May 11, 2010

Challenge

I like a challenge. And that was just what I got with a patient the other night. She was a very young teen mother with an entourage of equally young, demanding young women. I usually do very well with the young mothers. I'm not sure why, but somehow they seem to put their trust in me and I'm able to help them through the labor/delivery process. This mother was a challenge. Normally a mild mannered, shy girl according to her father, labor brought out "the worst" in her (her parents words, not mine). Yes, labor will do that. I'm used to that: cursing, yelling, screaming, grabbing, flailing arms and legs (I draw the line at kicking, hitting and biting, and yes, someone has tried to bite me, and one patient tried to kick me when I was 28 weeks pregnant with Isaiah because I wouldn't "Give her a c-section") She cursed, moaned, waved her support people off with her hands and was just downright hateful to everyone. Her mother was in tears by the end of the night from the stress and abuse she received at the hands of her daughter. The hard part was trying to figure out just what she wanted. She didn't want me in the room supporting her. She would shoo her support people out of the room then yell at them for leaving. She didn't want anyone talking, touching her, rubbing her back, etc. But she was on the call light all the time and in between, her friends were out at the desk, saying that she needed me NOW. No problem, that's what I'm there for. But after awhile, it became a bit tiresome. She rolled her eyes at every single suggestion I made to help her become more comfortable. She didn't want any pain, but didn't want an epidural. I gave her pain medication, but that only goes so far and after awhile, doesn't do a whole heck of a lot. And it was her friends that seemed to have the hardest time with the contractions. At one point, one of them made a trip (one of many) to the desk and asked with a very degrading tone if the patient could have pain medicine yet. So I go in the room and talk with the patient, who tells me she didn't want any pain medicine right now. The only thing I did that she seemed to like was give her warm packs and ice packs. Now these packs I had to make myself. For the warm packs, I would get a chux (disposable, absorbant, water-proof liner) put a towel in the middle, pour hot water from the coffee pot on the towel, wrap the chux pad around it, tape it and place it in a cloth girdle and taped the ends closed, so it wouldn't be too hot against her skin. For the ice packs, I double bagged crushed ice, placed two bags in a cloth girdle and taped the ends together. She liked those. Only problem - they won't last 12 hours. So I made them multiple times and she became angry when they weren't hot/cold. I explained to her and her friends that it would take a couple minutes for me to make them. Did that stop her friends from coming to the desk, giving me dirty looks, demanding to know what took me so long? No. I finally put them together in her room so her friends could see the process. I was in and out of that room only God knows how many times. I don't mind being busy, I like supporting women in labor, and I have spent an entire 12 hour shift in a room with the patient while she labored, but nothing I did seemed to be what this mom wanted. I am very patient and understanding, but I can only take so much abuse. I was frazzled and exhausted by the time change of shift came. In the end, I hope I gave her the support she wanted and needed. I did my best. Hope it was good enough.

May 7, 2010

A whole lot of nothin' goin' on

I've noticed a lack in my posts about labor and delivery. It's nothing intentional, I've just been a little preoccupied with the little one growing in my uterus. Another reason is we haven't been as busy as we used to be. Some of it I'm sure is the economy. People aren't having babies right now because they are unemployed or the job outlook isn't like it used to be. A lot of it I think is politics. There have been a lot of changes that have taken place since last fall and I think our patient census is down because of all the politics. But, we are starting to get into the busy season - we always have had a boom of babies starting the end of May through September. Hopefully that will be the case this year as well. Sure, I've had my share of patients but lately, I have spent most weekends as charge nurse, so I don't have a patient load. I've had an induction or prepped a scheduled c/s here or there, but really, that's the extent of it. I'm having birth withdrawal syndrome!

Pregnancy-wise, this little one wants to make sure I don't forget it's in there growing. I feel pretty good most of the time, still tired. I was ready for bed last night at 7:30. I did get quite a bit done yesterday. Got Jacob off to school, washed and folded 4 loads of laundry (which are still sitting in the baskets, but they're folded and clean), got groceries with all 3 kids in tow, and had to buy Jacob baseball pants, socks and cleats. In between all of that, I had my 3rd migraine this pregnancy. Yep, they're back. They started when I was pregnant with Isaiah, and really, I don't get a bad headache, just an annoying ache that doesn't last but a couple hours. It's the aura that drives me completely crazy. I know it's all hormone related, but it's obnoxious. I very rarely have them outside of pregnancy. Hopefully, they'll follow the same pattern as they did with Isaiah - several in the first 20 weeks, then they were less frequent after that, with a couple here and there in the first few months post-partum. On a much more positive note, I think I might have felt that first movement, or quickening. It seems a bit on the early side, but it felt like two little pops in my lower abdomen that felt just a bit different than the gas that moves it's way around. I can't be completely sure though. I felt the other kids at 16 weeks, so I'm fairly close to that. Fifteen weeks just seems early, but then again, this is my 4th baby, I'm relatively thin, and I remember what that first little flutter feels like. Soon enough, I'm sure he/she will be jabbing my insides and dancing on my bladder. We're still debating names...don't have anything for a boy and just a couple for a girl. If this is a boy, we're in trouble - we'll really have to buckle down and come up with something. And it could be that we are getting ready to be discharged home with the baby before we have decided on something!

