Thursday, May 27, 2010

Random Compliment from an EMT

EMS and the PoPo's brought in a pregnant lady who was picked up for a drunken disorderly to my OBT. This was FIRST THING IN THE MORNING- like 7am? Seriously? You're wasted already? She reeked of alcohol and beer. She couldn't coherently answer any questions, about how far along she was, about whether or not her water had broken (her chux and pants were soaked), about ANYTHING. I was trying to assess her, and I couldn't figure out if that was amniotic fluid on the pad or urine, so I leaned over and sniffed it. Yes, I really smelled it. The EMT looked at me with saucer sized eyes and said (off to the side away from the patient), "I cannot believe that you just smelled that crack whore's chux! You are hardcore!" I said, "I'm a (insert name of hospital here) Labor and Delivery Nurse. Damn straight I'm hardcore."

It was urine btw. Eeew. The things I do for babies.

Teenage Pregnancy

I have seen many many teenage mothers deliver at this point. The youngest patient that I have had was 12. You read that right. Unfortunately, I have become a pro at navigating through the Child Protective Service reporting system.

I took care of a 15yo this week (the FOB was 23) and after talking about it with a couple of my friends I realize that my take on sex education of kids is probably pretty different than the norm. A lot of my friends with kids the same ages as mine, haven't even started the sex discussions yet. My feeling is that it should be an ongoing conversation, not a one time lecture.

My daughter Little Miss is 8 going on 9, the sex ed conversation probably began about 5 years ago. Seriously. Early conversations involved the homebirth of her little brother Bean. I wanted her to be there for the delivery, so I worked really hard to prepare her for the sights and sounds of birth. We read books, watched birth videos, and howled together (birth noises). My best friend was her caregiver during my labor. They made a birthday cake for Bean and watched movies. Heck I even have a picture of Little Miss in the big birth tub with me rubbing my back (my sweet little doula)! She was brought into the bedroom right at delivery. She talks about it now, but I am not sure if she really remembers or just remembers the pictures.

She has always been interested in my tampons and pads, in menstruation, and recently has been asking about body hair. I have explained the basics of sex to her in very simple terms. I have explained that her private parts are hers and no one else is to touch them. She seems to get it. She hates me talking about sex now though. She seems annoyed, but she is informed!

So now back to my 15yo patient. The conversation went like this:

Me: How old was she when she got pregnant?
Her: 14
Me: What grade is that?
Her: (lots of calculating) 8th? She is still in a grade?
Me: Yes, but I think that she is 9th now. She was in 8th when she got pregnant though. How many more grades is that than you?
Her: 6
Me: Wow, that's not much. Do you think that you could take care of a baby and still go to school everyday?
Her: I dunno (eye roll).
Me: I think that she is going to have a really hard time. Taking care of a baby is really hard. They have to be fed every 2 hours (even during the night), they cry, they need diaper changes, and constant attention. That is pretty hard work don't you think?
Her: Yeah, it does sound hard. Why would she want a baby now?
Me: I don't think that she chose to have a baby, I think that she got pregnant by accident.
Her: Wow. What are we having for dinner?

And that was the end of that conversation! This really wasn't a "sex talk", but it was part of the ongoing sex education. Sex education is about more than the mechanics of the sex act and pregnancy. Sex education IMO is about 3 simple things:
1) Respecting yourself and your potential partner
2) Respecting the responsibility of having sex
3) Respecting the responsibility that comes with parenting
 If I can get those 3 key things through to my kiddos, than I will feel like I have succeeded!

Now Bean on the other hand.... Well, the little stinker totally shocked me today. Out of the blue he told me that was going to marry Natalie (a little girl at his preschool) and that he was going to put a baby in her tummy because she didn't have a baby yet and she needed one. Oh. My. Goodness. DEEP BREATHS! He is only 4! At least he knows where babies come from? Right? He knew that babies came from a girl's tummy because of my belly cast from my pregnancy with him, let alone hearing his mother talk about birth all of the time... However, I didn't know that he knew yet that boys put the babies in the girls tummies. Le sigh. I think that it is time to start the conversation with him!

They aren't teenagers yet. That is a whole 'nother type of conversation, but I already have plans. I have LOTS of medical textbooks with LOTS of graphic pictures of all kinds of STD's. By that time I will be a midwife and I will have access to EVERY BIRTH CONTROL DEVICE KNOWN TO MAN. And of course I will have a condom stash somewhere in the house that they will know about. Do I want them to have sex as teenagers? Heck no! But, IF they do I want them to be safe and responsible.  I want them to respect themselves and their partner. I want it to be a conscious decision- not a spur of the moment impulse decision. I want them to realize that they have a choice.

Wednesday, May 26, 2010

Can a woman deliver a 10lb baby vaginally?

