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.