The good and bad

Last night was one of those great nights where I had to be charge RN and labor nurse at the same time. Doesn't really work well doing these 2 things together, but we're so short staffed that it happens. We now have mandatory 12 call every month to try to help, but sometimes you just need another set of hands. Anway, my patient last night was in labor with her 1st baby. Her MD, one who is a very good physician but can be very manipulative told the patient from the beginning of her pregnancy that her pelvis is small and that she most likely would end up with a c/s. They are trained to know these things, I know. Well, the MD came in at 11 pm for another patient. She told me before she left that she was planning on sectioning her tomorrow morning so to turn off the pitocin, get her an epidural and let her rest. Anestheia was of course thrilled with this because it meant he had to stay in house all night when the OB expected to do a c/s in the a.m. All of us were crossing our fingers, hoping she would deliver vaginally. At 3:30 a.m she did just that. After weeks of being told her pelvis was too small. Very unfortunately, she ended up going up to surgery for a retained placenta. Turned out it was a placenta increta, where the placenta imbedded itself to deeply into the uterine wall and she ended up losing her uterus. This had been an IVF pregnancy and it was her first child. I know the family is happy that both she and the baby are healthy, but what if they wanted more children? Sometimes things happen that just aren't fair, but like my folks always said, Life isn't fair. But sometimes I wish it was.

Fugitive

Today I got pulled over for the first time in 12 years. Sucked. I deserved it though. The fam and I were heading into town and I was just driving with the flow of traffic. We stopped at a light and a cop pulled up with the lights on behind the truck next to me. Light turned green and I soon realized that I was getting pulled over, not the dude in the truck. Lucky me. To make matters worse, I couldn't find my current insurance card. The officer that ticketed me was a woman who I took care of when she had both of her children, AND my husband knew her from the football team in college because she was an athletic trainer. When she came in with her first child, her husband (also a cop) said that if they ever pulled me over, they'd let me go because I took care of them. Well, she didn't. I doubt she remembered me. Only reason I remembered her was because she has an unusual name. I wanted SO bad to ask about her kids and bring it up, but I didn't. She didn't give me a citation for the inurance and I didn't want to take the chance that perhaps she didn't like my nursing care and would decide to ticket me for the insurance too. The irony in all of this: I'm usually the one giving my husband a hard time for speeding and I usually don't speed. At least I don't think I do. Lesson learned I guess. :)

My post-weekend mind wanderings

Yet another busy night in L&D. It was one of those nights where people came in, not really sure if they were in labor or not, then all of the sudden, all of them become active at once. I also think that this pregnancy and the hormones are making me stupid. Here's my point. I admitted 2 patients within 1 hour of each other for the same MD. I sent urine specimens on both. On patient #2, her urine looked pretty nasty and I was sure she had a bladder infection. Well, I got the results was much surprised that it was clean and called the MD. 30 minutes later, I'm putting my charts in order and notice that the urine results I had given the MD on patient #2 actually was the results of the 1st patient I admitted. And patient #2 had an infection. Luckily, he was coming in for a delivery, so I didn't have to call him back. And he was nice and even laughed about it. A couple of the other docs wouldn't have found it too funny. I was so incredibly embarrassed, but what can you do? Anyway, after a long, busy 12 hours, one of the anesthesiologist thanked me for taking care of his wife (who's a pediatrician) when she had their baby back in May. Said they aprreciated that I treated them like normal parents, thought I was excellent and was professional. Its funny how great that felt to hear that I was appreciated. We don't hear much about not patients who thought they got good care. So many times all we hear is how bad their nurses were, how we didn't do this or that, etc. Yes, there are bad nurses out there, but most of the time it's just because we are working short-staffed, and have multiple patients needing things and we have to prioritize what call light we answer first. It also makes for better stories to talk about how bad the hospital stay and nurses were too. ;) Anyway, I don't know how many people actually read my musings here, but just know that 95% of nurses want and try our hardest to provide good care and we do it to the best of our abilities. We go 12 hours without eating, peeing or sitting down to try to provide good care.
The last few days my belly just popped out. I felt like I've looked pregnant for the last week or 2 but now I definately do. And I'm only 13 weeks!! I'm not so big I can't wear my normal jeans, but the ruber band I've been using to hold the buttons together is stretching a bit more. My chest is also bigger I noticed which is nice since I wasn't given much up top.
The kids were a little high maintenance this weekend. It stormed pretty much all week, so we were cooped up inside and I think that's what did it. But man, they just wouldn't leave each other alone. I don't know if it's because they are so close in age, or if they're bro-sis, but they pick at each other so much more that my mom said my sister and I did, but we're 3 1/2 years apart. Oh well, they're awfully cute, so we'll deal with it.

