Saturday, December 19, 2009

1:1

What an interesting beginning to my week. One that I wasn't too happy about...until after the shift was over and I took time to think about it.

We're one of the only hospitals in the city that has a psych unit (and it stays pretty busy!) For the last several weeks they've had a pregnant woman upstairs who came in with suicidal intentions (she wanted to cut her baby out). So they've been doing NST's etc on her and had just done an amnio and schedule her for an induction. Well, lo and behold, the same day she was scheduled for a cervidil, her water broke. So down to our unit she came. Her and her 1:1 status.

When I got there she had just gotten admitted and started. She was on pit and planning to go unblocked. So I settled down in my hard wooden chair for a very long night. When the FOB decided to come up to see her (one of many social problems) she decided to get an epidural to make him happy, and proceeded to progress nicely. She was a super pusher and let's just say there was some serious "counter pressure" waiting for the doc to come. Note to docs sleeping in the lounge: if you're going to sleep, please make sure the phone is on so we can get you when we need you!

When I left in the morning, I had left that room a grand total of 3 times. Once to pee, once to shove some food in my mouth and once to page the doctor. I felt rather helpless not even being able to go get zofran on my own. I felt even worse b/c I knew the rest of the girls were dying with people walking in and staying, but I couldn't do anything to help!

Afterwards, when I really got to thinking about it, it was a pretty cool experience. Being able to be there, at the bedside, and not knowing I was next up for triage, or knowing that I had other patients to take care of, but being able to focus on one woman, her labor and her experience. I would do it again. If only our staffing would allow for that...

Babies today: 1f
Babies total: 68M/86F = 154
Vag:52M/66F = 118
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Saturday, December 12, 2009

Fired

I know, 3 weeks is a long time to go without blogging...but 3 weeks is a long time to go without a baby too!! We've all been running our tails off at work the last several weeks, but I've seen no fruits of my labor. I keep getting antes, cervidils or getting a labor patient started and then leaving them blocked, comfy and well on their way in the morning...just to let someone else get the fun of delivering :( Even worse are the nights I've come in and had 3 recoveries to move...that's just the dirty work!! Oh well...I guess it's all a part of the process, so I'll do it anyway.

I did get "fired" for the first time by a patient this week. I was more than a little upset and hurt by it...until I found out that there hadn't been a nurse yet that she'd gotten along with...including the "reverend mother" of the unit (the sweetest, most caring, gentle, knowledgeable nurse on the unit). The first words out this woman's mouth were "how old are you, how long have you been a nurse and do you have any kids?" I guess my answers of "23, 2 years and no" weren't good enough for her. I didn't mention the fact that I've helped/observed with birthing a baby many more times than she has. I know, it's no replacement for actually doing it myself, but it has to count for something, right? She wasn't happy with the fact that since she was already being induced early for PIH and really high pressures that I said that an epidural might be something to think about, simply because as labor progressed and her pain got worse her BP's were going to naturally keep getting higher...and wasn't really what we wanted (hence the fact we were delivering her early). She did go on to deliver unblocked, so I guess that showed me. From here on out I will no longer be asking someone if they would "like" me to check their cervix to see how far they're dilated...since I'm the nurse and supposed to be managing them. Good grief. I felt bad for the nurse I handed her off to...

Since Thanksgiving I have yet to work another 3 in-a-row. I've been using up some of my required PDO time, so I've only been working 2 scheduled days, plus whatever extra I pick up. This next week I go back to my 3 nights...and I hope I survive!!

Friday, November 20, 2009

Back to the Babies...

I'd forgotten how hard it is to go back to work after a long stretch off! Maybe that's because it's been so long since I had more than 2 days off in a row! After going in extra for a few hours both last Thursday and Friday I was off 'till last night! Count it...that's 5 whole days off!! It continues to be super, crazy, insane busy at work. We had 7 deliveries just on night shift alone, with a board full of cervidils and antepartums to beat. We were busy, but thank goodness we had 7 nurses there too! I had my first delivery in what's seemed like ages. At least 2 weeks I think.

I wasn't all sure that it was going to be vaginal, but she did it!! I was so proud of her! 1st baby and a great support system in her sister, boyfriend and boyfriends' mom (even more impressive that the baby wasn't this boyfriend's but from a previous relationship). It was fantastic!

We've had 210 babies as of midnight on the 18th...that's a lot. If it weren't the holidays next week I think we'd really be breaking numbers this month...is everyone else this busy!?!


Babies today: 1m
Babies total: 68M/83F = 151
Vag:52M/62F = 114
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Saturday, November 7, 2009

Babies Everywhere!

I set a new record at work last night...3 babies in a shift! I don't think I sat down all shift! And I know I didn't have a chance to pee all night (but that's nothing new anymore) :(

I had one delivery right off the bat @ 1845. Sweet little gal I had cervidiled the night before. Getting induced early for low fluid, never really thought she'd deliver vaginally. She did awesome!!

Got delivery #1 recovered and moved, then took over another labor patient from another nurse. She was 5, blocked/comfy and went from 5 to complete in about 45minutes! She was a great pusher and had a fantastic soundtrack of "pump-it-up" music that we played while we pushed. It was the best pushing session I've had in a while! It gives the nurses energy too! She had a little bit of a long repair afterwards, but was a trooper about it.

Got delivery #2 half way recovered before my next patient got there. She labored pretty well, tried the tub, tried an epidural that didn't really work. She SROM'd then was really hurting. In the midst of trying to redose, then finally having them just put in a combined spinal epidural she was laying on her side involuntarily pushing. We called the doc for delivery, had the laborist standing at the bedside and about 3 nurses in the room. We knew as soon as we laid her back we'd have a baby, you could see the perineum bulging with every involuntary push...

The CSE worked great and she got comfy really quick. Her doctor got there and then didn't I look like the idiot when we pushed for an hour and delivered straight OP. Fun, fun times. That was the first baby I'd ever seen delivered straight OP though. It does look quite odd when they come out looking at you instead of looking at the ground...

The day shift nurse who came in and tried to take over in the middle of the delivery (my turf...back off!) asked how the night had been. I said we'd been pretty busy, 5 or 6 deliveres. She said "we long for the pace. Must be nice." I bit my tongue but really, really wanted to say something along the line of "must be nice to have 2 or 3 times as many nurses on day shift too..." Oh well, all the babies get here and it always works out :)

Babies today: 1m/2f
Babies total: 67M/83F = 150
Vag:51M/62F = 113
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

She's Finally Here!

One of my favorite things is when I get to deliver someone who has personally asked me to be her nurse. It gives me a warm, fuzzy feeling in my stomach that someone picked ME to be their nurse and I wasn't just the one who got assigned to her! One of my friends asked me months ago to be her L&D nurse and we've just been waiting and waiting. I think the waiting's been worse on her than me...she's been ready for this baby to be here for months I think!!

I just finished a stretch of 8 days off and was out of town for part of it and we all knew that's when Little Miss was going to make her appearance. Mom had been contracting for days and days. She'd gone in for a labor check and wasn't doing anything. She was scheduled for an induction a couple days past her due date and wasn't too thrilled about that. Finally, my first day back at work, she came in ruptured and delivered in 3 hrs!! It was so fun! Super delivery and a super sweet baby. Congrats to Mom, Dad and big brother!!

That was the night we did 5 c/s in a row. Started W 1845 and rolled the last patient out of the OR at 0400. We had at least one nurse in the OR or recovery room all night. The patients just kept walking in and staying. It was crazy.

P.S. To doctors sleeping in the call room down the hall: when I call you for delivery, please don't take 5min to walk down there, sit on a stool to put on shoe covers and take your own sweet time then yell at me because I'm not "holding the head in well enough." I am ready for delivery when I call.

