Thursday, November 19, 2009

Must be able to deal with MD temper tantrums - part of the job description

If you are a nurse or have been for more than a week, then you've been chewed out by a doctor.  I don't understand what happens to them during the course of med school and residency that makes them think they can talk to other human beings (especially nurses) like dogs/idiots/children...  Not all of them behave this way, but unfortunately, the polite and professional doctors are in the minority.  I can only think of a small handful of doctors I work with that I haven't been eye witness to one of their outbursts.  I used to cry when doctors yelled at me, but now I've gotten to the point where I can politely and professionally defend myself.  I once heard a nurse say that when a doctor starts yelling at her she just thinks, "The louder you yell, the slower I am gonna go."  That totally cracked me up.  Maybe when I'm on my way out of my nursing career, I'll have a chance to say this to someone.  Doubt I'd be able to do it, but it's fun to imagine=).
The doctor I was working with the other night chewed me out for something ridiculous and you know what kills me?  If I had talked to her the way she talked to me, I can guarantee, I wouldn't have a job.  The hospital seems to set the tone that it's okay for a doctor to yell at a nurse, but not vice versa.  I don't work for the doctors, I work for the hospital.  Nurses are just as vital to patient care as doctors are.  But apparently because I don't have and MD behind my name, I am less deserving of respect.
For any of you budding OB's out there, let me just clue you in on something.  OB/GYNs don't have a "great lifestyle" all the time.  It is a busy specialty.  So, if you don't like long hours and working late, this might not be the profession for you.  But if you do choose to go into OB, please don't take it out on your patients and nurses when you have a crappy week. 
Have a nice day!

Wednesday, November 11, 2009

Importance of Skin to Skin Contact in the minutes, hours,and weeks following birth

At work we had an inservice on the importance and benefits of STSC (skin-to-skin contact). So, I wanted to post some of the information to share with everyone. I knew it was beneficial for infants, but didn't know it was for mothers.

Benefits of STSC for infants:
-greater temperature stability
-blood glucose stability
-greater heart rate and respiratory rate stability
-decreased crying and anxiety
-accelerates weight gain
-better organized and restful sleep
Benefits of STSC for mothers:
-less anxiety at 3 days post birth
-greater confidence of childcare abilities at hospital discharge
-greater sense of well-being
-decreased pain sensation int he mom, as endogenous opioid are released as a result of the pleasing touch

It is important for mothers to continue this even after they get home for several weeks. So, make sure to tell your nurse this is very important to you after delivery, even if you have a C-section.

Thursday, November 5, 2009

Recent Births

I have had two beautiful, natural deliveries recently. One planned, one unplanned. Both had done it before and both did awesome. One even delivered her sweet baby OP (head looking up). It reminds me why I truely love my job!! I love helping women through one of their greatest times of need. I love being right their reminding them that they can do it. I even started to tear up during one....I have been doing this for 5 years!! It just shows that I am absolutely doing the right thing if I still cry when seeing women giving birth! I hope I have many more natural deliveries coming up!

Tuesday, November 3, 2009

I'm getting a medal!

This email made my day!  Sheridan from "Enjoy Birth" is sending me a medal because she liked my blog.
Blog or no blog, all moms really should get a medal for the sacrifices they make for their families every day.  If you are a mommy or mommy to be, I want to take this opportunity to applaud you for all your hard work and self sacrifice which most of the time goes unnoticed.  Go hug a mom today and tell her she is doing a great job.  You just might make her day too!
Thanks to Sheridan for being a great example!

Psalm 127:3
Behold, children are a heritage from the Lord,
The fruit of the womb is a reward. 
Like arrows in the hand of a warrior,
So are the children of one's youth.
Happy is the man who has his quiver full of them...

Here is the email I received from her today!

I love how your blog supports pregnant moms and gives them information so they can make the best choices regarding their births!

I want to send you a medal, because YOU deserve one!
If you send me your snail mail address, I will get a medal out to you in the next few weeks. (I am heading out of town, but once I am back and settled I will mail out your medal!)

Thanks for all you do!
Sheridan mom of 3 boys.Hypnobabies Instructor.Doula

Thursday, October 29, 2009

Beautiful VBAC Birth Story

This is something I found on the blog Stand and Deliver. This is such a beautiful story of how a dissatisfying birth changed this woman's life completely and shows her realizing her ultimate dreams. Like I have said, I'm not sure how I feel about home birth for me, but it just doesn't get much better than this story! Can I say again, women never cease to amaze me!!

My Journey to a VBAC from Lindsey Meehleis on Vimeo.

Wednesday, October 28, 2009

The Business of Being Born

So, I finally got to watch The Business of Being Born, the documentary that Ricki Lake made on home births. I finished watching it with mixed feelings. I do DEFINITELY agree that we intervene way too often. I wish we would stop inducing everyone for no medical reasoning. I know this is what women think they want, but if they were educated on the implications it can have, I don't think it would be what they wanted anymore. It is so funny because I am someone who DID NOT want to be induced and have had to be induced for medical indications both times.

