In need of more good reading

So I am a big fan of reading, and believe it or not, I manage to find time to read (usually while in the bath, a slow night at work or cutting into sleep time). I've been a big reader as far back as I can remember. Back in 5th grade, they did a short little blurb about me in the small town paper because I had read so many books during the school year. Rare is it that I find a book I don't like. Even if there are aspects I don't like about a book, I usually end up finding something I like about it. Just like the book review I did of "Your Best Birth". While I don't agree with every aspect of the book, I still found it to be an enjoyable read for the most part. One book in particular, called "Geek Love", was one of those books that was way, way beyond my idea of a good topic to read about, but I'm still glad I read the thing. It's no longer in print, but if you are looking for a most disturbing tale of circus freaks, this is your book. Most people would find this book disturbing. I won't get into the topic too much, but look it up if you're curious. I have a hard time not liking a book, but I'll admit this book took me longer to read than any other book. One of the OB's I work with recommended it, no less. Very disturbing, but oddly fascinating. Anyway, my usual supplier of good books is trying to finish the "Twilight" series and hasn't provided me with any new books to read. Dangnabit! Ha Ha! So, if anyone has read any good books, no matter the topic, let me know. I've been re-reading all the "Chicken Soup for the Soul" books I have, and I've read several midwifery books lately. One thing I treat myself to is a bath most nights of the week, and in order for it to be a "successful" bath, I have to have a book of some kind to read, and a glass of wine. Yeah, yeah, judge me if you want. I need time to myself, even if it's 30 minutes, and enjoying a glass (or 2) of wine is good for my sanity. So, let me know what you're reading these days.

Book Review: Your Best Birth

I have always enjoyed reading, and since I started working in OB, I have read numerous books about pregnancy, childbirth and midwives. Recently, I read Your Best Birth: Know All Your Options, Discover the Natural Choices and Take Back the Birth Experience by Ricki Lake and Abby Epstein. I love books that empower women and encourage them to take control over their births and this book does that. They encourage women to really think about what they would like for the birth of their baby. There are many choices for women when they deliver, like continuous vs intermittent monitoring, epidural or not, delivery at home, at a birth center or in the hospital. Women should know that they can and should question their doctor. Not every labor follows the same timetable and just because a baby is measuring "big" does not mean a vaginal delivery isn't an option. I remember one mom, pregnant with her 3 baby, scheduled for a primary c-section because the baby was "big" Now, she had delivered her first two vaginally with no problems. She ended up going into labor on her own and delivered her baby before the doctor had a chance to get there - and she didn't tear at all! She had said that she wondered why she needed a c-section but figured "doctor knows best". Childbirth has gotten further and further away from the natural event that it is and seems now it is more a medical problem that needs managed. The equipment designed for the high-risk pregnancy are now used routinely. There are personal stories where the moms talk about what they liked and wished they had done differently about their birth. Every aspect of childbirth and post-partum is covered in this book and I think this is an excellent resource for expectant women. Their suggestions will help to sort out all the different options so that each woman can decide what is right for them. They even have a list of questions to consider when coming up with a birth plan. When you do write a birth plan, it is imperative that you talk to your doctor about it. The tone of the book is like you are having a conversation with the authors and it is an enjoyable read. The personal stories add a nice touch and they also provide descriptions of alternative pain relief, such as hypnobirthing, and the Bradley method.

I must say, as a hospital trained L&D nurse and a mom who had an epidural and 2 c-sections, there were times I was a bit offended. The descriptions of a typical hospital experience was very cold and I would be a bit intimidated if I were reading about this as a first time mom who planned to deliver in a hospital. Most doctors and nurses really do have the best intentions at providing the mom with safe and compassionate care and want moms to have a great birth experience. The ultimate outcome is healthy mom/healthy baby. It is very biased toward medication free births and home birth and they are very up front about that, and they do recognize that that may not be for every woman. For the expectant mom, it is a great book for suggestions on how to prepare for your birth, but not medical advice. Overall, it was a very enjoyable and informative book for the expectant mama.

