Saturday, December 14, 2013
My original quote read, "When you are considering and preparing for the birth of your baby, think about where your focus should be. Are you raising a labor story? Or are you raising a child?"
What got printed was, "When pregnant, focus on your baby, not your birthing plan. Are you raising a labor story, or are you raising a child? A safe delivery is all that matters."
I never said a woman shouldn't develop a birthing plan. I never even mentioned a birth plan! In fact if you have read my posts you will know that I expect a woman to be well prepared and ready for labor, and if she isn't it bothers me. And I always respect a patient's birth plan.
Please don't write me hate mail until you have read my posts and know what I believe. Also, I never attacked anyone personally, so those of you writing me hate mail, please stop attacking me!
I take every word in every email very personally whether I should or not. So, I have removed my email contact information. Truthfully, I need to stop writing for a while...to get the negativity out of my life.
Thank you so much to those of you who have been so kind and supportive.
Thursday, April 4, 2013
The day has come! It's that first day that you are totally on your own at your first nursing job! No more clinical instructors! No more preceptors! No more agendas laid out for you! It's all you! It's a monumental day!
There's nothing between you and your patients now. You are solely responsible for your patients' care. You will be the eyes of the physician when he is not there. You are the advocate, the educator, the mercy-giver. You are the one the patient depends on. They will depend on your knowledge, your skill, your experience. Your decisions can mean their life or death. Your charting can mean your own professional life or death in litigation. And you will have nothing to depend on except that of what your instructors, preceptors, and teachers taught you...your experience.
No more clinical instructors. No more preceptors. No more agendas laid out for you. Its all you. It's a monumental day.
It's a paradoxical day.
The following story is my own. This is what happened to me on my personal version of that great day. I had gotten a job on a Telemetry unit in California and just finished a 3-month orientation for new grads. I had never been on my own before without another checking after me. Without someone as a resource. This is what happened:
I had gotten my report on my patients and started to make my rounds seeing each one...and doing my "head-to-toe" assessment like a good little nurse. I remember it was frantically busy. The other nurses were scurrying about like ants on an anthill. Patients were coming in on gurneys, the tele desk was alight with alarms and curly paper was being spat out in all different directions. The call light was continually screaming it's alarm, and no one was talking to each other.
My last patient to see was a post heart cath patient who had been out of his procedure for about 5 hours. The protocol back then was to have them lie completely flat with an 8-pound sand bag on their groin over the insertion site for 8 hours...applying pressure to the site to prevent bleeding. I entered his room and greeted him, and found him looking rather gape-eyed. "I don't think this is supposed to happen," he said. And looking down toward his groin there was blood lining his sheets. He lifted up the sandbag and blood spurted out of his groin like a broken water pipe, making an arch across the room.
So...here was my opportunity to apply all that I had learned. To be the one who "knows what to do." To make the choice that would make the difference between a critical situation, and everything being OK. Here it is. It all came down to this.
"Oh!" I exclaimed, "Let me go get the nurse!!"
Umm...Yes, I did that. I ran down the hallway and got the charge nurse who ran back to the room and applied pressure with her hands...and looked up at me like I was the complete idiot that I was. As soon as she looked at me, I realized, oh yeah, I AM the nurse. And quite frankly, I DID know what to do. I knew to apply pressure...I just...forgot. Or more accurately, I didn't put all the book-knowlege, the clinical experiences, etc, to a practical use. I could have probably gotten that answer right on a test, but in the real situation?...
And I'll tell you one thing... not a single care plan, out of the hundreds that I wrote in nursing school, helped me in that situation. Not a one.
So...I'm glad to say that I've grown over the years. I now know what to do when a patient is bleeding. :)
I tell you that story to make a point. I know that many nursing students come out of school with a specific specialty goal in mind, many being Labor and Delivery, and expect to go into it straight out of school. Many of you have contacted me for advice on how you can get in to L&D right away. I am glad that you all love my area so much, but you need to work on a Medical, Surgical, or Telemetry floor first. (Ah. I've just made some enemies.)
