May 28, 2011
I really love reading birth stories. I sometimes find myself searching for them online, because I want to hear about other people’s experiences – moms and midwives. All labors and births are different, and for me it is endlessly fascinating to hear the tales. The crazy ones provide the most interest, a lot of times, but the smooth/quick/easy births are wonderful to hear as well.
The most recent birth I attended was a woman having her second baby. She called me around 9:30pm (literally the moment I put my head on my pillow, in the comfort of my apartment, after a 100% quiet day which including several naps). She had been contracting on and off, mildly, for about a week – but now she was having strong contractions. They were still irregular, though, and she sounded very cheerful. After some back and forth I encouraged her to give it another hour at home and then call me back. Her water hadn’t broken and the baby was very active. It’s hard for me to make the call sometimes with a second baby – to decide when it’s time to come to the hospital. With a first, depending on the woman’s plan for labor – natural vs. epidural – I usually encourage her to stay at home as long as possible. First babies can take their sweet, sweet time, and as long as she’s doing okay at home, it’s to everyone’s benefit that she stay there. It’s better all around if a first-timer gets to the hospital in rip-roaring labor. But with second babies … they can come so quick. That’s why we love them! I think the closest I ever came to delivering a baby in the hallway or triage room was a second-time mom who called me with some mild contractions, called me back an hour later and arrived at the hospital thirty minutes after that already pushing.
Anyway – when this laboring mom came in she was 5cm, which was great, although oftentimes multips planning an unmedicated birth get to the hospital farther along than that. Her cervix was still posterior although I could feel bulging membranes. She was cheerful and could pretty much talk through the contractions, which were fairly spaced at 4-6 minutes apart. This was around midnight. We talked about how her first baby had come out with a compound arm and caused a significant laceration. We went up to the room where she would labor and birth. At two am, she was 7cm and more anterior, and beginning to feel less “like she was hanging out in a hotel room.” She used the tub which helped her relax and did a great job breathing through the contractions, now closer to 3-4 minutes apart.
I considered artificially rupturing her membranes when I admitted her, which is something that is fairly standard at my hospital. I suspected that if I broke that bag of water, the head would come right down and she would dilate quickly – oftentimes it does happen that way, especially when someone is having her second baby and her body has delivered one before. In this case, I held off because the baby was still pretty high and she was making good progress. Also, I have had not-too-great experiences at times after breaking someone’s water – sometimes once the amniotic fluid is gone, the cord gets squeezed with contractions and the baby doesn’t tolerate labor as well. I feel that this intervention is used too routinely – it can be beneficial and really speed things up, or it can cause other issues that might well have been avoided. In this case, too, she preferred that I not break her water quite yet.
At 3am she was beginning to feel a bit frantic. She felt more pressure like she almost wanted to push, but not quite. I checked her again, although it hadn’t been that long since her last exam … 8cm, the head had come down a lot and I felt very comfortable rupturing her membranes – which I did with her permission. On the next contraction her body began spontaneously bearing down, which is usually a very good sign! A few more contractions after that and her cervix was almost completely gone. She was panicking a little and saying she couldn’t do it, pretty much par for the course at that point in labor. We helped her get through a few more minutes of contractions and let her body do the pushing. I reached to touch the baby’s head to see how soon I would need to get the birth kit out, and it was very low, only about an inch inside. Mom was happy – “She’s gowning quickly, that must be a good sign.” We told her she was almost done, and reminded her that she would soon have her baby. I encouraged her to push long and strong so that she would be done sooner – and she did. I told her I did not want her flat on her back. I wanted her on her side because it is the best position for minimizing tearing. We helped her hold her leg back as she pushed. I could see the head rotating on the perineum as baby crowned, which suggests, I think, that maybe it was posterior throughout labor. Lots and lots of dark hair, a compound arm just like his sister, and then he was here! Really loud set of lungs and almost a pound and a half bigger than her daughter. A small tear that required just a couple of stitches. Grandma and dad in the room, aunt and uncle right outside ready to come in as soon as everyone was settled.
