Tuesday, October 5, 2010

It's an OPINION!

I figured my comment about home-birthing might cause some stir.....and I think I was right. Let me just say up front (again!) that this is MY OPINION. It doesn't mean that it's the only opinion or heck, even the right opinion! It's just how I see things through my eyes.

Someone asked what we have in a hospital that wouldn't be available at home. I'll admit that I've never been to a home birth, but from the research I've done here's a small list (not all inclusive) of things we would have in a hospital (not necessarily at every delivery but available within seconds) that usually wouldn't be available at home:

~ 5 L&D nurses
~ 4 NICU nurses
~ 2 Neonatal Nurse Practitioners
~ a full team to take care of mom after delivery and a separate team to take care of the baby after delivery
~ a labor bed that can be adjusted to many different positions to facilitate McRoberts maneuver (plus lots of others)
~ a full OR team/equipment (including anesthesia) ready for an emergency C/S if/when we decided we needed it

In my situation I think the things that helped the most were having all the (very experienced) hands ready and able to help. If it had been just the doctor and me in the room things could have turned out very differently. There is also no way that I could have taken care of the critical condition baby after he was born AND taken care of mom at the same time.

I know the great majority of births (home and hospital) turn out fantastic, happy healthy mom and happy healthy baby. I know midwives are trained and many have more experience than some doctors. I know that sometimes in hospitals decisions are made because of the extra monitoring that lots of times happens and that lots of times in the hospital we err on the side of  "preventing" instead of "reacting." My experience over the weekend reminded me how quickly a situation can go from normal, routine, and uncomplicated to emergent, critical and life or death. The thought that keeps running though my head is "why would I want to take the chance of the one birth that doesn't go as planned being MY baby's?"

Monday, October 4, 2010

If It Scares Us It Must Make Us Stronger...Right?

Every nurse has experiences that they never forget....shoulder dystocias are some of those experiences. Not going to go into detail....but all 7 nurses and the doctor were shaking pretty bad after a very cute and chubby baby destined to be a linebacker came out safe and sound. Scenarios like that are what put lots of things into perspective:
~the high acuity of what I get to do every night
~the great teamwork we have as a unit
~and why home birth is such a bad idea in my book!
This mom didn't push very long, nobody would have guessed after a recent sono showed a <7# baby that he'd be a tight fit!! If this mom had tried to deliver at home, the outcome would not have been good.....for her or baby.

On a less tense note...I got to deliver a baby for one of my friends from church this week. Those are so fun! Not only do I get to help Mom and Dad welcome their new baby but I get to watch her grow up over the next couple years. It's like a premature ending when I deliver a baby and then move them over after 2hrs and maybe see them one more time. I don't usually get to see the "continuing project" over the next few years! This is the fun way to do it!

It feels like maybe our crazy summer is winding down. The last few nights at work have been a little more relaxed. Several deliveries, but not the crazy non-stop, no more rooms, no more nurses pace we've been running all summer. A total of 339 babies in September! Waiting for the 2 sets of triplets to come in any day this month.....

Babies this Month:1m

Babies total: 111M/122F = 233
Vag:82M/94F = 176
C/S: 29M28F = 57
Babies 'caught' = 2f1.5m

Sunday, September 19, 2010

The Babies Keep on Coming

Even though I live in a large metropolitan area, it continues to amaze me how many babies we continue to deliver every month. It's not like we're the only hospital in the city, there are several other hospitals who deliver just about as many babies as we do......and the last few months we've been >350! A week or so ago we had 23 babies in 24hrs...and with only 17 labor rooms that makes for some crazy times!

