Wednesday, August 24, 2011

More please!

Many blessings to whomever came up with idea for the on-call shift.

Its a great thing that I was able to spend today on the couch instead of on the job. Tonight, Jordan and I begin the first leg of our trip to Augusta. I'm thankful that I don't have to pack and swoop at 8:15 pm tonight, only to arrive in Houston at 11:30. (To swoop: that frenzied cleaning that you do when you know someone is coming to your house. Beware of opening closet doors post swooping. Other tell-tale signs of a recent swoop? Doors to various rooms are shut, hiding the mess held behind them. What can I say? I like a clean house before a trip/company.)

But instead of packing and swooping, what am I doing? I'm laid out on the couch in my pajamas, hacking up a lung, pushing clear fluids and advil, and blogging. The dreaded summer cold has impeccable timing. But, I'm grateful for a shift off to rest and hydrate and pack and clean and take the dog to the kennel and put together 50 baby invitations and finish laundry and exercise and catch up on my L&D Q&As.

Disclaimer: I haven't been doing this labor thing forever. I don't know everything. Things are going to get gross FAST. Don't say I didn't warn you. All names/patient identifiers have been removed. All stories written are my own experiences unless otherwise noted. If talking about body parts makes you uncomfortable, this isn't the blog for you. The end.

What's your take on hair down there?

This is another widely asked question, but less by laboring patients and more by curious friends. Let me start by describing what a perfect world in labor and delivery would look like. Enter a patient: She is of average height and build- and healthy but not overweight. Her baby is easy to monitor regardless of how she is positioned in bed. Likewise, her contractions are easy to monitor regardless of positioning. Her IV is easily placed in the middle of her non-dominant forearm and runs like a faucet when left free-flowing. She has taken a shower recently and is wearing deodorant. The bottoms of her feet are clean and her pedicure is perfect. Her teeth are brushed and she is not a smoker. Her legs are shaved.... and so is the vag- which incidentally smells like roses.

OK! So - I just stepped on a lot of toes with that one. Of course, that's a perfect world, and in the real world, there are many things outside of a patient's control. Like how the baby is positioned or what veins look best for the IV. But cleanliness and hygiene? I can think of very few circumstances where it is excusable for someone to come into the hospital dirty. Come on people! You wouldn't go to the dentist without brushing, flossing, AND Listerine-ing, right?! Take care of those HEB feet!

So back to the first question: what's my take on hair down there? (Haven't read the disclaimer yet? Now's probably a good time.) First and foremost, if I haven't already made this obvious enough, I expect my patients to be clean. This means I don't want to smell your lady parts before I pull the covers back! Soap and water! Use them!!! Secondly, at the least, be well-manicured. Got a chimpanzee hiding out in your underwear? You'd better tame that sucker before coming in to have your baby. Look- there is a lot of stuff (secretions, fluids, blood, poop!) that comes out of the hoo-hah while in labor and all that hair down there just gets gross. Am I really all that put off by Amazon Woman? Not particularly. But -like I said- in my perfect world, there would be no hair. Wouldn't it be great if that were a side effect of pregnancy? Loss of pubic hair? {chuckles}

Here's a side note: If you know you're having a c-section, take it all off. Because if you don't trim the beast, I will. And I have to do it with a hospital grade electric clipper, which is not as gentle as Schick's twin moisturizing strips. Plus, it hurts enough to have a bulky pressure dressing taken off of the incision after surgery. Add in the torture of pulling off your lady hairs along with the dressing and you'll understand why I encourage my patients to take it all off. Yowzers!!! Next question!

Are most laboring moms vulgar?

The ones who do it without medication/epidural usually let the language fly. Not horribly so, but think about the last time you stubbed a toe or even worse, stepped on a lego. Try pushing out a baby without muttering a few expletives. Most patients are fairly well contained and some don't curse at all during labor. I think a lot depends on what the patients know to be appropriate in their own lives, and stressful situations (a la labor) can magnify a person's character. For example: A teenager from a rough neighborhood uses expletives in everyday conversation. I would expect she would be prone to let the profanities loose when the difficulties of labor set in. Conversely, A pastor's wife finds cursing to be distasteful and disrespectful and chooses to use other, more appropriate words to describe her everyday experiences. She'd probably be one of those who keeps it contained while in labor. Everyone is different and every situation is different.

In my own opinion, however, it's not the patients you should worry about. It's the nurses and doctors who are the real potty-mouths.

