Wednesday, October 15, 2008

No Blocks

So today I got my unblocked patient to practice all the things that all the smart nurses and mom's out there have been telling me! G4P3 age 21 was my induction stats this morning. Wowza! I'm 22, and I'm a Gzero and planning to stay that way for a while! Anyway, this gal was much more "normal" than I was expecting, and she said she'd had all 3 of her other babies unblocked and had been induced with two of them, so this wasn't a new process at all for her.

I have 100% confidence that she could have done the whole deal without me sitting in there by her bed all day, but after a few minutes of watching how the dear FOB was acting, I felt too sorry for her to leave. He sat in the recliner (all 400lbs of him), with a box of doughnuts and the comments I heard (when SportsCenter was below a dull roar) were "Want a doughnut...oh wait, you can't have one!" "Hurry up, just push and get the baby out!" "This is taking way too long, it's been 2 hours already!" "I'm tired, I've been up since 6am!" "This contraction feels good, just think that it feels good!" 'I've been waiting 20 years for this moment, hurry up already!"

So by the bed I sat really for about 5 hours. I've never done such thorough charting in my life! This gal had amazing control, and actually would fall asleep in between contractions. She was never on much pit, and got a total of 2mg of Stadol the last two hours. I was almost 100% happy with how her labor went.

Things once again seemed to fall apart right at delivery time. It was 1430 and I had taken a 2minute break after her 2nd dose of stadol and a check that said she was still about 4-5cm, to shove some food in my mouth when one of the doc's for the same group as my pt's doc finished a delivery. He was the same doc that had AROM'd for me that morning per my doc's request. J suggested that we have him check her. Now wouldn't you go figure, as I'm telling him that I had just given stadol and checked her about 15 minutes earlier and she was 5, his magic fingers appear and she's 9cm with a rim. Really? Why...

I know that's how multip's do it, and I know that's normal. But I'm sick and tired of looking like the idiot who checks her and she's 5cm and 2 minutes later when the doc's check, she's complete and has a baby 5 minutes and 1 1/2 pushes later over an intact perineum. It makes me feel like a complete moron, and I'm just sure that the docs are all getting really good impressions of this new nurse who has no idea what shes doing. I was a little surprised though even when I'm drawing up pH's and I'm trying not to cry because I'm so frustrated at myself. I know I have to get over it and know it's not my fault, that I'm always harder on myself than anyone else is and that I have to remember that I am new, and I'm NOT supposed to get it perfect every time. All those things that are easy to tell yourself after the fact but hard to remember at the time :) I know it could have happened to anyone, but why does that someone have to be me!? I should be counting my blessings that he was there to check her because once she pushed, the baby was there. I would have REALLY been in trouble if nobody had been around when she "made the move" and went from 5-complete in 10 minutes. And I should also be counting my blessings that I'm not 21 and going home with 4 kids under the age of 6. I couldn't handle that right now!

2 busy days, now I don't work again 'till the weekend. My friend from church is supposed to have baby #3 any day and she asked for me as her nurse. 1st time I've been "requested" by a patient! Now she's just got to deliver on a day that I'm working. What are the chances...

Babies today: 1M
Babies total: 22M/15F = 37
Vag:16M/14F = 30
C/S: 6M1F = 7

6 comments:

  1. You can test this theory and see if it happens to other women...but for me with a baby who was not OP I would have a nurse check and declare me 4cm, 8cm, whatever and say I had a little bit and suddenly, I feel the urge to push and baby is out. It's like the check stimulated the cervix and whammmo, dilation and the urge to push and baby born. It happened two or three times in a row for me. The only reason I think it didn't happen this way on baby no 6 was the OP position with baby actually tilted on sonograms from 34 weeks...to a few weeks out. I wonder if a woman is ready to go and has labored for a while, if she doesn't finish off with that last check in some cases? I've had nurses literally check me because I was giving the signal, declare me 8, then baby is out...cervix just melted away.

    Hey, I've had nurses only in the room for my last three births, and my 3rd born got the OB just in the nick of time. In fact, the first one had the OB for about 10 minutes before he was born. I had only been pushing for 5-10 minutes at that point. Some women just go faster.

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  2. My guess is it wasn't the check that stimulated the contractions - it was just that she had a very fast active phase! Probably the doc thought nothing of it at all. And that woman would have hit her call button if she was pushing...

    You said she was very in control so it might have been hard with this particular woman, but often I can tell when they are hitting transition just by observing (as a doula I can't do vaginal exams). And then there's of course watching a woman spontaneously bear down at the peak of a contraction - that's always a really good sign that things are about to happen ;)

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  3. Don't beat yourself up about cervical checks. Sometimes you're right on the money, other times, not so close.

    Multips, as you know, can go from 4-5 cm to complete in just a few minutes. The stadol you gave her, probably relaxed her enough to go that quick.

    Keep up the great work - you're doing wonderful!

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  4. I know what you mean about the quick change/ MD finding something different. We do it right 1,000 times and naturally they come and find the one quirk that's different...

    I recently had a girl with a THICK epidural who was NOT moving the baby at all. Furthermore, she was puking her guts up every time she layed back in the bed (she had to be in a more sitting position, just to *reduce* the vomiting, not even to stop it). She was comfortable pain-wise, but tiring out, and making no progress, so I asked her to rest through a couple of contractions and went out to get a drink and update MD.
    MD decides to come in (which is odd anyway, but I think he wanted to be able to be done & leave the floor to do other things).

    First, he chastizes me for the (somewhat) upright position (most of our docs have a belief that patients push better lying way back "so the baby can get under the pubic bone")... put her back and pushed with her. She did make some slowish progress at this time, and eventually had the baby probably 30mins later. Then, MD goes out the door saying "SEE, she CAN push!" ... like I don't know who can and can't push, like I don't know how to push a patient, like I haven't worked with this MD for a couple of years now!

    If MD was about to go OFF duty, I'm SURE he would have found that the patient needed to labor down, you know?!! Hmph.

    You just have to let those quirks go... over time, they will know you... and if not then 'whatever'!

    As far as helping acquaintances through labor, I have decided that I don't want to do it as a primary nurse. To me, it would be too difficult of a situation if, god forbid, something bad happened. For me, it's much funner to pop in and out as appropriate and make sure they are doing well and do little extras for them as I can. There are certain people I would do it for, but not most. But I'm a worry-wort ;)

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  5. We disagree a lot about cervical checks on my unit--but we all agree on when mom is complete and baby is descending! :0)

    Gotta love those fast, uncomplicated deliveries. They are GREAT!

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  6. Don't worry about it. I was with a primip on the Midwife-Led Unit. She came in at 4-5cms and four hours later was 7-8cms (still okay within our protocol). 2 hours later she is desperate to be examined (normally we only examine 4 hourly). Still 7-8cms. She was offered ARM, meconium grade I. Bugger, now she has to be transferred to the obstetric unit (same hospital). Anyway, before she is transferred, she is fully and pushing. (about 30 minutes from ARM). That's a primip!

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