Saturday, September 29, 2007
Oh, I know, work sucks...kinda. It looks like we are going to lose two students from my class. One for major attendance issues - which is a shame because I can see her being a great nurse, when she shows up. The other - I can't imagine her being a good nurse so it may be just as well if she gets tossed out. She's on strict probation for numerous issues that I won't go into here because it's really rather boring. The boss seems to be in a crabby mood lately so no one can do right - or at least this is the way I am feeling. I am finishing grading the first assignment, which was a culture paper. It's depressing - some write well but then don't address all of the criteria so they lose points. Others write almost as well as my 12 -year-old but at least address all the criteria requested. Grrr. I can't win.
What's still good about work? We are getting closer and closer to OB!!!!! Meanwhile, clinicals are going well for OB and peds. I can't wait to show students the Gentle Birth Choices DVD I got recently. I'm reminding them frequently that birth is not always like what they see in the hospital (it's a county hospital which should tell you a lot about the experiences they are getting). That birth can be very different...and of course, I am always reminding them about being sensitive to the needs of the patients. They are a good group of students and are so excited to be there :)
Tuesday, September 18, 2007
The charge nurse says "Do you wanna do postpartum? It's the easiest".
I say "sure, whatever". Normally I hate postpartum but I'm tired and she tells me its the easiest...ok...whatever.
I have no ass left...I worked it all off running with a full load of couplets (mom/baby). Grrr.
If you'll recall myself and three others get the new office to share. One of those three is part-time and only there when I am not, which is why we were paired up. Works good for me. The third officemate is funny at times and boring at other times...she talks a lot but is an incredibly intelligent woman. The third...
She is the one who is completely computer illiterate...she is the culprit also for heavy breathing.
And it's not even regular heavy breathing...it's not sighing. If it was regular, maybe I could stand it. When I have my mp3 player, it's not an issue. An atomic bomb could go off and I wouldn't hear it when I'm playing the music. But I forgot my music today...grrr....
So, everybody's in the office, it's quiet. Then big heavy breath. Then silence. Then big heavy breath.
AAAAAAAAAGGGGGGHHHHHHHHHHH! *banging my head against the wall and suppressing the urge to tell her to stop breathing*
Sunday, September 16, 2007
When someone is having back pain or back labor try this...
Have them lie down flat with their knees bent. Push on their knees just below the kneecap. The midwife I worked with yesterday tried on me and on a patient. I thought it felt great (I have a lot of arthritis for a youngin' - autoimmune junk). The patient, who was having back labor, also said it helped during the contractions. Neat!
CORONAVIRUS - my definition
-a debilitating illness following a night of drinking coronas excessively
The real definition from Wikipedia
-Coronaviruses primarily infect the upper respiratory and gastrointestinal tract of mammals and birds. Four to five different currently known strains of coronaviruses infect humans. The most publicized human coronavirus, SARS-CoV which causes SARS, has a unique pathogenesis because it causes both upper and lower respiratory tract infections and can also cause gastroenteritis. Coronaviruses are believed to cause a significant percentage of all common colds in human adults. Coronaviruses cause colds in humans primarily in the winter and early spring seasons.
The three vessels that run between the baby and the placenta are very important to the baby's well-being. One of those vessels had likely torn thus causing the decel in the heart rate. The baby was fine fortunately - big boy weighing 8-13 and mom recovered well from the anesthesia.
So while they are off during this emergency c/s I care for a young woman who is stalled out at an anterior lip (which is like 9 and a half cm dilated). She has an eipdural. In this part of the country it seems that when women have epidurals, they get Foley catheters (a catheter left in place to continuously drain the bladder - when you have an epidural, you lose the sensation associated with a full bladder). I'm in the room introducing myself, talking to everyone, and checking all the lines she has. I notice there's no catheter so I ask the patient if the nurse had emptied her bladder since having the epidural. She says no. She had her epidural at 0700. It's now 1130 and she has had at least 2 liters of fluid since then (momma was running a temp probably related to prolonged ruptured membranes and all the fingers and IUPC that was hanging out of her vagina - well the fingers were hanging out but the vaginal exams is what I mean!). When momma runs a temp, the baby's heartrate will start go up. So bolusing her can sometimes alleviate this stress on the baby. Oxygen can help too but the nurse had not done that either. So I put in a catheter and get a whole lotta urine back, slap some oxygen on her and before you know it she's complete and numb! Her epidural was working all too well - apparently the CRNA likes to really make them numb - grrr.
The charge nurse comes up to me and says, I want you to take the new labor admission and give this patient back to the original nurse (who has the personality of a fish). I explain that I have already bonded with this patient and would like to keep her. She is concerned she will need a c/s because of the lack of progress. I gumble and think to myself "well if someone had bothered to assess her bladder and and cut the damn epidural down we might have already had a baby by now" but I am contract here so I just say "ok".