May 5, 2010

Inernational Doula Month

Who doesn't like to win jewelry? I'm a big sucker when it comes to jewelry.



This is International Doula Month and Nicole over at Bellies and Babies has a post on her blog about a jewelry giveaway in honor of this month. The jewelry is woman-inspired and really is very beautiful. I especially like the "Blooming belly" piece.



Go on over and check it out!

April 30, 2010

What is said vs. what is heard

I found this link on another blog, and I can relate. We just yesterday announced this pregnancy to everyone we know, partly because we wanted to wait until we knew this one was going to stick around. But now, it's because we, well I, did't want to deal with the comments like "Wow, 4 kids, you're going to have your hands full", "Don't you know what causes that?", "dont you guys have another hobby?", "Are you going to get fixed?", "How are you going to handle another one?"or "How are you going to afford that?". I know sometimes people say things and they don't really mean anything by it, they just think they're being funny. Other times, people say things and they are being judgemental of someone else's decision because it isn't what they would do. Mothers are the worst at this. You see it all the time, the critical comments left on blogs when someone tells the truth that motherhood isn't always a rose-colored world. God forbid someone think it's hard, or maybe want a moment of quiet time to herself. We are judgemental when someone does something different. Or if she chose to deliver one way or another. Or if she breastfeeds or doesn't, co-sleeps or doesn't, vaccinates, or circumcises, etc. We should all just support each other and agree that we all do things a little different, and different is okay. Because this happens so often, we are insecure about our decisions and we feel like we have to justify them. Anyway, I'll get off my soap box. I found this on Notes from the Trenches and wanted to share this with you.

She said, “Are all those kids yours?”

I heard, “Is that impossibly large number of children yours? Have you ever heard of birth control?”

I said, “Yes. They are all mine.”

She heard, “They are all mine. I am a saint.”

She said, “Oh my god, I didn’t know people still did that.”

I heard, “Have you ever heard of birth control?”

I said, “I was an only child so that is probably why I always wanted a larger family”

She heard, “Being an only child was so awful. Your child is going to grow up and be lonely and resentful”

She said, “What do you do? Do you work?”

I heard, “Do you just stay at home all day doing nothing but watching Oprah and eating bon-bons?”

I said, “No, I just take care of my children all day.”

She heard, “I don’t put my children in daycare and let someone else raise them.”

She said, “I could never do that. I mean it’s great that you do, but I would go crazy.”

I heard, “You are obviously mentally deficient to be around children all day and therefore I am better than you.”

I said, “Well, there are days… It is a sacrifice.”

She heard, “You suck because you aren’t willing to give up your entire life for the good of your children.”

She said, “Well we couldn’t afford it. We want to give our kids everything, you know.”

I heard, “Unlike you who wants to give your kids nothing.”

I said, “Yes, I guess I am… lucky.”
She heard, “Poor you forced to toil away at a job when everyone knows that it is better to stay at home with your children. Too bad your husband didn’t make more money.”

She said, “How are you going to afford to send all those children to college?”

I heard, “How could you be such an irresponsible breeder and not think of the cost of a private college education times seven? Don’t you want the best things that money can buy for your children?”

I said, “No one gave my husband or me a free ride, and I’d like to think we are doing fine. It will work out.”

She heard, “Your priorities are all screwed up.”

She said, “Wow, and now you stay home? Even with a college education?”

I heard, “I thought you were too stupid to know better before, now I think you are a sell out to the feminist movement. What a waste of an education.”

I said, “Yes. I do.”

Silence.

I thought, “Why do I feel like I have to justify all my decisions. I wish I were as confident as she is that I have made the right choices.”

She thought, “Why do I feel like I have to justify all my decisions. I wish I were as confident as she is that I have made the right choices.”