Top Reasons I Love Night Shift

1. No "white shirt and ties" walking around
2. Doctors are around only when I need them (no offense to MD's)
3. More autonomy
4. Staff work together well because we have to in emergencies because there aren't MD's in house.
5. Higher pay
6. Fewer visitors
7. JCAHO visits rarely take place between 11pm and 7 am
8. More patients come in and deliver quickly because they try to go back to sleep instead of coming in.
9. Our director of over 1 year still doesn't know any of our names.

Disadvantages of night shift
1. Lack of sleep
2. No doctors in house
3. The overall view that night shift is full of inexperienced people, so we don't know what we're doing.
4. Patients that come in because they can't sleep.
5. No one from other shifts will come in/stay over to help when we're short-staffed.
6. Administration don't see our work, so we go unnoticed, not always a bad thing.
7. Our director of over 1 year still doesn't know any of our names.

In-laws or out-laws?

WARNING: very negative and whiny post here!!!
I know everyone, or a lot of people can complain about their in-laws. But, I think mine might actually be in the running for the worst set in the United States. Here's a quick overview: My MIL is an alcoholic to the point she is hurting herself because she is always drunk. She knows she's killing herself and she doesnt care and refuses treatment. My FIL also an alcoholic but is more functional than MIL, but he also does a variety of illegal drugs, plays in a band and still thinks they are going to "make it someday". He is also atheist, verbally abusive to his wife and sons, and is so closed minded that even if you prove that he is wrong, he will still argue that he is right. they come down to visit about 2 times a month or more and they drink as they are driving the 2 hours trip down. And that's just some basic background on these people. How their sons turned out decent is quite amazing. I am uncomfortable with these people around my children for so many reasons. One being all the drinking. They are always drunk. Always. When they were still allowed to babysit, my daughter was about 4 months and son about 18 months. I had worked a busy nightshift and they were babysitting while I was sleeping. I woke up at 11:30 the the sound of my daughter crying like she was in pain. I waited, and waited for them to comfort her. Finally I got up and found both MIL and FIL feeding my son who was perfectly able to feed himself at that time and my daughter downstairs, alone, in the swing shrieking. She was in her PJ's as well as the same diaper I had put her in when I put her to bed the night before. I knew it was the same diaper because I had used the last Huggies diaper. (We always used pampers b/c they don't leak, and we had problems with breastmilk poop running out the back of huggies). Her diaper was so saturated, the diaper stuffing had turned to gel and was all over her. Needless to say I took her upstairs, changed and bathed her, breastfed her and she was fine. My in-laws response? "I guess she just wanted to nurse again". I won't get into the conversation that followed, but they were no longer allowed to babysit unless my br0 and sis in law were around.
They were down this past weekend. Luckily I had to work and my hubby wasn't working. But they managed to make a mess of my house, stuffed my children full of chips, cookies and the sort instead of decent meals and drank an enormous amount of alcohol. I'm talking 2 JUGS of wine for my MIL, and about 2 cases for my FIL. And I had to break up a fight between the two grandparents b/c FIL was yelling and cursing at his wife in front of my kids. It was a fight over how much charcoal she thought we had of all things. Hubby and I are considering not allowing his parents down unless they can control their drinking because I worry about the safety of my kids, and frankly, they are poor influences. Not only the drinking, but their lack of spiritual beliefs. Not sure it's going to go over well. Hubbys brother and sis-in-law are also considering doing the same once they get pregnant. Having a plan to do this is the easy part. Actually doing it is the hard part. Anyway, I feel better getting that off of my chest. I apologize again for such a negative post.

