Friday, May 31, 2013

M4M: Character That Counts!

It's the last day of May, so you know what that means!!! Tonight, Kendra from The Mommy Diaries is joining us to share about building character in our babies. It's a full time job which starts early, so this is a post that all of us mommas need to keep close to our hearts. Check out what she has to say:

Have you ever stopped to think about the impact you are having on your child’s future? I often think of the man Klayton will someday become. I envision Klayton being the friend that parents want their kids to have, I envision people of an older generation not shaking their head in distaste when he walks by-when they see him they only have good things to say. I envision Klayton as a man who will want to honor his parents, will love his wife, provide for his family and tell his children that he loves them. What a humbling thought it is to me when I realize that the training he receives today will be a part of that molding. I realize that I am raising my son in a society that focuses on “getting by” and I don’t want to just “get by” with my child. I want to put effort in him because of the man I hope Klayton will become-by God’s grace of course!

My husband and I pray every night with Klayton. We pray for him and with him, my prayers used to be, “thank you Lord for Klayton and please protect him and keep him safe from ALL harm!” Because seriously who wants to see their child get hurt? It really isn’t a bad prayer; but the Lord reminded me that Klayton is a gift that God has given me to raise for HIM! God reminded me what I want for Klayton might not be what He wants for Klayton and there are certain things that must be necessary to shape him into a man. So now I pray, “thank you Lord for Klayton and please God do your will in His life-even now begin shaping him into a man for You”. With prayer comes conviction! Conviction that as a parent I have a part and I have no right to hope and dream my desires for who he will someday be if I am not willing to be the proper example in those areas! You know that phrase, do as I say not as I do

Well, our actions speak louder than our words and as a mom I want to be the example he needs at home! And in our home we are currently working on 3 things:
  1. Obedience.  We often forget that obedience is a key component in forming character. And often if we can raise a child to be obedient most other good character traits will follow! As time goes on our children will have teachers and bosses. And the thing with teachers and bosses is they often tell us what to do and except follow through! We are teaching Klayton that obedience is obeying right away…not the 2nd or 3rd time! I still remember standing behind a mom and daughter, the little girl was throwing the most obnoxious tantrum. The mom would say, “if you don’t stop screaming by the time I count to three I will take that candy bar away from you!” The little girl would continue to scream and mom would begin counting, “one…two…two and a half…” and before she could say three the girl would stop. But, guess what? Ten seconds later this interaction ensued once again! I was embarrassed for that mom and realized that I don’t want to be that mom! So, yep we are those parents who are working at getting our child to do what we say on the first “try” and yes his future bosses, teachers and other authority figures can say, thank you! (Did you notice how I conveniently left out the anecdote of Klayton not obeying right away? Because maybe or maybe not we have never had an experience of a disobedient melt down in public!)                                                                                                                                
  2. Be willing to say, "I'm sorry I was wrong". This has been quite the doozy for me-I have LOTS of pride! Just the other day Klayton was having a bad and I was having a bad day -- he hasn’t learned that its not a good idea to share bad days with mommy! Klayton was being needy, he was having lots of potty training accidents. Then he spilled his bag of crackers and spilled his drink all over the floor. It seemed to all happen within 2 seconds and I was very irritated. I harshly sent him to the couch to “ponder” and went to continue my load of laundry that was a mountain high, not to mention the reminder of dishes that had yet to be done beckoned me as I passed the kitchen sink, further adding to my irritation. Before I could even start again on my chores the Lord prompted my heart that I didn’t handle things well. I could go to Klayton explain to him why I reacted that way…I have so much to do and I am having a bad day; but that would just be excusing the apology away. So, I knelt before my little guy and said, “Klayton, I’m sorry I was wrong for reacting the way I did over an accident. I love you, can you forgive me?” Then with a hug and a kiss we were on our way!
    Source: via Kendra on Pinterest
    Our society likes to pass the blame to others, never taking responsibility for our wrong doings. If I can teach Klayton now to admit when he has done wrong and make it right…wow!      
  3. Responsibility. My little guy is only 2 and a half but he already has “jobs”. Around his 2nd birthday I started having him throw his own diaper away. Not a huge thing; but something he can do. He doesn’t always like doing it and I have to remind him that we all have a part and he can do it! We may not always feel like doing something; but that doesn’t mean it is to be ignored. I don’t always feel like paying my bills; but guess what if I didn’t pay our cell phone bill it would be disconnected. But, let me take this moment to brag on Klayton…since he has started throwing his own diapers away he can often be found without me having to ask throwing away trash, putting his own dishes in the sink, picking up his own toys as well as helping me sweep and mop! I want Klayton to grow up to be a man that will be responsible and do what needs to be done to provide for his family and I am often reminded that he is on his way to becoming that man as he realizes he has a “part” in the family and he is accepting that part responsibly! And just so you know I don’t ALWAYS make him throw his own diaper away!
                                                                         Source: via Kendra on Pinterest

Basically, I am constantly looking for teaching moments…things that I know are struggles that his daddy and I have had and can be avoided. For example: Klayton usually wants EVERY ball in the store and yes he already has a gazillion at home! We take those little moments to teach him to be content with what he already has, it is definitely a work in progress. But, this is the thing I don’t expect obedience, being responsible, admitting wrong, contentment or whatever good character trait you want to add to the mix to be developed by the time he is 3! I understand that this journey has many days, weeks, months and years ahead of us. I just think that, sometimes we-myself included-forget to see that there is a bigger picture and what we do with our kids now matters for tomorrow, for their future spouse, their future children! Lets make today count and ask God for lots of grace!