I did feel like I had to justify having #4. On my facebook announcement, I put a comment under a belly pic: "Yes, this is baby #4, yes, we know what causes it, and no, it wasn't an accident. Our hands may be full but so are our hearts and our arms". I felt like I needed to to say that to avoid all the comments people may have made. I'll still hear them, and that's fine, it's sort of like a big pregnant belly seems to be an invitation to touch, which I also don't really like, but that's another discussion. Maybe someday we'll all just support each other regardless of decisions we make.

April 29, 2010

14 weeks

So babe is about the size of a lemon according to babycenter.com. Again, I love the fruit analogy!

S/S: I'm starting to feel better. I tell you what, that first trimester really kicked my butt. My energy is coming back so I'm able to get my usual stuff done around the house and play with the kids like I usually do, without feeling completely wiped out. Nausea is almost completely gone. Not sad to see that symptom go. If I eat something I know I shouldn't, like greasy pepperoni pizza and then ice cream, yeah, it makes a reappearance, but for the most part I'm feeling pretty good. Not feeling any movement yet. I can't wait, but it'll be a couple more weeks, at least. I think with the other 3 I felt that first flutter at 16 weeks. My main complaint in constipation. Man, oh man, is all I can say. I don't remember this with the other kids, but the mind is good at remembering only the good parts. Here's an example without getting into graphic detail. The week I went to New Orleans, I went from Monday to Saturday with nothing! I'm sure some of it was the plane and the traveling but you should have seen the size of my abdomen! I do have colace and I'm eating better since I'm not nauseated constantly, so I'm hoping it will get better.

Cravings: Really I haven't had much in the way of cravings. I've been enjoying potato and cheese pierogies the last few days (lots of carbs), and Triscuits with cheese. I'm also able to enjoy a diet Coke again, so I allow myself that morning indulgence on most days.

Aversions: Nothing really makes my stomach turn anymore! I do remember with the other kids craving a Margarita (obviously never indulged) the whole pregnancy, thinking I'd have one once I delivered, but never actually did. The mere thought of alcohol makes my stomach sour this time.

Running: Haven't really been doing too much. I'm just trying to maintain some level of exercise and I'll run 3 miles when I have time. My half-marathon I signed up for a few months ago is this Saturday. Everyone that is running is excited and it makes me wish in a way I was taking part in this run. There are 13,000 runners among the 5K/half/full marathon! It's going to be huge. But, I'm sitting it out for a good cause, and there's always next year!

Appointment: It went well yesterday, although I could have done what Doc did at work, without the 1 hour wait. I can weigh myself, take my BP and listen to the babe. But, I did want to see what she said about the whole platelet thing. She said if there was a problem, they wouldn't have gone back up, but that we'll just keep an eye on things. Okay. Baby sounded good and we could hear him/her moving around, BP 94/50, usual for me, and no weight gain, yet.

Girth: I actually had a patient's mother ask me if I was pregnant! I have a rule that I NEVER assume someone is pregnant unless it's very obvious, like they are normally 140 and they are probably 8 months along. What if I wasn't pregnant? Wouldn't she have felt bad? And I don't really feel I look that pregnant, especially in those lovely flattering scrubs. Ok, so down in New Orleans, when my bowel was full of stuff, I had someone say "Oh, you'll want to do this cruise because you're pregnant and won't want this boat's food". Ok, I understood that because of the way the shirt was cut and I was pretty distended, but come on, in scrubs? Really? I really don't mind and wasn't insulted in the least, I am pregnant and it's nice when you do hit that point that it's obvious you're with child and not just drinking too much beer. I'm still in normal clothes, although I have a rubberband holding the buttons together. But like I said, in a week or two, I'll have to give in and wear maternity clothes.

And here's a belly pic for your enjoyment. I feel much larger then what the picture shows, especially in the evening.

April 27, 2010

Whew, what a week!