Oh, what a night...

Last night was yet another busy night at work. I had to be charge nurse and I just LOVE doing that. It's rather difficult to take care of patients and try to maintain some sort of order when we're short-staffed and patients keep rolling in. It happens every time I'm charge. Usually I'm counted as not only charge RN, but as a labor RN too. Anyway, we all got through it, the patients were all doing well when we left, despite the fact every labor nurse had 3 active labors plus a few out-patients, and the mom-baby nurses had 7 dyads a piece, including myself (charge RN's typically don't take patietnts), and the peds nurses were maxed out as well. Hopefully the moms didn't realize how busy we were.
Had my sono yesterday. I actually found out exactly what they are trying to get certified in. There is a test called nuchal translucency where they measure the thickness of the nuchal fold. It's done at about 12 weeks and it's looking for the risk of Down's Syndrome and other heart defects. If it's thick, it means the baby's more at risk. THe sono tech said 3.5 or above they would consider at risk. The little bean measured 2.5 which she said is a negative measurement. He/she was all over the place and didnt' want to cooperate. It's amazing that they can move around so much and you not be able to feel it.
I've also been waiting for the "feeling" of boy or girl that I got with the other two. I knew they were boy and girl before the sonos. I havent had as strong of a gut feeling, but I'm thinking boy. All the old myths say girl, and my co-workers think girl, but I just kinda feel its a boy. We'll have to see. Hubby doesnt think we'll be able to wait until the birth, but I think I can. Since we decided not to find out the sex this time, I don't have that overwhelming desire to know. But, who knows. We may be at that 20 week sono and cave when they ask if we want to know sex.

Mother Nature was in control last night

Last night was actually a pretty busy night and I had a great delivery. Well, I didn't deliver, but , anyway, you get it. I'm working mother-baby and get pulled out of a room and my co-worker said, they need help in L&D because they just got a patient up. I was thrilled because I prefer L&D over mother-baby. It's the adrenaline, I think. Anyway, she then tells me the MD broke her bag of water without a nurse in the room or an IV, and that the nurse back there will take over once her patient delivers. So, I go back, thinking I'm just going to admit this patient. I walk in the room, the MD is still there and I notice that I won't be just admitting the patient, but doing her delivery, now. I turned the monitor on for the time. Never checked the baby's heartrate, no IV and she delivered. 3 MINUTES after I came in the room! I think most every labor nurse loves these deliveries. Not because they're quick and easy for a nurse, but because it's more like mother nature intended, without all the unnecessary interventions, monitores, etc. There is a place for the interventions, but a nice normal labor doesn't really need that. The baby did great, and the mom felt wonderful and was proud of herself that she did it without any pain meds. The other nurse that was working L&D who was in a delivery herself, her patient was a repeat c-section, on the schedule for next week, never delivered vaginally before and she came in at 8cm and delivered Vaginally 6 minutes before my delivery. It's amazing what the woman's body can do when given the chance. (Again, there is a place for c-sections, inductions, forceps, etc. and thank God for that)