I've been doing lots of thinking over the last several weeks as we're losing some nurses to day shift and have a new traveler with us and just in general about how much the last 2 1/2 years have changed me as a nurse. We were all sitting around talking (one of our rare moments of peace and quite!) about 'seniority' and off all the nurses on our night shift I'm 3rd on the list for seniority. Not by experience by any means, but by employee time at the hospital. And there are several nurses with less experience too. I don't feel like I've been doing it THAT long!! But having some of the newer nurses come up and ask ME about what I think about a strip or what I would suggest they do in a certain situation...it still surprises me. The things that used to scare me to no end are things that don't really phase me any more and the things that I didn't used to think were necessarily a big deal see the significance in now! I think I've grown up a lot.

I worked an extra 15hr shift last week, went in at 2300 and left the next afternoon at 1400 after the delivery. It was a great bonding experience with the patient and her husband, but I don't think I realized it until how much we bonded until I was talking to them in the NICU a few nights later. They kept saying over and over "you helped us so much. We didn't realize how much our nurse would actually do and how little we would see our doctor. We couldn't have done it without you, you made the whole experience so positive even though it didn't go exactly as we had planned." This was the same couple who had a doula who told me that since I didn't have children of my own I didn't really know what it was like to be in labor...hmmmmmmm. She had a point...but I thought that my point of delivering way more babies than she had was a valid one too. But, I think I will always feel slightly dis-advantaged as a labor nurse until I have my own kids someday.

One thing I always seem to struggle with when I have patients who have doulas is when they ask their doulas for "permission" before they do anything. The patient was thinking about getting an epidural after 10+hrs of backlabor and no real cervical change. She had been talking about it and going back and forth and I asked her if she wanted me to start her fluid bolus prior to her block. She looked right at her doula and said "what do you think?" When her doctor wanted to start pitocin a few hours later after she was comfortable and still not changing her cervix...again she looked at her doula and said "what do you think?" (after waking her doula up from the nap she had been taking on the pull-out mattress) HELLO!! This is not your doula's labor! This is your labor, your baby, your body, your experience! You don't need your doula's permission!!! Doula's are great support people, they're awesome, don't get me wrong. But (most of them...and especially not the one in the previous scenario) they're not trained medical personnel...they're not your doctor or your nurse...don't ask their "permission"!

Several of us L&D nurses have thought that we could make a killing working as doula's on the side :) Best of both worlds!!

Babies total: 108M/119F = 227
Vag:80M/91F = 171
C/S: 28M28F = 56
Babies 'caught' = 2f1.5m

Saturday, August 7, 2010

Lots of Babies!

July was a record setting month at work...for all times! 361 babies in 31 days...with an 18-bed L&D, no antepartum unit...that's a lot of babies! We had 6 sets of twin, 4 of which happend the last week-and-a-half. I had at least one 3-delivery night (all vag!) plus several 2-delivery nights. We were a busy bunch for sure :) I think all of us nurses are more than happy if we don't break the record again for a VERY long time! It was kinda cool though, I delivered the record-breaking baby one morning(356) and then came back that night and delivered the new record-setting baby (361) that night. How cool is that?!

We had a lot of earlier babies too...2 sets of 31wk twins, some 32wk PIH moms...our NICU is full to overflowing! Job security is amazing!

I was thinking this week that the begining of August marked my 2-years as a L&D nurse, and my 2-years as a nurse period. I sure feel like I've been doing it longer than that (and am very guilty of telling my patients that I've been doing it longer than that...just to make them feel better). I know there is still tons that I have left to learn, but so many things that I used to think were such big deals aren't that big of deals anymore and things that used to get me all flustered don't any more. I think that's a good thing. And yet everytime I go to work and get in the "just another day at the office" funk, I have a delivery, or a patient, or a conversation with someone that makes me remember what an amazing job I have and all the miracles that I see happen every night at work. Whether it be working hard with a mom to delivery that miracle, or working hard with that mom to keep her pregnant just one more day. Ah...life is good :)

Babies total: 100M/114F = 214
Vag:75M/87F = 162
C/S: 25M27F = 52
Babies 'caught' = 2f1.5m

Wednesday, June 2, 2010


My 200th baby!! I've been waiting for like a week for that and it took one of the nursery nurses to point out that I had it last night! And check out these stats...