It was a really lovely birth. Welcome baby.
July 2, 2009
I meant to keep a journal of my summer in Oklahoma but now it’s half over and I haven’t written anything. I’ve been keeping a birth log, which helps me remember the babies I’ve caught so far and their parents, but already the details are fading and I can’t remember things like names and ages and how many weeks my patients were when they delivered. I know it’s unrealistic to expect that I’ll be able to remember names, but I want to. I can picture mother’s faces really clearly and I can remember them with their babies … but I need to write down more than that.
Dad tonight missed his first baby’s birth because he went out to smoke a cigarette. It was unfortunate that nobody caught him on his way down to the first floor … or thought to call him when mom started pushing. It was her third baby so he only took a few pushes to get out. Dad came back after she was already cleaned up … “Are you serious?” There he was, a little chunk of a baby, much fatter than we expected and just awesome. Mom had limited prenatal care and was unsure about her last period, so at first we thought she was seriously preterm and gave her MgSO4 to stop labor. Lucky lady got to puke crazily for a few minutes after that got started. However: he measured bigger on ultrasound, and he came out bigger than we expected. I didn’t stay to check on his actual weight. I had been there 12 hours already and had a headache. I took myself home and drank a ginormous glass of wine.
Drinking alone is so not very fun. Also I need to write more about these births. Also … I am still shocked every time by the amount of traction you can put on a baby’s head to get it out of its mom. I need to get used to that part.
April 28, 2009
At the last birth center birth I was privileged to attend, the mom was a woman from one of the Centering classes I had gone to several times. The midwife who led those Centering classes was on-call that day, so it was exciting she was able to catch this mom’s baby. The parents already had one son, an adorable 2 year old, who was over 9 pound at birth. I was a little … not nervous, but well … ok, maybe a tiny bit nervous. I know that some moms grow big babies, and this lady was completely healthy (very rare for the population served by this birth center), and she had one big baby already no problem.
There’s just always that moment of adrenaline rush when the head comes out and you think, god, that’s a big head, I hope the shoulder comes out soon after … and then it usually does.
I wanted to write a quick note about this birth so I don’t forget it. It was such a positive experience for everyone involved, even me, and all I did was stand there. The mom coped so beautifully with labor, the dad was such a perfect support for her, and the atmosphere was completely peaceful and quiet. She stayed in the tub until she was almost complete, when the midwife broke her water and there was light meconium … another moment of “oh my god I know that’s normal but what if it’s not oh god I hope the baby’s okay” for me, standing in the corner. Paranoid student. A minute later she got out of the tub and onto the bed, we turned the lights down low and J (midwife) started encouraging her to push.
I loved the two births that I was able to see with J catching. I mean, I loved all of them, they were all totally awesome in their own way. I should really write about them all, I think I’ll do that … but J had this incredibly calming and reassuring presence that I aspire to have some day. She is older than the other midwives at that birth center and more experienced. As the mom was pushing this day and getting distracted by the pain, J would catch her eye and say, in a quiet voice, “Everything is fine. Everything looks very normal. Take a deep breath.”
But my favorite moment was after the head came out. Mom paused, saying, “whew, that’s better” after the widest part of the head was delivered. A moment or two later, as my shoulder dystocia nerves were making themselves known again internally, J looked at her and said calmly, “Ok, push the rest of him out,” and she did, one big push and a huge fat baby boy was born and was the most vigorous baby I have ever seen. I think he was crying before he was even all the way out. He looked EXACTLY like his brother, and he ended up being even bigger. 9 lbs 9 oz, I think.
(And she had not even one stitch worth of tears on her perineum. Gorgeous.)
An hour or so later, she was back in the tub with the baby, relaxing and watching her new son enjoy the warm water.
This is why I think I want to work at a birth center.
