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

2 comments:

  1. It sounds like you would make an awesome doula! I wish I could tell you that you'd make a killing working as a doula, but I regret to say that no one is making a killing working as a doula ;-) If only!!

    As a doula who has not had kids, I'm sorry that doula was saying stuff like that to you. Just hazarding a guess, you were doing a great job of being like a doula to her patient and she was feeling threatened instead of properly feeling appreciative and welcoming. I disagree with her...I think having gone through labor can be an advantage but can also be a disadvantage in terms of thinking that now you know what it feels like for everybody else. We know from women's descriptions of their birth experiences that they feel the sensations of labor very very differently - one woman can even have very different experiences in different pregnancies.

    I have a couple perspectives to share on the "permission" thing. Sometimes as a doula I get clients looking to me for "permission". I understand what they're doing, they hired me in part to be a sounding board and an independent voice, and they want to know what I think. Because it's not my role to give them medical advice, I generally try to turn it around and talk them through the situation and ask what more information THEY need to make a good decision. I wouldn't want a client asking me for "permission" if her doctor told her she needed a c-section. But if she turned to me and asked what I thought, and it meant I could help her talk through the fact that baby was showing no distress and that her progress was slow but was happening, that might be a good thing for her making an informed decision about whether or not she wanted to consent to the section. If you have the independence as a nurse to give her the space, time, and support to potentially question her doctor's recommendation, that's fabulous! But many nurses don't, or won't, and I feel that's where the doula's ability to be an independent sounding board comes in.

    And sometimes I also recognize that as someone they shared their birth plan with, and trust, they just need emotional validation for the path they're about to choose. It would be nice if they could get it from the medical staff, but unfortunately many people who hire doulas are doing so because they do not completely trust the medical staff - and sadly, with good reason in some cases. So in those cases I just say "You seem so exhausted, I think an epidural sounds like a great idea" or whatever it is they need to hear to feel good about their decision.

    I have experienced this from the other side (less often) doing lactation support where the mom looks to her doula when I recommend, for example, a nipple shield. "Do you think I should try it?" And I get this flash of irritation - "Your doula didn't train for this work and take the LC exam and work with hundreds of breastfeeding dyads, why are you asking HER?" - and then I go "aha, this is what the L&D staff must feel like when my doula client turns to me!" So in that moment I remind myself that I have just met this woman - why should she trust me? She trusts the person who she met and has been working with for weeks, and just went through many hours of labor with. She is going to consider her options and make a decision instead of just agreeing with what I suggest, which is a strange feeling for me but a good one to get used to. I may not agree with her decision but she will be the one who lives with the consequences, not me, and I have to make room for the possibility that I am wrong and she is right. That this is so uncomfortable for me to do has been an excellent learning experience and given me a lot more sympathy for all sides!

    Phew, this may end up as a reply-turned-post on my blog ;-) Sorry for the length!!

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  2. Permission: authorization to do something

    Advice: to give counsel to

    Big difference. Nobody is questioning your knowledge as a nurse. It sounds to me like this woman/these women are simply seeking input from a trusted advisor with whom a previous relationship has been build.

    Let go of the defensiveness and listen to the conversations. You might be surprised with what you hear---especially from a Mama's perspective. This might be something you do all day, every day, but for many women this is the first time they have ever even been IN the hospital as a patient.

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