The area I'm focusing on at work right now is "catching babies." On our maternity floor, that means doing all resuscitation and care of the infant directly after birth.
I've been easing my way into it, slowly. First by observing my preceptors catching. Then by assisting by doing some of the care after the baby is stabilized, like giving vitamin K or erythromycin ointment, etc.
Recently, before a birth, my preceptor informed me that I would be doing the next catch on my own - with her in the room in case the infant needed resuscitation (as I am not NRP certified until next week).
I was both excited and terrified. It was a c-section. So, before surgery my preceptor asked me to prepare the warmer. I did this without any problem: This involves making sure it is turned on and set to the correct temperature, gathering the correct equipment (neonatal stethoscope, measuring tape, newborn medications, thermometer, security bracelets, blankets and towels, newborn scale, etc.) It also involves setting up oxygen and suctioning equipment, making sure they are on the right settings. Then we ensure there is a DeLee and a working laryngoscope in case of emergencies. Finally, we have to ensure all of the correct paperwork is there for apgar scoring, vital signs, etc.
After I set up the warmer successfully, my confidence was boosted, somewhat.
Then, surgery began. When it gets to the point in the surgery where the bladder blade is removed from the tray, we know that birth is close at hand. So, that's when I picked up the sterile blue drape from the operating tray and carefully draped it around myself. This is easier said than done. My preceptor helped me by pulling the corners back around my neck for me. I then prepared to catch the new baby in the drape, putting my arms out in front of me. creating a pocket-like area.
I was so nervous, trying to hold the sterile blue drape the correct way. How will I grasp the wet, squirming infant? I heard fluid being suctioned... I knew this meant the amniotic sac had been punctured and the baby would soon be appearing.
I held my breath and clenched every muscle in my body as I saw the head being delivered.... Then the shoulders. I stood there waiting...hoping...and praying for that first initial cry - Please let the baby I receive be pink and crying. How dreadful would it be to receive a pale or blue limp baby.
Then, with great relief, I heard the lusty cry announcing the entry of a new life into the world that early summer morning.
I greedily cradled the wet, squalling infant that the doctor handed to me into my body draped in sterile blue.
How perfect. I dry and stimulate the baby, rubbing the vernix from it's body. The baby was pink, crying and had adequate muscle tone... that meant I was now singularly responsible for the little bundle during this transition period after birth.
I've discovered that it is amazingly hard to distinguish what you are hearing through the stethoscope when your own heart is beating a mile a minute!
My job is going so wonderfully, I feel like it is all but a dream come true. Next week I will be certified in neonatal resuscitation. I dread the day I have to use that training. I know it will come, but just cannot even imagine how I will pull myself together and be able to use my training and knowledge to bring a baby through who has 'one foot in heaven.' I know it won't be through my power, but God's will. I will only pray that I can be used by God in that way at that special time.
Tuesday, July 29, 2008
Monday, July 28, 2008
Being the Change
I love the quote from Gandhi:
"You must be the change you wish to see in the world."
Because I've chosen to take the "Change the system from within" route of gentle birth advocacy, the change will be slow in coming. I am aware of that.
When midwifery services are few and far between and when the existing ones that are available to the communities around us are facing challenges and some are closing, it is at times disheartening.
My part of birth change will be especially slow in coming. It took me four years to complete one step in my path in becoming an RN. Now gaining experience and respect from my co-workers is my focus before I can move on to other levels.
Because most of my time so far has focused mainly on learning the ropes of the new hospital and becoming proficient at clinical tasks, I haven't made many strides forward in promoting gentle birth and peaceful postpartums. However, for the first time - just this past week, I felt like I was able to be of some help to a woman in a real way.
The secretary couldn't find the nurse assigned to this particular mom and just announced to those of us who happened to be in the nursing station that mom in Room # such - n - such was asking for a nurse to bring a bottle into her. Since I was up to date on my charting and my patient's needs were already met, I said I could do that.
Not knowing anything about this patient, I walked into her room and asked her what type of formula her baby needed. That's when she broke down. She continued to cry and tell me how she couldn't get her baby to latch on and that the doctor just came in and told her her baby's bilirubin levels were too high, necessitating bili-blanket therapy.
(If you aren't familiar with hyperbilirubinemia, it is basically jaundice because of excess broken down RBC's in the infant's system. It is usually benign and clears up as the baby takes in adequate protein - from milk - which binds to the unconjugated bilirubin and aids in its excretion from the body).
