I was chatting with my repeat c/s patient this morning. She had a vaginal delivery with her first, c/s with her second and inquired about a VBAC but her MD advised against it so she was doing a repeat c/s. She had asked about my expanding waistline and how I delivered my 2 kids. She said "so you'll be doing this in a couple months or so then, too?" At that time, I didn't know that she had origninally wanted a VBAC. I told her "No, I plan to labor and deliver vaginally". She got this puzzled look on her face and asked "I thought they didn't want you to do that and that it was pretty dangerous?" It was at that time I realized that this issue may come up a few times before my delivery day. I didn't want to say "no, actually a repeat c/s is riskier than VBAC and that the reason your MD probably didn't want you to VBAC was because she would have to stay in the hospital during your entire labor". I just told her each individual is different and that her MD may feel she is at risk for complications. It was a bit awkward.

I also had the privledge of taking care of one of the former daycare teachers at my kids school. When Clara was a baby, this girl had a major attitude. Clara was exclusively breastfed, I came in every a.m. to feed her before going home, and I made it perfectly clear that I didn't want her given any formula and that if she ran out of breastmilk that they could call me (not enough milk was never an issue). Clara also wouldn't take a pacifier and hated bottles. She knew what the real thing was and didn't want a substitute. This girl would give me dirty looks every a.m. I came in and was pretty persistant about telling me I should give her formula, that she wanted more substance. Clara was a chubby little baby. She wasn't starving. I tolerated it for awhile and finally I told her that I was a labor/delivery nurse and that I knew what was best for my baby. Well, she came in last night with contractions at 37 weeks, thinking it was labor. I sent her home after a bit because her cervix didn't change. She was much nicer last night, probably because I was the one with the gloved hand and drawer full of needles. I was very nice and took good care of her, but I enjoyed the recognition in her face when she saw me.

Fall

Yesterday was one of those beautiful fall days I've been waiting for. Sun was shining, a slight breeze, and temperatures comfortable for either long or short sleeves during the day and light jacket temps in the evening. Farmers were harvesting and it smelled like fall outside. I realized a couple years ago that fall is my favorite season. I love the mild temps., the fall scents of candles and spices, and all the fall activities. With kids, its been more fun at the apple orchards, pumpkin patches and hayrack rides. I guess it lets me feel like a kid again taking them to all these places and watching them, not that I ever needed an excuse to act like a kid!

My darling, graceful daughter probably broke another bone yesterday. I had just finished giving the kids a bath and had them dressed when I had an urge to vomit from all the acid reflux I was having. So I shooed them out of the bathroom and did the deed. I really wasn't in there very long and I heard her scream. I assumed they were fussing over a toy again, but when I opened the door, she had blood on her cheek and coming out of her nose. Apparently she was running with pillow over her face and tripped over something and fell flat on her face. Her poor little nose was swollen, started to bruise and of course was bleeding a little, which scared her more than anything. I don't know for sure but my guess is that she may have broken her nose. It doesn't look too bad this morning. I assumed she'd get black eyes under both eyes, but her nose really just looks swollen and not too bruised. Doesn't seem to be giving her much trouble or pain either. This is her second broken bone (if it is indeed broken). When she was about 19 months, she fell and had a minor fracture in her arm. She had a cast for 3 weeks, "to give her support", although she used it as a weapon against her brother. I don't want any of my kids to break anything, but I expected to have that with my son and not my daughter! Lord, give me the strength when they get into grade school and if they decide to play sports!

Admission Madness and Major milestones

It feels good to hit a major milestone in pregnancy - viability. Not that I've ever had any problem with preterm labor or any kind of pregnancy loss, but getting to the point where there is a possibility that the baby could live should I deliver now is comforting a bit. Even though the difficulties that a 24 week baby would face would be huge.