I know complications with home births are rare, but WHAT IF mine was the one birth that went wrong and my baby died. How would I ever get over it when I know had I been at the hospital, it most likely would not have happened. I just could not forgive myself. In a perfect world, I would love to deliver at home, but I just don't think I could take the chance. Not to mention, it happens to be illegal in the state of Alabama. So, in my ideal world, there would be a place where women could go and give birth without intervention, however be next door to a hospital that could take care of the emergencies. I just wish there was a happy medium.

They definitely did make some good points against hospital births in the movie. They talked about the "snowball" effect hospitals have. We have to start and IV, and once we do that and your not progressing quickly enough ...let us just put some pitocin in your IV to speed up your labor. Once women get the pitocin, some find it hard to go unmedicated, so they get their epidural. That slows down there labor, so more pitocin and then eventually our interventions end up stressing the baby out. So, off for a c-section we go. Then we are all so happy we were able to "save" the baby, but would we have had all of these problems without our interventions? I think if we could just let labor occur, then we wouldn't have nearly as many emergencies.

They also brought up some very astonishing statistics. The US has the 2nd worst infant death rate and one of the highest maternal death rates of industrialized countries. They mentioned that in 2005 1 in 3 births was a c-section. Wow...that is unbelievable. What have we come to?

I am so excited about our hospital beginning to offer water births and hopefully we will continue to progress (or regress) back to what birth SHOULD be, but still do it in an environment which has the capabilities to care for those patients who do have true emergencies.

Monday, October 26, 2009

Brewer's Birth Story

To tell Brewer's birth story, I feel like I need to start with Emma's. While I was pregnant with Emma I developed pre-eclampsia. I got put on bedrest at 34 weeks and the increased blood pressure caused me to have be induced at 35.6 weeks. I had an epidural with Emma and was also on magnesium sulfate (a smooth muscle relaxer) to keep me from having seizures from my blood pressure being high. Emma delivered in about 7-8 hours(fairly quickly for a 1st time mommy and especially because the medication I was on is also a medication we use to stop pre-term labor). Since I was on the magnesium, it made Emma very sluggish at delivery and she ended up being a "code pink" since she wasn't breathing initially. My nurse Melissa did a WONDERFUL job getting Emma stimulated and things were already better when the NICU got over there. However, she still was very floppy and had to be taken immediately to the "transition nursery". But, I was very lucky because the brought her over to me as soon an she was looking better and let me nurse. I had never seen them and still haven't seen them do that for anyone else. I was very grateful for that. However, after having Emma, my blood pressure never went back to normal and I have had to be on blood pressure medication since then.

So, when I got pregnant with Brewer, we knew there was a possibility of the same thing happening. I did very well throughout the pregnancy physically, but I think I drove my OB crazy because I was waiting for the ball to drop! At 35 weeks she put me on bedrest, because she felt like we could prolong the pregnancy by doing this. So, back to the bed I went, which by the way is very hard. My heart goes out to women who do this their whole pregnancy! We decided at 37 weeks it was time to be induced. I was kind of teetering with my blood pressure and we wanted to do this while we had a healthy momma and healthy baby. Very wise decision, because I was hospitalized for pre-eclampsia one week post-partum. Would have been worse if I was still pregnant! However, this was not my dream of delivering. I really wanted to go natural and not to be induced, but Abby and a friend Lorrie had recently done it being induced/augmented. So, they inspired me to try anyways.

I got to the hospital around 6:30 and got into bed. Nina got my IV started and started my antibiotics for GBS protocol. At 7:29 Dr. Tamucci came in and broke my water. Clear fluid (yay!!). She called me 3 cm. At that point Nina started the pitocin, but she "pitted me gently". She increased it very gradually which was very helpful. My youth leaders at my church came in to visit. I had my praise music playing and was feeling very relaxed and talking through the contractions. My husband so kindly invited them to have a seat and read the newspaper. Thanks a lot Bobby! I felt a lot of pressure to entertain them. However, at this point I wasn't hurting just feeling them.

At 8:54 Dr Tamucci came back. I asked them to step out because she was going to check me. At that point they decided to leave and come back after the baby came. Dr. Tamucci called me 5/75/-2. I was very excited because it had gone by so fast, but I was starting to get uncomfortable with them, just slightly. I think it was because I felt the need to entertain everyone and couldn't focus on what my body was trying to do. My family had not gotten here yet and I really wanted to see Emma that morning before Brewer arrived. I had a "gift" for her from Brewer. It was a camera, so I wanted her to have it before delivery. My parents arrived close to 10:15 or 10:30. I was definitely feeling discomfort at this time. We visited briefly and we sent them to the waiting room. This is when the real work begins.