Thank you to once again to Pinterest for the picture. And thank you for not automatically assuming that I too am a nurse with a foul language problem.

Friday, August 19, 2011

Muy Rapido!

It's that time again friends! I think most of the nurses that I work with are aware of my little series and it leads to lots of interesting conversations around the nurse's station. It's been fun hearing about their own experiences with disrespectful patients, poop, and... their fastest deliveries. Babies born in wheelchairs and toilets and sweatpants- oh my!

Disclaimer: I haven't been doing this labor & delivery thing forever. I don't know everything. Things are going to get gross FAST. Don't say I didn't warn you. All names/patient identifiers have been removed. All stories written are my own experience unless otherwise noted. The end.

Fastest Delivery Story:
I had recently started my orientation in Labor and Delivery at BASMC- before it was AWH. I'd already been working in postpartum for 6 months and had gotten a great deal of unlicensed experience while I was in nursing school, so this whole labor thing wasn't entirely unfamiliar. I think I'd been orienting for a few weeks already and was growing more and more comfortable with life in labor.

We get a call from a lady who is on her way to the hospital. She tells us she's having a contraction about every 25-30 minutes. Now, there are a few things that will guarantee a quick admit and discharge, and I was already pretty certain that this woman's lack of labor would earn her walking papers in 20 minutes. She waltzed onto the labor unit with a friend and I escorted her to her room and asked her to change her gown. She looked like she was no more in labor than I was. Or am. Whatever.

But here's where it gets interesting. She walks back from the bathroom, freshly gowned, and climbs into the bed. I'm in the process of getting all the monitors powered up and belts behind her when she gasps and says: "Oh- I think my water just broke." I pull back the covers just to see if I can see anything (Is now a good time to mention that this lady was of the rather large variety?), only to find a growing pool of thick green meconium-stained fluid under her bottom. I excused myself from the room at this point to find my preceptor, so that I could tell her that this patient was indeed staying to deliver because she had just spontaneously ruptured and not only that, but the fluid was yucky (meconium = fancy name for baby poop) and we would definitely need extra nursery personnel at delivery.

So we both head back into the room in order to expedite her admission process and find her now huffing and puffing and moaning and writhing around in the bed. Mind you, at this point, she hasn't even been put on the monitor. Has had no vital signs checked. Has no IV, arm band, or chart. Anyway, so I go to check this woman's cervix and she is 7 centimeters dilated.

At this point, chaos ensues. My preceptor and I are calling for the nursery, and a delivery table. The patient starts dry heaving, which is a sure sign of transition, and within seconds, the baby is crowning. Now we're screaming for help- the NICU team, extra nurses, instruments and a midwife. The patient is also screaming. And pushing. And pooping. Everywhere.

I remember this day like it was yesterday.

This woman was a definite 20% Code Brown-er.

So, the baby's head pops out. We are yelling at the patient to stop pushing the entire time while still trying to get a hold of at least a pair of scissors and a cord clamp. My preceptor immediately notices that the umbilical cord is wrapped tightly around the neck of this baby and it cannot be reduced by slipping it around the baby's head. The safest way to deliver at this point is to clamp and cut the cord, unwind it from the neck and then deliver the body. However the patient is still hysterical and pushing, despite our very vocal urgings to quit. The body squirts out covered in meconium and mom dookie, blue and limp. Finally, my preceptor clamped, cut and unwound the cord and handed the baby off for resuscitation. The baby shook off the crazy/fast trip pretty quickly and was pink and screaming in no time. Welcome to the world.

I think the time from door to delivery was about 8 minutes. Now, it's not unheard of to have patients come in who have been laboring at home and are 9-10 centimeters on arrival, but this woman was by FAR the fastest, start to finish. Later, we come to find out, that this patient has a history of rapid labors, including an unexpected delivery on her couch and another in the back of a taxi cab! I'd hate to see that fare!

...stay tuned for more!

Tuesday, August 16, 2011

Let's Get Down to the Nitty Gritty

You get 6 points if you read the title in your best Nacho Libre voice.

Disclaimer: I haven't been doing this labor & delivery thing forever. I don't know everything. Things are going to get gross FAST. Don't say I didn't warn you. The End.

What percentage of patients poop while pushing?

Sorry, I couldn't resist.