Thanks so much for sharing that Kendra! Go visit her blog for lots of great family stories and cute pictures of her handsome man! If you're interested in contributing to a future month of Month 4 Moms, shoot me an email! 

Wednesday, May 29, 2013

The One that Makes you Cringe

I'm back with the next installment of L&D 1102. This one... it's a little... um, personal. So here's the disclaimer: If you don't have the necessary organs to grow and deliver a child, you might want to keep on surfing. What I'm trying to say here is --guys, boys, men, XYfolks-- beat it. For the ladies that stick around, also be warned, I'll use anatomical terms that might make you blush. For certain though, this is the one that'll make you cringe. This is the kind of topic that sometimes comes up between friends outside of work and I can rarely make eye contact while talking about it.

Today, we're getting to the bottom line. Literally. Like, as in tears, lacerations, and episiotomies.

Did the air just suck out of the room?

I told you this one would be fun.

So, babies come out and sometimes things tear in the process. But what does that mean??? What is the difference between an episiotomy and a laceration? What is the recovery like? We'll tackle all things tear-related, and I'll share my tips for post-delivery bottom care.

First things first: Lets get super simple... when delivering, sometimes to accommodate the baby's head, shoulders, or body, things tear apart in the mother's bottom area (here comes the anatomical words.... google searches eat your heart out.) and most often you'll have tears around the vaginal walls, perineum, periurethral area, or cervix. There is a continuum of tearing, going from a First degree all the way to a Fourth degree; the first degree being very superficial and requiring very few stitches to put back together, and the fourth degree is, well, um, pretty significant. We in the biz like to call 4th degree tears a "vaginal c-section." Basic anatomical structures have to be reconstructed. Lets just say, take the colace. The difference between tears/lacerations and an episiotomy is that the latter includes the use of scissors. Catch my drift? For all comparative purposes, the depth of cut with an episiotomy is roughly equivalent to the depth of a second degree tear. Is everyone feeling a little light headed yet?

Do your kegels ladies.

There are basically two camps: pro-epis and anti-epis. Most doctors will fall into one category or the other. Those who are pro-episiotomy are open to cutting an episiotomy if it appears like the patient will tear anyway. Some doctors are even more snip-happy and will cut an episiotomy regardless. The draw is that episiotomies are a clean cut that are easy and straightforward to repair. We're talking stitches in your bottom, people. The anti-epis camp will do whatever it takes to deliver without doing an episiotomy. The theory here is that the perineum is designed to stretch to accommodate a baby, and while repairing a tear is sometimes more complicated than an episiotomy, cutting an epis can lead to deeper tears. Humor me for a minute and go get yourself a sheet of paper.

I'll wait.

Are you back yet? With that sheet of paper? Lets do a little experiment, shall we?

Grab your sheet of paper where the arrows are and try to tear the paper by pulling it apart. This isn't a strongman experiment, just try to tear it.

NOW... cut a slit in the middle of the piece of paper and try it again.

Ok, so paper #2 was way easier to tear in half, right? It's the same principle with episiotomies and the anti-epis camp. Disrupt the integrity of the perineum and it's easier to tear even further -- doesn't always happen, but the possibility is there. Make a little more sense? Have a discussion with your doctor to see which side of the fence he or she is on before it's time to push a baby out, but whatever you do, do not ask for a daddy stitch. It's revolting.

Lets reel this back in... I mean, in the end, you still have stitches in your netherrrregions. And stitches that bring a torn bottom back together feel pretty much exactly like those stitches that bring an episiotomy back together. So what do you do about basic life functions? Like sitting? And using the bathroom? Here are my top tips for keeping post-delivery bottom discomfort at bay