As a labor and delivery nurse, I know that everyone checks differently. I "check" similarly to Nina, so I told her "I have to know what I really am." She checked me at 9:43 and called me 5/80/-1. At this point I decided to get up and move around. So, first I tried standing with my head laying on the bed which we had raised up. I was rocking back and forth and Angi (another nurse friend) came in and gave me a hand massage. After that, she left to get some of her work done. We went to the ball and the rocking chair, but I just couldn't get comfortable on those. I felt like the best way for me to relax was to sit in the bed, where I didn't have to support myself. I kept reminding myself to just let my body do what it was supposed to do and not to fight against it. I reminded myself that the pressure I was feeling was Brewer's head moving down in my pelvis, just like it was supposed to. Another friend of mine, Audrey, who teaches hypnobirthing classes, had told me to keep reminding myself of that. She, a lactation nurse, was at work that day and stopped in and out. It was nice to have such great support.

At 10:47, I wanted to know what I was. I was slightly more uncomfortable and really curiosity was getting the better of me. So, Nina checked me. I was 7/90/-1. I decided a position change was in order. Won't do that again!! I got on my hands and knees to see if that would help relieve some of the pressure, but oh no, that is when it started getting hard. I remember starting to breathe and moan through the contractions. At this point I remember getting scared and saying, "I can't do this, I can't do this." My husband and Nina were right there encouraging me and telling me that of course I could. I don't think I opened my eyes from this point until Dr. Tamucci came in for delivery. I flipped back to the position I was in earlier, a left tilt. Was feeling a little better, but definitely wanted to know what I was. Had to be like 8.5 cm, just had to!

At 11:06 I started vomiting, I knew I was in transition. "Check me", I told Nina. 7/100/0. WHAT???? No progress. Nina says, "but his head has moved down." Oh great, as an L/D nurse, I know what it means when we say that. When patients aren't doing much and they need a little encouragement. Nina immediately saw my disappointment. She said, "but I can stretch to almost 9 cm." Pretty sure this was a lie, but a lie that I so much needed. I was absolutely panicking. Nina called in some re-enforcements. Angi came to help all of us survive this!!They were all so encouraging me. Bobby totally surprised me and was so supportive and did just what I needed. (Might I add, I didn't tell Bobby I wanted to go unmedicated until our dinner at the Cheesecake Factory the night before.) They got me wet wash clothes because I was so hot. At this point I wanted to give up. However, Nina (a great L/D nurse) knew it was getting close by my actions. She turned on the warmer and pulled it out (I did not see this, but these are very familiar sounds to me.) This gave me encouragement. I knew we were getting close. She pulled the delivery table in, another good sign. She sat at the end of my bed and talked me through it.....and even laughed at me a little. I am sure I was a sight. We have since talked about that and she said, "Katie, it was either laugh or cry, you were pitiful." She checked me again and I was 8.5/100/0 at 11:35. I was really getting out of control. I asked her to cut the pitocin off, which she did at 11:37.

At 11:40, I decided, as many do at this point, I wanted my epidural. She tried to talk me out of it, but I told her I was serious. She said okay, and increased my IV fluids in preparation for the epidural. I hear someone knock on a door and say, "Dr. Lewis, I'm here for your boost." Wait a second, that knock is not at my door. He was next door in LDR #11!!!! Oh my goodness, it is going to be longer. Nina checked me at 11:42 and I was 9.5 cm. She told me to sit up so that I could get my epidural. I told her I wasn't sure I wanted it, I really just wanted this over. I think I was crying at this point. She told me that Brewer's head wasn't coming down well with the contractions, so I really needed to sit up to let gravity help us out. I screamed that I couldn't do that. So she said, "just push with your next contraction". I did and it was so painful, but it worked! At 11:45 I was 10/100/+2. I was now feeling the urge to push and pushing, but it hurt so bad. Nina called for Dr. Tamucci. This was another encouragement, I knew it was time. When she got there she said, "why isn't she crowning and in stirrups?" I had mentioned that morning that I was going to try to go unmedicated, but her response was, "okay, well you can get your epidural when you want to." I think a lot of people doubted me. But, with the next contraction, she knew why I wasn't crowning. She heard the screams/grunts. She then realized I didn't have an epidural and quickly got dressed for delivery.

At 11:53, my beautiful baby boy came into this world. It was great! I had done it. I felt so empowered. I'm not saying I wasn't hurting, but I was so excited! I think even I doubted myself the whole time. Next time, I will know better! I can do it!!

The worst part about it was that I had asked for my epidural, so Dr. Lewis was right outside my room ready to do my epidural if I decided I wanted it again. So, he heard the screaming and always like to bring it up every time I see him around the unit!! He has told me how great he thought I did and came by to see me the day after!

Special thanks to all of my support through both pregnancies, especially Nina, Melissa, Bobby, Audrey, Angi and many more I know I am forgetting. And to all of those who inspired me: Abby, Shannon, Lorrie, and all of the beautiful natural deliveries I have been privileged to witness! The women I work with and those I take care of never cease to amaze me with their abilities!