Babies today: 1f/1m
Babies total:66m/81f = 147
Vag: 50m/61f = 111
C/S:16m/20f = 36
"Caught":2f/0.5m

Saturday, October 24, 2009

12 Out Of 14

Just finished up working 12 shifts in 14 nights...not something that I would recommend doing again for a long time to me or anyone else. That's a lot of work in a not-very-long amount of time!! We have been so busy that the norm anymore is to have no empty room and have to put the elective inductions on hold just because we don't have anywhere to put them!!

I could have easily worked both of the nights that I didn't if I had wanted to...but I just couldn't knowing that the first time it would have been 9 nights in a row and the second time would have been after I had stayed over from night shift 'till noon the next day and couldn't force myself to go back at 1900 that night. Anyway...is everyone else seeing a big increase in baby #'s for October?! Our thing is too it's not just "babies" it's pre-term stuff and antepartums filling up the board! A complete previa at somewhere around 30wks...that's gonna hold a bed for as long as possible, kidney stones take a bed for a couple days, all this H1N1 stuff floating around...never a dull moment!

We were even having babies in the hallway this week!! One night the phone rang about 1940 and I picked it up. I hear "This is the ED, we're bringing you a patient in active labor and we need the laborist to meet us in the room." They say that all the time and lots of times the patient ends up being like 10wks pregnant or something. So I asked when her EDC was, who her doctor was, etc. The freaking-out-lady on the other end says "No, no, no! Listen to me, we need the laborist down here." I asked if the patient was delivering and the lady said "yes" and hung up the phone! So someone when to go grab our laborist who was in the middle of surgery and I flew over to the ED with a precip pack and asked the nurses where the delivering lady was. They said "oh, they just took her upstairs." Hold it...I thought she was delivering and they needed the laborist stat...

I met the laborist, the gurney with a grunting patient on it, and an ED tech in the hallway on the way to L&D. The patient kept saying "I need to push..." and when we rolled through the door of the room we heard the screaming under the sheets. Sure enough...welcome to the world baby! Mom was a grandmultip and baby's UDS came back positive :( Sad story, but sure added some excitement to our evening...we were simply counting our blessings that the baby didn't come out in the elevator on the way up from the ED! The ED told us they looked under the sheets and didn't see a baby so they thought they should bring her up to us.

For as much as I've worked, I don't even really feel like I've had that many babies! I had 4 this week...and I thought that was impressive!

1st one was a primip who acted about 10 years younger than she really was. If your mom is talking baby talk to you...are your really ready to have your own baby?! She was unblocked because "you know epidurals paralyze you...". When I first checked her I could have sworn she was complete, so called the doc, put her up in stirrups and pushed twice....then when she finally let me really feel...nope, she was more like 8. So out of stirrups and to her side. Thank goodness by the time the doc got there she was more like a rim that slid back pretty easily. The delivery was a little chaotic, she pulled her IV out twice while we were pushing, wouldn't listen to the doctor, wouldn't push...but baby finally (somehow) came out and screamed right along with mom. Healthy mom, healthy baby, and mom could walk to the bathroom on her own...fine with me!!

Another fun baby that same night, mom came in and did great, got her epidural about 7cm, doctor was there and AROM'd her and she pushed about 30 minutes. Thankfully it happened to be a little slower moment in the shift and before mom got her block for about 2hrs I got to pretty much sit in the room with her and coach her through it. The dad asked me afterwards "do you always get to sit in the room with the patients like that? That is so cool!" I wish I DID have the chance to do that with everyone!!

My last night of my stretch was the best one, even though even before I got to work that night I had decided in my head that I was quite done with work for a few days and was not too excited about going back. When I walked in the door they told me that I was going to need to take care of a recovery who wasn't moved because "she hadn't eaten yet." Her recovery was over, but since she was still working on her dinner tray they hadn't gotten her up to the bathroom yet. I'll be honest...the recovery/up to the bathroom/moving process is my least favorite thing about L&D. So...as soon as day shift left I went in, got her up to the bathroom and moved her. Now why couldn't have have been done before I got there? I don't understand.

So after moving my recovery the patients keep on rolling in. Took a non-contracting SROM back to her room and got her settled, just as my cervidil showed up. Loved both couples!! Cervidil was a couple so excited about getting to have their first baby. Dad was just finishing up his residency and it was so nice to have someone in the room who knew how to help if I needed it! An extra set of hands when I was starting the IV, he knew how to silence an IV pump...but was so non-threatening about it. Other couple was their 2nd baby and had lots of family in the room all night.

I don't know where they ordered the batch of cervidil that we had that night...but it was doubly potent for both of them! I put it in and both of them took off! About 5min after I put the cervidil in the "scheduled" cervidil she was contracting every 1-2". I got both of them epidurals before midnight and ended up pulling both cervidils and both labored on their own. An hour after I pulled the scheduled cervidil she was still contracting every minute and I ended up terbing her. I NEVER terb cervidils!!! I figured the doc would be ticked in the morning. My SROM girl delivered right at shift change and I handed her off to a day shift nurse right after baby came out. I went in to say goodbye to my other patient and just for curiosity sake I checked her. She was 7! How to do you get to 7 after I terb you for hyperstim!!!

I begged to stay and deliver her and somehow it got approved, so I got to stay! When the doctor came around about 0745 she was almost complete..and delivered within an hour!! I was so excited and it was a great delivery. Both mom and dad said Thank You over and over for staying over my shift for the delivery. That makes it even better. Great ending to a LOT of work! Isn't that the way it was supposed to be?!

Babies today: 2f2m
Babies total: 65M/80F = 145
Vag:49M/60F = 109
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Wednesday, October 14, 2009

Still Here...

Promise I haven't fallen off the face of the earth! More like into the crater of work! Even though it's the middle of October we're still busting at the seams and somehow managing to survive and laugh about it.

Several fun babies lately...all girls, go figure!!

There were moments that I felt like and idiot, a bad nurse and almost shed a few tears on the job...but then I look back on that night and think of all the things I learned and all the things I did that I didn't know I new how to do! I learned all about doing a D&C in our OB OR's...something I'd never done. How to do a sterile vag prep (I've talked to 1 nurse on the floor who'd ever had to do that...). I learned that I could put a scalp lead on someone who was 1/60/posterior when I had heart tones in the 50's (even the doctor was impressed at that!)...and I learned that I could stand up to a doctor and get what I needed for a patient. I also learned that I have some of the BEST co-workers ever. They're always there when I need them, they always are willing to help me out and I love them!! We just got 2 new nurses coming off orientation on day shift and they said they've already noticed a big difference between days and nights and how supportive night shift is of one another and how it's a team approach instead of everyone nurse for herself. I like that :)

I almost got to catch a baby the other night, I was all excited! But the doctor was in the lounge so I made sure she made it. You gotta love those multips who push once and all of a sudden the baby's crowning :)

Babies today: 4f
Babies total: 63M/78F = 141
Vag:47M/58F = 105
C/S: 16M20F = 36
Babies 'caught' = 2f0.5m

Monday, September 28, 2009

50 Best Blogs for Neonatal Nurses | Nursing Schools : LPN RN BSN MSN : Online Nursing Degree

50 Best Blogs for Neonatal Nurses Nursing Schools : LPN RN BSN MSN : Online Nursing Degree

This is what I find surfing the blogging world...I had no idea!! Check out #9!! It makes me feel special :) Congrats to all the other bloggers out there who made the "Top 50 List" too!!

Saturday, September 26, 2009

Question to All My L&D Nurse Readers!!!

Things have been super busy/crazy/insane at work these last several months (welcome results of winter "coziness"!) and it has led us night shift people to think about our staffing situation. I'm asking for your advice/input/ideas!! My question is...how are you staffed on your units? What have you found that works best and what doesn't? How do you handle putting nurses on call? Any suggestions would be MORE than appreciated!!

A little bit about our unit...

We are a 17-bed L&D unit for both labor/delivery and antepartum. We average between 320-340 deliveries a month during most of the year, closer to 300-320 during the winter. We don't have a separate antepartum unit/rooms nor a triage area. We have 17 rooms that we use for all of the above. We triage/labor/deliver then after 2hr recovery move patients to postpartum.

