to decide if it was the duramorph that I had an allergy to. He suggested I list morphine as an allergy and also that I might have a latex allergy. Gloves don't bother me, but he thought maybe with exposure internally, it would cause the systemic reaction I had. But anyway, life was good. Caleb got to stay with me, never had to be in the nursery - I did let him go at night between a couple feedings b/c some of the girls wanted to get their hands on him...we love to cuddle with babies, especially babies of "one of our own". When I saw my coworkers I worked with Sunday night...you know, the one's who were in on the little joke about my water breaking...we had a little laugh. They said when they heard they felt guilty. We nurses are superstitious...but we also know it was just irony at work, but we all agreed - no more jokes like that on the nursery nurses!
Part of me is a little frustrated with my physician...looking back over the last several weeks, I had contractions that weren't painful, but were there. And I realize that hindsite is 20/20 and at the time, things seemed to be under control. She did multiple fFN tests and when one came back positive, she took the approach that b/c my cervix was still thick, I wasn't at too great a risk. She never changed anything. Never gave me steroids, no bedrest, etc. She did give me brethine to take as needed, but several of my coworkers expressed concern that she wasn't taking me seriously. Even when I was admitted and started on Magnesium, I felt she didn't think I really needed to be there. I didn't want to be off work if it wasn't necessary...I didn't want meds if it wasn't necessary, etc., but I also wanted to be smart about the whole thing and if she felt I needed intervention and medication, then I wanted to do whatever needed to be done to keep him in until term. I trusted that because my cervix wasn't changing, and that my doc didn't think it would change, that it was safe if I kept on going, I was just one of those women who "just contract and their cervix never changes". I was ok with that. I looked to her for guidance as my doctor - I trusted her judgement out of all the docs I work with and maybe in the end it wouldn't have mattered regardless of what we did...Caleb was tired of being stressed and I think he took his little finger and just went "pop" and broke the membranes. I perhaps should have listened closer to what my body and my "mother's intuition" was telling me. I told a few of my coworkers when I was about 20 weeks that I had a bad feeling I wouldn't make it to term. A mother always knows. He did fine, but most don't do that well. I brag how well he did after delivery, but the reality is that my uterus wasn't a calm happy place for him - the stress of being in utero probably made him mature faster. It's easy now to look back and wonder if maybe something should have been done differently - I'm not really a big complainer and I don't advocate for myself very well, so maybe I should have been more vocal about how I was feeling, or maybe my doc and myself shouldn't have been so laid back about the whole thing, but oh well, it worked out in the end. There were several prayers said for this little boy and I believe that is partly why he did so well...I am a firm believer in that.
I had my whole delivery planned: I had hoped for 10/22 to have a scheduled 7:15 c/s. My nurse friend S would circulate, the baby wouldn't leave the OR and I would get to hold him as I'm wheeled out of the OR. I wanted to avoid working most of a shift and then being admitted b/c I would go into delivery with lack of sleep. S was off after carpal tunnel surgery but had planned on being back in 2 weeks. I was admitted after a weekend I worked Friday night/Sunday night - and those weekends wear me out because I get very little sleep, plus we had a busy weekend with my daughters bday. I never wanted to experience mag or another preterm delivery. It just goes to show you just can't control delivery - and even though it was full of things I didn't want, all I really wanted in the end was a healthy baby, and that's what I got. I have a beautiful, healthy new son that we are thrilled to have, and his older siblings adore! I couldn't ask for more! Plus, now I can empathize even more with my patients: I've had a nice normal vaginal delivery, an emergency c/s with a preterm 36 week baby who spent a day in the special care nursery, a nice scheduled term c/s, an incomplete miscarriage and D&C, and now a preterm 34 week delivery after trying to stop labor with terb, procardia and Magnesium Sulfate...so I'll be a better nurse for it!