So my new patient is another primigravida (first pregnancy) who came in to triage at 5 cm - asking for an epidural. Just my luck - most of the patients I worked with as a student midwife did not want epidurals so I guess I got a little spoiled by that. So another nurse (who I do like) comes and helps me get her admitted and the epidural. She continued to labor and make good progress. She probably had her baby about an hour after I left because she was complete (10cm) at shift change. I thought for sure I was going to have a shift change baby - which kinda sucks for the nurse because then you have to stay and do paperwork. At least I do because I don't want to desert the oncoming nurse.
Teamwork is not something I see much of with these nurses. When I worked L&D in South Carolina, you always had back-up for delivery. Out here, it doesn't seem to work that way. At the big factory L&D I worked at when I first moved here and couldn't stand, you were always on your own. Same at these other places. It's weird how geographic location really does make a difference in some things.
Thursday, September 13, 2007
Credentialing paperwork = life history
My god, the amount of paperwork to fill out between regular stuff (I-9 etc) and the credentialing stuff was enough to kill a whole forest!
But it was exciting - one step closer to working as a midwife again. I so very much miss it. I start with nursing clinicals tomorrow on OB but it's just not anywhere near the same. I guess it's better than nothing. At least I can work on teaching nursing students that pregnancy and birth are not pathophysiological processes...hopefully the nurses won't come behind me and screw up their heads with junk! I'll post this weekend to let you know how it went.
Monday, September 10, 2007
First the options available (depends on where you live to some extent)...
1. Certified Nurse Midwives (Of course I put this first - I am one :) -
A certified nurse-midwife (CNM) is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of ACNM. Work in hospitals, birth centers, homebirth.
2. Certified Midwives - A certified midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of ACNM. Work in hospitals, birth centers, and homebirth.
3. Direct entry Midwives - generic term that includes a wide range of practitioners who enter the profession of midwifery through routes other than nursing education. While in the past most were apprentice-trained, there has been a recent trend toward credentialing DEMs following more standardized
educational preparation. Work in birth centers or homebirth.
4. OB/GYN - a physician who has received additional training in the specialty of obstetrics and gynecology. Work in hospital and rarely OOH.
5. Family Practice doctor - a physician who provides care to the entire family including birth - some provide this service and others do not. Some have received additional training, such as a fellowship. Work in hospital and rarely OOH.
6. Certified Professional Midwives - has received formal education, with no nursing background, work primarily OOH (out of hospital).
Ok, the options to consider when choosing a provider...(some may add to this list!)
1. The most important thing - whether they have caught (midwives catch, pizza is delivered) 100 or a 1000 babies, they should be as excited about your birth as you are! It is an honor, not a job, to catch someone's baby and be a prt of this special moment in their life. It should not be treated with a cavalier attitude. If they aren't excited - trust your instincts and find someone else. Which brings me to another very important point...
2. Trust your instincts!!!! If they don't feel right for you - find someone else!
3. Think about what kind of birth you wish to have. Remember, hospital does not equal the safest birth. Some may not have all options available to them depending on where you live.
1. Recovery - almost immediate
2. Breastfeeding - immediate
3. Food - almost immediate
4. Respiratory distress in the baby - much less likely as the baby gets a good squeeze coming out of the vagina, which helps to push out secretions
5. Vaginal birth - safer, mom and baby less likely to die or have complications (such as wound infection, acute renal failure, etc)
6. Bonding - immediate
7. Depression - less likely
Thursday, September 6, 2007
My older daughter, who is 7, has a best friend who she rides the bus with, has the same classroom with. It's so cute because she was invited to go rollerskating with her friend on Sunday. So I had to call and speak to her mom then she had to of course speak with her friend. I watched her on the phone and saw our future...hell is a teenager. I already understand why some species eat their young - no teenagers that way.
Tuesday, September 4, 2007
Monday, September 3, 2007
Here's the link on this topic... Vaginal Rejuvenation
It sounds like ACOG (American College of OB-GYNs) might be on the right track for once. Why do women need to have their vaginas tucked, and nipped, and rejuvenated, especially after childbirth and aging? Why??? Is it to please a man? Why do women get boob jobs? Many will say "So I feel better about myself". Perhaps we need to spend that money that went to the vagina fixer-upper on some therapy?
I think that there are some vaild reasons for 'fixing' our bodies up - you know, after being scarred and disfigured and that kind of thing. But to say, my pussy is tired and worn out, or not as pretty as it used to be before I had babies...come on, give me a break.
My husband informed me that he likes mine just as much now as he did 15 years ago - nice to hear that but if it wasn't ok? There's the door, don't let it hit you on the ass. :)
Saturday, August 25, 2007
Apparently this is a practice where instead of cutting the cord once baby is birthed, the cord is left intact ...meaning the placenta will deliver still attached to the baby. The cord and placenta are left this way until the cord detaches from baby on its own. The placenta can be treated with salt and herbs to dry it and decrease smell (although If you have a cat they may be very interested). The concept behind this practice is that the baby has a slow transition to detachment from mother's body. A midwife I spoke to has researched this and found no evidence that it has been used in other cultures nor is their any 'scientific' evidence to back the validity of the claim that it also allows baby to get maximal blood volume (beyond what is achieved with just waiting til the cord stops pulsating). But some people just like the concept, which is ok. To each his own. I'm a firm believer in delayed cord clamping/cutting...but not quite this delayed. I'm clamping that sucker once the pulsation stops (unless momma wants otherwise).