Work this weekend was absolutely exhausting. It's like the phone wouldn't stop ringing, and I couldn't seem to keep up with everything I needed to do. every time I thought I was almost caught up, the phone would ring. I swear, every time we turned around it was the ER letting us know we had yet another patient. And twice when the tech went to bring the patient up, she'd come back with 2! Saturday was the worst. There we 4 patients for me and the other labor nurse (third had be put 'on call' due to decreased census at the time). Two of the patients needed to be admitted. Then the phone rang 5 minutes later, with a patient that turned out to be 2 patients waiting to come up. Then within the next 30 minutes, we got 2 more patients. A total of 6 admissions for 2 nurses. Luckily they called the on-call girl in and she got there very quickly. Everyone seemed to have spotting, high blood pressure or ruptured membranes but not contracting. We figured by midnight, we had admitted 8 patients, and by 7a.m, we had admitted 14 patients and discharged 8. This may not be really busy on some units but we are a fairly small department with 7 labor rooms and a 4 bed triage/monitoring rom. Last night wasn't much better. But, man does 12 hours fly when you are going full speed all night! I slept for 6 hours straight today! A big feat for a pregnant woman who usually gets up to pee about every 3-4 hours!

Instincts

I think it was about 2 weeks ago, I admitted a 26 week patient with 'gas pain' as she called it. Well, if you have gas bad enough, it can kinda feel like contractions. I've spent a couple nights during my pregnancies thinking, 'ok, I must be having contractions', only to pass a huge amount of gas, followed by a complete bowel evacuation. After assessing her, I found she was contracting every 3 minutes, and I really felt that this was labor and not just preterm contractions. She was acting just like a labor patient, so I checked her cervix without an order (we're suppose to get a MD's order for less than 34 week) and her cervix was closed, but the external part of the cervis was about 3-4 cm and soft...not what a 26 week primip cervix should be. Called the doc, he gave me orders for terbutaline. Gave her the 3 doses, patient reports feeling 100% better, but I still see a lot of irritability on the monitor . Call the doc back explain what I see and that I'm still concerned about her uterine activity, even if she says she feels better. He says to observe and give more terbutaline if she states that contractions are getting stronger, and that he'd be in pretty soon. I tried suggesting Magnesium Sulfate but really, she said she felt good, uterine activity wasn't as bad, so the doc didn't feel it was needed at that time. Plus, she wasn't having contractions like she had on admission; it was just frequent blurbs of 10 seconds. By this time, its about 6:30 a.m. I knew I'd be on my way home before he got in. I found out last night that they actually discharged this patient, only to have her come back a couple hours later, in active labor and they had to deliver her by c/s that afternoon. Now I haven't been a nurse long enough to go on instincts alone, but I just knew she was going to break through the terbutaline and not be stopped. Sucks to be right sometimes.

Last night I had a magnificent delivery. Mom's second baby, 7 years after her first. She presented at 2 cm, and man that baby's head I swear was almost a +2 station it was so low. Maybe an exaggeration, but you get the idea. I'm not sure how she walked around, but I've never had a patient (who wasn't 10cm dilated) have a baby sitting that low in their pelvis. She progressed on her own within 5 hours. Of course, it didn't take much pushing at all and she delivered, without any lacerations. Perineum wasn't even swollen. Only odd thing was the umbilical cord was 35 inches long. Had to measure it because it was so obviously long. Well, I'm off to bed as I'm starting to ramble on a bit.