Babies today:1m
Babies total: 94M/106F = 200
Vag:70M/80F = 150
C/S: 25M25F = 50
Babies 'caught' = 2f1.5m

A 3:1 split on the vaginal deliveries vs C/S's...
Almost a 50/50 split on the male/female deliveries...
An exact 50/50 split on the male/female C/S deliveries...
And 3/200 babies I got to catch... :D That one's the best one!

Less than 2 years to make 200 babies, that's pretty good I would say!

Saturday, May 22, 2010

Birthday Twins!

Every year (all 2 so far..._ that I've been a nurse I've worked on my birthday. Last night it was the night of my birthday, this year it was supposed to be both ends. Everyone thinks I'm nuts for doing it, but I personally think that it's kinda fun! I've gotten birthday twins both times, and that's fun for me!!

This year I looked like a slight idiot doing it, but it all worked out OK. I had a triage come in for bleeding and she sure wasn't bleeding, and she was contracting every 7min, SVE unchanged from the office earlier in the week, cervix way posterior and she said she wouldn't have come in except for the "bleeding." I sent her home with some vistaril after I told the doctor "she's not bleeding or laboring." She was back 1hr later, contracting every 2-3min and 3-4cm. Chalk one up to my great triage skills!!! Oh well....she delivered a few hours later, blocked and comfortable, girl #3 with 2 pushes! We almost had extra people at our birthday party after I picked up the phone and accidentally switched 2 numbers in the doctor's sleep room and asked the friendly lab tech to come to my delivery. Oops...

Almost at 200 babies! I was hoping to hit #200 before midnight on my birthday but I got put on call. Good thing I picked up a couple extra shifts last weekend!

Babies today: 1m/1f
Babies total: 93M/106F = 199
Vag:70M/80F = 150
C/S: 24M25F = 49
Babies 'caught' = 2f1.5m

Saturday, May 15, 2010

Catching Babies!!

I must say....I've been waiting to catch a baby for a long time now! It's been almost a year since I've caught a baby! Yet another reason I love unblocked multips with no doc in house :) Yay!! I have yet to catch a nice, normal controlled delivery, all my babies just shoot out at me. And once again, one glove on and one glove off. I guess it's my signature :)

Shift change, I had just gotten report. Grand multip, unblocked, on pit, ruptured. The doc had just called, she was 5cm and he said to call him when we were ready. I checked her about 20min later and she was 6cm. I stuck a warmer in my room and put a delivery table outside my door just to be ready. Someone else delivered and needed a gelpie, so I went in to help them look for one. I got back to my room and my Mom said "I gotta puke..." I put on a glove, sure enough, there was the head. I grabbed the phone and called the laborist's room.....it rang....the head came out...I put the phone down in the bed....reduced the nuchal while telling Dad to find the delivery button....the rest of the baby came out....Dad found the delivery light and I found my emergency badge button....a nurse brought me the table and I clamped the cord, let Dad cut it (spraying blood EVERYWHERE...note to self, milk the cord next time)....baby to warmer....cord for pH's....cord blood for nursery....about that time the laborist came dashing in and I let her deliver the placenta. Mom was intact and very happy that the baby was out! I was impressed 'cuz the only blood I had on my scrubs was from Dad spraying blood everywhere. Nice!

The rest of the shift followed the pattern and I did 2 more deliveries. One a Mom who walked in 9cm with a bulging bag who I was afraid I was going to catch too, but she was a prime who had great control and only pushed for 30min. I learned my lesson though and had the laborist in the room with me for that one!

I went in for an extra 6hrs tonight and had yet another unblocked multip on pit who was 5cm when I got there. Thank goodness that doc was hanging out in-house at least, he almost missed the delivery anyway. I would have caught 2 babies in a week, but he wouldn't have been quite as laid-back about missing a delivery as the doc on Wednesday night!