Here are some links to check out if you are interested in Lotus birthing...
Dr Sarah Buckley She has written some other great articles which you can find on her website http://www.sarahjbuckley.com/ .
Tuesday, August 21, 2007
One of her readers posted a comment about the lack of requests and desire for a low intervention birth from the women she serves. I think this is interesting because I have seen it. Some women really do believe that hospitals are the safest place for having a baby. Hell, I don't even want to be in the hospital if I were sick. They are filthy, disgusting places. I shuddered at letting my kids come to visit my husband when he stayed overnight at one after his AICD was put in.
The problem is one of education...for society as well as for providers of care. I could sit here and go on and on about the awful things I have seen but there are plenty of negative stories out there. We need more women telling about their wonderful, beautiful experiences. People are always so quick to share the bad, but we need to get the good experiences out there too. We need to stop ruminating on how bad hospital birth is and figure out what are we going to do to change it.
*sigh* I've got to get off here but stay tuned for part II of Birth.
Clinicals with the students are over! Woohoo! I get a break from trekking all over the valley, listening to whining and bitching that I could just as easily hear at home.
The most commonly heard phrases from students...
"It's too much paperwork" Well, if it was easy everyone would be doing it.
"Why do we have so many clinical hours?" Uh, because we prefer to train you sufficiently to not kill a patient.
"Why do we have to pick a patient the day before? Real nurses don't do that" Hmmm, you aren't a real nurse and it's really questionable about whether you ever will be!
Me to students asking these questions "Is it possible that maybe your faculty know something about nursing education that you don't?"
FACULTY = nurses with MSNs, BSNs, MEds, PhDs, and a combined total of like 200 years experience in various fields.
Student = CNAs, LPNs, bartenders
Seriously though, I love working with the students for the most part - but you can definitely tell those adult learners from the 'others'.
So we have a great faculty - really smart people who all get along and have fun...except for the one I will call the Lone Dinghy. LD for short.
LD likes monkies...she went to Borneo recently for two weeks to play with the monkies. She brings cat food to work to feed the occasional stray. No children. Likes horses. Loves to sunbathe - even after having 2 cancerous growths removed. She looks a little like a prune. She wears outfits to work that I wouldn't wear outside my home, to even water the plants. We had a faculty meeting last week, from which she was absent (she doesn't attend any meetings, nor have lunch with any of the rest of the staff). The dress code for faculty was discussed as complaints had arisen that someone was wearing streetclothes to clinicals - and not even appropriate street clothes. See-through stuff...no bra (like LD today)...open toe shoes...etc. We are all looking at each other wearing scrubs, wondering what planet this person is from.
Now, this all wouldn't be so bad if LD was a good teacher. I did the evaluations last sequence...I felt incredibly sorry for her as the students tore her apart. Apparently she was cussing in class, telling graphic personal stories, etc. Her syllabus? Out the window apparently. Tests on knowledge required of seniors, not freshman.
Oh, and if she goes near a computer, it explodes apparently. She won't check her email, use the website, etc. She relies on everyone else to clue her in to what is going on.
Ok ok, the bitchfest is over. I love my job :) Not as much as I would love a midwifery job but close.
Sunday, August 19, 2007
I've decided that I am having withdrawal from school. I need to be stressed out and overworked and spread as thin (this is the only kind of thin I will ever be) as possible by the demands of a full-time job, full-time family, and full-time school. School will fill the empty void left in my life upon graduating from midwifery school. Let's face it - I've become addicted to knowledge. I have even contemplated med school! But I realize I would be doing that for the wrong reasons (mainly my desire to not be beholden to a medical establishment, and not being able to get a job so far). Forget med school - I just don't want to even get sucked into that system. And I want to give a little more time and attention to my family than med school would allow for.
Now, the PhD on the other hand...I have said for quite some time I would pursue this. I can do it at my own pace and there is no oral defense for the dissertation (woohoo). I chose Clayton College of Natural Health to do a PhD in Naturopathy. I plan to get started in the next couple months...just gotta get the finances situated so I can make the down payment for the tuition payment plan. Once I finish this I am done. No more school...
Well, maybe the FNP program at Frontier...
Saturday, August 18, 2007
On that note...what about this cat Oscar who curls up beside residents in a nursing home shortly before they die, essentially predicting their death? Maybe this cat is evil....mwwhhhhuuuaaaa!
Maybe we don't understand cats like we think do...
A Cat's Diary
Day 183 of my captivity.
