Chart Review

Documentation on labor flowsheet (nurse documentation):
SROM @2:10 am, clear fluid, nitrazine positive . FHR 155,
reactive. Contractions every 5-10 minutes, (no change from prior entries). Mag Sulfate rate 2.5mg/hr.
3:25 am entry: EFM discontinued, patient taken to OR suite #1. FHR 150, reactive, contractions every 5-10 minutes, no vaginal bleeding. Mag Sulfate dc/d.


History & Physical:
IUP (intrauterine pregnancy) at 34 5/7 weeks, preterm labor. Gravida 5, Para 3, Prior c/s X 2. No response to terbutaline or procardia. Magnesium Sulfate protocol initiated.
PROM @ 34.5 weeks.

Progress note entry @ 3:30 am
Patient refused to go to OR until spouse present.


Hmm, sounds kind of silly to me to document on the patients chart that refusal. The patient is stable, baby is stable, doesn't appear anything changed after the patient water broke, and it is documented as such. Doesn't sound like such an unreasonable request of a patient in L&D to have her spouse present when she is delivered, since the baby was fine and there were no signs of uterine rupture. Especially since the time of SROM was only 1.5 hours prior to the time the patient was taken back for a c-section. I'm sure the patient would have consented to immediate surgery without her spouse should it have been necessary. I understand the need to document our backsides, but really? I've not seen this documented unless there was an issue that the baby wasn't tolerating labor or there were signs of a problem. Doesn't seem too necessary in this case.

This patient was very tearful, worried about a preterm delivery, hadn't wanted to deliver preterm. Not a case of tired of being pregnant. Not a patient who refused care just to refuse care. This was just a mom who wanted her husband there when their last child was delivered and really thought that her request to wait until her husband was present before going back for delivery wouldn't be a big deal. Her husband had been home, taking care of their other children and he was there in her room within about 1 hour. She would have consented to a c-section with no anesthesia, in the labor room, without her spouse, if it had been necessary.

I'm perfectly fine with that documentation on my chart. ;)

Hi-Ho, Hi-Ho, It's Back to Work I Go

I went back to work this past Sunday night, something I was dreading. I got used to being home with the kids and although I was going stir crazy being at home, I didn't want to go back to work. I'm not sure why but going back to work after maternity leave got harder with each kid. But, anyway, I went back to work Sunday night, only did an 8 hour shift, and had just a few tears as I left. Thank goodness it was a slow night. We actually had plenty of labor nurses (which is surprising) so I was only going to have 1 patient, the midnight induction. So I had about an hour to get ready, try to remember my passwords to everything. Thankfully, I was able to log into the 2 charting systems we use, one for the fetal monitor and the one for meds. But I couldn't log into my email or into the Omnicell, the machine that dispenses medications. And it wasn't because I forgot my password. Apparently they had disabled my user id and of course, being a Sunday night, no one was there to fix it. It was fabulous. The charge nurse was able to give me a temporary id and password so I could function, but it was a pain in the arse. It becomes almost mindless when you log into different things so when you have to change a password or, in my case, have some funky user id, it slows you down. As for my work email, the guy in IS who can usually fix anything with the computer couldn't figure out what the problem was with my email. So who knows when that will be fixed. Beyond the technical difficulties, the night wasn't too bad. The midnight induction was a no show, but I did admit one patient. Like I said, it was a slow night. I felt just "off" going through the millions of questions we ask when someone comes in. I had no problems with the assessment/hands on stuff, like the IV, cervical exam, reading the monitor, but it was more in my organization, my routine. It's a bit hard to explain, but I just felt like I had been gone for 10 weeks. Monday night was much better. I felt like I was back to my old self, well, maybe 95% back to normal. I think this weekend I'll feel "back".

Caleb did just fine with my return to work, sleeping through the night for the first time Sunday night and again on Monday. Lucky Husband. Of course last night, since Mommy was home, Caleb was up quite a bit. Figures, right? A friend of mine, who has 5 kids, calls it survival mode. They know Mom isn't there so they figure they might as well sleep.





On a completely different note, I want to take just a minute to remember my stillborn niece Mirabel. She would have been 7 years old today. My SIL and BIL have been actively trying to conceive for the past year without success. I finally talked her into making an appointment to see her physician. Today I pray they are able to conceive again soon. My thoughts are with them today as they remember...she may be gone, but not forgotten.

Spirited Child

One of the many good things about maternity leave is that I've been able to go to church. When I work Sat. nights, I just can't stay awake to go to the service at 11am. I'm just too exhausted and I figure God understands. But I do miss it. Last Sunday, a family had their baby baptized and their almost 3 year old son was running all over the sanctuary and the poor mother was stressed trying to keep him under control since Dad was holding the baby, trying to keep him from knocking over the candles on the altar, etc. It was quite distracting as the Pastor went through the Baptismal Covenant. He had a pencil and one of the envelopes meant for the offering with him. He would lay on the floor, in front of the congregation, color a bit, then get up and run to the other end, run by the altar, jump up and down to make noise, try to get his dad to pick him up even though daddy was holding the baby, and he just was nuts. The poor mom, she picked him up a couple times to try and control him, he resisted, fought her the whole time but she managed to stay focused on the son being baptized. Finally, she gave up, let her elder son lay on the floor and color while they finished the baptism. Every mother in the congregation was silently glad that it wasn't their child that was acting up. Seriously, how could that mother let the kids get away with that? Why didn't she have more control? How embarrassing!! Oh, wait, that mother was me and the child was my own sweet "spirited Isaiah that was running amok while Caleb was being baptised!!