The paperwork side of nursing

Over the last couple months, it seems to me that the Hospital has doubled the amount of documentation and paperwork they require us to get from patients. We already document like crazy, especially in OB because there is such a high risk of litigation if something goes wrong. All of this in the name of good practice, informed consent and patient safety. That's all fine and dandy, but it's gotten a little out of hand. Right now, when a patient comes to us in labor, we have to have the patient sign 2 hospital consents (1 for mom, 1 for baby) 2 HIPPA forms (mom and baby), epidural consent if they desire one, a consent that states we offered the mother the option to donate cord blood although we haven't had collection kits to do so since 2004, consent for the baby's hep B vaccine, and the internet picture consent. As of Monday, we now have a new universal protocol that has been implemented for patient safety for invasive procedures, which includes 3 verifications of a procedure and a 3 page informed consent form. The idea is that the doctor explains the procedure, the risks, benefits, etc. to the patient in the office and then the doctor signs the form, attesting that they have obtained informed consent. That consent form is then supposed to be sent over to the hospital before the patient arrives for the procedure. We, the nurses, are then supposed to have the patient fill out the rest of the form on admission, where they write in what procedure they are having, whether or not they will allow the procedure to be photographed, have observers or sales reps present and that they will allow the hospital to dispose of bodily fluids and tissues. It's a HUGE pain in the ass. I understand the reasoning behind it, but it just hasn't been working. At all. We have to have patients sign these for c-sections, epidurals, pp tubals and inductions. Here's where it gets ugly - we have midnight inductions about every night except Friday and Saturday. We cannot start pitocin unless we have an informed consent signed by the doctor AHEAD OF TIME. Guess how many we've actually gotten ahead of time? None. So the docs are pissed because they aren't about to come in at midnight to do the consent, the patient's pissed because they are there at midnight and we can't do anything, and the nurse is pissed because we get the ass chewing from both the doc and patient. They decided that an induction is an invasive procedure because we are using a dangerous medication (if not used properly). But, we use pitocin after the placenta is delivered to help the uterus clamp down, and to augment labor if the labor has stalled and we don't have to get informed consent in those situations, even though we are using the same medication. None of this is going smoothly and it's a HUGE HUGE pain in the ass and very frustrating. There really has got to be a better way to ensure that the patient understands the procedure and that informed consent has been obtained.
In addition to this, we now have to start doing formal instrument/lap counts for vaginal deliveries. The techs have always done a count before and afterwards, but now we have to do one like we do for c-sections. And for c-sections, we have these nifty blue bags with 10 pockets that we can put the laps in to help with counting. They have now decided to do away with these, as the center divider can break and there is the potential that one lap could slide across 2 pockets and look like 2 laps, leading to an incorrect count. Seems logical, but now we have to figure out a way to lay out all those bloody laps some other way. We also have to turn in our count sheets. Really, I'm all for patient safety, and they've added these things to help with that. The only problem is there are already policies and procedures in place for that. People just have to follow them, and with the extra stuff they've added, there are just more places for things to break down and for errors to occur.
Oh, we also now have quarterly mandatory meetings for nurses hospital-wide, a new recorded reporting system called Optivox (which so far has been a pain in the butt), an 8 hour training session for the hospitals computer charting because of a huge upgrade (we only use that charting system for medications - we have a different one because of fetal monitoring but we still have to sit through the whole damn thing), training for the new OB hemorrhage rapid response team, which will add yearly competencies. All this in addition to monthly staff meetings, CPR and NRP renewal every 2 years, annual unit competencies, ACLS, and a number of committees that are busy trying to lay out workflow in the new unit. I am really starting to feel like most of my time is spent in meetings or documenting, instead of being at the bedside, taking care of patients. All of this extra stuff I know is suppose to be fore patient safety but it's taking time away from hands-on patient care. Sometimes I wonder what my grandmother would think about nursing today. She was trained as a nurse in the 1930's. She'd probably be appalled. Sigh. It's for the greater good. That's what I'll keep telling myself.

Action!