My captors continued to taunt me with bizarre little dangling objects. They dine lavishly on fresh meat while I am forced to eat dry cereal. The only thing that keeps me going is the hope of escape and the mild satisfaction I get from clawing the furniture. Tomorrow I may eat another house plant.
Today my attempt to kill my captors by weaving around their feet while they were walking almost succeeded. Maybe I should try this at the top of the stairs. In an attempt to disgust and repulse these vile oppressors; I once again induced myself to vomit on their favorite chair. I must try this on their bed. Decapitated a mouse and brought them the headless body in an attempt to make them aware of what I am capable of and to try to strike fear into their hearts. They only cooed and condescended about what a good little kitty cat I was. This is not working according to plan.
There was some sort of gathering of their accomplices. I was placed in solitary confinement throughout the event. However, I could hear the noise and smell the food. More important, I overheard that my confinement was due to my powers of inducing something called "allergies." Must learn what this is and how to use it to my advantage. I am convinced the other captives are flunkies and maybe snitches.
The dog is routinely released and seems more than happy to return. He is obviously a half-wit. The bird, on the other hand, has got to be an informant. He speaks with them regularly and I am certain he reports my every move. Due to his current placement in the metal room, his safety is assured. But I can wait.
I had another job offer in NJ while I was out in PA making rounds - was interested but decided for the above mentioned reasons not to take it.
The next job that really disappointed me was for a Women's Health Nurse Practitioner. They are a holistic integrated practice and I really liked the OB and office manager. They were intrigued by the possibility of adding a midwife as the OB backs lay midwives. Unfortunately the hospital they were moving to (brand new state of the art blah blah blah) does not credential midwives. I assured them that I would be interested in a in-office position (something is better than nothing since I can feel the knowledge seeping out of my brain as we speak!). They said they were very much interested. Then I got an email that they decided to continue to look but if something changed at the hospital they would give me a call. Again, I was really upset.
So here I am being cautiously optimistic - which means I am assuming I won't get the job even though I really want it and it went really well. They will let me know next week. Even if it happens it could take up to 3 months to get credentialed :P
Monday, August 13, 2007
I teach nursing students at an associate degree level...meaning they have an associate degree and can take the NCLEX to become a Registered Nurse when they are done with the program. Now, please remember that I ultimately really like my job (even though I would much rather be working as a midwife!).
Adult learners = students who have obtained the maturity, either through age or through having been a student previously (such as getting a degree in biology, etc). to realize that learning is their responsibility.
Pseudo-college-students...= students who think faculty should spoon feed everything to them, that everything in the program should be changed to accomodate them, we are all so unfair, it's too hard, etc.
Nursing school = If it was easy, everyone would be doing it, do you really want the person responsible for making sure you don't die to go to an easy school?
Please don't get me wrong, I love teaching. But they can drive me insane some days. I wish I could make a deal with them...you be responsible, I'll make it interesting!
You can tell it's the end of the semester...I'm burned out and so are they.
Sunday, August 12, 2007
By the time this kid rolled around (again unexpectedly but wanted - we wanted three children but the girls both came when I was on birth control and to this day, still don't do things my way!), I was an RN and working on general education requirements for my bachelor's degree.
I had switched at about 16 weeks to a private ob/gyn (I was seeing the family practice group which involved seeing residents *ugh*). There were no midwives anywhere in the reasonably near area. I liked the idea of seeing one provider throughout my pregnancy and that provider being present for the birth. I wanted to establish a bond. I really wanted a female provider however, I found none in practice in anything but large groups. My provider was very nice - although he kinda laughed off my wanting to have natural childbirth. I prepared myself during the pregnancy by reading Penny Simkin's Pregnancy, Childbirth, and the Newborn: the Complete Guide, and the Birth Partner. Unfortunately, my husband is a birth idiot and had no idea what he was supposed to be doing or how he could help. So the hospital I would be having my baby at had doulas on call and it was at no cost to me. So I planned to have a doula.
I was feeling cranky, crampy, and tired so took some benadryl on a Tuesday evening to help me sleep. I had a five hour chemistry class (and test) the next day. I had been studying that evening and wasn't feeling good about the material!! So I went to bed about ten pm. I woke up at midnight, banging out hard contractions. I had had several bouts of 'false labor' (how I hate that term now) previously but felt like this had to be the real thing. My husband was calling his sister to come stay with the kids so we could go to the hospital. I decided to take a warm bath for pain relief while waiting (she lived almost 45 minutes away).
I couldn't stand it...being in the tub was incredibly uncomfortable. Which was a bummer cuz I really wanted to shave my legs. Now I haven't met a laboring mom yet who cared whether we noticed if her legs were hairy or not at the time a 7-8 pound baby is coming out of her cootchie. It usually seems to be the least of her concerns (and I certainly couldn't care less). But I wasn't at that point yet.
