May 30, 2009

Another Milestone

We had our first visit from the tooth fairy last night. Yep, Jacob lost his first tooth! We noticed that he had a loose tooth about a month ago and it gradually started loosening up. Last night, he showed me how loose it was and it was barely hanging on. Finally, he got it out. He was okay with losing the tooth, but it bled just a bit and the blood upset him. Even thought he said nothing hurt, it took just a bit to convince him that nothing was wrong. He's just fine now. He thinks it's pretty cool. It seems so weird to see him with a gap in his teeth!

May 28, 2009

17 months

I can hardly believe that Isaiah is 17 months old! Time flies, and it seems to keep going by faster and faster. He does still nurse, but not really that often or for very long. He will nurse before his short morning nap, before afternoon nap, and before bed. Occasionally, he'll want to nurse sometime in the early evening. But, my milk supply is pretty low and he's gotten to where he wants his sippy cup with him so he can drink from that until he's pretty much satisfied, then he'll nurse. Which is fine. I imagine by the end of summer, if not before, he'll have weaned himself. I have been blessed with 3 babies that all breastfed like champs. Not everyone has as easy of a time with breastfeeding. When I think about it, there are numerous things that where in my favor for successful breastfeeding.
1. All 3 of my kids nursed well right from the start. A lot of babies go into a sleepy stage after that first hour after birth, and might not always nurse well. All 3 of mine seemed to want to make sure they had their meals.

2. I have great breast anatomy for breastfeeding. I won't get to graphic here, but I'll just say that there was never any worry about needing a nipple shield or nipple shells.

3. I also seem to lactate like crazy. I always had enough milk, and with Clara I actually produced more milk than she needed. I would nurse her and still have to pump afterwards to get relief. Although that just added to further overproduction because I was stimulating my breasts to continue to make more.

4. I built up a good stocked supply of frozen breastmilk. While I was off on maternity leave, I would set up my electric breastpump in the corner and I would pump after 2 or 3 feedings everyday. That way I had bmilk for when I went back to work, plus it boosted my milk supply.

5. An electric breastpump is a must. With Jacob, I used a hand-pump, and I thought that worked well, until I got a double electric pump. I was able to pump 3 times more milk in half of the time with the electric. My pump became a staple of my wardrobe.

6. I am pretty darn stubborn. Husband has said that he managed to find the one woman in the world more stubborn than he is and married her. I was absolutely determined after Clara and Isaiah were born that they would be exclusively breastfed until 6 months. I don't look down my nose on people who don't breastfeed...that was just a decision that was right for us. So, after I decided to EBF, I was stubborn enough to make it happen. I also made the time to pump at work. My nurse manager gave me some of the greatest bits of advice. She said to make the time to pump at work. It takes 20 minutes, and yeah, you may be a few minutes late giving that scheduled med, or getting that assessment done, but that it was important to make the time. And I did. It also helped greatly that my letdown reflex is almost instant when I pump. A lot of people really struggle getting that letdown reflex when they pump.

7. Another thing that I did, which was probably crazy, is on the days when I would sleep after working all night, instead of just sleeping 6-7 hours straight, I would actually set my alarm to wake me up after 3 hours and I would get up, pump, and go back to sleep. At work, I would pump 2 times in an 8 hour shift, I would go home/to daycare, and nurse Clara/Isaiah before going to bed, and then wake up and pump, go back to sleep. I didn't do it as regularly with Isaiah as I did with Clara, but I did do it. And I was lucky to work with people who were supportive of my decision and helped me to take the 5 minutes to pump (yep, it only takes me 5 minutes).

Like I said, everything seemed to help with my breastfeeding success, my breast anatomy, huge milk supply, supportive family and co-workers, my easy letdown reflex, etc. When Isaiah is finally weaned, I'll be glad to have my body back as my own, but I'll also be very sad that those days are over. The comic strip "Baby Blues" had a strip awhile ago where the mom is talking to the youngest baby, saying that when she is finally weaned, her breastfeeding days will be over. The next box shows the mom jumping up and down saying "Yippie!", and the next box shows her crying. I can totally relate. You want to watch your child grow up, but at the same time you want to keep them babies for just a little bit longer.

May 22, 2009

Why are you a Nurse?

Random person:Do you really like being a nurse?

Nurse: Um, yeah, why?


Nurse: Yes.