September 5, 2008
If everything goes as planned, in approximately 8 days I will be a registered nurse. This is exciting and surprising and I’m trying not to freak out about the test I still have to take. I think it’ll be okay … well, most things usually end up okay in the end. But I mean to say I think I can pass it in the first go-round. Nerves never have helped me perform well, so I’m just focusing on the fact that most people pass the first time and I like to fancy myself to be at least as intelligent as the majority of nurses that exist. It’s good to not be very nervous. I’m starting to have a bit of insomnia/nighttime anxiety about it, but whatevs. It’ll be over soon.
I have started my second year, my specialty year, the MIDWIFERY YEAR. A week from now, as well as having taken the NCLEX, I will have done my first internal pelvic exam. In fact, I might have done two already. This is something else that I feel some anxiety about, but really not too much. Although I still don’t know that much about how to be a nurse, the past year has definitely made me infinitely more comfortable with the human body and all of its oddities. Everyone is a little different, but we all have more in common than not, and this is comforting and interesting at the same time. I find myself able to discuss strange and sometimes off-putting things that bodies do, and not feel grossed out or awkward or whatever. I guess this is a good sign. And that’s why I’m not too worried about hopping up onto an exam table and letting my midwifery classmates practice using a speculum on me. Better me than an innocent, unknowing patient, I think. It’s good to have the practice.
This semester is going to be a bitch and a half, but our women’s health/midwifery classes & labs are so much better than anything I’ve ever done in nursing school before. We still have theory, and boring pathophysiology (SO BORING), but seriously, last week on our first day of class, time actually passed relatively quickly. I was at school for eleven hours, but most of it was interesting. Fun, even. Finally!!
June 30, 2008
The other day Patrice asked me if I died this week, would I be disappointed? The following conversation went something like this:
C: YEAH … there’s still a lot of things I want to do. If I have to die when I’m 24, at least let me die after next weekend when I get to see Ringo and after August when I get to see Bob Dylan.
P: Dude, don’t be greedy! You already saw Bob Dylan once.
It’s almost July. I haven’t gotten a letter from the kiddos in a long time … I think they’re probably having some vacations in various parts of the country. I wish I was traveling at this moment — well, maybe not this very moment, I’m fucking exhausted. But I’ve been really feeling the travel bug lately, my latest craving is to go to Bosnia or Croatia. I was looking at pictures of Sarajevo today online, it’s so beautiful. But I can’t, and I’m here, plugging away, so close to being done with this year that I can taste it.
Good news is, I’m starting clinicals tomorrow NOT at the depressing hospital where students aren’t allowed to do anything. I’m going to the hospital I can walk to, which is a considerable benefit when I have to get up at 5:30 and be there by 6:15.
Bad news is, I have a final the next morning at 8am. I don’t understand why they would do this to us, a final at 8am after a 12-hour shift the day before, not to mention the 9-hour workshop we had today, but whatever. WHATEVER. I can handle it.
I still feel overwhelmed by self-doubt and anxiety a lot of the time, when I think about what’s coming up in the near future, but I try to remind myself that I have handled a lot of shit in the past year that I had doubts about, and I’ve overcome my fears, been pushed out of my comfort zone and only made a couple of mistakes. That’s not bad.
I’ve completed a head-to-toe assessment, written it up, passed a skills test, interacted successfully (therapeutically?) with most of my patients (and very awkwardly with others), started a foley catheter, tested blood glucose, given insulin injections, pulled out a nasogastric tube, hung a blood transfusion, started IVs, given an IM injection and drawn blood. I have discontinued IVs & catheters, given tube feedings, flushed PICC lines and pushed IV medications. I have presented papers, projects, case studies … I have watched two c-sections & insertion of a pacemaker, given bed baths and written countless pages of care plans. I have rocked babies, walked the halls with post-op patients and gone in search of toys for bored little ones.
I have accomplished a lot, and I try to keep this in mind, because I’ve decided I’m going to do my best to just fake it. I’m going to ask a lot of questions, but I’m going to fake the confidence that I don’t feel until I do feel it … fake it ’til I make it. I feel like I still know nothing, but that’s not true, it’s just that I still know very little compared to all there is to know.