We have 2 OR's and then 4 separate PACU rooms for our 2hr C/S recoveries before we move them to postpartum. Our L&D nurses do both vag and C/S deliveries, and then we are are the ones who are responsible for moving them to postpartm (a good 30minute process). Unless we have to we don't usually have both a C/S recovery and triages out on the floor. If we take a C/S back we're "in the back" until that recovery is over.

We have NICU nurses staffed in our well-baby nursery and the NICU "admit" nurse comes to all our deliveries to catch our babies.

We have one charge nurse who is over L&D/postpartum/NICU and our Women's & Children's unit (usually an extension of M/B but can also take GYN surgeries/peds patients). The charge nurse doesn't do patient care.

We are usually staffed 4:1 antepartums, 2:1 or more often 3:1 labor patients and whoever can handle it takes the next patient that walks through the door. If we have Mag patients we are usually 2:1 as along as they're somewhat stable, sometimes have a mag patient + a labor or something else.

Our L&D nurses can all float to mom/baby and if we're OK on labor and M/B is short then we get floated. None of the M/B or NICU nurses float to L&D.

Our core staffing is minimum of 3RN's. Most of the time we're staffed with 4-5RN's/night. If we're lucky we'll have 6 or 7. We usually have 2-3 scheduled cervidils on the weeknights plus a 0730 C/S that comes @ 0530. Day shift usually brings in between 10-12 RN's. If the day charge nurse thinks we are overstaffed for the night shift someone (rotates by dates or requests) is put "on call." If we need the "on call" person during the shift they have to be there within 30min of being called. If you get "called in" before the shift is half over (0100) it's time-and-a-half 'till 0100, and if you come in extra it's time-and-a-half.

Finally Some Babies!!

Wow, I'm been doing this blog in spurts lately...I end up doing it AFTER I've worked for the week 'cuz there's not much energy in between shifts! This month has been crazy busy, we were already pretty close to 300 babies when I left on Thursday morning!! I've had several nice deliveries, 2 of them last night!! Yay for double deliveries!


The two last night were 2 within an hour, that's always good for getting the heartrate up! I did one delivery of "my girl" that I'd had since the beginning of the shift, then walked out and there was another girl that was 7-8 and for some reason the nurse that had her wanted me to take her and finish her delivery. I'm not sure why but the girl was unblocked and there wasn't much time to argue!!!

By the time I walked down to the room (for the first time) the midwife said that she was 9+ and wanted to get back in the tub. I wouldn't have gotten her up to the tub at that close to delivery, but the midwife did so I didn't' say anything. I'm realizing about this time that there is NOTHING in the room. No IV fluids hooked up, no pit for after delivery, nothing set up for cord gas collection, no delivery equipment. Wonderful...

I got everything ready and thank goodness too 'cuz when the midwife got the girl out of the tub and back on the monitors we had heart tones in the 70's and needed to have a baby NOW. It was a long 5 mins while she broke her water, tried to have her push, then cut an episiotomy...I was calling people, getting the laborist to stand by, asking some of my nurse friends to come be some extra hands, etc. Baby came out fine though, mom did great, and my heart rate finally returned to normal...

I had antes a couple times this week. I was supposed to be orienting a new hire one night, she's been a nurse for a while, used to do L&D but then took 12 years off to raise her kids. She's like twice my age and I always feel a little funny "telling" people who could be my mom what to do. Anyway, first time I was orienting anyone in the first place so I'm already a little nervous, I don't like antes, I feel way more comfortable with a labor patient, and yet I'm supposed to teach someone how to do it. We had a FULL load of antes, and one of them had been admitted a week or so ago for bleeding...and had bled 4 times during admission and was on her 6th bleed for the day. The doc showed up right at shift change to assess her and got another clot out, wanted to cut her, it turned into a long process, we had to call in another nurse to take her back to the OR, and it was almost 2100 before I got to my other patients rooms. Not good patient assignments, but everyone turned out OK!

I feel like I've been living at the hospital lately. If I hadn't been sick one night last week I would have been there 5/7 nights and all the nights have been crazy! Thank goodness it's job security!!

Babies today: 1f2m
Babies total: 63M/73F = 136
Vag:47M/55F = 102
C/S: 16M18F = 33
Babies 'caught' = 2f0.5m

Friday, September 18, 2009

2 Little Boys

No babies this week, but last week I went OOT (out of town) before I got to talk about the 2 nice deliveries I had one of the nights I went in extra. The first was a C/S that was walking to the back as I came on. I almost feel guilty "claiming" that baby because I hardly even got to say "Hi I'm BDay Nurse" to the mom before the drape goes up and the baby comes out. Then in recovery they are usually so out of it, and after laboring all day, all they want to do is sleep. Doesn't leave much time for the "bonding" time. But nice, quick section. We were actually in the OR from in time to out time less than an hour. That's pretty impressive! It was a one of my favorite CRNA's on too, so that always lends some humor to the situation.

I was ready to go home after my section recovery was over and I probably could have, but there were 2 patients who were almost complete so I told them I would stay until both of them delivered so that then they would have 2 more nurses open. The 1st delivered pretty quick but the second one was an un-blocked primip and she took several hours to get from 9cm to complete. She was about 9.5cm and it was almost 1am when a SROM came in that I went ahead and took all the time thinking "I kinda wish I had just gone ahead and gone home already!" But I took her down to her room, she was 4-5cm, ruptured, multip who had gone natural with her 1st baby (all 28hrs of labor) and wanted to go natural again. Ok, that's all cool. Until she'd been on the monitor for 5min and I was doing the "interview" and she had a contraction...and I had a nice variable decel. (I thought this article on interperting a fetal heart rate tracing was really good. It's a decently short overview, and does a good job of covering the basics of what takes lots of time and experience to understad and apply!)

So after watching a few contractions there were several things that became apparent...these variables weren't going away with position changes, mom was NOT going to get off the monitors on my watch (or license) and she needed to make cervical change QUICK or she was gonna get a section. The doc for that group is known for NOT watching ugly strips for very long, and the last "questionable" strip I had with her I got my head bit off for not calling her sooner, so within 15mins of Mom showing up, I had someone start my IV while I called the doc. I told her right up front that I was having decent variables with each contraction, and that mom wanted to go natural. Surprisingly, she came in to the hospital without me even asking!

When she got there mom was a good 5-6cm, and in GREAT control. The doc came down to the room, checked her and looked at the strip. Then proceded to tell me that baby was "fine" and that what I was hearing was the monitor moving during a contraction and picking up mom's heart rate. Then she left and went back down to the Dr's lounge. I don't usually argue with doc's but I KNEW that wasn't mom's heart rate, so I slapped a pulse ox on mom's finger (to monitor mom's pulse), had another nurse come down and listen and when she agreed with me that it wasn't mom's heart rate I put a scalp lead on baby'shead. The more of those I put on the better I'm getting at them!! Anyway, by this time mom was a good 7-8cm and my variables weren't getting any better. Variables into the 60's and 50's (dropping from a baseline between 130 and 140bpm) sound horrible to a labor nurse and you find yourself holding your breath between beats just willing it to beat again. I finally called the Doc again and said "just FYI I put a scalp on and now my variables are in the 50s lasting throughout the contraction." She came down and thankfully mom was complete. She pushed twice and had a baby with a tight nuchal...but came out screaming!! Thank heaven she was a multip and went fast!

She delivered 2hrs to the minute from walking in the door. And about 15min before the previous patient that I had been waiting on to deliver before I left! Mom was in SUPER control of herself and I would do an unblocked (or blocked!) delivery like that anytime. She was fantastic. I told her before I left that doing deliveries like that remind me 1) why I love my job and 2) why I don't mind coming in extra :)

Nothing like a little excitement at 2 or 3am to liven things up and get your heart racing!!