So I got out of the tub and got ready - my sister-in-law arrived and we headed out to the hospital. By the this time it's almost 2am and even though the streets were deserted, we hit every red light. We finally arrived at the hospital. I'm tolerating contraction pretty good as long as I'm upright and moving...we danced in the parking lot several times :)
Mistake #1 - I let the receptionist lady put me in a wheelchair to ride up to L&D. I could feel the intensity of my contractions so much more! So by the time we get to a room...
Mistake #2 - the nurse (who knows I want to go natural) gets me in the bed and checks my cervix (I know I looked pretty active), which was 5-6cm. She asks me if I still want to go natural or do I want an epidural now. I would have not ever have asked for an epidural but when she offered it I said yes. Oh wise readers, you are probably asking yourself what exactly she did wrong. You don't ask someone who is strapped in a bed experiencing intense contractions if they want you to make it go away. Well, no sh*t sherlock, the answer will be yes. Instead, she could have been supportive and helped me cope. And if she wasn't capable of doing that, then get the doula there ASAP.
Anyway, I got the epidural - which at least I can say was a great one. I had good leg control and absolutely no pain. My water broke and I was ten centimeters. I labored down so much that the baby almost fell out. I didn't tell the nurse I was pushing...*giggles*...I just kinda did the grunty thing because it felt so good. Wehn I felt like my body was starting to really push though I asked to come on in. She had me push once to see if she needed to call my doctor...
Ok, I'm a multip stating I really need to push....naturally she says "whoa, wait a minute, I have to get the doctor here". I'm telling her ok but you had better hurry.
The doctor arrives, the tech is setting up the table, and he asks me to go ahead and push. I do. He says "stop, wait until she's done setting up the table". What on that table do I need to have a baby??????
So I had a 7 pound 10 ounce baby :) The doctor had offered to let my husband catch the baby but he declined. I kinda wish he had though...I think it's so awesome to know that the first hands to touch this baby are mommy and daddy's.
Overall, it was a nice birth experience but I do regret that I didn't go natural. I know I could have. It was my last baby though, so no more opportunities. I don't want women to experience those regrets. I had a woman who wanted natural childbirth, second baby. She told me in the beginning not to get her an epidural even if she asked for one. She labored wonderfully and quickly, but towards the end did ask for something for pain. I checked her and found her to be 9 centimeters. I got her standing upright and she had the baby in 15-20 minutes. The position change was all she needed.
I don't know why there is such a general mistrust of a woman's body. Our bodies are so capable and strong, but this seems to scare others (read: mostly men). Well more on that later...(soapbox).
While I do agree that those difficulties (development of autoimmune disorders, surgeries, pain, etc) could certainly contribute to the increased incidence of suicide, I disagree that it could be the cause. I do believe these women had issues prior to the procedure - mental health issues to be exact. One has to ask what drives women to plastic surgery? Why do some women feel that in order to be happy, they need bigger breasts? Is it in part because our society places such a huge sexual emphasis on the breasts (breasts are for sex not feeding our babies)? Is it a self-esteem issue? I certainly think it is a combination - I just struggle with the notion that it could be 'normal' to want to surgically alter the parts of our bodies that we are unhappy with.
So what I am getting at is I believe that these women who committ suicide after implantation, were likely suffering from mental health issues prior to the procedure. We all know there are many unscrupulous plastic surgeons out there who will do whatever a woman wants for that dollar, even to her detriment.
Anyway, would love to hear what others think!
Thursday, August 9, 2007
He was a psychiatrist and incredibly intelligent. He was 25 years older than my mother so she knew it was quite likely that he would die before she did. But it was a bit of a shock because it happened fairly quickly. He was diagnosed with lung cancer, which had metasticized from his kidney, last July. He died less than a month later in hospice. I flew out here for a couple weeks when he was admitted into the hospice inpatient unit. We didn't quite realize that it would be over soon - but he deteriorated rapidly and I thank god that I was able to be here for her and him...see him once last time.
Sh*t....now I'm crying. What bothers me more than his dying...we WEREN'T THERE WHEN HE DIED. We had been doing the bedside vigil for a few days, but my mom and I were getting stressed so we decreased the amount of time we visited. It bothers me so much, I feel so guilty. I never asked if he died alone because I didn't want to know.
It's funny, we weren't very close. I hadn't actually seen him in a few years, just talked on the phone occasionally. When he and my mom met I was 15. We didn't get along very well (I was a tough teenager to deal with sometimes). We got a little closer when I got older (and more mature).
He had done amazing things in his life - he really led a full and exciting life. He backpacked through the uncharted areas of the Cascade Mountains, liked sailing, gourmet chef, was a pilot in the Royal Canadian Airforce. Amazing man. He was 86 when he died.
Monday, August 6, 2007
But wait! I have a job interview next Monday...they had a birth center but have closed it. The practice however, continues - deliveries at a local hospital now.
Oh gotta go meet my daughter's new teacher.....see ya!