At the core of the jaundice problem is milk intake. This combined with the first time mom's inability to get her newborn to latch was all this poor woman needed to push her over the edge. She needed kind, support from an experienced mother - in this case a mother who also happened to be a nurse.
So, we worked on the problem together. And, after many tricks and tries, we got a successful nursing session out of the couplet! I made it a point to tell her several good things I observed that would contribute to their successful nursing relationship. Like her having good "nursing nipples" and the baby being big and able to suck strongly.
She left later that afternoon with her nursing relationship growing with a good foundation.
I was blessed to have been around when she called out to the nursing station that day. What a rewarding experience among the challenges of orientation....a time when I feel all I'm doing is learning - it was nice to be able to do some teaching and helping, too.
"You must be the change you wish to see in the world."
Because I've chosen to take the "Change the system from within" route of gentle birth advocacy, the change will be slow in coming. I am aware of that.
When midwifery services are few and far between and when the existing ones that are available to the communities around us are facing challenges and some are closing, it is at times disheartening.
My part of birth change will be especially slow in coming. It took me four years to complete one step in my path in becoming an RN. Now gaining experience and respect from my co-workers is my focus before I can move on to other levels.
Because most of my time so far has focused mainly on learning the ropes of the new hospital and becoming proficient at clinical tasks, I haven't made many strides forward in promoting gentle birth and peaceful postpartums. However, for the first time - just this past week, I felt like I was able to be of some help to a woman in a real way.
The secretary couldn't find the nurse assigned to this particular mom and just announced to those of us who happened to be in the nursing station that mom in Room # such - n - such was asking for a nurse to bring a bottle into her. Since I was up to date on my charting and my patient's needs were already met, I said I could do that.
Not knowing anything about this patient, I walked into her room and asked her what type of formula her baby needed. That's when she broke down. She continued to cry and tell me how she couldn't get her baby to latch on and that the doctor just came in and told her her baby's bilirubin levels were too high, necessitating bili-blanket therapy.
(If you aren't familiar with hyperbilirubinemia, it is basically jaundice because of excess broken down RBC's in the infant's system. It is usually benign and clears up as the baby takes in adequate protein - from milk - which binds to the unconjugated bilirubin and aids in its excretion from the body).
At the core of the jaundice problem is milk intake. This combined with the first time mom's inability to get her newborn to latch was all this poor woman needed to push her over the edge. She needed kind, support from an experienced mother - in this case a mother who also happened to be a nurse.
So, we worked on the problem together. And, after many tricks and tries, we got a successful nursing session out of the couplet! I made it a point to tell her several good things I observed that would contribute to their successful nursing relationship. Like her having good "nursing nipples" and the baby being big and able to suck strongly.
She left later that afternoon with her nursing relationship growing with a good foundation.
I was blessed to have been around when she called out to the nursing station that day. What a rewarding experience among the challenges of orientation....a time when I feel all I'm doing is learning - it was nice to be able to do some teaching and helping, too.
Sunday, July 27, 2008
Continued....
Here is a good article about the PA midwife recently proseceuted who is now returning to her Amish home birth practice. I've written about this case before on this blog.
Friday, July 25, 2008
The Wizard
Today is the big day! 2 of our children are in the community theater's production of The Wizard of Oz!Lance - Here as part of the "Lollipop Guild."
And, Madeline as an "Ozian Beautician."They are both soooo Cute in it!!! Well, Mads is beautiful.. Lance is still cute!!
Work has been busy. I "caught" three babies today!! And, by the third, I was doing everything independently with my preceptor there for support. I'm making some strides in learning and am still LOVING it!!
Thursday, July 17, 2008
Ups and Downs
It is hard to believe I've been work as an OB nurse for over a month!! Amazing. It feels like I just started last week. The time is flying by. I meet with my supervisor weekly along with my preceptor to evaluate my progress. Today's meeting was just great. The supervisor is always willing to help and genuinely asks what I think I need in order to enrich my learning experience. We all decided today that I had a good grip on postpartum patients and we are adding "Baby Catching" to the equation now. So, today, I began my focus on learning what nursing measures are necessary immediately after birth when the physician hands the baby to the nurse.