RP: How can you enjoy a job that demands that you work hours outside the typical 8-5 M-F, and you have to work weekends, holidays and nights? Plus, you don't have a set schedule. That would drive me crazy not always working the same days every week.

Nurse: That's one of the great things about nursing, the flexibility. You can work around doctors appointments, school functions and other things you need off work for. You can work just weekends to be home with the kids, or you can work evenings or nights if you aren't a morning person.

RP: Another thing. Nursing is frequently cited as one of the most respected professions, but most of the time, all people hear about are how horrible their nursing care was. How their IV bag ran dry, or they waited forever for pain meds, or that their nurse seemed rushed. Oh, and the patients who think their nurse was a horrible ogre for not giving them the medication they wanted, even though it was the doctor, not the nurse, who decided against that med. Or the family who doesn't think you're doing enough for their family member, even though you've gone above and beyond to care for that patient. That's got to be disheartening. The saying "don't shoot the messenger" comes to mind. Sometimes you hear about how great a nurse was, but not as often. Plus the butt-reaming you get on occasion from a doctor, for reasons justified or unjustified, must suck. I've seen you come home in tears after a particularly horrible shift.

Nurse: There are times when no matter what I do, I can't seem to make a patient or their family happy, and times when I've had my ass chewed by a doctor. That is very frustrating. But, most of the time, patients are pleasant to deal with and the doctors are easy to get along with. After one night of verbal abuse by a patient, I've had the doc decide she needed to go in and talk to the patient about treating the nursing staff with respect and that the decisions made for her care came from her, not me. Occasionally, I've been told I'm a good nurse, that I made a good call, that I really helped a mom enjoy her birth experience, or that I've given them great advice when caring for their baby.

RP: You also frequently talk about shifts that are so busy that you don't get eat, drink much or even pee for 12 hours! Some nurses even get bladder infections from shifts like that! Or on the rare occasion you get to sit down to eat, a family member of one of your patients sees you eating and is instantly pissed because you are sitting and eating and not taking care of their family member. You can't win. You've gone into work feeling like crap, just because if you didn't they'd be way too short staffed. I also remember hearing about a nurse working with a broken bone, or in active labor until the end of her shift, because she felt she had to. How many other professions will do that?! It's high stress, and hard manual labor turning patients, running down the hall for an emergency delivery. Plus the sadness of death, whether it's an elderly man or a stillborn baby. How do you deal with all of that? How is it worth it?

Nurse: Nursing is very emotional. I had to understand my own beliefs so I could deal with the bad things that happen. Especially working OB. The good is really good, but the bad is really bad. We cry alongside patients and their families while still doing our job. There is a grieving process with death, not only for the family, but for the caregivers as well. I do what I can to provide resources for them and to help them start the process of grieving.
I guess what makes nursing rewarding are all of the little things. When you do something for a patient, whether by getting their pain under control, by helping them achieve the birth they want, and giving encouragement to go on, or by just listening to their concerns, that's what makes it worth it. It can be as simple as a successful IV start on a patient who is a "hard stick" and is deathly afraid of needles, or as big as reporting a suspected child abuser. It's when your bedridden patient smiles after a complete bedbath and back rub - that makes it worth it. When a new mom gets her newborn to latch on and breastfeed after hours of unsuccessful attempts. Or when you sit holding a dying woman's hand to let her know she's not alone. It's when I advocate successfully for a patient, and the patient never knows, that's why I'm a nurse. Those moments overshadow all the bad nights. Knowing that maybe, to at least one person, I've made their life a little easier, even if in the smallest measure - that's why I'm a nurse.

May 19, 2009

I Saw the Sign

..and it opened up my eyes, I saw the sign. Sorry, got a little carried away there. Ah, Ace of Base. I almost forgot about them. I remember jamming out to them back in High School. Funny how you can go for years without thinking of something, or a song until something jogs your memory. The song will make sense later on.

The last couple days at the visitation/funeral went about as good as you can hope for under the circumstances. We went to the visitation and we talked with Jacob and Clara quite a bit about what to expect. So we walk in the room, and the see Meema, up by the casket. They go up and you can tell they are curious. They look at Great Grandma, ask me and Meema a couple of questions, and they look at her some more. Clara I don't think *really* understood. She was the one I was worried about her getting scared, but she ended up running off and playing with other kids. Jacob, however, I think got it. After a bit, I was looking at the photo collages they had up by the casket and then I look back to the kids and see Jacob's lip quivering and he's crying. It's a completely normal thing to happen at a funeral, but it absolutely broke my heart. I wanted to scoop him up and take him away from there, wishing that as a parent, I didn't' have to explain life and death, and be there to witness when they finally understand. He was just fine later on, but he was sad that Great-Grandma had to die.