You betcha. A 4 foot 9 inch grandmultip being induced for A1DM, just a whiff of pit (2 hours) and a butter birth of a 10lb 3oz boy into the waiting hands of her nurse. The doc was fumbling with gloves, for some reason he thought that an unmedicated grandmultip could just not push while he gowned and gloved. Even while the nurse is telling him "just gloves!". (insert ginormous eye roll here)

Intact perineum btw. Thank you. Thank you very much. :)

Friday, May 21, 2010


It is an aspect of Labor and Delivery that isn't talked about. Miscarriage and fetal demise. There are tons of women out there who have experienced miscarriage, it is more common than we realize. For some reason, it isn't talked about. The only people who ever ask how many times that you have been pregnant are health care workers. Everyone else always asks how many kids you have. For those that have experienced a fetal loss, there is always the thought of that child that is somehow not counted, not talked about, but that you can never forget.

I have been spending a lot of time at work organizing all of our bereavement supplies. We have knitted hats, lovely sewn outfits, blankets, memory boxes, and lots of handouts to give our patients. I know that I try really hard to do my very best work when I am taking care of a mother who has a demise. Labor is an unforgettable event as it is, but when you add grief to it everything that happens to you stands out in stark contrast. What I have realized, is that my training as a doula is what has best served me in nursing to help someone die while feeling comforted (a nursing school experience) and to help a family experience the loss of a baby.

It is more than being nice or being respectful. It is being present, and being a witness. It is holding hands, while normalizing the process. It is doing everything possible to make memories for that family to keep. I take lots of pictures, make tons of hand prints/ footprints, take a lock of hair from the baby, the family keeps the baby with them as long as they wish, and I always call pastoral care. It is comforting and praying with the family. Honestly, it is the hardest thing that I do.

I have taken care of all kinds of demises at this point. 12 week miscarriages to 38 week demises for no known cause. Babies with multiple anomalies that lived for hours after birth to babies that died in utero a week before delivery. What people need to realize is that it is all the same. That 12 weeker will be just as missed as the term baby. That mother will cry just as much, will hurt just as much, and still needs just as much support. The family will feel confused, will be scared, and will need as much help as you can give.

I've used the word "miscarriage" here, but I have  to admit that I hate it. It implies that somehow the mother did something wrong, that she didn't carry the baby properly. I don't even really like the word "loss". It is like they left the baby somewhere- like they lost it. In medicine we use the term spontaneous abortion, but the word abortion has so many other negative connotations in our society. What it is, the word that you can and should use is "death". It is a death and it should be treated accordingly. Using the word death absolves the mother from blame, whereas every other word implies somehow that she did something wrong.  I say immediately, "I am so sorry" shortly followed by "this is not your fault, you did nothing wrong". I leave it at that, I answer questions if asked, but I really try to avoid using the above words.

I wanted to post this so that maybe if you have experienced a demise, you would know that you are not alone. That if your friend, or sister, or client has a demise you would know how to act.

Tuesday, May 18, 2010


I know that I spend a lot of time complaining about my job, but one of the best things about my hospital is that we encourage vbacs for those women who have only had one c-section. Two c/s's though? Well, you are SOL.

Yesterday we had two great vbacs! One was a woman who came in in an active labor pattern. She was already 6cm on admit, within an hour and twenty minutes she was pushing! No time for an epidural (yes she wanted one), her labs weren't even back. She had a vaginal delivery, but it was completely bungled by the resident. He allowed her vagina to explode (descriptive right?) And practically exsanguinated the baby with how he cut the cord. Baby ended up needing an IV bolus, but perked up after that. She had her vaginal birth, but her vagina is going to be very sore for a long time. Her c/s was for breech presentation btw.

The second vbac'er came in contracting, but barely. I do not know why she had her first section as she was not my patient. She did have borderline high blood pressure which was part of the reasoning in putting her on low dose pitocin (yes we pit vbacs) and her contractions were adequate (as determined via IUPC) at a mere 4mu of pitocin. She delivered vaginally too! I don't know the specifics of her birth, but I am happy that she was able to deliver vaginally.

I have to wonder though why the only hospitals in the area that allow vbacs are teaching hospitals? These doctors are taught how to manage a vbac, yet when they create a private practice they refuse to do it for fear if litigation?! Really? (Ginormous eye roll inserted here). The research supports vbac, docs are trained in it, and it is still so difficult for a woman to get one in the private world.

One of my favorite kind of births (hospital anywhoo) are when I get to be the nurse to a vbac'er. Honestly though, most of my patients don't seem as thrilled about it as I do. I wonder how many of them realize how rare it is to get an opportunity to vbac at a hospital- let alone having the hospital encourage them to vbac. As I am grinning ear to ear and telling them how amazing they are they look at me like I am a crazy lady. Well, maybe I am the crazy birth lady :).

Sunday, May 16, 2010

The beauty of extended breastfeeding....

My daughter breastfeed until 2 1/2, my son Bean nursed until he was almost 3. He is 4 almost 5 now and yesterday as he was snuggled up on my lap while we were sitting on the couch reading a book, his hand was ever so slightly resting on my breast. He said out of the blue, "Mama when I was a baby I drank milk from your boobies" while kind of giggling and pulling on one cheek like he does when he is nervous, embarrassed, or knows that he is being cute. I said "yes you did- do you remember it?" He emphatically said "Yes! It was better than the milk in the fridge!" We talked a little more about breastfeeding and all of the good that it did him. He seemed satisfied with the conversation and put his head back on my shoulder so that we could finish the story.. :) I love my munchkin!