Babies today: 2m
Babies total: 61M/72F = 133
Vag:45M/54F = 99
C/S: 16M18F = 34
Babies 'caught' = 2f0.5m

Wednesday, September 9, 2009

Ready for Another Baby

So let's see...I haven't had a baby in a good week! I think I'm failing in the "delivery" part of my job! I can labor them fine apparently...but I have a hard time getting the baby out! I have had 3 nice (well, exciting if nothing else) births the last couple weeks.

1st baby was a super fun couple that I cervidiled one night and then ended up doing the section for the next night because her cervix stopped at 9cm. They were lots of fun and their baby was ADORABLE! Honestly, most newborns aren't that impressive looking...but this little guys was super cute :) I even went back to visit them the next day on my day off to see how they were doing. I love stories like that!

Next delivery was one of those "all of a sudden" ones where I had the C/S papers sitting on the desk because she'd been about 4cm for the last 3hrs. We had put in an IUPC and said we'd give her 2hrs and then were going to the back. 2hrs later she was complete! Yay!!! She did super and half way through pushing we were chatting and come to find out, Dad was an ICU doctor at one of the other hospitals in town. Great! Thanks for the heads up...He was quick to point out that he didn't know anything about L&D but still...a doctor is a doctor! They did an OB rotation in school and he's probably actually "caught" more babies than I have! Oh well...he was a great help when Mom passed out X2 in the bathroom on me 3hrs after delivery. Sigh...I had another nurse in the bathroom with me and the 2nd time Mom went down she really went down to the floor. So there's two L&D nurses sitting on the floor with a naked patient (she'd puked all over her gown on the way down...) on top of them and ICU-doc-Dad holding Mom's head and nobody could reach the wheelchair. So I hit my emergency badge and when everyone else from the floor came thundering into the room there we all were! Sitting on the bathroom floor! All we needed was a wheelchair...

Next baby was the "exciting one". Problem #1: Mom was 5'0"...Dad was 6'4". Not a good combo for a baby. Sure enough, baby was pretty big, we pushed for 2hrs and baby was "gettable" but not quite coming out on her own. So doc came in and put on the vacuum and pulled baby out...all 9#5oz of her! Well, when all of baby came out, poor mom got a really bad 4th degree tear. It wasn't very pretty. So doc gets ready to repair...and Mom's still bleeding...and bleeding...and bleeding. 3 bag of pitocin, 2 doses of Methergine, 1 dose of hemabate, 400mcg cytotec orally and 400mcg rectally...2000cc EBL and doc could start the repair (8 sutures...). Yahoo for nursing teamwork!! We didn't leave that room for an hour and half after delivery. Mom did fantastic afterwards...but she's going to be SORE for the next several weeks!!

Within an hour of my hemorrhage there was a scary delivery next door with a Family Practice doctor. I know many women go to family practice doctors and continue with them for their OB care. It's nice...same doctor can take care of you before, during, after your pregnancy and you can throw in the kid's visit at your doctors appointments too! But think about this: would you let a family practice doctor take care of your heart attack and do open heart surgery on you? I didn't think so...consult the experts for your OB care too...just a word from a labor nurse. Take it or leave it :)

Anyway...this baby was 10#, had a NASTY strip, a bad dystocia (shoulders and body) and then it took the placenta an hour to come out after delivery. We had to call in the OB backup (all family practice doctors have to have an OB back them up during deliveries for emergencies, C/S's etc.) to get the placenta out. Scary stuff.

I don't know if they don't trust me after my Mom hemorrhaged or what, but I've done nothing but antes and triage's since! I did 8 triages the other night...that is craziness!! Here's hoping for some actual babies in the near future!

Babies today: 1m/2f
Babies total: 59M/72F = 131
Vag:44M/54F = 98
C/S: 15M18F = 33
Babies 'caught' = 2f0.5m

Thursday, August 20, 2009

Only 2

Only 2 birthdays in the last week :( We've been having babies right and left it seems...I just haven't been involved in them. That makes me sad!!! I want some babies!! It seems like I've had cervidils and antes a lot lately. Boo.

Neither of my birthdays have been terrifically outstanding either. Pretty "run-of-the-mill" almost...for lack of a better word...boring! The first one was a close friend of the doctor...so get this...the doc stood in the room and pushed with her for an hour and a half!! Seriously?! I love this doc, she's great, one of our favorites. But come on. I can think of only a handful of things that can make an L&D nurse feel more useless and a waste of space than standing at the perineum and pushing with the patient the entire time. Makes it even worse when the patients husband is there, and so is her sister...who is a pediatrician. So for an hour and a half I stood in the corner, dumping some astroglide everyonce in a while while doc, patient, husband and sister carried on their own wonderful conversation and the doc did my job!! I was a little sad :( The poor kid crowned for about 20 minutes "stretching". Mom didn't have any major tears...but that poor baby head was bruised and looked horrible!!

2nd birthday was a C/S after pushing for an hour with a kid who wasn't in there straight and a doctor who ran out of patience and a mom who wasn't the hottest pusher. Baby ended up being >9#...the most exciting part of the whole section was the section that happened across the hall at the same time.

We only have 2 OR's, so our rule is not to run them both at the same time (to ward off the emergency walking in). The first time I ever saw them run @ the same time was a couple weeks ago when we had to crash a patient...let's not do that again. Until Monday night. We had just taken my mom back and baby had just come out, when the charge nurse sticks her head in and says that the scrub tech needs to open up the other OR for another case. Huh? When we hear that we suspect emergency, so the scrub tech left to open and prep for the other case and sure enough, pretty soon the other patient came back. After my 2 docs were done closing, they broke scrub and left my OR. So I'm left in a pool of blood, my patient still draped, and the CRNA hanging out at the head. I asked the docs if one of them could do a final count with me and I was told bluntly "we can't. we didn't do the initial count so we can't do the final count." And they walked out.

So now what? I scrubbed in and at least covered the incision. Then counted and thankfully found everything. Then I called out to the desk to see if someone could come back and help me move my patient. My patient was number than a 2X4 and not the smallest mom. So I started cleaning her up by myself and finally the 64yr old charge nurse comes back to help me move out. All the more interesting. So 30min after closing time...we roll out of the OR.

I was NOT a happy camper and when I asked what the emergency was next door...I found out it was a failure to progress section and the doc called it right after I went back for my section. There was no fetal distress, no maternal distress, no fever. No complications, just no cervical change. Then she said that ACOG standards are "30minutes from decision to incision" and insisted that they go back that instant. The charge nurse tried to get her to wait, but she said no. Then they said she could go to the main OR if it was an emergency, but she said no, she wanted to go to our OR's. Seriously?

Thank goodness everything turned out OK, all the instruments, laps, sutures, blades, everything was present and accounted for when I counted and when 2 other people went back and counted. The whole situation made me nervous and a little frustrated. Patience doctors...patience!

Babies today: 1f/1f
Babies total: 58M/70F = 128
Vag:44M/52F = 96
C/S: 14M18F = 32
Babies 'caught' = 2f0.5m

Wednesday, August 12, 2009

I Hate IUFD's

We've had 5 IUFD's (Intra-Uterine Fetal Demise) in the last week. 21wks, 33wks, 32 wks, 35wks and 36wks. Come on! That is WAY, WAY, WAY too many. I haven't taken care of a demise in a long time, since that one last Christmas that hit me so hard. I feel like I've helped with almost every one, but last night was the first one that I've actually taken care of since last December.

I hate them so much. All these babies who never have a chance, most of the time we never even know what happens. Mine last night was a rare case, he had a chromosome anomaly that the parent's had known about for most of the pregnancy. They were prepared, then were expecting something like this, and they knew exactly what they wanted. That makes it so much easier on us nurses, and in some ways, I think it makes it easier (at the time) for the parents. They had all their family there, they had all the little outfits for him there, they had their cameras, they had a name, they had everything and they had a plan.