I'm afraid that in nursing school, you mostly learn how to take your boards You need to take the time to learn how to be a nurse. Go and put in some time on a Med/Surg or Telemetry unit. I would recommend at least two years to start. (Because it takes a year for you to figure things out, and another year before you truly can say that you're comfortable.) Once you've done this you'll have gained two very critical things. One being a good solid basic medical knowledge. (No, you haven't gained that in nursing school...not the kind I'm talking about.) The other being development of time management skills. Without these being mastered, no matter what you do, you will struggle. And let me just say that trying to nurse without having time management skills is like being a bull in a china shop. You'll hurt more than you help, and you just don't belong there. If you can't be good at time management, you will fail, plain and simple. L&D will teach you time management somewhat, but on a intermittent basis. Only a med/surg unit will force you to gain a grasp on having to keep up with constant infringements on your time and focus.
When you specialize, that's just it, your knowledge is special...exclusive. In other words, you know a lot about a little. So before you do that, take the time to know a little about a lot. You will be oh so much more effective.
A pregnant woman in labor is a whole different animal than a non-pregnant adolescent or adult patient on the floors. They have completely different body system functions going on, all of which fall into the category of "normal." When something happens that causes this abnormal "normalness" to become even more altered, the caregivers really need to be on their game. I have seen it time and time again, that a new grad nurse... who has limited experience and knowledge in the basics of Med/Surg...struggles. And what's more, they don't even know they are struggling. They just don't get it...and they don't know what they don't get.
Now, I've known some new grads who have gotten hired straight in to L&D. And some of them have done just fine. It is possible to do. Most L&D units, however, will at least make you do a stretch of time on the postpartum unit before coming to L&D. It's not easy to find an L&D unit that will hire new grads, so if you do want to go this route, I would recommend getting a job there as a tech, CNA, unit secretary, or of the like first, perhaps during nursing school, to get your foot in the door. I can pretty much say that it won't happen otherwise. At least not at a hospital at which you should or want to work...in the long run.
So as Nike would say, "Just Do It!" Do the two years on the floor. Do it, and get really good at it. If you think that won't take two years, then I'm afraid you're overconfident. And one thing I can't stand is an overconfident, yet green nurse. That's a dangerous combination. Do it. Gain knowledge, get experience, become a resource. You'll hate it, but you won't regret it. And you will be better for it. Then, come to Labor and Delivery and you can focus on learning Labor and Delivery, and not trying to learn how to be a nurse as well.
And besides, you just can't call yourself a real nurse until you've had to digitally disimpact a 97-year-old woman with dementia, screaming like a banshee, saying, "AHHH!!! It's a wee cattle prod up me ars!!! GET IT OOUUUUT!!!!!" That's just good times.
Thursday, February 14, 2013
Monday, August 27, 2012
But when the "victim" is someone we love...we sort of lose some judgment.
A couple weeks ago, we got a frantic phone call directly to our unit at about 2am with a man yelling, "I need an ambulance! My wife is having a baby!" Our secretary of course told him, "Ummm, Sir, you need to call 911 for an ambulance." We all found it so peculiar that this man thought out how to call directly to the L&D unit, having had to find our phone number most likely. Why wouldn't he just call 911? Weird.
So, about 30 minutes later, we received an ambulance with a patient who had had her baby at the side of the road about 5 minutes away from the hospital. Her husband accompanied her and was obviously high as a kite on adrenaline and joy. He had caught the baby before the ambulance got there.
So, a few minutes later, after the doctor delivered the placenta and we got the patient and the baby settled, we heard this father on the phone saying, "Yeah Sarge, she had the baby...uh huh, I delivered it...so I won't be into the Station tomorrow I guess...Thanks Sarge." My friend and I were stunned and had to hold back baffled giggles.
"Oh, are you a policeman?" I asked, still holding back snickers and feeling astonished.
"Yep!" he said proudly.
"Sir," my friend gave him a sideways smile, batted her eyes, and asked teasingly, "Did you call here?"
"Um..." he looked at the ground and we could see his neck reddening, "Yeah," he said under his breath with a meek smile.
There was a brief silence as we went about our work, with our brows raised in amazement. I mean, he was a policeman...and he didn't think to call 911? I would think that a policeman would know how to get an ambulance.
"It's OK," my friend said. "It's a little different when it's your wife."
Shoot, we can't really blame the guy. At least he has great bragging rights when he tells the guys that he delivered his own baby, right. We won't tell.