At the hospital where I work, the OB department is a couple floors up from the emergency room. After hours, women who are coming in to be seen in L&D come into the ER, where the triage nurse calls us, tells us who's here, her doc and her reason for the visit. We then send the scrub tech or secretary downstairs to bring her up by wheelchair. Most of the time, this gives us nurses time to pull her prenatal record and get the room ready for her. But every once in awhile, we either get a call from ER triage that they are bringing a patient up, which usually means the patient is "active" or the scrub tech calls on her way up to let us know to either get ready, or that we better meet her in the hall. You never know what you're getting into after those calls. They are few and far between but not too long ago, I got a call from the scrub tech. She politely said "Nurse Lochia, would you mind meeting me half-way?". That's my cue to grab the precip delivery kit (a basin for the placenta, bulb syringe, 2 clamps, scissors, and a baby blanket), and grab another nurse and we go dashing down the hallway. Before I go on, let me describe the woman who will get this kind of attention: Huffing and puffing, leaning to one side in the wheelchair, making those deep throaty moans that tell you 'hey, she's pushing'. And 90% of the time you either have a mom who hasn't delivered her baby yet only because she still has underwear on, or, she's 1cm dilated with a raging UTI. Seriously, there's usually no in between. So, back to my story. I get called to meet them in the hall and I actually know nothing about the patient coming up as I didn't take the call from ER triage, so I'm thinking "Crap! Is she term? Is she preterm? Will we make it? Is this real?" The last couple times I got "the call", we've gone running and when we checked mom, she was only 1cm. Usually though, if its the scrub tech instead of ER calling with a patient like this, it's more likely a hurry your butt down here, she's having a baby. So I grab the charge nurse who just happened to be the one in the hall at the time (and also a former NICU RN), and we take off running. Picture a slow motion, hurried, worried scene where 2 nurses are running in slow-mo, carrying a precip tray, something like you would see in some soap opera. Ha ha, just kidding. Anyway, we meet the scrub tech in the hall and as expected, mama has a sweaty upper lip, hair pulled back in a messy ponytail, leaning to her left side, Dad is carrying 2 pillows, a bag and a suitcase looking like he could yak at any moment, and we realize we're probably having a baby! We pull her out of the wheelchair and as we rip the pants off of her, out comes the baby's head and a second later, we have a screaming full-term infant hanging out in this mom's underwear that's only pulled half-way down! It turns out this mom had been in a couple days before, thinking she was in labor and sent home. She was so embarrassed at coming in too early, that she kept refusing to come in because she wanted to make sure she was really in labor. Finally, her husband decided they were going when she started making "funny grunting noises" and that's how she ended up with a delivery in the hallway in the middle of the night. Now that's a good story to tell your kid when they ask about their birth!!

Packed

This weekend I am off! Yaahoooo! I am taking the kids up to spend the weekend destroying my sisters apartment. The original plan was for Husband to come too, but his asst. manager left and he wasn't able to get the weekend off. It should be fun. The only part that sucks is the 4 hour car ride with 3 kids. I'm actually pulling Jacob out of school tomorrow so we can get up there at about 5:00. Today I'm running around, trying to get the laundry done and the house straightened up so I don't have to do it when I get back Sunday. In my fantasy, Husband will keep the house clean! Here's a list of the items needed for me and my 3 kids to go on a weekend trip.

I-pod, loaded with new songs for my enjoyment and also kid's Bible songs to keep them entertained
2 drinks with lids and some snacks for the kids
bottle of diet coke for mommy
2 air mattresses
2 comforters
2 blankets
4 pillows
Clara's blankies
Jacob's blanket
3 Isaiah blankets
Clara's purple baby and her baby's blankies
3 sippy cups
pack of diapers and wipes
2 pull-ups (just in case, even though Clara's been dry most nights!! Yeah!!)
2 sets of pj's X 3 kids
3 sets of clothes for Jacob, and Clara
5 sets of clothes for Isaiah
4 bibs
butt paste
baby lotion
baby soap
baby shampoo
barrettes, ponytail holders, brush
pack-n-play
stroller
high chair (our's is small and sits on a chair so is easily portable)
bag of big kid toys
a few of Isaiah's toys
2 leapsters to entertain the big kids for the 4 hour drive
and 2 grocery bags of kid food.

And that doesn't include my bag! Amazingly, all of that will fit into my van.