The baby was perfect. He was handsome, adorable, and looked AMAZINGLY good for probably being dead for going on 36-48hrs. I was thankful for that. Mom, Dad, and all the family got to hold him. Dad got to give him a bath, they took picture after picture, they all helped with footprints, I did plaster molds for them, and when I left, Dad was sleeping in the recliner with baby on his chest. Wow.

I hate IFUD's. They're my least favorite part of OB nursing, because they're not fair. Not fair at all. And there's nothing that I can do to prevent them.

Babies today: 1m
Babies total: 58M/68F = 126
Vag:44M/51F = 95
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m

Monday, August 10, 2009

Ante City

I promise, promise, promise that I still blog once in a while! Somehow, when I'm so exhausted in the morning, blogging's the first thing that gets put off. So I have to wait 'till I have a day off to do it! Those seem to be pretty few and far between anymore...

I was scheduled to work Thurs/Fri/Sat last week, and I did. But Wednesday I went in and worked extra at the last minute. I was mowing all day long, and they called looking for help during the day shift that afternoon, and I couldn't do that. But then the 2nd time they called me @ 1700 looking for help that night I felt too guilty to say no. So I jumped through the shower and went in. I don't think I've caught up on sleep after that...

It has been raining antepartums and pre-term patients for the last week! I swear, we'll have 5-9 antes on the board every night...and when there's only 17 rooms total...that doesn't leave room for too much else! I can't wait for our new unit that is supposedly going to have an antepartum wing...and I hope heavens to betsy that I don't have to work it more than once or twice a month. Antes aren't too bad...but I didn't work medsurg for a reason! We have everything under the sun sitting on our unit...a couple pneumonia patients, kindey stone patients, patients with diabetic issues...and the thing is, is all these things are fine, but they don't really have anything to do with being pregnant! You treat a kidnestone patient the same way whether she's pregnant or not, same with pneumonia. So besides a NST every shift, or in some cases, every day...they're a med-surg patient. But medsurg or any other unit won't touch them if they're pregnant...so they sit on our unit taking up nurses and rooms. All fine and good until you have 349 babies in a month, and then things get a little tight! They don't stop coming in either...we clean out a bunch of the "green names" (antes) and another troupe comes in to stay for a few days. It's taking 2 or 3 nurses just to take all the antes every shift!!



I was the "resource nurse" on Thursday nights. That really just means that you're in charge of assignments and the bad guy telling someone that they have to take care of the next triage that just walked in. Our unit is pretty good about figuring out who should take the next patient, so it's not too bad of a job...most nights. When we got there it was crazy, and it never really slowed down. People kept walking in...and staying...and more people kept coming in. I think at one point we had about 9 nurses there. I had all the antepartum patients, we had one patient who was a cervidil on an insulin drip, we had 2 DIU patients, we had a patient who pushed for 3 hours and then had a C/S and bled and ended up with a bakari balloon, we had no rooms aka nurses on postpartum so we "couldn't" move out any of the delivered patients...it was the never ending night. I never want to be "in charge" again!!! Here I thought it would make me feel all grown up to be the resource nurse and make me feel like I was finally "stable" as an L&D nurse...not so much. It pretty made me want to run and hide and tell someone else to handle the issues of not having enough nurses to take the patients!! Thank goodness for my amazing team who helped shuffle patients and make sure everyone got what they needed.

I only had one baby out of all 5 days I worked. That delivery wasn't even very exciting, she was complete when I got there, we pushed for 10 minutes and had a baby @ 1913. And then it was back to triaging "preterm labor" patients who came in doubled-over in pain, I put them on the monitor, got a FFN, checked them and found them closed, watched them "contract" for an hour, re-checked them, dipped their pee, maybe gave them a glass of water and miraculously cured them and they walked out after I had to wake them up. Do people have nothing better to do at 3am than come to the hospital? And are people really so tired of being pregnant at 24, 28, 30, 31 weeks that they want to be in labor so bad and have a baby in the NICU for months? Tough it out a few more weeks and take home a healthy baby!!

Anyway...so I worked Wednesday night, Thursday night, Friday night, Saturday night, and I went in extra last night from midnight to 7. So I've got tonight off...and then I start my "real 3" for the week!

Babies today: 1f

Babies total: 57M/68F = 125

Vag:43M/51F = 94

C/S: 14M17F = 31

Babies 'caught' = 2f0.5m

Tuesday, August 4, 2009

Still Here!

I'm still here...don't worry...haven't fallen off the edge of the earth. Even though, after working 6 out of 7 nights in a row...I was pretty sure that it was going to be a good possibility. I had a couple nights of antes, a couple good deliveries, several quite nights...except of course the one night that I asked for "call." That night it was crazy busy.

One of my nights included a double-forceps delivery. Mom was a very petite woman, and baby kept turning OP and wasn't very tiny. Finally after pushing for an hour and a half the doctor came in and used one pair of forceps to turn the baby and then another pair to expediate delivery. This particular doc is a pro at forceps, and is one of only a few who I would trust to use them. But still...they always make me a little nervous. Especially since this was the doc who the LAST forceps delivery I saw with him was when he missed the stool he was sitting on and fell and knocked out one of the nursery nurses. This delivery went off without a hitch besides a nasty 4th degree tear for mom...

Another night tested my patience to no end. My patient had some psycho-social issues, plus some mental dissabilities. That was a little difficult for me. I'll be honest, I hated my psych rotation in school, I have always had a hard time with it and accepting it as a real disease just like cancer, diabetes, etc. I know it is a real disease, it's just always been something I've personaly sturggled. The patient was not handeling labor well, she wasn't tolerating any pain, wasn't taking suggestions to help with coping and had limited coping skills all together. Her cervix wasn't changing, and when it finally did start changing and after an IUPC, she started begging for a C/S. I talked to the doctor, and we did end up sectioning her, good thing too because her baby was >9#!! Afterwards, I felt like a horrible nurse for not having more patience, for not pushing for a vag delivery and for giving in to the section so easily. Honestly, I was pulling for the section myself just because I didn't know what to do next! So next time I'll have more patience...

To round out my 6 our of 7 nights...a very fun family came in, 2nd baby, SROM, 4-5cm. Got her a block quick, settled her down...and then something just didn't feel right when I put the foley in. There was a major crease on the baby's head, like major molding. After a very awkward exam, I finally asked someone else to come and check, cuz I wasn't 100% sure it was a head I was feeling. Sure enough... it wasn't! So we headed back for a section.

One of our night nurses delivered during my stretch, so it was cool to get to see her and her baby while they were there. I wonder how perspectives change after being on the "patient" side of our job :)

Babies today: 1m/1f + 2f
Babies total: 57M/67F = 124
Vag:43M/50F = 93
C/S: 14M17F = 31
Babies 'caught' = 2f0.5m

Thursday, July 16, 2009

Wednesday

Sunday night kept a 30wkr with no pre-natal care pregnant one more night on Mag prior to her C/S in the morning, plus a few triages. Since when are Mag's 1-to-1?!

Went in extra for a few hours on Monday night from 2300-0200, did a C/S recovery. Then wasn't expecting to get off @ 0200 after the desperate phone call I'd gotten, but since I was there I decided to just go to the gym anyway. That was a little weird working out by myself @ 0300 and 0400...but it felt good when I was done!

Last night...got my butt kicked. I took a girl who was 6-7, blocked, on pit. Figured she'd deliver soon. Then another SROM who was 1/80 who had been 1/80 all day. She'd had a leep, so I figured after that band broke she'd start making some change. Planned on MAYBE getting her delivered. Well...things just snowballed from the get go. Assessed both patients, then my 1st girl had heart burn, then my 2nd girl needed checked and an IUPC, she was 2-3 at that point. Then I couldn't trace her baby so I put a scalp lead on (2nd one ever...yay for me!!!), then walk into my 1st patient's room and the doc's in there and she's complete, so we rushed to get the room set up, then I pushed with her for an hour.