A year from now, if all goes well, I’ll be catching babies. For now I’m going to go review that whole insertion-of-a-catheter thing, because I haven’t done it in a while and I don’t want to give anyone a UTI.
May 30, 2008
I thought I should write now, about the fun I had last night, so something positive goes on record in this meager blog. First I engaged in some retail therapy, which I have been doing far more than I should lately, but it was still great. P and I got glammed up and went dancing at this place which, conveniently, is right across the street from my apartment.
70’s funk music is awesome. So is whiskey and club soda. We danced for hours like the hot dancing nursing students we are, it was great. We got home a little after 2 and crazily enough I am already up and out of bed, feeling slightly bleccch in the stomach but not bad.
Today is a library day. I have to finish my paper on “self-efficacy and pain perception during labor and delivery.” Actually an interesting topic, a very interesting topic, but I have no desire to write this paper. Surprise surprise.
Mmm, tea. I love tea.
May 29, 2008
Tomorrow is supposed to get up to 90. Hello, summer. Spring was nice but I knew it would be short here.
I have paid back some of my sleep debt, after a four-day weekend and a short week, finishing clinicals for the semester and writing a good chunk of the fun paper due on Tuesday. I’m feeling annoyed at pretty much everyone and everything in my life right now, but I’m going to go ahead and chalk that up to hormones for the moment. At least for today. I don’t actually think everyone and everything that I come into contact with are inherently irritating. A fair amount of it is probably me.
Today I became trained in the art of phlebotomy. Actually, it’s really easy. Drawing blood is so much simpler than starting an IV, it gave us all a little boost of confidence so we could go for the needle with the catheter right after. We aren’t supposed to be starting IVs on each other at this point because the school hasn’t officially trained us to do it yet, but this is something that seems totally idiotic to me. They should be encouraging this type of thing: one instructor, six students, careful supervision and experience gained. It’s totally stupid to think we can learn something like IVs in a one-day four-hour seminar. It doesn’t happen like that, OBVIOUSLY. It doesn’t happen in a classroom.
Anyway, it was fun, and it was our second time doing it so that’s good. If we have an instructor in July who drags us into a patient’s room to start one, we won’t be quite as scared.
Speaking of which, I don’t know what I’ll do if I have “boot camp” at the hospital where we had our OB clinical experience. Our instructor was fabulous, but OMG. That place is so depressing. It just really creeps me out the way the patients have practically zero control over their own experiences. They put everyone -everyone – on pitocin to “augment” labor, and I would bet my bottom dollar most of those women do not know the risks involved with that drug. It’s not informed consent if the woman doesn’t speak English, Miss “I’m a third year med student and I know everything.” And it’s certainly not informed consent if you say, “No there are not any other options if you want the baby to be okay and you want the baby to be okay DON’T YOU,” Dr. 80% C-section rate. YUCK.
Also they don’t let students do ANYTHING. I probably shouldn’t get started on how totally stupid it is to not let students ever do anything (simple shit, not like actually delivering babies. Not that they do that there very often except in the OR). We don’t have any experience, you say? Well, help us out then by not letting us do anything. That way, when we’re actually nurses, we still won’t know how to do anything. It’s clearly the best system.
Wow, I really am full of whine. Let’s see. Um. Good things, good things, happy things …
I’m coming up blank. I think I only write in this thing when I need to vent. And the fact is that I need to vent a lot. Oh well. The next time something thrilling and wonderful happens, I should write about it.
May 14, 2008
Week 3? It’s only week 3. Third semester, third week, oh. god.
Every time I leave my apartment I have this horrible feeling that I’m forgetting something crucial for my day. (And the number of times I’ve had to go back –for my stethoscope, a book, my lunch, etc –is very high.) But it’s SUCH A BAD feeling.
I wake up in a panic every morning, totally disoriented by my alarm clock. What time is it? What day is it? What do I have to do today? Where am I supposed to be? Am I late? Am I ready? Why is it still so dark, why do I have to get up?