Another example is when a friend of mine who is an ER nurse had to deliver Epinephrine emergently to his child with an EpiPen who was having a life-threatening allergic reaction to a bee sting. He administered it with the Pen upside-down and injected his own thumb. Oops.
Tuesday, May 29, 2012
You have read all the articles that have told you how to gain control over as much as you can in the hospital. You've read through the many samples of birth plans and have picked out your favorite points...you've even typed up one for yourself. Good! You've read all the research that supports the benefits of having an unmedicated childbirth including optimal breastfeeding sooner after delivery, smoother and quicker labor, emotional and physical benefits for you...just to name a few. Good!
But then, you've read about how to deal with contractions. How to request that we not inquire about pain, that we not offer you medication. You request us to refer to your contractions as "surges" or "rushes." Don't remind you in other words. Trick your brain.
Ladies, call it what it is.
Real. Bad. Pain.
You can do all the academic preparation in the world, but unless you make peace with this fact you will NEVER be able to have the natural birth experience that you want. There is a difference between being well-read about it and calling yourself prepared, and actually having a complete emotional and mental mindset that is deep enough to transform you during labor. And that starts with embracing the fact that you will be in horrible, deep, mind-numbing...pain.
Do NOT come to the labor and delivery unit unprepared for this. I've had people tell me, "People do it all the time, so it must not be that bad," or "You mean it gets worse than THIS?" (And they're only 5 centimeters.) It drives me crazy when women come in and act surprised when it hurts. It seems to be a huge secret in modern gibber-jabber on the Internet: Labor HURTS. Period. There's no covering that up. There is no "tricking" the mind. Don't be fooled.
I am not telling you this to terrify you. I'm telling you this to prepare you. You have to come to my unit knowing full well what is ahead of you and you have to be OK with it. Take that fact, mull it over in your head. Put it down somewhere deep inside you and really come to a place where you know the full reality of what you are facing...and only then make the decision if unmedicated labor is the correct path for you.
You say, "Well I have a really high pain tolerance." No you don't.
You've made a pact with your husband or partner and say, "No matter what I ask for, don't let me have the epidural." Neither you, nor the person you are making this pact with are in pain now or have most likely never experienced any real pain so you are not in a position to be able to make this pact intelligently.
You say, "It's safest for the baby." Come on. This argument isn't valid anymore. The baby can have problems whether you get drugs or not. We have the capability of protecting your baby either way. Childbirth is dangerous. You're not really doing much to affect safety by staying unmedicated.
So, you think you want to go for Natural Childbirth? Good for you! You go girl!... Just keep it real. Have the following points in mind:
It is a very good clue when you arrive to the unit crying and screaming...and you are only 1 or 2 cm dilated...maybe natural labor isn't the best choice for you.
Or, if you are screaming so loud that you are scaring the patients 6 doors down the hall, then maybe you should start thinking about what you are doing. Why would you want to do that to yourself? Really... Unless it's some kind of attention-getting thing...but do you really want people to think that of you? No matter what they show on TV, screaming is NOT OK with us. (Not when you've chosen this for yourself.) If you're screaming out of control, then maybe you are not the best candidate for natural labor.
And that's just it: the word "candidate." Some people are great candidates. Some just are not. Some are able to make peace with the pain, go into a "zone," and just do it. Some just can't. This is not for everyone. Do not assume that since it's what all the most convincing articles are about, that you can just do it. And, more importantly, don't be tempted to allow yourself to be influenced by all the voices around you telling you that if you have an epidural you are somehow less worthy, or even a failure. They are lies. They are NOT empowering women, they are actually limiting and oppressing women. We are living in modern times. Educate yourself about all your options and make an informed decision that is right for YOU. That's empowering.
And if you've made the decision to go ahead with natural labor, then I say with all sincerity, good for you. We will help you in every way we can. But if there is any point in this post that I want you to remember it is this: If you're labor begins to change from being the empowering experience you envisioned, to becoming TRAUMATIC, then stop. Maybe you need to consider something else. Ask your nurse or physician what options you have. Maybe you are meant to do it a different way.
Ask for that epidural with all your heart, and don't be the least bit ashamed.