While I'm standing at the perineum pushing I notice my strip in my 2nd room looks horrible. So I called out the desk because I obviously can't do anything about it while I'm pushing. "We'll send someone in." 5" later it's still having deep variables after each contraction...call back out to the desk. "oh ya, we'll send someone in." Finally it starts to get better and someone comes and and tells me that she's 7. Ok...

Then right after my 1st delivery (with a nasty 3rd degree repair) someone tells me, your other patient's complete and the doc wants you to start pushing. Ok, well then someone's gonna have to take my recovery...

So from one delivery to another, and since we had turned the pit off with her bad strip we started pushing and were only pushing every 5-7minutes. Finally the doc let me re-start the pit and we delivered in about 2 hrs. By the time I sat down to chart I had been pushing/delivering for about 4hrs straight! And had I charted ANYTHING in the computer? Of course NOT!!! I loved both of my patients and husbands, so that made it a fun 4hrs at least :)

I finally finished moving, charting, taking care of the couplet that I was keeping about 0330 or 0400 . Just in time to get a preterm twin rule out. I ruled her out pretty quick but then had to wait for a fetal fibrinectin to come back and finally sent her home about 0630 just as day shift was pullin up.

Another crazy night at work...I think we had 6 or 7 deliveries between 1900 and 0700. Sheesh...this is AMAZING job security!!

Babies today: 2f
Babies total: 56M/64F = 120
Vag:42M/49F = 91
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Thursday

So after my stint on Mom/Baby on Tuesday...I picked up the back half of someone's shift and went in 2300-0700. 2 great couples (one of them I saw 3 times since she was a cervidil and already tucked in when I got there) and what I thought was a great delivery right before shift change.

Then I found out on Sunday that they had just shipped the baby off to the high-end children's hospital in town because she had pulmonary hypertension and was not doing good AT ALL!!
She was pretty unstable and they were thinking about maybe a heart/lung bypass machine. Poor girl! Poor parents! I loved them!!! I haven't heard anything else about the baby...but I'm worried. I hate it when anything goes wrong with one of my babies. And I hate it even more when it's a term baby where everything's expected to go perfect! Sigh...I know it was nothing to do with the delivery or anything I did, but it's still tough to swallow.

Babies today: 1f
Babies total: 56M/62F = 118
Vag:42M/47F = 89
C/S: 14M15F = 29
Babies 'caught' = 2f0.5m

Tuesday

Well, I guess this is technically talking about LAST Tuesday...shows what my life has been like! I went in at 1730 for J so she could go to a party, and so I took her c/s recovery. I had admitted the girl the night before...just a little on the high-drama side of the scale. I finished her recovery and the anesthesiologist wanted to keep her on L&D overnight with hourly vital signs re: some panic attack issues on the OR table (we don't ask questions...we just follow orders...). So I was set to take her for the night, then they tell me that actually, I'm going to give report on my post-op and go take a full team on Mom/Baby for the night. Come again?

So...wait 'till 1900, give report to ANOTHER labor nurse to take my recovery back out to the floor, then hightail it over to Mom/Baby to get report on my team of postpartums and babies. I'm already flustered b/c I'm running behind schedule and that threw my whole night off.

Here's the kicker that made me mad...I asked if there was any chance that they would call me back over to L&D during the night and they said no. They would call in L&D nurses for X1 1/2 and leave me on postpartum. This is turning into an issue for me. I don't mind floating if I need to, and I did it and whatever. But I still don't understand how it is our problem if mom/baby nurses don't want to come to work. I don't see how the river only flows one way. L&D nurses can cover for mom/baby and SOME mom/baby nurses can do feeder grower in the the NICU. But NICU can only do NICU, and nobody from anywhere else would dare touch a still pregnant mom except for us. So who gets shorted in the end? And yet who's problem is it to fill in for all the other unit's being short? Whatever...

But I survived, did a little breastfeeding 1-on-1 and grew more thankful that my REAL job is one that I LOVE and that I don't have to settle for something I can just tolerate. And I proved to myself that I CAN handle a postpartum team and leave with everyone breathing at the end of the shift...I do feel lonely over there without my group of nurses. It's even weird if I have to go back over for something...I feel very alienated, and it's obvious I'm not "a part of them" that night. Hmmm...something to think about!

So kudos to all you postpartum nurses out there! THANK YOU for all you do and for doing it so I don't have to!!! :D

Monday, July 6, 2009

Here We Go Again...

And the craziness at work hasn't slowed down over the holiday weekend at all!! Took my labor patient back for a section @ 2000...what a painful section it was. I had all kinds of pain orders from the doc after the section was over. It was going to be that kind of recovery. Then when the patient slept through most of recovery, I didn't want to keep pushing meds on her. Then got a nice chewing out from the postpartum nurse because the patient (who had no pain tolerance) rated her pain 7/10 when she got over to the other side. "Why didn't you start XYZ pain meds in recovery if she hurt so bad?" Well...because she was sleeping through recovery and couldn't keep her eyes open even when I was checking her fundus. Didn't sound like she needed pain meds to me!

Moved that section recovery and took a ROL who walked in 3cm and ruptured. 20 minutes later she was 6cm so I called the doc and said "you better head this way..." and she did. Then as I'm hanging up the phone "the scream" happened. I ran in, patient was easily complete, thank goodness the laborist followed me in. We got her in stirrups. Someone called the doc who was on her way and she said "don't let her deliver, I'm on my way!" Far be it from me to tell a multip who's complete, unblocked and +3 not to push. Doc walked in as the laborist was delivering the placenta. Thank goodness the laborist backed me up 100%.

I'm half way through my vag recovery when one of the breech PPROM (preterm premature rupture of membranes) started having very ugly decels. The laborist who had just walked out of my delivery went down to check her and there was a foot in her entrotis (vaginal canal). Time to head back to a C/S! I was really the only one who could take her, so I (kind of) handed off my recovery and ran down the hall with the new C/S. She was still contracting away so they slept her ( I went from never doing a general anes C/S to 2 in a week!). I went to go put in a foley and when I spread her labia, the ENTIRE foot was sticking out. There is just something all wrong about that. I didn't think I could get the foley in, and the laborist said " just push the foot out of the way..." so I did and somehow got the foley in. Not really sure how that happened, but if I NEVER see a foot hanging out of a vagina again that will be OK with me...

So finished section #2 for the night. There was another ROL that I should probably have taken but another nurse already had her started, so I took the next one. The first patient delivered, mine didn't. I gave the nurse a hard time and said that I should have taken that first ROL because then I could have beat a personal record and had 4 babies in a shift. But looking back, 3 babies is MORE than enough, considering that I didn't admit my vag delivery 'till after she was already over on postpartum. I'm sure I missed something on charting, but everyone was breathing when I left, so I'll fix charting tonight if I need to. I'm getting on a role here, I'm not gonna know what to do if I go a night with less than 2 or 3 deliveries!

Babies today: 1f/2m

Babies total: 56M/61F = 117

Vag:42M/46F = 88

C/S: 14M15F = 29

Babies 'caught' = 2f0.5m

Sunday, July 5, 2009

7 Wasn't Enough...

I was so thankful to have a day off yesterday! I knew how crazy it had been, so I took brownies up to work last night about 2100. The board looked beautiful!! Couple green names and 2 ROL's. Why can't I work on nights like that!?!

So I dropped the brownies off and on my way out the door I made a funny comment about "now I don't want my phone to ring tonight because I've already driven over here once tonight!" I should have kept my mouth shut...!

Sure enough, about 0245 my phone rings. When I'm in a dead sleep I don't really think about what I'm doing and I just grab the phone and answer it. Sure enough "we need help! People just keep walking in!" Ok...I'm on my way. I couldn't say no after what I'd said earlier, and after the week we'd had, I know what it's like when nobody will come in to help. Only as I was getting ready to walk out the door did I realize that it was torrentially pouring buckets outside...no wonder the flood gates had opened at work (pun fully intended...).