This is probably one of the most frequently asked questions. EVER. Apparently this is one of the few things that pregnant women are truly concerned with, because almost every patient makes mention of this smelly bodily function. I've had to have a few "Come to Jesus" talks with patients who simply didn't want to push because they were more concerned with pooping than they were with delivering. But here's the thing: this kid's head is going to take up every last square centimeter of it's momma's bottom when it's coming out, thus anything hanging around gets pushed out by the head. There's no way around it people! Anyway- Being that this is quite the hot topic, I didn’t want to mislead any of you lovely (and curious) readers. So, I polled a small group of nurses to check and make sure my experiences were universal.

We all pretty much agreed on... 70%. Give or take a few.

Probably 80% of those who poo-poo just make little dingleberries. Aaaaaaand the remaining 20% will stink up the entire unit. With some clever usage of underpads, washcloths and Hibaclens, the dingle-ers may not even be aware of their smelly indiscretions. If you ever hear the term “code brown” being thrown around the nurse’s station, you can rest assured that some patient somewhere on the unit has dropped a bomb. Obviously, it's not a pleasant part of my job, but it comes with the territory. L&D is slap full of disgusting bodily fluids. And besides that, lets face it...

Taking it a few steps past the line, I’ll be gross and frank: A patient’s nurse is usually already aware if her patient is … ready to deliver. And by ready to deliver, I don’t mean a baby. Let me bring you to another level of gross awareness: We labor nurses can feel whats in your poop chute when we check your cervix.

While my little opinion group was giggling over our own disgusting patient poop stories, one of the OB-GYNs interjected with his own absolutely revolting experience with an impacted patient. He said this lady had not pooped in 4 weeks and her dookie had become hard and impacted (meaning stuck in her rectum). Being that he was only a lowly intern, he got the job of digitally removing this giant mass of turd. The "digital" that I'm referencing in this story is not referring to a type of clock. Picture this- he said it was so bad, she would've needed a C-section because there was no room for the baby to fit through there. Anyway, there was a sea of diarrhea behind all those rocks and when the dam was broken, Dr. X needed a new change of scrubs. Moral of the story? Take your colace ladies.

Lastly, keep in mind, those of you who are planning on one of them fancy-pants crunchy granola all-natural at-home water/tub births, you’ll probably poop too. But you’re in luck!...

(Thanks Pinterest for the pics. You've made my blog picture searching life so much easier.)

Saturday, August 13, 2011

The First of Many

I have great news! The Q&A will definitely need to be a series! I love my job and I enjoy talking about my job (just ask my husband- He knows more about the ins & outs of Labor & Delivery than any man should ever know, OB-GYNs excluded of course.). I've already started thinking about my answers to some of the questions and depending on what I'm talking about, I could go on for hours. Yikes!

Series it is.

Disclaimer: I haven't been doing this labor & delivery thing forever. I don't know everything. The End.

1. What is the most appreciated thing a patient can do for their nurse?
For this question, I hit the streets. And by hit the streets, I mean that I asked a few of my coworkers for their opinions on this topic. I got lots of great answers:
  • Hang up the phone when I come in to talk to you.
  • Don't ask me to get you ice chips when there are 18 family members sitting nearby.
  • Take a shower and brush your teeth before you come to the hospital. (more on this in a separate post!)
  • Don't touch the call bell.
The last one's a personal favorite of mine.

In all seriousness, I just want to be treated like another human being. All the coworkers I talked to first answered with, "just say thank you and mean it... ... and don't touch the call bell." A sincere 'thank you' goes a long way. Talking on the phone or having the TV turned up while I'm trying to discuss your care is disrespectful. As is eye rolling. Flexibility should be a prerequisite for labor as things rarely go as planned. If you don't understand something, ask questions nicely. If I can do something for you within my scope of practice, I will do it! I don't have phenomenal cosmic powers (name that movie!), I have to follow YOUR physician's orders. I work hard to make your experience safe and healthy for everyone involved. Please don't treat me like I'm an idiot or a slave or a nobody.

2. What is the best thing a patient or family has done for you?
This is another question I posed to several nurses and would have to wholeheartedly agree with this answer: "I consider it the biggest compliment when a patient asks to have me in their new family picture- the patient, her husband, baby and myself. It's such an honor to be a tangible memory of their experience." Now, there have been hundreds of times where grandma-to-be is running around taking pictures of all the tiny minutiae that clutter a labor & delivery room and says,"oh I guess I should take a picture of the nurse." Look, lady, I know you're meaning well, but I'm not a room accessory and I have a name. When I say I love pictures with family, I mean the parents come to me and ask for me to be in a picture with them or even just a picture of me holding their precious baby. It really tells me that you've valued the effort I've put into your experience.