Okay, now here's what jogged my memory of Ace of Base, and in particular the song "The Sign".
The next day was the funeral service. After that, we went to one of the daughter's house (Husband's Aunt) and had the usual meal. The kids had a blast. The yard was huge, they had a very large playset and there were tons of kids their age to play with. It was a nice time. I also saw something I have never before seen. Now before I say too much about it, I have to explain my beliefs. I am a Christian and believe in miracles. I'm skeptical about spirits roaming the earth, but believe that maybe it's possible, I've just have never seen it. I am also skeptical of signs sent from those who have died. Again, I'm not saying I don't believe it isn't possible, but I've never seen one and I'm more likely to believe it was a coincidence. But yesterday, I changed my mind about signs. I was sitting on the deck with SIL and we were watching all the kids play and the groups of adults gathered all around the yard. Then I notice this huge white bird, a hawk or a gull of some kind, (I'm not up on my ornithology) just sailing around in circles over the yard. The house is in the middle of a corn field. This bird was flying incredibly low, so at first I thought it was hunting mice in the field, but it wasn't flying over the field, it was flying over the yard. It circled around and hung real low for 10 minutes before it finally flew off over the trees and disappeared out of sight. I turn to my SIL and before I could say it, she says it for me: "I think that may have been Grandma". Later on, Husband, who isn't religious and doesn't believe in signs or stuff like, that asked if we saw the bird. He then said he thought it was Grandma, letting everyone know she was okay, and peeking in on the whole family gathered together. That's saying something if my skeptical husband thought the same thing about that bird. This sounds just like other stories I've heard about people seeing signs, and I've always thought "Yeah, yeah, it's just a coincidence", and honestly, if I was reading this, I'd be thinking the same thing. But having seen it myself, I have little doubt that this was just a bird flying over the yard. And, if it was a coincidence, so what? I'd rather believe that it was grandma looking in on her whole family, letting us know she was just fine. Somehow, it makes it a little easier.

May 16, 2009

ACLS and Funerals

I am proud to say that I am officially certified in Advanced Cardiovascular Life Support (ACLS). A few months ago, it was decided that all of the labor RN's needed to obtain ACLS, that way we can recover our patients who end up general anesthesia for a c-section. Rarely, does that happen, but up until very recently, we had to call a nurse from the PACU to come recover the patient afterwards. There are horror stories about taking ACLS training and having to do the "megacode". But, it wasn't so bad. It wasn't my idea of a good time, but now I will know what drugs to push if my patient, God forbid, goes into cardiac arrest. The thing is, I'll probably never, ever have anything to do in a code. I am not on the hospital's code team, we rarely call a code (only know of 2 since I've worked OB)and by the time the code team gets to us, all we'll have time to do is grab the crash cart and start compressions. ICU is directly under us. So response time is very quick. Which, is just fine with me. But, I'm still ACLS certified either way. Feels good to be done with it.

This past week, Husband's grandmother passed away. She'd been sick for quite awhile and she's been ready to go "home" for several months. She had been seeing her late husband, a daughter who died years before and a late son-in-law, so we all knew her time was running short. She was ready, and although it is never easy to say good-bye, as we all want her here, she is no longer in pain and is with her family and God. This will also be the first time Jacob and Clara will go to a funeral/visitation. We've tried talking to them, trying to prepare them for seeing Great-Grandma, looking like she's sleeping, trying to explain that it's just her body and that her spirit is with God, etc. They seem to understand as well as can be expected for a 4 and 5 year old. Part of me wants to shield them from it, because, really, our society's approach to death is strange. We force the immediate family to stand next to their loved one, lying there in a coffin, for hours while people come through to give condolences and have a "last look". I remember that was how it was explained to me when my grandmother died when I was in kindergarten. A last look. But, death is a part of life, they know about God and Heaven so hopefully, they'll do alright.

May 13, 2009

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.

May 12, 2009

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.

May 7, 2009

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.