When I got there I took one of the nurses SROM girls. After looking closely at the board I don't think it was quite as desperate as it had sounded on the phone, but I'm guessing it had all hit at once and when people keep walking in, there's no telling when they're going to stop walking in! So I checked on my girl, I actually used to work with her at the hospital day care before I went to nursing school. That was cool. She was ruptured and contracting, but hadn't really changed much from the office per the nurse who had admitted her. She didn't want any pain meds quite yet, so I let her rest for awhile. The doctor had given pit orders but I decided that since she WAS contracting, I would give her an hour or two to see if she did it on her own.

Baby looked great, and finally about 0530 the patient said she was getting more uncomfortable and wondered what she was dilated. So I checked her and something just wasn't quite right. I couldn't really find a cervix, and couldn't feel any suture lines, it was just all kinds of funk. So I had the original nurse check her and she didn't know what it was either...but she was definitely more than the 2cm she was when she came in. So we grabbed the ultrasound and then had the laborist come verify presentation, sure enough, it was a butt. You would have never know from where we were picking up heart tones, but then mom mentioned that "I have been feeling the baby kick me down low." Hmmm...well, no vag delivery for you! So we called the doc, Mom was about 5-6cm, and we took her back for a C/S. Baby was born just before 0700, little girl, perfect, adorable and sure enough...butt first!

So...8 deliveries in 1 week, I caught a baby, I checked (and almost pitted) a breech baby, I did a crazy, messed up C/S with a bakri balloon, rectal cytotec on the table and general anesthesia, I got along good with the docs, and I got 1 day off before I do another 3 in a row! Ah..the life of a labor nurse :)

Babies today: 1f
Babies total: 54M/60F = 114
Vag:42M/45F = 87
C/S: 12M15F = 27
Babies 'caught' = 2f0.5m

Saturday, July 4, 2009

Thursday

By Thursday night I was seriously dragging. We had all gotten our butts kicked all week long, and you could tell all us nurses were getting near the end of our strings...

I took my patient back for a C/S about 1910 after her being a cervidil the night before and then on pit all day and having made NO change. That and the fact that every time she rolled or changed position baby would have a nice 5-6min decel. A C/S was definitely the best decision for her and her baby. She was a young mom, first baby, and she was giving the baby up for adoption after 24hrs.

Got her all ready and back to the section we go. That's where things started spiraling out of control. We had a great anes team on that night, and usually it takes all of about 10 mins to get the spinal in and the patient comfy. So we started working in the back, since we didn't really want to move mom and cause another decel anes tried to put the block in while Mom was laying on her side. This is nothing new for them, and it's usually no problem. Well the CRNA tried...and tried...and tried...and tried...about 30 minutes of trying. The patient started getting a little uncooperative and stressed out about the block as time went by. We finally called the anes doc to come and he tried a couple times on her side, and then said we had to sit her up. So we sat her up and he got it in, then the patient started freaking out that she couldn't breathe. She said it was only on one side and even though she was satting 100% on room air she started getting out of control. They waited long enough for me to get the foley in and prep her and then they slept her. At that point, I knew I was getting in over my head in things I'd never done before. So...let's just keep the ball rolling!

It's amazing how fast people start to move when the mom's actually slept instead of with just the block. That's impressive! So baby came out fine, but then of course it couldn't just be all said and done with...the uterus wouldn't firm up, it stayed soft and "soggy". So...1 dose of methergine IM. Still boggy. So let's try something else. 800mcg cytotec...rectally...on the table...by me. Seriously? This is not a skill I learned in nursing school OR during orientation! Anyone tried to shove 8 little pills up a rectum while the patent's strapped down on a narrow OR table on her back? Without breaking sterile technique during an operation? MORE than a little difficult. Add in the fact that this patient isn't the smallest patient I've ever taken care of either. Seriously...

Too bad her uterus still didn't clamp down...so let's try some hemobate...nope...more methergine...nothing. So when all else fails, pull out the bakri balloon. This is a balloon that actually goes into the uterus vaginally and is filled with fluid to completely fill the uterus and put pressure on it so it stops bleeding. Never done one of these either. So let's list the NEW things that BirthdayNurse got to do during ONE c/s:
1. General Anesthetic
2. Rectal cytotec on the table
3. Bakri balloon
4. Hemobate intrauterine

That's too many new things to learn in one night!!! So 2hrs after we got in the OR, we left the OR. I'd never recovered a patient with general anesthetic, or a bakri balloon, or one who was as out of control as this girl was after general anesthesia, so I very willingly handed off my recovery to a different nurse and took her patient back for a C/S.

Thank goodness the 2nd section went according to how it was supposed to, other than her begin 29wks with PPROM, but baby was great for 29wks, mom did fantastic, and I got a chance during recovery to finish charting on BOTH patients! After moving my recovery I finished up another recovery for another nurse who was going home, meanwhile people kept on walking in the door...

After finishing up the last recovery, I went back out to labor land and picked up someones blocked/comfy/tucked-in labor patient who turned out to be the same girl I had sent home the morning before after she slept all night off vistaril. I was happy she came back in labor.

I took another multip ROL who was actually ruptured but only about 3cm. She wanted a block too, so I got her comfy, charted and sat down for about the 1st time all night. It was about 6, so I went in to check my ruptured girl one more time before I started some pit on her and low and behold she was about 8cm with a nice bulging bag. The doctor was sitting out at the desk and when I told her she said "well, let's rupture her and then I'll deliver her before I leave." Ok...whatever you say! So AROM, drag in some delivery equipment and have a baby at 0635!

Another 3 baby shift...and my 1st boy of the week! I was seriously starting to wonder if there was something in the water to get all these girls! And 2 of them have had the same name, and 2 of the other's have rhymed!

Babies so far this week...7. I think I'm done for the week!!!

Babies today: 2f/1m
Babies total: 54M/59F = 113
Vag:42M/45F = 87
C/S: 12M14F = 26
Babies 'caught' = 2f0.5m

Wednesday

After Tuesday night I was already tired and it was only my 2nd shift! The fact that I picked up an extra 6hrs Monday night really threw me off, and I couldn't even tell you what day it was!

Wednesday I took a patient that followed me in the door for a rule out labor (ROL). I ruled her out after an hour, made her mad that I was sending her home, and tried to explain that I couldn't "force" her to leave but that I really thought she'd be more comfortable not in our beds and not being able to drink, eat or smoke her cigarettes. She finally decided to leave.

Then I took another ROL, got her in a bed, then got a page that somehow it was my turn to take ANOTHER patient. Ok...so I ran for about an hour and a half, the on-call doctor for the 1st patient decided that since she lived an hour away she should stay and would "probably go into labor during the night." I got her settled, gave her 50mg of vistaril to help her sleep (same sleepy effect of benadryl) and she slept the rest of the night. Hmmm...maybe not real labor?

2nd ROL went home, and I finally sat down to chart on BOTH patients. All fine and good, got everything caught up, I was good to go! Then another ROL walked in, of course it's my turn. She was definitely in labor and wanted a block so IV, block, check her and she was pretty near complete. Her doc came in, we had a great delivery! All right then! This was another doc who isn't always known for being super friendly but she came and sat at the desk with all us nurses and chatted for a while waiting for her other patient across the hall to deliver. I really like it when the docs sit out with us and socialize and just share in good old conversation. It breaks a lot of the the doctor/nurse walls down and makes everyone seem a little more human.

Right at shift change the same ROL that I had sent home 12 hours before came back and her cervix had changed, so she got to stay this time. You could tell she wasn't very happy, but in my mind, she got to go home for 12 hours, she got to eat and she got to smoke the cigarettes she wanted. She couldn't have done any of that if she had stayed. I'd say she was better off at home.

Total deliveries for the week so far...4

Babies today: 1f

Babies total: 53M/57F = 110

Vag:41M/45F = 86

C/S: 12M12F = 24

Babies 'caught' = 2f0.5m

Tuesday

I could sum up this last week in 1 word: CRAZY!! But...to be fair, I'll post about each day. Since it's Saturday now (and this recaps Monday through Friday) I may be minus a few details...but all my numbers are correct!