Monday, May 10, 2010

Mother's Day!

If I couldn't be with the munchkins on Mother's Day I was so happy to be at work. I didn't have any births, I had a postpartum mother on MagSulfate and an induction, but my pod partner had a good birth. A first time mom who was PROM'ed for days (and in our high risk antepartum unit) was induced at 34 weeks. She went from 1 to 10 in 3 hours! Talk about surprised! Everything went just fine though, quick easy birth. Baby did very well, but still went to NICU because s/he was so small.

Saturday, May 8, 2010

Day as Circulator... Happy Nurses Week everyone!

I was not super thrilled to find out that I was circulating yesterday. I was missing laboring patients! It had been a few weeks since I had a day with a couple of nice births. BUT, I had a GREAT day as circulator!

First case was a primary section of a 5/3 for transverse lie. She was SROM'ed and that baby's head was stuck up in her rib cage. The CNM tried to see if the baby could be versioned, but no luck (probably because of too little fluid). Off to the OR, and shortly thereafter a beautiful baby. Mom seemed okay with everything. She understood the need for a section and understood that she could have a VBAC with her next pregnancy (at my hospital anyhow) if she liked.

Second case was a scheduled section. This would be her 3rd section and her previous two sections were done overseas and both had negative outcomes. I was really hopeful that she would be able to be awake for this birth (for the first time) and that she would be very happy with the outcome. Unfortunately, her spinal was placed by a RRNA ( a student nurse anesthetist) and it was not a good one. Was it the student's fault or just a failed spinal? I really don't know. Anesthesia had to basically put her into a twilight sleep for the birth because she felt a lot of pressure when her muscles were moved (but not when the doc was doing the incision). I didn't get a chance to talk to her in PACU once she was more alert, but I was sad that her experience was not the excellent one that I had hoped for.

Third case was a twin vaginal delivery! Yes, we take all of our twins back to the OR (eye roll). She was a gravida one with PIH who was being induced at 30 weeks. She had received two doses of betamethasone (for fetal lung development) and MULTIPLE doses of antibiotics because she was chorio at this point. She was also morbidly obese and we were very worried about having to move her to the OR table if something went wrong. The big issue (according to my hospital) with twin deliveries is that the second baby can prolapse a cord... Bleh. Guess what? She ROCKED! She pushed that first baby out with no problem, second baby was born a mere 16 minutes later! Both babies ended up in NICU, but with everything said and done this was a fantastic outcome of a not so favorable situation.

Fourth case (some tired feet at this point), was a section of a 35 weeker for severe PIH. Sitting that mom up for her spinal I saw multiple blood pressures of 200+/ 115+. I was ready for her to seize. Seriously. This baby was as little as my 30 week twins earlier. So little in fact that the NICU nurses rolled a scale into the OR to see if s/he was big enough to even go to the newborn nursery, which s/he was not. Another baby to NICU. Sigh. At least I was keeping the NI nurses in a job.

I work tomorrow and cannot wait to see what Mother's Day will bring. I am sad to be away from my kidlets on Mother's Day, but helping other mothers makes the separation bearable :).

Monday, May 3, 2010

Amnesty International Report on Maternal Health in the US

"The likelihood of a woman's dying in childbirth in the U.S. is five times as great as in Greece, four times as great as in Germany and three times as great as in Spain. Every day in the U.S., more than two women die of pregnancy-related causes, with the maternal mortality ratio doubling from 6.6 deaths per 100,000 births in 1987 to 13.3 deaths per 100,000 births in 2006."

Catching Baby

Yesterday I heard the yoodle of a push and ran into my patient's room. I threw back the covers to see a head! Quickly I put on gloves and caught the baby's body. Mama had a 2 degree tear (probably from that head coming barreling out without a helper there to slow it down), but baby was perfectly fine with 9/9 apgars. She was unmedicated and I had a gut instinct that she was getting ready to deliver 10 min earlier when I was in the room, but I didn't check her because my other patient (an induction for ancephaly) was up to the bathroom. Big mistake!I had just checked her within the last hour and she was 4-5, but paper thin. I knew that she was going to go fast. Looking back on the strip, I had one minute where I lost the baby's heartbeat. Was the baby's head out for that whole minute? I really don't know and that bothers me.

This is a perfect example of why I hate that my hospital does not follow AWHONN standards concerning nurse/patient ration. AWHONN states that all fetal demises should be one on one, that women in the active labor stage and beyond should be one on one. So clearly, there should of been two of me to take care of these two patients.

One of the things that I love about out-of-hospital birth is that your midwife is there with you. In the hospital, you really just have the monitor with you during your labor and a nurse that comes and goes. 

Btw, baby was 8lbs 3oz :). Cute little guy.