Sprinklers, nausea and the little bean

I've been really enjoying only working 3 days a week. It stinks a little that I have to work every Saturday and Sunday night, but man, I will have been off 4 days in a row by the time I get back to work. For the second time in 3 weeks!!! Yesterday, I took the kids to one of the sprinkler parks in a nearby big town. They're these water parks where they have several types of sprinklers, fountains, etc that you can run through. I think maybe they are also called zero depth pools? Anyway, my son LOVED it. Daughter, not so much. She clung to me and didn't want anything to do with it. She actually laid down on the towel and covered herself with her brothers towel. The water was cold, but it was about 90 degress, and how many kids worry about that anyway? Well, today we filled up a kiddie pool and played in that. That water was cold, but both kids had a good time. Today I realized that the nausea I've been "blessed" with this pregnancy is getting better. I'm actually keeping meals down, I'm not constantly queasy and it's been since Sunday that I actually threw up. But of course, being the worry wort that I am, Ijust hope it isn't because the little bean stopped growing. I'm sure it's probably fine because I still feel pregnant and there's no reason for me to worry. Next week I get a free ultrasound. The sono techs at the office are trying to get certified in something or another and they have to do so many sonos to do that. So, I agreed to let them practice. It's going to take about an hour, which seems really long, but oh well.

Ups and Downs of working in L&D

I just want to start out by saying that I love my job. I love that I get to witness one of the most important events in people's lives. Sometimes I feel like an intruder looking in on such a huge moment. But, every now and then, things happen that make working in L&D not so fun. For example, pregnant women who have no respect for the gift they have been given. Not too long ago, I took care of a couple in their late 30's, pregnant with their first child. They went through fertility treatment after fertility treatment and finally they were pregnant, with a girl. I met this couple at 35 weeks. For a delivery of a stillborn. It was heart-wrenching, as it always is. The baby was born and looked perfect except for the tight knot in the umbilical cord. Now I cant even imagine what it was like for the parents. I can tell you that there was not a single dry eye in the delivery room that night. It's SO hard trying to maintain your composure enough to take care of the patient. I have no problem crying with the patient and family. God willing, they will have another child they can take home in their arms.
Then there are patients like the one I took care of this weekend. She was pregnant for the 3rd time. She had a 6 y.o. daughter she had just gotten back from DCFS custody. She was 24 weeks (viability) and her water had broken. Now, she had done EVERYTHING she could to cause this, horseback riding, punching herself in the abdomen, cocaine, etc. She had delivered her 2nd pregnancy at 20 weeks by doing the exact same thing. Her reasoning? She didn't want to mess up getting custody of her daughter back. When asked why she didn't have an abortion, she said she just kept thinking that she'd do it tomorrow, and praying that God would take care of it. Sick, sick, sick. Anyway, she'd come in 5 days after her water had broken and was close to delivery. The baby was still alive, and able to live outside the womb, although would have many hurdles to face. She refused any resuscitation. So she delivers a perfect little boy, breathing, CRYING, and all we could do was let him go. He was wrapped in warm blankets as he slipped away. Afterwards, she then says, "Maybe I should have let my Aunt and Uncle take him, since they haven't been able to have kids". It was bad enough the first time she did it, but even worse that she did it twice. Now, it's very, very difficult to take care of a patient like this, but I had to. I had to refrain from judgement and focus on the woman and provide good care.
At the end of the day, the good always out weighs the bad. I can remember the names of the mother, father, gestation and sex of the baby for every stillborn/too early delivery I've had. A month ago, the couple who had been my first delivery of such, a 23 week delivery, came in a delivered a healthy little boy. I doubt that they remembered me after 4 or so years, but I remembered them. Again, I cried with them, but this time they were happy tears. Then I remember, Hey, I do like my job.

C-section or VBAC?

So ever since the day we decided we wanted to have another baby, I've been thinking about how I want to deliver number 3. Let me go back...