Finally, a good delivery

The other night at work, I finally had a good vag delivery. It's been quite awhile, since it seems that either my patients never deliver for me, and I've had to be charge nurse quite a bit lately. I was charge the other night, but this mom came in, 3rd baby in "really active labor". You know a woman is about to deliver when she comes by in the wheelchair, sitting sideways. She was completely dilated and ready to push. She was a bit upset because she desperately wanted an epidural, and she had presented ready to delivery with her second baby. Only that time, she said she never made it to the bed. Her labor started at midnight, she came into the hospital at 12:55 and delivered at 1:15! Her actual labor nurse encouraged her not to push, but to do what she needed to do and the patient didn't push until she saw the doctor and within 2 pushes, she was holding her son. I was doing 'baby care', so mom got to hold the baby until she was ready to find out how much he weighed. We usually have a nurse from nursery do baby care and they want to whisk the baby away and do their thing, but when a labor nurse does it, we tend to let mom spend time with her baby, unless of course there is a problem. But this little guy was fine. I figure if they're screaming, their heartrate is fine and they'll pink up in a minute or two. I depserately needed a nice delivery as I've been a bit frustrated and stressed with all the BS going on at work.

Yesterday, the kids had a check-up with the doc. Usually the office lets me know if they are due for shots ahead of time. Husband took them and Jacob was due for 3 and they also wanted to check for lead since we live in an old house. I guess they gave Jacob his 3 shots first, then wanted to draw the blood. It took 3 nurses and my husband to hold him. He was just done with being stuck. They should have drawn the blood first, then given the shots because that doesnt have to be as precise as a blood draw. After they finally got the blood, they looked around for Clara and found her hiding behind the curtain, with a tissue over her face, whimpering. When I heard this I cried. I guess she was just scared for her brother. As much as they fight and argue, it seems they really do love each other.

I also did too much around the house yesterday I think. I went crazy mad cleaning, put together a dresser for Clara and around 10pm, I noticed I was pretty crampy. Then it turned into noticeable contractions every 5 minutes or so. I thought, "great, just what I need". They did go away after I laid down and drank a bunch of water and then followed a rememdy one of the docs told me about. I'm sure I just over exerted myself, but that worries me some, considering I work 12 hours shifts and there have been some nights where you barely have time to sit down. Maybe this was just an isolated incident. We'll see.

Plan of action

I feel some relief from the stress of this past weekend after venting about it in the last post. I'm still hearing about some of the things Meema did when I wasn't around. The last straw was when Jacob announced "I don't have to take naps anymore because Meema said I'm too old to be taking naps". Last time I checked, I was Jacob's mom, and he does need a nap, if not to sleep but to have that quiet down time. And honestly, mommy needs him to keep taking a nap! My husband and I sat down and we have a plan with how to deal with his parents. In the past, we were so close to having an "intervention" with his mom, but at the last minute his brother and sister-in-law backed out of it. I seemed to be the only one who saw the importance of getting this woman help. There isn't a good way to do it. So, our plan is to wait until she brings up taking the kids for a weekend again, and I can guarantee that it will happen the next time they call. I plan to just tell her that until she goes into rehab and is sober that an overnight with the kids will not happen. It will not go well, even though I'm going to do my best to try not to come across as attacking her and I will be respectful. I've talked with obviously my husband, and his brother and his wife. My sister, who is in med school planning to be a psychiatrist, talked with one of the psychiatrists that works with addiction during that rotation, and we've gotten some helpful hints over the past few months on how to handle it. The problem is just actually doing it. But, for the sake of not only my kids, but for her own health, we've got to do something. One of my grandmothers died of alcoholism before I was born. My dad said that none of his siblings ever did anything, and that he really regrets that they didn't try. It may not work, but at least we can say we tried. Main problem will be my father-in-law. He's also probably addicted, but he'll be beligerent, rude and I doubt that he will quit drinking for his wife. Regardless, we've got to do what's best for our kids. I want them to be a part of their lives, but the drinking, and going behind our backs has got to stop. That's all I'll say about that for now, as I kinda feel like I'm airing the "dirty laundry" so to speak, but hey, thats' what an anonymous blog is good for, right?