Monday night started the ball rolling. I took report on a very nice patient from one of the day shift nurses. The patient was a multip already in labor, already had an epidural and was comfortable. So it was the waiting game on her. She labored very nicely.

About 1930 I took a triage who came in contracting, it was her 4th baby. She was in great control, but was ready for an epidural ASAP, so I got her blocked, comfy and then sat down to chart. Meanwhile, my 1st patient was starting to have a few variables, so I went to check her and she was complete. I set her up and we only pushed a few time, called the doc in and had a very nice delivery! I came out of her delivery, stuck my head in to check on my 2nd patient and she mentioned she was feeling a little bit of pressure. Sure enough, she was complete. So I somehow managed to hand off my 1/2 way done recovery to another nurse and went to my other delivery. She pushed about 2 times, we called the doc and had another great delivery. I check the times and it was 1hr and 5min apart from my 1st delivery. Nice work for before midnight :)

The doctor for my 2nd delivery can more often than not be a little difficult to get along with, even though I've never had any troubles with her at all. We had a great delivery, she was very chatty, happy and sociable the whole time. When I came out to the desk afterwards, one of the other nurses said "whatever you did to get on her good side, don't get off of it!" I don't know what I did either...

As I was sitting down to chart my admission database on my 2nd delivery patient (who said that admission stuff has to be done BEFORE the baby comes out?!), I head a blood curdling scream from a room and any labor nurse knows the sound of "the baby's coming" scream and that was for sure it. I dashed into the room, threw the cover off the delivery cart and sure enough under the sheets there was a head full of dark hair crowning up nicely. The actual nurse was standing at the bedside holding the sheets up looking slightly panicked (I don't blame her!) I grabbed the top pair of gloves off the delivery cart, reached down and caught the baby just before the laborist walked in. Baby went to mom's tummy, cord clamped and cut and I let the doctor take over. Hey, a TOTAL step up from the last baby I caught...at least I had on gloves, and I didn't get anything on my scrubs! It was a slightly awkward angle to catch a baby since I was standing behind mom, but whatever works I guess...

What a way to start a week. All girls! And chalk another baby up that I've caught :) I'll take one of those ANY day!! Counting the 2 babies I had + the one I caught we had 322 babies in June! That's alot!

Babies today: 3f
Babies total: 53M/56F = 109
Vag:41M/44F = 82
C/S: 12M12F = 24
Babies 'caught' = 2f0.5m

Wednesday, July 1, 2009

Friday Night

Probably should talk about Friday night before I talk about the craziness of last night!

Friday night...I walked into a girl who was unblocked and on pit but who really hadn't changed all day. I walked down with the day shift nurse to check her right before shift change...she was 8. (Still unblocked). Got the room all set up, gave her a few more contractions...checked her again...she was 9.5...few more contractions, complete. Please let the doc get here! I didn't put her in stirrups 'till I had the doc present and accounted for and I was sure I was gonna catch the baby...but I didn't. Nice delivery, she was so proud of herself for going un-blocked, and with good reason! I love it when they think they're only 2 and then realize that they're like 8 or 9 or complete. It's amazing how well they stay in control that way vs. knowing that they're getting closer and closer. I wonder if it really is a mind game!!

So I hung out with my postpartum cuplet (since I've been trained now...hahaha!). Did the whole breastfeeding thing, etc, etc. Then about 430 I got a R/O labor/SROM who was indeed in labor and SROM'd. I got her block, comfly, did my charting and checked her about 0630 and she was complete! Got the doc there, pushed 1 and a half times and had a baby at 0658...handed off the recovery to the day shift nurse and left the unit at 0710. That's how I like it! Get the fun of bonding with the patient, do the delivery, sign the chart and walk out. I think every delivery should be that way :)

So...3 shifts this week...5 babies...all vag...what a week! Reminds me why I love my job (most of the time!)

Babies today: 2m

Babies total: 53M/53F = 106

Vag:41M/41F = 82

C/S: 12M12F = 24

Babies 'caught' = 1f1/2m

Thursday, June 25, 2009

Babies Anyone?

Needless to say, it's been beyond crazy at work. I somehow managed to slip by on-call for part of my shift Friday night, I couldn't believe it! Then the calls started coming...

Saturday night...sorry I have a wedding Sunday morning!
Sunday... the manager of the entire Women's & Children's department called...twice!...sorry, I've got a bridesmaid dress on and I'm getting ready to march down the aisle!
Monday...just got off a mower after 5 hrs in 100 degree heat.
Tuesday... I was scheduled to work, and sure enough it was crazy. Somehow we've only had like 3 or 4 nurses scheduled every night, to cover an completely full board. We had more nurses there on time and a half pay than we did straight pay Tuesday night! I delivered a girl on mag about 2100, and as I walk out of that delivery with pressures of 160's/100's I get a page that there's a cervidil coming that I need to take. Since when is an unstable mag patient not 1-to-1? Whatever works I guess...
Wednesday...crazy again! I had one laboring patient and triage. Isn't that my favorite hat to wear? But it turned out not so bad. The labor patient I got at shift change was an SROM from early in the day who hadn't really gotten into any kind of labor pattern, and was stuck at about 2cm. I got report on her, got a quick triage about 1930 and had her gone before an hour was up. Then as I'm wrapping up the traige charting...in walks in another rule out SROM...who was very SROM'd. So I got her started, got both patients blocked, got my first patient an IUPC and a AROM of her forbag and attempted to tuck them both in to sleep.

About the time I started trying to chart my every 15minute heart tones on both patients since 1900, my 2nd SROM girl started having variables, so I went in to check her and flip her. She was almost complete...so I called the doc. That was my first mistake....I guess I thought going from 3-9.5 in an hour was impressive so I thought I should update the doctor. I guess I should have waited until she was complete and ready to deliver! The doctor came in and was upset that we weren't pushing yet! Um...first baby, she wasn't even quite complete. All I really wanted was for her to come and sleep and be there for delivery. Heck, she didn't even have to come yet! I just wanted her to know that we went from 3-9.5 in an hour! So the doc set my room up, rush, rush, rush, stood in there and pushed with us for an hour! I felt like a retard, totally useless, there were several implications made that maybe I wasn't the best nurse and that I clearly didn't know how to do my job. I felt like I had never done a delivery before! That will teach me to call before I should...

Half way through pushing with that patient, my other patient had several impressive variables so another nurse went in to check her and she was 7-8. Nice! So I finished my first delivery, checked my other girl, she was complete, tried to give report to a M/B nurse about my first patient so I could go push with my second but couldn't ever find the M/B nurse so I was an hour into my recovery before I could actually focus on my patient who was complete. Then my doc calls and says he's across town getting ready to head into surgery and he'll be another 45min-1hr before he's there. Ok...

Long story short, everything went great, she had a fantastic delivery. I had never done a delivery with that particular doctor and I loved him! He was great! Great bedside manner, very personable, calm, cool, collected. He knew his stuff and was great at explaining everything to the patient. He came up to me afterwards and said thank you for all my help, that I did a great job and that he wishes more of his patients came to our hospital. Total opposite experience from 1st delivery!

I haven't done 2 vag deliveries in one shift in a long time. I didn't realize until after I was leaving that I hadn't really sat down all night except to chart and that I was a little hungry! Oh well, the price I pay for loving my job and getting 2 babies in one shift! One of each none the less. It was kinda cool, neither couple knew the sex of their baby before delivery, so after the first one was a girl I told the second couple that they needed to have a boy so that I could have one of each on my shift, and they did!

2 shifts so far this week...3 babies, not bad!!

Babies today: 1f...1f/1m
Babies total: 51M/53F = 104
Vag:39M/41F = 80
C/S: 12M12F = 24
Babies 'caught' = 1f1/2m

Tuesday, June 16, 2009

Awaiting Sweet Sleep...

Last night will get blogged about AFTER I have not been up for 22 1/2 hrs and when I am in a better mood...