So that's 3 babies I've caught in less than 2 years. Yay! My knees were still shaking a little bit, but not near as bad as the first time!! Now I want to do it again!!

Babies today: 2f/4m
Babies total: 92M/105F = 197
Vag:69M/79F = 148
C/S: 24M25F = 49
Babies 'caught' = 2f1.5m

Thursday, April 22, 2010


For as busy as we've been lately...it's been pretty ok! It's so nice having enough night staff to go around, and my phone hasn't been ringing off the hook every night looking for help! So what's the answer going to be? We're sending more nurses to day shift....of course! But, we will survive, because we always do, and we'll laugh our way through it :) I've realized over the last few weeks how much I love the girls I work with. They are 50% (some nights more) of why I love my job so much!

I got my first "thank you" from a student that's been working with me. I got so excited! She wasn't even really "my" student, but she needed some more shifts, so she's been working a couple nights with me over the last few weeks when her normal preceptor wasn't working. It's been fun and really an eye-opener for me. I've never really "preceptored" anyone before. It's hard for me to preceptor new nurses to the floor because most of them are older than me, and have been doing this for a lot longer than I have, just at different/slower/smaller hospitals. Telling someone who's older than me what to do or how to do something is still one of the things I'm working on, so I'll stick with students and new nurses who I've still got some (if however small) senority over! It's fun to watch it click for the first time for these new girls. I remember when it clicked for me and that's when I got hooked...

Babies total: 89M/102F = 191 (almost 200)!!!
Vag:65M/78F = 143
C/S: 24M24F = 48
Babies 'caught' = 2f0.5m

Saturday, March 13, 2010

14 in 7

Does Friday night have an OB curse everywhere?! It's like a full moon...Friday nights have a reputation for being beyond crazy!! Walk in the door @ 1830 and there are no empty rooms...and the board is FULL of labors! Labors are good....it means that they will get delivered and open up a room eventually...but they also can't be stacked up with one nurse, so it takes more nurses to take care of a board of labors over a board of antepartums. Still...I'd rather take labors anyday! Most of the labors were inductions hanging around from 0700, anywhere from 4-8cm.

First clue that maybe the night is gonna be full of surprises, in the midst of a pushing marathon a family member passes out, splits their head open and is unresponsive on the floor. It took 3 docs and multiple nurses calling down to ED to have them send a gurney up to get her. "Well...can you put her in a wheelchair and bring her down, we're busy." Um...no. She's unconscious, we can't jus put her in a wheelchair and bring her down!! After a few minutes she woke up and after some stitches she came back up to see the new arrival :)

I started the baby cascae with a vag delivery about 2030, about 3 minutes of pushing. Yay!! I'd taken care of this mom on multiple antepartum admissions and it was fun to get to do her delivery to wrap up the pregnancy.

About 10min into her recovery I took a triage (to our only empty room. She was about 3/100 with a BBOW and contracting every 3min. In the midst of asking her admission questions she mentions "I'm scheduled for a C/S next week." Hmmm...maybe the fact that you're a repeat C/S x3 is something you should mention to the doctor on-call when they tell you to come in. Thankfully that doc was already in-house in the midst of a C/S, so we prepped and followed pretty quickly. Baby #2 for me!!

As soon as I come out of the OR we keep the OR's running and double up PACU recoveries. I headed back out to the battle field and took another labor patient from a nurse going home. This gal never really made leaps and bounds of change but she was hurting and contracting pretty frequently and wanted an epidural. The doctor wanted to AROM her, but I convinced her to let me get Mom comfortable before AROM.