In 2003, i delivered a healthy baby, vaginally, no complications and no 'help' ie pitocin, AROM, forceps, etc. But, oh I did love that epidural. So number 2 is close to being due. I figured, well, I had a pretty quick and easy labor the first time, so this one should be easier since it's my second baby. I hit 36 weeks and my OB is off on medical leave for several weeks. At the appointment that day, I would find out who would deliver my baby and if I was dilated at all. Nurse practioner comes in, listens to the heart rate and say's "Sounds a little irregular today. It could be that the doppler is picking up your heart beat and the baby's, but lets do an NST to make sure". So on the monitor we go. Heart rate looks good, a little fast at 165, but the babe was moving everywhere. Then, heart rate in the 50's. An abrupt drop. I'm thinking, maybe its my pulse, so I check. I'm running about 70-80 and starting to climb as I realize that the heartrate of 50 is indeed my baby. Of course, in the office, there isn't a call light. So I turn the monitor volume up and as I was about ready to holler, in comes one of the docs. She immediately has me go down 2 doors for a sono to make sure that there isn't any fluid around the baby's heart. Sono didn't show any fluid but did show a VERY irregular heartrate. She then says "We need to get you delivered and I know you know that means a c-section". So rushed over to L&D I go, trying not to cry on the walk over. I do okay until I see my co-workers waiting for me when I promptly start sobbing. Within 15 minutes, I'm heading back to the OR, hoping my husband can make it in time. Luckily he does make it as they're cutting. She was born 35 minutes from the decision to deliver. As we say, 30 minutes from decision to incision. She was under oxygen for 10 hours, monitors and had cardiology tests. She's perfectly fine now. But, I must say that her birth was the scariest thing imaginable. I thought she was going to die. I was blessed with knowing the staff and the doctors. Had I not been a L&D nurse, it would have been even scarier. So, back to my dilemma.

I can't decide if I want to deliver vaginally or by repeat section. I know the risks of a section are greater than a VBAC and my OB is leaving the decision in my hands. The very small risk of uterine rupture is worring me. Being a nurse, I would be that one whose uterus decides to come apart during labor. All I want is a non-emergent delivery. I'm not sure my mental health could take another dash back for a crash c-section. But the recovery from a c-s sucks big ones. So, luckily I have some time to decide. Maybe little bean will make it easy for me by either being breech or by coming so fast that I hit hte hospital a 8cm and have no choice but to deliver. I guess we'll see.

Big OB appointment

Today i had my "big" ob appointment, as they call it at this office. I had already had the ultrasound to make sure the pregnancy was developing 2 weeks ago. This one was to do the whole bloodwork, assessment and health history thing. I had wondered why they didn't do all of that the first time, but a nurse there told me that they had a string of people come in, go through all the stuff and then when they did the ultrasound, they found out it wasn't viable. So they decided to do that first thing, then in 2 weeks do the rest. it made more sense this time. What was funny, the nurse asking me about my history got to the part about my last delivery by c-section for fetal arrythmia and heart block. She kept saying "I think I remember that, sending you over for a c/s". I had been at another office and switched OB's with this pregnancy, so that wasn't possible. I know she was trying to be nice and I wanted to say, no, I saw a different OB then, but I didnt want her to feel silly. And it doesnt really matter. Got to see the little bean and it was moving all over the place. Heart rate fast, but strong at 180. Seems fast to me, but MD said it was fine. I thought when I started working in OB a few years ago that pregnancy wouldn't be as cool because I see it all the time. Not true. It's still awesome to see the little being growing inside and to hear the heartbeat. It still gets to me like it was my first pregnancy before I worked in OB.
Work was steady last night. No deliveries but we had a revolving door of triage patients coming in for contractions, UTI's, etc. I realized that I haven't personally had a delivery in about 2 weeks, possible more. My patients have just been moving pretty slow recently. I'm sure this coming weekend I'll probably have my share.

This past weekend at work was really, really slow. It was one of those nights where I was able to start and finish a book in one night. And it has about 400 pages. We all realize that we should appreciate those kind of nights to make up for the nights when patient after patient comes through the door. But it makes for a LONG night. I had one of those labor patients that labor nurses love. She was reasonable, asked good questions and wanted any and all information I could give her. She was 6 weeks early and had delivered her last one that early too. A lot of times, when patients have had a preterm birth before theyre either scared to death, or they think the baby will be just fine, no problems. She was in between. Anyway, I took care of her the next two nights after she delivered and boy did she change. Gone was the perfect patient, and in her place was a woman who could care less about what we had to say and teach her about her premature son. It was quite a transformation.
On the pregnancy side, I'm still pretty nauseated. Some days I feel fine, but other days not so much. Hopefully that means that the little bean is developing like it should.