Now back to the grind tomorrow :(
Friday, August 3, 2007
Seriously though, check out the post on this cuz it's going to throw another wrench in the HPV vaccination works. First you had the deaths related to HPV and undiagnosed cardiac problems and now this. But maybe the men have it because...well, I hate to be vulgar...they are putting their fingers in certain places - namely women's vaginas. Is this going to be like a carrier state maybe? Interesting stuff and well worth keeping an eye on.
My oldest daughter is only 7...so I still have some time to sit and watch how this unfolds. Initially I was excited about the possibility but then the cardiac + HPV deaths freaked me out a bit. With the strong history of heart problems in my husband's side of the family I am not real keen on it anymore. We shall see...
For more info on HPV and the vaccination go to the CDC website .
The students are burned out for the semester and so are the faculty. The seniors in particular are whiny. The freshman have been refreshing (no pun attended) - they are eager and excited to learn, which is fun. I will only be working with them next semester. I will miss teaching the seniors (some of them anyway) though. At least I will see them at the school pretty often. It seems that the seniors have gooten dumber as they go along. Their desire for independence sometimes gets them in trouble...
"Ms X, I went and performed open-heart surgery. It was so cool!"
"Uh, you did? And was someone there to hold your hand?"
"No, I didn't know I couldn't do this invasive procedure all on my lonesome."
*Bang my head against the wall a couple times*
"You must always have a RN or myself present for any invasive procedure as I mentioned at orientation and is also included in your student handbook"
*astounded expression appears on the student's face*
And so this is why I have brain damage by the end of the semester!
Did I find a job you ask? Why no, of course f*cking not. Although, I sent an email to the local ACNM chapter president asking for her help. She sent me an email back saying she had found me a job - this was Monday night. She gave me the contact info, so Tuesday morning I sent my resume and called and left a message. Haven't heard a word naturally. Do you think people are sensing my desperation? It's not like I beg over the phone or get down on my hands and knees begging. Well, not much anyway. So in the meantime I said to hell with it for right now...I signed up full-time with the school again to teach. I'm hoping that there will be a couple positions opening up at a local IHS facility at the end of the year. My old preceptor will become the director then and I think she plans to hire me. I would be totally cool with this.
I went to see a movie last night with my mom - 1408, which is based on a Stephen King short story. They usually butcher any movie made out of his stories but this was pretty good. The ending was a little screwed up - there obviously was some 'creative license' there to get a happier ending. Otherwise this was well-done. It would have been a difficult story to do because the whole movie is essentially about a man in a room...John Cusack really pulled this off. He had the whole to trip to the edge of insanity down really good - I mean, I do it all the time but I'm very practiced.
So Las Vegas here I come!!!!!!
Sunday, July 29, 2007
After we moved out here to Arizona, he was due for a cardiology check-up. They decided to order a echo and also a stress echo (he had never had one of these) since it had been a little more than a year since the last one.
Yep, you guessed it, bad news. His ejection fraction was now 10%, with an increase to 15% during exercise. The last echo was a mistake or something. So they tell us this lovely news and add that he needs an AICD (pacemaker/defibrillator)...like....in the next week or so preferably. You see, these people with really low heart function have a really high chance (50%) of sudden cardiac arrest. And statistically, when this happens, it only happens once...cuz you die. The debrillators apparently have really had good success with treating this and increasing survivability. Naturally, I spoke right up and said he'll take it. You can put it up his butt for all I care - as long as it works. He could pull a crash cart around behind him for all I care. Give that man a shocker! Fortunately he has never had an arrythmia (abnormal heart rate) problem.
So now we wait...it's amazing cuz you wouldn't even realize he's sick, other than he gets tired easily. He works full-time as a cook and goes to the gym. He's gonna give up his job and go to school for a culinary arts degree as soon as I can get a job and pay for it.
The hardest part for me - will he be around to see his youngest child graduate, give his duaghters away at their weddings some day, grandchildren. What a sucky thought. And I don't think about it much, just once in a while. You get to a point, where it's (his illness) just part of life. He's made it over five years since initial onset. That's pretty damn good and way better than most. I mean the five year survival rate is 50%. I thank god he's part of that good 50%. *knock on wood and kiss the voodoo doll and all that*
I think what B.S. I have caught some babies as a L&D nurse because the doc didn't get there in time. Sometimes we can't always tell Mother Nature what to do. Sometimes women go really really fast. The way things are going, there will be no one left to catch babies anymore. They will all be scared out of the field due to the malpractice issues. Then women can deliver at home...on their own...what's that called? Autonomous birth or something?
School was hard. By the end of it my husband and I were in marriage counseling. It wasn't just the school thing. There were other issues that contributed to a breakdown in our communication. Never fear, we are back on track :) But I think it's really hard for anyone to understand what it is to be a nurse, a midwife, a doctor unless they have been in that role. I don't think my husband and I had any idea what kind of commitment it was gonna be. I mean, you know it's going to be hard - it's graduate school! But you can't get it until you are there. I just recently cleaned out all the articles and paperwork that accumulated over the two year program. I sorted out the stuff I wanted to hang on to and the rest went in the recycle bin. I am having a major guilt complex over the forest of trees I killed! I ended up keeping enough journal articles that I could wallpaper this 3000 sq. ft house I live in.