Epidural went fine, and so the doc came in to AROM her. She was having quite a bit of bloody show, and when the doctor checked her there were several clots. The fluid with AROM appeared to be clear but we kept a pretty close watch on the bleeding. About 10min after AROM, heart tones started sliding. Turn, turn, O2, fluid bolus etc. No response. Doctor was sitting at the desk and she came in and put on a scalp lead. Still low heart tones. So to the back we run. No time for an epidural dose, so we had to sleep her. By the time we got to the OR heart tones were much better and we all breathed a little better. 7min from the time we left the labor room to delivery (including waiting for anes to put Mom to sleep) and less than 45sec from incision to delivery. Our manager was there working the floor with us and both she and the doctor said they were pretty impressed with how fast we moved. That was the most people I've ever seen in the OR at one time, but I'm so thankful for each one of them!! Baby came out only slightly stunned but did great and Mom was good afterwards. Pretty good size abbruption.

As a whole, we had 14 babies in 7hrs that night, and I had 3 of them. Needless to say...I slept like a LOG the next day! Funny thing too, I wasn't even originaly scheduled for that night, but had switched nights with someone else...That's one of those nights you don't forget!

Babies total: 80M/99F = 179
Vag:62M/76F = 138
C/S: 18M23F = 41
Babies 'caught' = 2f0.5m

Monday, February 15, 2010

Still Here!

I know...it's been over a month since I talked about babies...but trust me, they're still coming! We beat our record for deliveries in January...ever. >330 in 31 days...we thought that was pretty impressive! It's seemed to me that for as many deliveries as we've had I personally haven't done very many :( Lots of cervidils and antes. Maybe my turn is coming soon :)

I did have some excitement Sunday morning @ 0600 when a SROM walked in and was in the best abbruption pattern I'd seen in a long time! Right off the bat banging out contractions every 30-60sec. Baby looked like one nice straight line (NOT a good thing). When I went to check her instead of a gush of clear fluid I got a handfull of blood. Of course we didn't have a laborist (in-house OB) that night, so I had to call her doc and get her to come in. I am so thankful for my amazing labor-nurse friends! We had the doc on her way, an IV started and a chart put together in about 15min of her getting there! After some IV fluids and some O2 baby started looking beter and she wasn't saturating pads with blood, so doc decided we had time for a more controled C/S. We didn't have to sleep her or anything too scary-run-down-the-hall, but still had a (>9lb) baby in 1hr 15min! Nice way to end the shift I guess.

Poor girl, she was more than a little scared, and was planning on going all natural. I have my doubts that baby would have fit anyway, didn't seem like a very big pelvis. Hopefully next time around she'll get the chance to VBAC!

I promise to start making a better attempt at posting on a more regular basis!

Babies total: 75M/95F = 170
Vag:58M/73F = 131
C/S: 17M22F = 39
Babies 'caught' = 2f0.5m...I'm TOTALLY in the mood to catch another baby! Another nurse got to catch one this weekend when the Dr. got stuck in the lounge when the infant security alarm went off...I want my turn!!

Friday, January 1, 2010

End of A Decade

And how did we finish the last week of the year?! Like crazy nurses at work! Our "goal" to beat a yearly record of babies was to deliver 315 this month. Because of the holidays we were a few behind, but I think this last week we went crazy and ended up at 300. I worked Christmas night...and the next 3. Christmas night was super slow, we were in the middle of a huge snow storm. I sat for 8hrs without a patient! It was pretty amazing :) We sat around and made no-bake cookies in the lounge and had some good laughs.

The next 3 nights...were not so laid-back and relaxed. We had like 19-20 babies every day, there were a bazillion inductions/c-sections scheduled and we kept hoppin'! I had a good delivery each night, did my first c/s with the new (kick me!) charting system and survived :) We all learned a valuable lesson about not opening our mouth about our shift being over and took a crash c/s back at 0643 at change of shift. Craziness!!

Ready to see what another year brings! How many babies, how many new experiencs, how many more things I can learn!! I feel like a totally different nurse than I did last year, and that's a good thing :)

Babies today: 3f/4m
Babies total: 72M/88F = 160
Vag:55M/68F = 123
C/S: 17M20F = 37
Babies 'caught' = 2f0.5m