Yes, there are some women who are very fortunate and can labor without feeling much pain at all. (My Mother-In-Law is one of them.) They are certainly an exception to the rule. If you are one of these lucky ladies then congratulations! You are blessed!
Tuesday, May 22, 2012
For instance, I’ve seen fathers (as I’ve mentioned in past posts) strip down to their underwear; or even sit naked with their wife in a bathtub full of amniotic fluid, feces, vernix, urine, and blood. Yuck. I’ve seen them smear vernix over their hands and chest so the baby would “recognize” them. More commonly, many step in and direct us to speak to them, and not their wife, since the man “directs” the labor (a concept taught by some Bradley Method classes, of which I’m not a fan for this very reason.)
A couple weeks ago, I had to laugh. There was a dad whose wife had to have a c-section. At my hospital, the baby will meet the mother in the recovery room so that we can begin “skin to skin” and breastfeeding as soon as possible. This dad, while waiting for his wife, took off his shirt and had the baby skin to skin on his chest…his hairy chest.
We see this occasionally and roll our eyes a bit. Understand, I’m a complete advocate of “skin to skin.” But I can’t help but be bothered by the sight of a strange man sitting there shirtless with his baby rooting against him. I get it; it’s done for bonding, warmth, soothing, etc. And it may happen after the baby goes home all the time. There’s nothing wrong with it, but somehow there’s something not right with it either.
First of all, honestly, unless you’re Channing Tatum, we don’t really want to see that. Second, it’s going a little overboard. There’s really nothing about a man’s bare chest that would interest a baby. They want to be held, and talked to, and cuddled. That all can be done with a shirt on. Third, it's out of place. You are not a patient, keep your clothes on. (And chest hairs are getting in the baby’s mouth…that bothers me.)
That said, we would never interfere if a father decides to strip and do skin to skin. If it’s what makes him feel useful and helps him to “bond,” then so be it. (We'll just giggle to ourselves about it.) At least he’s keeping the baby warm.
But this is not
What made me laugh was the anesthesiologist summed up all our thoughts when he entered the room and, horrified, exclaimed, “Are you trying to breastfeed him?!” Oh dear. We turned away and stifled our giggles. The poor doctor wasn’t exactly up on the trends of naturalism in childbirth and had to be filled in…affirming the practice in front of the dad to reverse his embarrassment.
To the other extreme, there are the dads that would probably just drop off their wife, if they could, and come back when it was all over. They would be a lump on the couch if we didn’t make them at least hold a leg. One of the worst behaviors by a father I’ve ever seen sadly came from a dad who was an orthopedic surgeon. He came in looking like a million bucks, sporting his hospital badge as if to say, "Be afraid, I have authority here." He ignored the nurses, and griped to himself, "My schedule is completely shot tomorrow." He was short tempered at his wife for her whimpers of pain ("Oh, you're fine!"), and actually asked the OB physician if she could “just do a c-section” to get it over with sooner. Apparently, he forgot that it’s not about him…it’s about her today. He eventually went to sleep on the couch while his wife labored on in pain. We left him there. Better without him.
Then, we have the obnoxious dads. The ones who, during a repair, say, “Hey Doc, can you throw an extra stitch in there for me?” and think they're funny. They point to their girlfriend's belly and say proudly, "See dat? I did dat." Really? How many "dats" did you "do?" I guess that means she's been frolicking in peaceful pastures for the last nine months. Idiot. I have no patience for these characters.
Another father came out of the labor room and asked, “At what point do you just do a c-section? I mean, how long are you going to let this go on?” His wife had been laboring for about 12 hours…long for him, not long for us. We explained she was making steady progress and that there was no reason why we would need to do a c-section at this point. He put his face in his hands and started to cry. I mean actually mourn! We looked at each other in puzzled amazement. According to their nurse, he and his wife had been saying strange things like this all day and kept talking about a c-section…not exactly requesting it, but acting disappointed with every report of progress.
Later, it became apparent why both he and his wife were so sad. She was crowning, and like we commonly do, we asked her if she wanted to see her baby (in a mirror.) She said sadly, “No. I want to remember my vagina the way it was.” To that, her husband welt up with tears again, looked at the ceiling, and touched her as if to comfort her. They were mourning her vagina! Is that really what you think about when you are about to give birth to your first child? Hmmm…..