Rub-a-dub-dub

Recently, I had 2 moms use our labor tub and finally had my first tub birth. I've taken care of several women who have labored in the tub, but never delivered there. When I first started in OB, women weren't allowed to deliver in the tub, but one midwife started doing tub births and now I'm glad to say that all of the doctors are more open to this. We have a small room that houses our labor tub. There is really only room for a nurse, the doc/midwife and 1-2 support people. It is usually sniffling hot because the water is warm and again the room is small. I've found that most people either love tub deliveries or hate them. Nurses who love them like the solitude and cozy, quiet environment. Those who hate them don't like the idea of sitting in a tub with amniotic fluid, blood, mucus and feces floating around. All that happens in every delivery but it is localized in one place. We have a little scooper, basically its a net like you use in fish tanks to scoop out the poop and dispose of it. I will admit, that is one of the more interesting perks of the job. It just feels a bit odd to be fishing for turds. But I guess it doesn't bother me. One mama was a first time mom. All of her sisters, aunts and her mom all delivered very quickly without epidurals or pain medication. Once they hit 5 cm, they were delivered within an hour. A few little pushes and they delivered their baby. She thought she would be the same. She did great laboring. She walked the halls, moved around until she got to 4-5 cm then she wanted the tub. And she did go very quickly for a first time mom to fully dilated. This is where things didn't go as she planned. I don't think anyone really understands what it's like to have a baby's head trying to push it's way out of your body. I've heard it described like a hot bowling ball covered in spikes. I don't know from experience, but I can imagine that would be about right. But, she got on her hands and knees in the tub and started pushing. And pushing. And pushing. And she was very vocal. For 2 1/2 hours, she pushed. Anyway, she just wasn't budging the baby's head. Finally the midwife decided we needed to do something different. We were all afraid we would be heading back to the OR. So mom got out of the tub, and got an epidural. She kept apologizing to her family, like she had let them down. I kept reassuring her that she did a fabulous job and that she didn't have anything to apologize for. After she was comfortable, she started pushing again and this baby was just getting tired. The midwife had called her covering physician and I knew if she didn't' deliver before he got there, she would end up with a huge episiotomy and a vacuum delivery. And that's what happened. But, mom was happy she didn't end up with a c-section. I had really hoped things would go as she planned, but she was open to what needed to be done in order to have a healthy baby. She just kept wondering why she couldn't deliver as quickly as her family. One reason: they all had 6 lb babies. Her baby was over 9 lbs! All and all she was happy and said she'll try for that tub birth next time. As she was breastfeeding her baby, I overheard her ask her sister if she pooped much. Her sister said "not really, just a few little ones". And the patient said "Darn, I had hoped to go more". I have never heard anyone say that HOPED to poop! Apparently she'd been constipated for the entire pregnancy and had bowel issues all her life. So she hoped to finally have a massive BM while delivering!
Now my tub delivery was about as smooth as deliveries can go. She was a multip, and she came in at 4 cm, bag of water still intact. She entered the tub, and it really seemed like she was asleep the whole time. Her eyes were closed and she only moaned a little with each contractions. Then, she looked up and said I need to push and over 2 contractions, she delivered her baby. The midwife helped ease the baby out and towards mom and the mom reached down and really delivered the baby without much help from anyone else. It was a really nice delivery.

Voices

Heart and Desire: You know you want to, just admit it. Think how much fun it would be!

Logic and Reason: I'm not so sure, but you're probably right, another baby would be cute and cuddly, but there's no way. No way.

HD: I want another baby.

LR: No I don't.

HD: I don't believe you.

LR: Well, I should.

HD: But, I don't.

LR: How can I not believe me, we're are the same person.

HD: This is true, but I don't believe you.

LR: We sound crazy, arguing like this. I think that makes me crazy in some way. I'm not sure of the diagnosis. Maybe we should consult Dr. Sister, the psychiatrist to diagnose my issue.

HD: Yeah, I guess having conversations and arguing with myself is kind of crazy.

LR: Yep.

HD: But, now that we've established that we are completely nuts, lets get back to the argument...why not another baby.

LR: Well, for starters, just no, and kids are expensive and the older they get, the more expensive they will become.

HD: Well, I guess there is that.

LR: Plus, I can't get anything done now with 3 kids, let alone another baby. Can you imagine that chaos?!

HD: After you have 3 kids running around, what's a 4th going to do? I already can mulit-task like a mad woman, plus by the time another would come around, I'll have 2 kids off in school and Isaiah will be close to going too.

LR: Right, but there's the expense and managing everyone's schedule...all the field trips, parent-teacher conferences, school activities, etc. Yeah, let's throw in a newborn, and more sleepless nights, exclusive breastfeeding, etc again. I'm still not getting a full nights sleep now.