BTW, all you midwifery students...the AMCB exam is easier than the comprehensive exam I had to take to graduate. I left from taking comps, feeling really really dumb.
Saturday, July 28, 2007
"Oh your girls are so beautiful!"
"What gorgeous babies you have"
"Are you babysitting these pretty little girls?"
Wait...what???? Yes I have been asked that. Or variations of that. Now mind you, we lived in South Carolina until last year. SC is 20 years behind the rest of the country. People still have outhouses. And they use them.
So anyway, my older daughter is beautiful and somewhat tomboyish. She likes sports, plays with the boys (and usually wins), but says she is never having a boyfriend. I'll enjoy that one while it lasts. My husband says he is putting bars up on the windows. He says the first time some young thug shows up on our doorstep, he's buying a gun. I like to remind him that he used to be a young thug. He says that's why he'll buy the gun.
I was induced with my older daughter at 38 weeks. Low AFI (Amniotic fluid index) of 3.47. I was a green apple so was admitted the night before for cytotec then the plan was for pitocin (the hurtin' medicine) the next morning. Well, it was never needed as the cytotec put me into labor. After cramping all night and only being 1cm dilated, my water broke and I immediately started contracting pretty bad. I remember they came in threes. My husband was useless naturally. He watched a baseball game. Looking back I should've thrown the IV pole at him. I haven't let him live that down yet. Three hours later I was 10cm. I did get an epidural at 5 cm...but it didn't work. When they cam back 20 minutes later to do it again, I felt the need to push while sitting up. I told the doc, who was still in the room. This is kinda what the conversation was like...
Me "I need to push" (mumbling this into the pillow I was leaning over)
Doc "You can't be, I just checked you and you were 5cm"
Me "Then I need to shit, can I go to the bathroom?"
Doc " no-no, let me check you after they finish"
And I was then 9cm. Here's a lesson...when the pregnant laboring woman says the baby is coming...it usually is! Of course there are times when I have had women tell me I gotta push, then you check them and they are 1cm. uh, NO YOU CAN'T PUSH.
So, after three and a half hours of pushing, three attempts with the vacuum to help, and forceps my older dughter arrived in the world. The third degree tear, not being able to pee for 24 hours, and the bleeding nipples I would have later all paled in comparison to her. She was sweet, and beautiful, and a doll. I can't figure out when she changed into the devil spawn whe is now. Just kidding. Sorta.
So enough for now...next post I'll tell you about my third birth and my tattoos :) Can we say almost total back coverage????
Friday, July 27, 2007
And episiotomies....let's get with the times please - I have tons of research that shows little or no benefit to this practice. Let's stop cutting on women!!!!!!
Not only do I miss this, but the longer I go without a midwife job the more fearful I become that I will start forgetting what I learned. Probably not too realistic in light of the fact that I am reading Spiritual Midwifery . I'm also part of nursing faculty at a local college and am teaching OB/GU among other things this upcoming semester. That serves for good review for me at least.
So anyway...all my babies were born vaginally...I know...what a shocker huh! It's surprising in this day and age!
My first baby - born when I was 20...and yes he was actually planned. Oh and even better, all my kids are by the same father. Don't see that much anymore! He was premature, born at 34 weeks. I did a lot of reading about pregnancy to educate myself but was of a low socioeconomic status at that time. I had three strikes against me and was treated as such...poor, no higher education (not even a HS diploma - got a GED), and unmarried to a black man. I was 'cared' for by residents (baby doctors - and I don't mean neonatologists). It was time in and out of the hospital being 'treated' for preterm labor. Yucky medicines such as terbutaline (makes you feel like you just jumped out of an airplane - kind of jittery and nervous) and mag sulfate (which makes you feel like the Mack truck rolled over you...then backed up...then once more over you for good measure in case you didn't notice the first time). Not a pleasant experience. When I was finally allowed to labor (I was 6 cm) they broke my water and made me get an epidural. What a sucky experience. And was he ok? No, he had chronic subdural hematomas that caused brain damage due to going undetected. He's 'ok' but not 'ok' in the sense of my two other kids. But he's a great kid nonetheless...starting that teenage smart mouth crap though.
My second child was the worst experience...and I'm still waiting on it to get better! She was warm and cozy in there and didn't want to come out.
Thursday, July 26, 2007
I hate to even bitch about this after looking at Billybob's blog , but what the hell.
So since I am a new midwife naturally I am job-hunting. I initially was planning to re-locate elsewhere since all the jobs where I live ask for experience only - and there ain't a lot of jobs at that in this area. So I get job offers in other states but then decide we are too broke to re-locate at this time, nor do we really want to. After all we haven't even been here a year yet! Now I can't find a damn job...I started applying for Nurse Practitioner jobs in OB/GYN offices in the hopes of creating some opportunity. No such luck - had an interview at one place which sounded really really really promising...then after stringing me along for two weeks, emailed me today and said thanks but no thanks...but good luck! I'm so bummed cause I thought this would be a really good fit for me. Had another interview which didn't sound real promising - they just want another mid-level provider to do gyn work. The third option I have been holding on to is another practice who is looking for a midwife. But I applied for it a month ago - they have assured me that I am at the top of their list...so what the hell are we waiting on????