September 25, 2010
September 24, 2010
Sorry for the long time between posts but we've been pretty busy! Last Sunday night/Monday a.m., I had to clock out at work and be admitted for preterm labor. They tried to stop contractions first with terbutaline, then with procardia and then I was finally on Magnesium Sulfate. After being on strict bedrest, npo and Magnesium contractions slowed to where I only had 4-8 in an hour...on 3grams of magnesium. But my cervix stayed the same. Around 1:15 am Tuesday a.m., I noticed fluid leaking and hoped it was just the KY jelly from cervical checks...but at 2:00 am. I knew that my water had broke. At 3:47 am Tuesday September 21, 2010, Caleb Dean entered the world by c/s. He was 34 5/7 weeks gestation, weighed 6lbs 1oz and was 18 1/4 inches long. He has done Fabulous! Never had any respiratory issues, breastfed better than most full term babies, has kept his temperature up and his weight. He is a bit jaundiced but we are at home with home phototherapy for a couple days. He didn't even have to stay any extra days! So I'll update with a full birth story soon...right now I'm going to go cuddle with my four children!
September 15, 2010
...your toilet basically explodes all over the bathroom. Yep, that's how my day started out. It all started when I went upstairs to vomit. Yes, I still average a vomit episode about once a day. It really comes up out of no where. I'll feel just fine, eat a meal and then 1-2 hours later, I'm running (i.e. waddling) to the toilet. That's what happened this a.m. I figured after I emptied my stomach of my entire breakfast that I'd turn on cartoons for Isaiah and I'd take my shower. He'll sit and watch tv for 20 minutes and I can get ready for the day. Since we live in an old house and have old house plumbing, I didn't flush the toilet right away because I didn't want scalding hot water for my shower, and it takes forever for the temperature to go back to normal. I jump in the shower, it felt great and then I get out feeling refreshed after a long night of tossing and turning. I then flush the toilet. Here's where it got really ugly. I guess I hadn't noticed the water level wasn't where it normally is because, well, I was in a hurry to just get there in time. It started rising and I realized it was clogged. Usually the water level will fill just to the brim or maybe go over just a little. But that wasn't what happened. It just kept coming and coming. Not only did it cover my entire bathroom floor with water and vomit, it was apparently clogged with feces and toilet paper, so that was all over the floor. So there I am, standing stark naked, 34 weeks pregnant, on the verge of panic because the nasty water just keeps coming. I didn't know what else to do so I piled my bath towels on the floor to soak up the water. Then I ran out of the bathroom, trying not to cry. Didn't work. The smell was awful. I then had to figure out how I was going to clean it up. Ok, so I've had every bodily fluid on me: blood, urine, feces, vomit, sputum, amniotic fluid, breast milk, you name it, I've worn it. But this was more than I could handle. After a few hours I finally got up the stomach to clean it up. I wanted to wait until Husband got home, but it would have been hours before he got home and this wasn't just a case of a messy bathroom, it was unsanitary. I also considered calling a maid service, but I quickly realized I couldn't do that and they probably wouldn't clean up a mess like that anyway. So it was up to me. I had to throw some of my towels away because they had chunks of stuff on them and I just couldn't deal with that. Then I used bleach cleaner and went to town. My bathroom is now nice and clean and sanitary. I had planned on cleaning my bathroom today, but I hadn't planned on a mess like that. Hopefully tomorrow will be better, with no exploding toilets.