It gets better and better with the out-laws

This weekend I had my patience tested like I've never had it tested before. My in-laws came down Friday evening and stayed until Monday evening, and I had the first labor patient that I actually lost my patience with.
Anytime my in-laws come down, they drive me nuts. Friday night at the kids bedtime, Clara wanted a drink for bed and I told MIL she gets water for bed. Clara then comes crying to me and says Jacob has juice. I told her no, Jacob has water too. MIL agrees and says, "I gave hime water too." Jacob then takes a drink and says "I got juice". I look at the sippy cup, and it is indeed juice. My MIL tried to get Jacob to lie to me. Then I was the bad guy when I took the juice away (yes, we let the kids have sippy cups still at night so they don't spill) I woke up Saturday a.m. to my kids eating potato chips at 8:30 a.m. Told her that we don't give the kids snacks that early. Thought I got through to her. She took them for a walk and when they got back at 11:30, Jacob comes and tells me "Meema gave us big candy bars and said not to tell you". Man was I pissed. She deliberately went against what I had told her earlier. And my FIL, who was meeting with my dad to put in new outlets upstairs and deciding when to actually switch over our old electrical wiring, had decided that he was going to just do what he wanted to do, regardless of what we thought was going on. We bought all the outlets, and other stuff so that outlets could be put it, and he refused to do that, saying we needed to replace the wiring to the lights first, which is untrue. It involved ripping up floor boards in the attic, drilling and was very loud, all while I'm trying to sleep. The outlets would have been quieter. He forgets whose house it is and who has to pay for the stuff. I was pissed enough that I refused to pay for all the stuff he needed because it wasn't what we thought was being done and had agreed to. My dad, who doesn't get mad easily, was pretty ticked by the time he left Sunday afternoon with my FIL attitude. So, my dad plans to come and put the outlets in for us over then next few weeks.
At work, things weren't a whole lot better. I was dying for a nice labor patient and I love first time parents. And I thought I was getting this. This patient was laboring with her 1st baby and apparently all she said until she got her epidural was f#*k. I came on after her epidural. She was a very immature 24 year old, had a doula, the husband wasn't there and she was naked the entire time. Okay, I can deal with nudity, being ill-prepared for labor because who is ever really prepared and who am I to judge her family life. He decided to stay home until she was ready to deliver, which turned out fine because when he did come it he was a waste of space. Anyway, this patient told her doula that she didn't prepare her enough for labor. SHe said she didn't realize that the pain would come and go like it did. I thought, how do you miss that? But, the doula was very supportive and good with her. Then it came time to start pushing. She apparently thought that you push once or twice and the baby pops out. She pushed for 10 minutes, and when I say push, I used that liberally as she wouldn't listen to how to push, and started yelling at me that she couldn't do it, that she was tired, etc. etc. Okay, no big deal, I've dealt with that before. I tried every approach - compassion, gentle encouragement. Then she told me I didn't know what the f$*k I was talking about, that I had no idea what it's like and she then refused to push. Then she told me to get the vacuum and pull the baby out, or to cut her open. She was thrashing around in the bed, not because she was uncomfortable (she had a good epidural) but because she was pissed at me for not helping her by pulling her baby out. She pulled her IV out and almost pulled her epidural out. And she was a very hard IV stick. After 12 hours of her, it was all I could take.
Man, I sound like a whiny brat, but seriously, this weekend sucked. As my inlaws were leaving, my alcoholic MIL told me "my plan is to come get the kids some weekend and take them with me while I decorate for Halloween". Um, no, not going to happen, never, not until you check yourself into rehab and have proved to me you are sober. No way would I let you drive my children 2 hours to your house while you drink your wine out of a water bottle (yes, they drink and drive). I just told her that I don't like the kids to be gone that long, becasue I didn't want to get into the whole alcohol issue since they were getting in the truck to leave. I hope she'll forget about it, but my husband said that he'd take care of it if she brought it up to him. If I was a good writer, or could find someone to do it for me, I think I could make a buttload of money talking about life with my inlaws because you can't get a good picture in such a short paragraph. If I put out a book, I think it would be a best-seller because no one can believe that they're really this crazy. You can't make this stuff up.