I have my neonatal resuscitation class scheduled for two weeks from now. Up until that time I will be slowly taking over the role from my preceptor, then after I have my certification, I will be handling it all, including resuscitating "bad babies." I'm both scared to death and thrilled. I've been working my way through the required neonatal resuscitation book and I find it fascinating. Today at our "catch," the baby was fine: pink and crying right away, so I was able to handle a lot of the care because the baby didn't need resuscitation. I was able to help baby onto the breast within that first golden hour, even though the birth was by cesarean.
I still absolutely LOVE my job. But, it's not all rosy. Surely, the part of my job that I dislike the most are the circumcisions. I dread it when the doctor tells us he/she is ready to do the circ. Now, it is I who must take the baby from the mother and strap it down and hand the doctor the tools they need to do the job.
One of the doctors does a penile nerve block so the child doesn't feel any pain, and another compassionately talks directly to the infant during the whole procedure - telling him gently, "Now there is a hurty part coming up." Or "This is the last hurty part, then it is all over." Etc.
In any case, it is just a terrible part of my job.
I guess with anything, I just have to take the good with the bad, I suppose.
I have my neonatal resuscitation class scheduled for two weeks from now. Up until that time I will be slowly taking over the role from my preceptor, then after I have my certification, I will be handling it all, including resuscitating "bad babies." I'm both scared to death and thrilled. I've been working my way through the required neonatal resuscitation book and I find it fascinating. Today at our "catch," the baby was fine: pink and crying right away, so I was able to handle a lot of the care because the baby didn't need resuscitation. I was able to help baby onto the breast within that first golden hour, even though the birth was by cesarean.
I still absolutely LOVE my job. But, it's not all rosy. Surely, the part of my job that I dislike the most are the circumcisions. I dread it when the doctor tells us he/she is ready to do the circ. Now, it is I who must take the baby from the mother and strap it down and hand the doctor the tools they need to do the job.
One of the doctors does a penile nerve block so the child doesn't feel any pain, and another compassionately talks directly to the infant during the whole procedure - telling him gently, "Now there is a hurty part coming up." Or "This is the last hurty part, then it is all over." Etc.
In any case, it is just a terrible part of my job.
I guess with anything, I just have to take the good with the bad, I suppose.
Monday, July 14, 2008
All in a Summer's Day
Look who has his first pair of glasses!
He looks cute in them, I think. And, thankfully, he is amused by them and thinks they are "cool." And, best of all, he can see things clearly now!
I have 2 days off a week...and they are easily filled with errands. Today Madeline had her eye doctor visit, we picked up Lance's new glasses, and Isaac had a dentist appointment - That was just before noon. After Lunch we went to the pool... and the boys jumped off of the diving board into the deep end for the first time!!! They were so proud of themselves.
Lance jumped off, swam like a mad man over to the ladder then immediately looked over to me with the biggest "aren't you proud of me?!" look ever. It instantly reminded me of the time when Madeline, just about 8 months old pulled herself up from the floor to a standing position and looked up at me with her eyes full of excitement for her accomplishment. I just wanted her to sit back down and be a baby a little longer... Not standing up, becoming a toddler!! But, I couldn't look at her big, wide eyes and NOT share in her excitement... So, like I did 12 years ago with Madeline, I shared in Lance's excitement today as he took one more step towards independence.
The evening was filled with endless carpooling to and from one practice to another followed by grocery shopping. And, that's how quickly a day off can go.
Monday, July 7, 2008
You'll Find Me With The Bellies
Funny thing happened today. I called home to talk to the kids. My daughter then wanted to call me back to tell me something. Instead of calling the unit number I gave her, she called the number that came up on caller ID for the hospital when I called her earlier.
Conversation went something like this:
Hospital Receptionist: Hello.
Madeline: May I speak to [insert my name here].
Receptionist: Ummm, does she work here?
Madeline: Yes. She's an RN who works with pregnant people.
She was successfully transfered to the maternity floor.
:)
So, if you're looking for me, just go where the "pregnant people" are and chances are, you will find me!
:)
Conversation went something like this:
Hospital Receptionist: Hello.
Madeline: May I speak to [insert my name here].
Receptionist: Ummm, does she work here?
Madeline: Yes. She's an RN who works with pregnant people.
She was successfully transfered to the maternity floor.
:)
So, if you're looking for me, just go where the "pregnant people" are and chances are, you will find me!