HD: But, Isaiah is doing much better lately. So yeah I'll be tired, but what else is new? Would I really know what to do with more than enough sleep? Plus, don't I just want to experience being pregnant one more time?

LR: Not really. I mean, well, maybe. The middle part is kinda cool. Feeling movement, seeing that positive pregnancy test, seeing the sonogram. But the morning sickness sucks, and I had preterm contractions this last time.

HD: But they never really caused a problem, remember? And isn't there no better moment in the world than meeting your baby at delivery?

LR: Yeah, that is pretty cool, but remember, I've had 2 c-sections...that means there isn't a chance at a VBAC. Yeah, yeah, I could push for a VBAC, quote all the stats about the unlikelihood of complications, but come on, this area is very VBAC unfriendly, and I'd be too nervous.

HD: It would be your second labor, so in theory, you could go too quickly to be sectioned. The c-section wasn't so bad. I know it sucked recovering and the pain, but do you really remember that now? And does it make any difference now that Isaiah wasn't a vaginal delivery?

LR: No, it doesn't matter, and you're right, I can't really remember how much it sucked after the c/s, but I know it did.

HD: So if I really didn't want another, wouldn't I feel done? Do I feel done? I don't really feel done. Wouldn't either Husband or I have been "fixed"?

LR: Well, yeah, I do sort of feel like another would be okay, in theory, but there's so much more than that. The idea is nice, but money is an issue. Room in the house is an issue. The kids each have their own room now, if I had another, someone would have to share a room. I am in an old house that requires constant upkeep and major fixes, and we can't keep up now. I've yet to get out into the yard and pick up sticks, weed the landscaping, etc. Oh, and there's only 1 1/2 baths! What if number 4 is a girl! That would be an issue with the number of bathrooms we have

HD: So what if the yard isn't perfect. And so what if they have to share a room? The house is big enough. Plus, I work weekends for great pay. Things are going great now. And by the time the kids are older, maybe you'll have the basement finished and a bathroom down there for the boys. And how long will we live here, really?

LR: That's a big maybe on the house renovations or moving. I don't want to make a big decision based on a list of maybes. Plus I don't want to work weekend nights forever.

HD: But what do I want to do? Do I want to work dayshift? Do I want to work another job?

LR: Well, no. For the most part, weekend nights are working pretty darn good. There are some kinks, but not as many as there would be if I worked a normal shift.

HD: I rest my point on that.

LR: I think I'm just being nostalgic because Isaiah is getting older and not so much of a baby anymore. I think I'm just a little sad to think there won't be anymore babies, that once he's done breastfeeding, I'll never breastfeed again.

HD: Maybe there is some nostalgia because Isaiah is getting older. Maybe some of that is desire for another baby. So just think about it. Another pregnancy, another baby, another toddler, another child. Plus, my kids are so smart and cute.

LR: Yeah, but every mother thinks their kids are the most awesome. And I've already have been blessed more than I deserve. Three happy, healthy kids. I feel trying again would be tempting fate. Haven't I been blessed enough? Wouldn't it be greedy wanting just one more? What if the next time, I actually have bad preterm labor and have to be off or deliver early?

HD: I can understand that. I have been blessed, but again, I have 3 great kids. Wouldn't one more just add to it?

LR: I don't know. I'm not sure the family would be so thrilled, just because they would worry about us. We did have a hell of a time Isaiah's first year, and it's still a bit of a struggle managing everything. It would just be more chaotic with another. Remember all the arguments and fighting Husband and I did? I don't want to go through that again.

HD: We worked things out, didn't we? We have a strong relationship and we can get through anything. I know the family would be thrilled. They may worry for a bit, but that's what families do. And what's more chaos but more happiness?! Things would work out fine, and I know it. Just think about it. Husband had kinda tried to test the waters to see how I felt about another. I think he just waiting to hear, yeah, why not one more. Think about it. Plus I'm not talking about doing it anytime soon. In a few years, maybe even when Isaiah is about to go to kindergarten

LR: But I'll be "advanced maternal age" by that point!

HD: So?

LR: So? So there is an increased risk at that point.

HD: Lots of women have babies after 35. I've even seen women as old as 50 have a baby

LR: Yeah, well, that's them

HD: Just think about it, okay?

LR: Okay, I'll think about it, but I make no commitments.

HD: I know you'll cave, you always cave to me

LR: I know, but we'll see.

HD: Yes, we will.