8 Weeks

I just can not believe that my baby boy is 8 weeks. It just doesn't seem like it has been that long. I also can't believe I go back to work in 2 weeks. I like my job, but I'm not looking forward to going back. The first night back is always the hardest, and it seems like with each kid, I'm more and more emotional about leaving them to go back to work. You'd think by now I realize it's no big deal...I work 3 nights a week. One thing that will be hard is going back to switching my sleep schedule all the time. Sleeping at night 4 nights a week, working all night the other 3 then sleeping during the day. You don't realize how much that messes with you until you are going to bed every night. I've talked with a few of the girls from work and apparently morale is at an all time low - people who no one ever thought would leave the department are looking for other jobs and are even willing to leave to go to another area of nursing, like ER or med-surg and these are die-hard labor nurses! It's busy, short-staffed and everyone is taking on patient loads that make it hard to give good-enough care, let alone give good care. So I'm really excited about going back to work. Maybe something dramatic will happen and it will be all sunshine and roses, we'll get to do one-on-one nursing care and be able to give the attention we want to give to our patients. I won't be holding my breath.
But, back to Caleb. He's starting to be much more attentive to the world around him. He's been spending a lot more time awake, just looking around. He's starting to smile purposefully now, too. I just love baby smiles! They are addictive and I can tell you I've spent so much time trying to get him to smile again. The other kids look at me like "Mommy, what is wrong with you?". They think I'm crazy, I'm sure. But Caleb will sit in his bouncy/vibrating chair and just wait for someone to come talk to him. Then he just lights up, his eyes get really big and he will try to imitate what we do with mouths. It's so cute. He's still a pretty decent sleeper. He has a good stretch at the beginning of the night for about 5 hours, then he's up every 2-3. He ends up in bed next to me about every night. I prefer to not co-sleep, but he sleeps so much better next to me, and I usually just fall asleep nursing him. But, so far, sleeping isn't too bad. I just hope when I do go back to work, he does okay with me gone.

First 5K is around the bend

I have decided I am officially crazy. I've probably been this way, since, oh, the first time I saw 2 lines on a home pregnancy test back in 2002, but I'm finally admitting that I am in fact nuts. I just got the ok to start exercising last week and I've decided to run a 5K December 4th. That's right, in a month. Its a memorial race back home, so I can hit up my parents for some good food while I'm there, if I survive the run, in the cold of December. My luck it will be sleeting that day. But that's not the real issue. I have a 7 week old baby that was born by c/s. And I am severely out of shape due to lack of exercise for months. The last time I ran, 3 days ago, I did manage to run an entire mile,...but then I had to stop and walk. It was only 1 mile, not 3.1 miles. Plus I was running on a flat treadmill. No wind, no hills, constant slow pace. I don't know what I'm thinking, running a race so soon. But, if I have to stop and walk some, so be it. I'm not too proud to walk. I figured I gotta get back out there sometime, why not sooner rather than later? Talk to me after the race, and see if I still feel the same way!

I'm Too Sexy..

I told Husband last night "I just don't feel sexy anymore, ya know?"
He just stared at me for a second and then laughed. For a brief moment, I was irritated until I realized what I was doing. I was wearing a pair of his gray sweat pants and a tshirt I got in H.S. My hair was pulled back in a messy ponytail and I had minimal make-up on. But the best part? I was sitting on the floor, my old tshirt hiked up, exposing my jowls-of-a-dog post-partum belly, with the breast pump milking me like a cow, with enough suction to pull my nipples to a very unnatural length as milk filled the bottles. Yup, motherhood is sexy!

Reunion with my Running Shoes

Today I decided to go for my first run in months. Tomorrow I see Doc for my post-partum check-up so I figured 1 day ahead of time would be ok. Plus I knew I wouldn't be running very far. I tried to remind myself that I had a baby 6 weeks ago, added to the fact that I haven't exercised since May. Rationally, I knew it wouldn't be that nice easy run around the neighborhood, but in my head was the memory of those nice, easy runs. Let's just say it wasn't pretty! I can only imagine what I looked like. I have a long way to go to get back into shape. That said, it wasn't as bad as I expected, I alternated running and walking, and ran most of the way. I ran slow, but that's ok. I didn't push it, as I haven't gotten the "official" ok to exercise, but I don't imagine there's any reason why Doc won't give me to ok tomorrow. So I did it, I got that first run under my belt. It will only get better from here.