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. :)