So I have a job - I teach nursing students. Fun but not what I want to do forever and forever. Unless they let me start catching their babies during clinicals. Humm...
Anyway, I'm wondering, did I waste my time becoming a midwife? I know I love it and its what I really want to do but crud - just can't do a move now to be one. So perhaps my next step will be to go back to school part-time to complete the FNP program (for which there are jobs) while continuing to teach my little nurslings.
On the lighter side of things - I got my state license to practice as a midwife and am sending off the application (and more money) to the board of nursing (black hole) for prescriptive authority. So when I get my non-existent job I can the write prescriptions on my non-existent practice scrip pad. Fun.
Wednesday, July 25, 2007
So back to my story...I had just finished nursing school (an ADN program), with 2 kids in tow, and a defective husband. A defective husband you ask? Yeah, two and a half weeks prior to graduation he goes into the hospital with congestive heart failure and a really piss-poor ejection fraction (this is the measurement of how much blood the heart can eject into the circulation in one beat - measured in a percentage) of 15-20%. This is a man who has never had a health problem before...no hypertension, no heart disease, nothing. Oh but wait! His mom died two weeks after he was born from heart failure (she was 20!!!!!). Her father died in his early fifties from heart failure. Anyone seeing a link here? My father-in-law was kind enough to never have shared this info with us. Proves up that knowledge is power I guess. Anyway, 8 days later and 20 punds lighter he emerges from the hospital in time for my graduation. Woohoo! So I occasionally tell him that I want to trade in for the newer, upgraded model. He thinks this is funny. Do you see me laughing?
I managed to get myself pregnant again...yes, he could still have sex. I had my third baby while getting prepared to start a BSN program. No really, I had the baby in the wee hours of a Wednesday morning - missed a five hour chemistry class that day (they excused it though - funny how pushing a baby out your cootchie is excused) and returned to my biology class on Saturday for lecture and lab. That was soooooo fun....*said sarcastically*
Getting the bachelor's degree was pretty uneventful - although it was during this time I discovered Frontier. I really fell for the heritage of this school. It seemed that even though it was a distance program they really fostered a sense of community unlike some of the distance programs at the big colleges I had looked into. So I decided to go for it and was accepted. Meanwhile my stepfather was telling me I should just go to medical school if I was gonna go to school that long (he was a psychiatrist). He didn't get the difference between being a midwife and being a MD.
Tuesday, July 24, 2007
You're probably getting that I am a Gemini by now.
So anyway, I guess I shall start out with a little about me.
I just recently grew up...meaning I have finally achieved my dream of becoming a Certified Nurse Midwife. *break into the Snoopy dance*
I am an alumni of Frontier School of Midwifery and Family Nursing (FSMFN), which is located in the mountains of Kentucky. Frontier is a distance education program where classwork is online and the clinical component is done in your local community. I consider myself fortunate to be part of such a historical midwifery landmark. As time goes by I will share some of the trials and tribulations of surviving midwifery school!
I was living in South Carolina with my husband and children (ages 12, 7, 4) when I embarked on this crazy, and at times tearful, journey. School has had such a huge impact on my life...it has been detrimental to my physical and emotional health, placed huge strains on my family...ok, did someone bring the cheese to go with my whine? I started nursing school in 1999. I decided to quit screwing around and wasting my potential (like all those guidance counselors tell you). At this point I had one son, who is a great kid with special needs. When I started nursing school I had no idea about being a L&D nurse, let alone a midwife. I kinda suspected maybe I would like obstetrics but wasn't really sure.
When I finally got to my OB rotation in nursing school I was in love. The experience that stands out in my mind was a patient who was having her second baby naturally. She was about 4cms and breathing beautifully through her contractions. I didn't know what to do with her and the nurse I was assigned to apparently felt that ignoring the patient was the best option in providing care. The woman sat on the bed in a zen-like position, with her eyes closed, breathing. I remember thinking how amazing she looked. How graceful. My next thought was "is she f***kin nuts??!! Where's the epidural????".
Yeah, okay, I wasn't enlightened yet.
So the experience decided it for me...as a nursing student I didn't like the whole 'sick people' thing. I much rather preferred the 'happy' environment of OB. Everyone is always happy and nothing bad ever happens...cue the Sound of Music...uh, so it wasn't realistic. I learned that soon enough. So during nursing school I learned about doulas, midwives (of varying kinds), and started contemplating the possibilities. During this time I also had another baby (baby girl who is now 7 going on 17).
Well...I want to keep you in suspense for the next installment...stay right there until my next post...I know you will :)