Most dads, you'll be happy to know, are just precious. When they cry, I usually do too (apart from the guy above.) I always cry when someone else is crying…especially a man. It’s my weakness. So around my job, I cry a lot.
Thursday, July 28, 2011
I did everything I could. We fought hard for her life, but she died anyway.
And the parents blamed me...and sued me.
This post is hard for me to write because to this day I mourn for little "Emma." I mourn for her parents and how much they wanted her; and for the relentless, sickening, violent pain forced upon them. There is nothing like the cry of a mother who has lost her baby. Nothing in this world.
As nurses we endure endless hours of training and retraining to know what to do when a life is at stake. So many times we use that knowledge and save lives...and it all pays off. But to come to a time when everything we know is useless; to try and fight and fight and...lose. And a baby dies. And we couldn't save it. What an unsurpassable defeat. It's indescribable.
And then to learn that the mother blamed me for the death of her child. I was completely broken.
In respect for Emma and her parents, I'm not going to tell the nitty gritty details of this story. My fellow medical readers will understand when I say that it involved a velementous insertion, ruptured membranes, and blood. To those of you who don't understand: it was a rare, disastrous, often undetectable situation that went as bad as it could go, and there was not a lot that we could do.
On a side note, Emma's mother came in for an induction having had a very normal, healthy pregnancy; expecting a natural, uneventful labor; and this situation is an example of why I cringe when I hear of women claiming that home deliveries are perfectly safe. They are not. If something goes wrong in labor, often it goes very wrong, extremely quickly, and although we couldn't save Emma, most of the time we can save these babies and/or their mothers if we move quickly. If you're at home, and you have to take the time to travel to the hospital when something is wrong, most of the time it's too late. Just have your baby in a hospital and quit arguing about it.
Back to my story, the parents named me personally in their case, and accused me of atrocities...and I do mean atrocities. Not only did they think I was negligent, they accused me of killing their baby. I was dumbfounded when I read the complaint. It's amazing how a traumatic experience can skew a person's memory. They not only named me in court, but they went after my nursing license, my very means of livelihood.
I went through months of interviews with the Risk Management department of my hospital. They were extremely supportive of me, which a lot of hospitals wouldn't do. They protected me when the mother demanded a meeting with me. They provided a lawyer for me who, I must say, was the smartest lady I've ever met. I had to write pages and pages of response to the parents' "Discovery" documents to answer everything from why I asked her about pain management at admission and "terrified her," to describing my hospital's policies and my understanding of them, to why I thought I had sufficient training to do my job.
Then, once that was over, I had to appear at a deposition. 8 hours of questioning by a large panel of lawyers with a video camera 1 1/2 feet away from my face. 8 hours. They questioned me on everything from each nook and cranny of the tracing, to discussing the personality of the patient. 8 hours. It was the longest, most demeaning day of my life.
But none of this was as hard as knowing that Emma died in my care...and that her mother blamed me.
The case was dropped because neither I, nor the doctor, did anything wrong. The Board of Nursing dropped the complaint against me, finding that I upheld all that my license holds me responsible for...including trying every reasonable attempt to develop a therapeutic relationship with this patient. Even though everything was dropped, and my nursing "name" was cleared of all charges so to speak, it still doesn't heal the pain and feeling of failure I felt. And it certainly didn't heal any of the parents' pain. But perhaps it filled a purpose.
For many months I desperately asked the questions: Why in the world couldn't they see that I tried so hard? Why did they think I was so unbelievably at fault and accused me of doing things I would never dream of doing?
Since then, I've come to an understanding. It's not about me. It's about Emma. It's about the parents' unbearable challenge of dealing with their grief and very deep anger over losing their baby girl. I can understand that. If I was deemed the object of their anger and they felt they were finding release and closure by their accusations toward me, then I guess I have filled my purpose...a nursing duty that I never thought about before.
Perhaps you are a health care professional facing a legal battle, and like me, you feel overwhelmed and even unsure of how you handled the situation. Remember that hindsight is always 20/20. Don't beat yourself up looking back over your actions, knowing the outcome, and thinking, "If only I..." Did you do everything you could? Did you follow policy? Did you follow your heart? Then keep your chin up and go in there and show what you know with dignity, and be proud of your plight. Perhaps you are filling a purpose too.