:)
Sunday, July 6, 2008
Recovery Done Right
I've accompanied several mothers through cesareans as their doula and one of the biggest practical challenges at the time of birth was the recovery period.
Their always seemed to be a struggle between what the parents wanted and what the hospital claimed they needed for "the safety" of the recovering mother and newborn. For example, the hospital I did most of my work in previously required the newborn to be in the nursery - away from the mother - for 2 hours, at least post cesarean. And, then even after the 2 hours it was a fight for the parents to have the baby with them, and the first golden hour of bonding and breastfeeding was obliterated.
This always frustrated me as a doula and the most I could do was to encourage the parents to continue to voice their wishes and needs and to speak up for themselves. Furthermore, I encouraged them to write letters of complaints to the hospitals afterwards complaining about the unnecessary separation of mother and baby during the postpartum period. Sadly few of them ever did.
Well, I am extremely happy to tell you that the routine separation of mother and baby - even post cesarean - is not a practice at the hospital I work at now.
I've been to several cesareans already, and just the opposite is true. The mother and baby spend the recovery period in their room together. A nurse is committed to the room for one full hour, monitoring both mother and baby AND promoting bonding and breastfeeding.
In fact, at one cesarean the mother was transferred from the operating table to her bed in the OR, then her baby was tucked in bed beside her and they both were wheeled out of the OR and down the hall to their room while snuggling close together.
None of the crucial post-op monitoring of either mother or baby had been compromised at all.
I just wish more women would realize that even though it is "routine" or "policy" does not mean that it is evidenced based. And, that they have the right to request and demand change based on current research and not accept the "routine" as necessary.
But, all too often we shrink in the face of big hospital policy and sacrifice precious moments in the process. If we allow them to continue things as they always did, just because, then they certainly will. If only consumers of healthcare could realize the collective power they hold. Voice your concern and disappointment. Stand up for yourself and your family. Do not compromise in the name of "safety." Educate yourself and realize there is a better way.
Their always seemed to be a struggle between what the parents wanted and what the hospital claimed they needed for "the safety" of the recovering mother and newborn. For example, the hospital I did most of my work in previously required the newborn to be in the nursery - away from the mother - for 2 hours, at least post cesarean. And, then even after the 2 hours it was a fight for the parents to have the baby with them, and the first golden hour of bonding and breastfeeding was obliterated.
This always frustrated me as a doula and the most I could do was to encourage the parents to continue to voice their wishes and needs and to speak up for themselves. Furthermore, I encouraged them to write letters of complaints to the hospitals afterwards complaining about the unnecessary separation of mother and baby during the postpartum period. Sadly few of them ever did.
Well, I am extremely happy to tell you that the routine separation of mother and baby - even post cesarean - is not a practice at the hospital I work at now.
I've been to several cesareans already, and just the opposite is true. The mother and baby spend the recovery period in their room together. A nurse is committed to the room for one full hour, monitoring both mother and baby AND promoting bonding and breastfeeding.
In fact, at one cesarean the mother was transferred from the operating table to her bed in the OR, then her baby was tucked in bed beside her and they both were wheeled out of the OR and down the hall to their room while snuggling close together.
None of the crucial post-op monitoring of either mother or baby had been compromised at all.
I just wish more women would realize that even though it is "routine" or "policy" does not mean that it is evidenced based. And, that they have the right to request and demand change based on current research and not accept the "routine" as necessary.
But, all too often we shrink in the face of big hospital policy and sacrifice precious moments in the process. If we allow them to continue things as they always did, just because, then they certainly will. If only consumers of healthcare could realize the collective power they hold. Voice your concern and disappointment. Stand up for yourself and your family. Do not compromise in the name of "safety." Educate yourself and realize there is a better way.
Thoughts on Authenticity
Definitions that I'm meditating on recently:
Simple - Without embellishment. Not artificial. Plain.
&
Authentic - Genuine. Full of truth.
To me, these two qualities go together. They are qualities that I work to incorporate into my daily life. It takes conscience effort, though, to be honest. Most of the times it is easier to be what others think I am or want me to be. But, to be authentic and true to myself, it takes courage and effort.
Is it because I fear what others would think of the true me? Is it seeded in the fact that I was never taught to stand up for myself or to value myself while growing up? What makes it so difficult to be authentic - without apologies? Why do I hold back?