Sure, getting food and thank yous from patients is nice, but the picture thing is a super simple way to really make your nurse feel loved.

You see, first and foremost, It's my job to care for my patients and make sure their labor and delivery is safe and healthy. BUT it makes my job so much easier and more fun if I feel like I've bonded with my patient and her family. Regardless, I really do consider it a true privilege to have even just a tiny role in this monumental occasion, even if I don't feel like I have any emotional attachment to my patient.

Lastly, I have to mention that getting cards in the mail is a huge HUGE deal. I once got a card in the mail with the picture that I took with my patient and her baby! What a mail day double score!!!!

Stay tuned for the next set of questions!

Tuesday, August 9, 2011

We're not talking about stirrup pants here people.

I've wrestled with this idea for 2 days now and am finally convinced to just Go For It.

I'm hosting my first (and maybe only) Q&A. Cue the cheers and applause!

And I know there are plenty of curious minds out there who want to know all the ins and outs and gory details of working in Labor & Delivery. Maybe some of you don't want to know ALL the details. Sometimes I try hard to forget ALL the details. But all the other fun parts, scary parts, hilarious parts and sad parts are fun to share. I've spent many a Girl's Night answering questions about my life in L&D. What's the most popular baby name? What's the craziest name you've ever seen? What's the grossest thing you've ever seen? And so on.

You know you're curious. Leave a comment with your question (or questions!!) and wait excitedly for a followup post with all the answers!

Don't leave me hanging here.


Leave me a comment... now.

Ps. Thanks Google for that great stirrup pant picture. Get the joke? Stirrups? Stirrup pants? Hello? Is this thing on???

Saturday, August 6, 2011

Some More?

As promised, I've made the S'more bars. Twice in fact! They were super delicious and got rave reviews from both parties. The first batch I made went with me to work and fed a large crowd of moderately grumpy nurses. A word to the wise: to get on your nurse's good side, reward her with food. Sometimes we don't get to eat (or pee or breathe) because we're too busy having your baby. It's no wonder we're always grumpy. Carbs are the wonder solution to hunger-induced grumpiness. There is no cure for stupid patient-induced grumpiness.

I digress.

And the second batch fed a large crowd of teenage girls (and a few adult ladies too!) I made the second batch a little different than the first and liked it much better. I'll make note of the change in the recipe and you can choose for yourself.

In any case, make these soon! And have a large glass of skim milk handy to wash the sucker down, because this dessert is sweet and rich.

(it's the same picture from Pinterest. I'm too lame and lazy to take my own picture. Besides, my bars didn't come out of the pan looking quite so pretty.)

S'more Cookie Bars
1/2 cup sugar
1/4 cup brown sugar
1/2 cup butter (softened!)
1 egg
1 tsp vanilla extract
1 and 1/3 cups all purpose flour
3/4 cup graham cracker crumbs
1 tsp baking powder
pinch of salt
1 and 1/2 cups marshmallow fluff
Several handfuls of semisweet chocolate chips.

350 degrees. Also, grease on up an 8x8 pan.

In a bowl, cream the butter and sugars. Once fluffy, add the egg and vanilla until smooth and well incorporated. Combine the dry ingredients (flour, cracker crumbs, baking powder and salt) slowly into the wet ingredients until everything comes together. The dough will be easy to handle- not runny like batter or sticky. Divide the dough into 2 equal halves and press one half into the bottom of the greased pan. Here's where I deviated from the recipe: The original recipe calls for 2 large Hershey bars (not the king size ones, but the really big bars- like what you find on the candy aisle or in the baking section.). I used the hershey bars for the first recipe and thought the result was a little TOO sweet. So for the second batch I used semisweet chips (even dark chocolate would be nice) and thought that it was a better choice. Whether you choose to use semisweet chocolate or Hershey bars, they make up the second layer of the bars, so press them gently into the crust. Only so that the crust helps to anchor the chocolate down, which is ultra helpful when it comes to spreading sticky marshmallow fluff. Once the chocolate is down, spoon on the marshmallow fluff. Resist the urge to cheat and throw mini marshmallows in- the writer of the recipe says that this just does not fly. So spread the fluff around to the best of your ability (this is where chocochips were a little difficult!), making sure to form a nice layer over the whole pan. Finally, top the marshmallow with the other half of dough. To make this easy, I break the dough into 4 pieces and pat it out flat and lay it on top of the marshmallow like a little dough shingle. Bake for 30-32 minutes. Cut into squares and enjoy.
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