September 8, 2010
A few months ago, at the beginning of this pregnancy, work was pretty darn slow, but wouldn't you know it, now that I'm getting large and having a hard time getting through my shifts, it has been pretty darn busy. Add to that I've been charge nurse the last several shifts I've worked, which I just absolutely love. Sense any sarcasm there? I've done it long enough I'm comfortable with the pain in the arse-ness that comes along with being charge nurse - I just would rather take care of patients and not deal with all the BS that comes along with it. One pain is figuring out staffing for the next shift. With the skill mix, a "flex list" and flex dates, it gets more complicated than it is for other floors. We have to have the right skill mix: nursery nurses, labor nurses, techs, secs, etc. and throw in there trying to see into the future as to what is going to come in during the day. I have to look at the number of patients we have currently, their acuity, and what is scheduled to come in, and then either try to find more nurses to work if they are short, or put nurses "on call" if it isn't busy. The hospital is really pushing keeping our staff ratios within budget so there is a lot of pressure to decide staffing based on what you have right then, not what could come in. But that can bite you in the butt if you aren't careful. So any "extra" nurses I always put "on call" instead of flexing completely off. That way they are available should a bunch of patient come in. Decisions and phone calls have to be made at 5:00am. But that leaves 2 hours where anything can and will happen. Like the other night. I made staffing decisions at 5:00. We had one momma who would be delivering - her doc was in the room, she was pushing and was very close - or so I was told. Well, about 6a.m. she's still not delivered - and ends up with an emergency c/s when baby decided he'd had enough of this labor business and wasn't going to come out vaginally. Then another patient comes through the door at 6:30, repeat c/s X 4 in labor and as she's being wheeled up, another pregnant momma had followed, with ruptured membranes. Plus we had 2 c/s already scheduled that would obviously be bumped. The first c/s didn't screw with the staffing for days much, or the patient with ruptured membranes, but a repeat c/s is a one-on-one nurse load for awhile and would require another nurse. No biggie in my head - pull one of the labor nurses off of postpartum, and call in one of the people on-call. But no, the day shift charge nurse threw a fit because I had put a labor nurse on call. With what we had at 5am, if I had left that other nurse on, she'd have been upset that I left them so overstaffed. It's a lose-lose situation sometimes and right now, honestly, I don't have the patience for it. I'm tired, uncomfortable, moral is very low on the unit right now and I'm burned out. I need a vacation and being charge isn't helping with the burn out. I know that is a a bunch of garbly-goo and maybe doesn't' make any sense, but trust me, it's irritating. Especially when I'd rather be the nurse taking care of the patient in labor or going back for the c/s, instead of being in charge and making the phone calls to get everyone there. And I'm scheduled to be charge on several more shifts over the next few weeks. Ugh. Oh well. Seven more weeks, well, more like 6 more weeks until I deliver then I'll have a nice break from work.
September 3, 2010
It's been pretty busy around here lately. We're trying to get everything set and ready for baby boy's arrival. Yeah, yeah, I'm only 32 weeks, but these last weeks are going to just fly by and before I know it, I'll be holding this sweet little baby that is kicking me in the bladder at the moment! This past weekend I realized that perhaps I need to slow down even a bit more. I worked 3 twelve hour shifts in a row. It seemed like a good idea at the time. I always work 2 12's on Sat and Sun, and then an 8 hour on Monday. Work called Monday and asked if I would take call from 7p-11p. Sure, I said. I figured "hey, I work anyway, what's 4 more hours". Of course, they called me in at 6:30 so I worked a full 12 hours...and boy was I hurting Tuesday morning. My ankles looked like someone wrapped them in marshmallows, my back hurt, my uterus was pissed as all hell, I was tired and looked like someone beat me. Looking back, that extra 4 hours wasn't a smart decision. So no more of that for me! What made it worse was Tuesday am, Jacob had a doc appointment, so I couldn't go home and go right to bed. I got home at about 9:30, in bed at 9:45 but had to get up at 1:30 for my Doc appointment at 2:45. So not much sleep. BP was up 30 points, 6lb weight gain in 2 weeks (ouch) ankles were still swollen, but everything looks pretty good now. I've been taking it as easy as I can with 3 kids and I can now see my ankle bones a little. Other than that, I'm feeling ok. Baby boy is moving all over, measuring right on track and my cervix is still nice and thick.
Other than that, we're keeping busy at home and work. Seems like there are pregnant women due this fall everywhere! Good for business and job security. Jacob is in the middle of flag football so we have practices and games to go to. We also had Isaiah evaluated for his speech. He understands everything we say, he just doesn't talk much. After his evaluation, they said he's fine developmentally, except in expressive speech. With that, he's at an 18 month level and he's 2.5 yrs. So we will be starting speech therapy once a week here soon. One good thing is those sessions will be here at our house, but they also recommend that any kid in speech therapy go to group speech once a week. That will be on Monday a.m. and we have to take him to that. So we're going to be running constantly...right about the time we bring a newborn home. Oh well, that's what happens with kids. I wouldn't have the luxury of just staying home anyway, with all the kids activities. I plan on getting a wrap or sling to carry baby boy around in, so I can at least have my hands free, plus I figure that will be easier than pushing a stroller. We're busy, but we're hanging in there. It will most definitely make these last 8 weeks fly by!