Simply Authentic
or
Simple Authenticity
Easier said than done... But worth the effort. I'm always pleased when I catch myself living authentically. And even more so when I catch my children doing so. I hope to instill in them the truth that who they are is precious and worthy to be honored and respected.
Simple - Without embellishment. Not artificial. Plain.
&
Authentic - Genuine. Full of truth.
To me, these two qualities go together. They are qualities that I work to incorporate into my daily life. It takes conscience effort, though, to be honest. Most of the times it is easier to be what others think I am or want me to be. But, to be authentic and true to myself, it takes courage and effort.
Is it because I fear what others would think of the true me? Is it seeded in the fact that I was never taught to stand up for myself or to value myself while growing up? What makes it so difficult to be authentic - without apologies? Why do I hold back?
Simply Authentic
or
Simple Authenticity
Easier said than done... But worth the effort. I'm always pleased when I catch myself living authentically. And even more so when I catch my children doing so. I hope to instill in them the truth that who they are is precious and worthy to be honored and respected.
Thursday, July 3, 2008
Resource Suggestions
I would like to augment the medical information being infused into me with some concurrent natural, empowering information as well in order to be well balanced in the care I am providing to the women I work with.
So, while I am focusing on the postpartum mother and baby I would love some suggested books from you. What is your favorite or a must read postpartum book, website, etc.?
Admittedly, I've never focused a lot on the postpartum period. I am a certified birth doula; I never went very deep into postpartum besides the one PP visit and breastfeeding help. I worked as a postpartum doula only for one client and was never certified as such.
I think the postpartum period is a very fragile time that should be respected and protected. The mother is especially impressionable and should be surrounded with encouragement and support. This is why I want my nursing practice to encompass more than the standard shift assessment, vitals and discharge teaching. I want to give the mothers the compassionate, well-rounded care they deserve.
Suggestions would be appreciated!
So, while I am focusing on the postpartum mother and baby I would love some suggested books from you. What is your favorite or a must read postpartum book, website, etc.?
Admittedly, I've never focused a lot on the postpartum period. I am a certified birth doula; I never went very deep into postpartum besides the one PP visit and breastfeeding help. I worked as a postpartum doula only for one client and was never certified as such.
I think the postpartum period is a very fragile time that should be respected and protected. The mother is especially impressionable and should be surrounded with encouragement and support. This is why I want my nursing practice to encompass more than the standard shift assessment, vitals and discharge teaching. I want to give the mothers the compassionate, well-rounded care they deserve.
Suggestions would be appreciated!
Wednesday, July 2, 2008
Anatomy of Orientation
The OB Orientation is very well organized. They've broken down OB nursing into five basic areas to learn:
Then, when I know that area - hands down - I move on to the next area.
I'm focusing on the postpartum couplet right now. Today I took care of two couplets. I am feeling more and more competent in this area. It is do-able and not overwhelming when it is broken down for me in this way.
When there are interesting cases, my preceptor always makes sure we are a part of them, just for exposure's sake.... And, if there aren't enough PP mom/babies, then I'll get assigned the random C-section, etc. and then take on the mom/baby couple afterwards so I can learn about the "fresh" postpartum period more.
It is a very organized orientation program that was key in my decision to choose this hospital as my first place of employment. I have not been disappointed in my choice so far. Just impressed.
Still Lovin' In (I think it's called the "honeymoon" phase of new employment, but I hope it doesn't wear off)
- Postpartum couplet (mom & baby)
- Laboring woman
- Cesarean deliveries (Scrub & Circulating nurse)
- Out-patients (BPPs, AFIs, Non-Stress tests, etc.)
- High Risk OB (PIH, HELLP, GD, Preterm)
Then, when I know that area - hands down - I move on to the next area.
I'm focusing on the postpartum couplet right now. Today I took care of two couplets. I am feeling more and more competent in this area. It is do-able and not overwhelming when it is broken down for me in this way.
When there are interesting cases, my preceptor always makes sure we are a part of them, just for exposure's sake.... And, if there aren't enough PP mom/babies, then I'll get assigned the random C-section, etc. and then take on the mom/baby couple afterwards so I can learn about the "fresh" postpartum period more.
It is a very organized orientation program that was key in my decision to choose this hospital as my first place of employment. I have not been disappointed in my choice so far. Just impressed.
Still Lovin' In (I think it's called the "honeymoon" phase of new employment, but I hope it doesn't wear off)
Subscribe to:
Posts (Atom)