Stressed, yes, just a tad. And anxious. Mostly so tired. I’m really starting to develop my theory that the school of nursing wants us to suffer. Is this all a big test? Are they waiting to see who’s going to fess up and say, HOLD ON. This is too much for me.
That’s what we’re supposed to do when we’re nurses. We’re not supposed to accept assignments we’re not comfortable with, that we don’t think we can do competently.
One day at a time, that’s my motto. I lay down to take a nap today and started picturing the little baby I took care of today … did I stick that thermometer too far up her butt? I didn’t hurt her, did I? Maybe I should have told the primary nurse about her spitting up later on? But it wasn’t too much. Maybe I should have measured her head circumference. Then I briefly imagined getting a phone call that something I did, today, had killed the baby.
Unlikely, but crap. Do all nurses go home every day and thank the lord that they didn’t kill anyone this shift?
6 more weeks of the semester. Suck. I just want to sleep for a week.
April 20, 2008
It’s beautiful outside right now. I am inside, studying flashcards on musculoskeletal & gastrointestinal conditions. My apartment has so many windows that it’s really not all that bad to sit on the couch when the sun is shining and enjoy it, even if I do have to force details about, oh, gout – and congenital diaphragmatic hernias – and Crohn’s disease – into my head.
Last night I took a friend of mine across the street to the Chabad house. It just happens to be less than five minutes from my apartment, which is convenient. We had an awesome seder … really awesome. Not super long, amazing food, good stories & religious explanations. The family who hosted it run Chabad at the school. Their apartment is basically an open house for anyone who wants to spend time there, at any time. There were people at the seder last night who just happened to be traveling through town and wanted/needed a seder to attend. I’ve only met this family one time before, but they were so incredibly welcoming and happy that we were there. My non-Jewish friend was nervous at first, but after chugging the first two glasses of wine she calmed down and enjoyed it like I knew she would. I love Passover.
On a tragic note: the father of another friend, who lives back in CA still, recently had brain surgery to remove a tumor from behind his eye. He was given a prognosis of about 6-12 months to live – from now – if he does all the chemo and radiation and everything. I can’t believe it. It’s SO UNFAIR. He’s so young, he shouldn’t be dying, he should not be getting ready to say goodbye to his family forever. And she has already had so many struggles to overcome in her life. It’s completely wrong that she will lose her father so soon. It really pisses me off. And it puts into perspective everything I might bitch about, because seriously. What could be worse than what they are going through? Some things, I guess. But not much.
I wonder if I’m going to be sick. In between those two paragraphs I had to jump up and hang my head over the toilet because I was certain I was going to puke. Yay. What perfect timing! Being sick for finals is AWESOME.
April 9, 2008
I got G & S’s 2007 interviews & pictures, done by mom. There are a few highlights. I don’t have Grace’s on-hand right this second, and I’m situated on the couch, so I’ll just post a few of my favorites bits from Nini’s.
Q: What do you like to do right now?
A: I like to read with my sister, bike ride, have circus class, & not have Soren mess up our room all the time.
Q: What do you want to do when you grow up?
A: I don’t know but maybe I could be a doctor or an archeologist. I would like to be an archeologist becuase you get to dig up all this cool stuff. You might not find anything, but you would know you tried your best.
Q: Favorite movie or DVD?
A: Ratatouille, because it has cooking in it and I think it’s really cool that a rat learned how to cook.
Totally awesome kid … love her. 🙂
OK, now I have to go get Grace’s because there were some fantastic quotes from her too.
Q: Tell me something you liked about school this year.
A: […] I like doing dioramas. I made a diorama of “The Death of Dorothy Bradford.” She was William Bradford’s wife, and when they went to the New World, they left their son behind. She was never able ot see her son again. She died when she fell off the Mayflower and drowned.
Q: Mom & Dad don’t let you watch a lot of TV, but when you do, what are your favorite programs?
A: Project Runway. It’s addictive. I like Heidi Klum and Tim Gunn. Sometimes Tim Gunn says really discouraging things and then says, “Make it work!” I think that’s funny.