Sorry, this is probably a long one.
I am back and let me tell you, I am exhausted. New Orleans was fabulous. The conference was very educational. The first day was on advanced fetal monitoring. I had taken a course shortly after I started working in L&D but it wasn't quite as in depth as this one was. It was very educational. The second day was about legal issues and litigation in Obstetrics. They had a trial lawyer who specializes in birth injury and a legal nurse consultant there to speak. After that day, I considered turning in my nursing license and going to work at the mall. It's scary stuff. But I do think that every nurse that works L&D should go to a conference like this. Like I said, it was very informative. In June, we're going to give an inservice to our department with a few other people who are attending this workshop in Chicago. I think we may actually change our pitocin protocol!!!!!! YEAH!!!! That was the biggest issue they talked about: the abuse of pitocin in the country. Our standing orders for induction/augmentation say to start at 1 munit and increase by 1 every 15 minutes until in adequate labor. The docs want the contractions every 2 minutes - that doesn't give the baby much time to recover after a contraction before the next begins. And sometimes in the second stage of labor when contractions should space a bit while mom is pushing, they will ask us to start pit because they want the contractions closer so they can get the baby delivered and be done. Big no no. It was recommended that pitocin only be used as a stimulant: stop the pit after mom is 4-5 cm. And there should be at least 60 if not 90 seconds of rest between contractions. It takes the baby 90 seconds to recover from the contraction. And we should not be starting pit if mom is contracting and making maybe slow change. There's no need, her body is working. And this whole attitude of increasing pit even if the baby isn't reactive because why pit them if we aren't' going to be aggressive attitude has to stop. I've never been one to increase my pit aggressively and I have never increased it (or started it for that matter) if the baby wasn't reactive. So many things that we do day to day are dangerous. I am very happy that we are working toward a better solution. We will probably start working with the other hospital in town so we both have the same policy. One nurse at this conference said they have a pitocin checklist. Every 30 minutes, they have to run down this list and if every single criteria isn't met, then they don't start/increase pitocin. She said once she was home, she'd email me a copy so we could get an idea of what other places are doing. I could go on and on and on about all the information they gave us. The other big thing they stressed was being a patient advocate. Our number one priority is to our patient: the one we can see and the one we can't. Even if it makes us unpopular, we need to not follow orders blindly. We need question orders that are dangerous. We have to be stand up for our patients.

After the conference, we spent time sight-seeing in New Orleans. It is a different world down there compared to my Midwest way of living. Especially the food. I don't like any seafood - they are known for seafood and it was crawfish season. The French Quarter was very cool, and I bought some fun things in the French Market. We took a tour of the city: saw the above ground cemeteries, a few celebrity homes, and the Ninth Ward. That was very sobering. You see the devastation on tv but you don't get how big it is. They have rebuilt some but there are still schools and hospitals that are closed, still houses in shambles, empty foundations. And seeing the wall that gave and picturing how much water came and how fast: very sobering. True to form, I came very close to tearing up just thinking about it. We walked down to Bourbon street, but I, of course, didn't have a drink. I was amazed that you can walk up to a vendor, buy a margarita and continue walking. And we also took a Riverboat cruise. The food sucked but the ride up and down the river was fun. Then we got up early with God to fly back so we could work Sat-Sun-Mon night. So I'm pooped. My house survived: Husband actually kept it clean! The kids were clean, laundry and dishes done. So it proves that he can do it.

Pregnancy-wise, I see doc tomorrow. I had my platelets redrawn at work Saturday and they were up to 166!!! And I looked at my records and with my other pregnancies, they were in the 100's, but non-pregnant they are in the 200's. So maybe it's a gestational thing. I'll talk to Doc about it tomorrow. I am starting to pop more, so I'll probably have to break down and buy some maternity pants within the week. Right now I'm getting by with my fav jeans with a rubberband holding the top together. Really, it's very stylish!

April 21, 2010

New Orleans, here I come!

I am up at a horrible hour, unless I've been up working. 2:00 a.m. just isn't a nice time to set your alarm for the day, especially if you hate your alarm clock anyway. But, I am catching an early flight to New Orleans. It will be a nice get-away for the next 3 days. I'm going for a work conference, but there will be a little time for some sightseeing and relaxing. I'll have 3 nights of not having to get up with a 2 year old, which will be nice, but I'll miss it. Ironic, this motherhood thing. I think it will be harder on me than the kids being gone until Saturday, but I'm sure we'll all survive. I'll get back early Saturday afternoon, just in time to relax with the kids for a couple hours before I work Sat-Sun-Mon night. That part stinks, but it will be worth it. The main thing I worry about, and it's pretty minor is the state of my house. Here's how a typical week goes for me: I have the house pretty clean and organized by the time I leave for work at 7pm Saturday. Working 12 hour shifts, there's not much time for anything else but to work, eat and sleep. By Tuesday afternoon when I wake up, my house looks like a battlefield: pajamas and a balled up wet diaper on the living room floor, sink full of dishes, pile of laundry by the stairs, cups everywhere, sippy cup with curdled milk in the toy room and just a general disarray. I spend the rest of the week tiding up just in time for Saturday night. So you can see where my concern lies. I'll be basically out of action until next Tuesday...God only knows what will be waiting! But, Husband may surprise me with a nice, clean house! One can hope! But until then, I'll be in New Orleans, learning about fetal monitoring issues and out on the town...as designated driver, but out nonetheless! See you Saturday!