  • ICE ICE BABY. Ice packs are your greatest friend. Be that annoying patient and ask for a new ice pack frequently. You should aim to keep ice on that bottom for at least the first 24 hours. Not only does it significantly cut down on swelling (please please please dont--- I repeat DONT--- look down there. You can never un-see things. Just say no to hand mirrors) and it also keeps things pretty numb. So, use the ice. After the first 24 hours has passed, some people like to do sitz baths, which is like a bottom-spraying-basin-warm-water thing. Personally, I never used a sitz bath, but some people swear by them. 
  • Pharmacological agents. Around the clock motrin and or tylenol will help. Your doctor may send you home with a prescription for a narcotic pain reliever, just make sure you aren't doubling up on the tylenol in that case. There will be a few painful days (Day #3 is always the absolute worst.), but it won't take long until things are just kind of inconveniently uncomfortable. Don't worry, you won't need to sit on a pillow forever. Speaking of pillows, stay away from the donut pillows. 
  • Topical agents. This is stuff like dermoplast (numbing spray), tucks pads (technically for hemorrhoids, but great for the stingies & itchies), and hemorrhoid cream (actually for hemorrhoids, but not good with those awful 4th degree tears). I like to make a nice little pad-sandwich for myself my patients: pad on the bottom, then an ice pack, then a layer of cold tucks, then topped with a generous spray of dermoplast. Ahhh, sweet relief.
  • Colace, Water, Fiber. The first time you need to go number 2 after pushing out a baby and getting stitched back together, you might consider asking for another epidural. That isn't actually an option by the way. Taking colace (an OTC stool softener), lots of water, and a high fiber diet will make that bathroom experience less harrowing. And a note: if you're breastfeeding, you need even MORE water to keep the constipation at bay. (FYI: Narcotics can also make you constipated. Yowch.)
  • Keep it clean. You'll receive a plethora of diaper-sized pads and a handy dandy squirt bottle, so with each potty trip, do the rinse off/pat dry/pad change. Most sutures dissolve on their own, so keeping them clean and dry is the only thing you should bother worrying about.
  • Rest. Lastly, give your birth canal a break for a few weeks. Stay away from tampons and men. Wait until your doctor gives you the go-ahead to do anything besides ice and spray. Things will heal back to normal with time. 

That was awkward. 

Saturday, May 25, 2013

Seven Months!

Seven months seems way closer to adulthood than 6 months did. I mean, at 5 months and 29 days, you were still a baby. Then six months came along and I think I handled it pretty well. But now you're seven months, which is closer to being 1 year old and if you're close to being 1, then you're close to going off to college. There's just something about it being beyond the halfway point that makes the seventh month sound really old. Either way, you're there, Mr. Isaac. 
Initially, when I was reflecting on the past month in preparation for your dedicated blog post, I mistakenly thought that this month was pretty low on big changes or new experiences. In my mind, I was sure this would probably be a short and sweet update (what was I thinking?!) I was also wrong in assuming that I was a horrible mother who hadn't taken a single picture of my child since your six month chair photo. Boy was I WAY off.

This month you started eating solid food!
It was a pretty big deal! So far you've eaten cereal, carrots, sweet peas, green beans, squash, sweet potatoes, applesauce, prunes, pears, and peaches. You're a sometimes messy but always great eater. We've been trying water from a sippy cup, but you really only like it from a straw so far. Sometimes I think you get more excited for a straw-sized sip of water than you do for the food itself. You crack me up. I ventured into uncharted territory and made all (well, almost all) of your food. Turns out, it's ridiculously easy and cheap.... Like 4 steps easy:
This month, on Mother's Day, your daddy and I dedicated you to the Lord in front of our entire congregation. You had a mini-meltdown during service number two, but Pastor Scott got your attention and you calmed right down. It was a sweet time for our little family, presenting you before our loving church family and promising to guide and direct you. I hope to always point you toward Christ, and I look forward to watching you grow into a great man of God - what an honor as a mom. We had several family members visiting for the occasion, which was both fun and [at times] overwhelming. Your cousins were quick to love all over you and you seemed completely unfazed by the chaos.
You also went on another plane ride to visit family in Georgia. We'll just call you the world traveler! It was quite the trip: there was more chaos, fewer naps, and tons of love. You did relatively well on all 4 plane rides (Houston - Atlanta; Atlanta - Augusta... and then in reverse), with the exception of a meltdown here and there. It was both easier and harder than your first big trip to Georgia; easier because dad was with us, but harder because you are now bigger, more squirmy, and needing more entertainment! But aside from the traveling days, our trip was lots of fun. We went to Augusta for a wedding, but between the many showers and festivities, we squeezed in as many visits as we possibly could with a 6 month old who needs his naptime. You visited with aunts, uncles, cousins, grandparents, and even great-grandparents. You even got to ride on a golf cart with Big Daddy.
My little son, I am so proud to be your momma. Your sweet and happy personality shines bright each and every day. My love for you, which seemed so deep and unending, actually grows more and more with each passing day. I am so very thankful for you, my greatest blessing.

Wednesday, May 22, 2013

Stick Around

Hi there.

Just me here. Touching base after a week's worth of silence. I'm happy to report that Jordan, Isaac, and I have all survived a LONG weekend (thursday to tuesday) trip to Georgia. Our trip consisted of: four plane rides, two three-hour-long car trips, a few baby meltdowns, lots of missed naps, and one spectacular wedding.

So now that we're back I've got some catching up to do. I've got about a million new blogs to read, a guest post to start and finish (more on this later), and of course, write out the next L&D 1102 installment. Plus, then there's unpacking to do, laundry to wash, church to attend, work in the morning, groceries and birthday gifts to buy. I've got to renew my driver's license and my nursing license... the list never ends.

See you soon!

Wednesday, May 15, 2013

You want to put that where??? Part III

You've made it through part numero uno and numero dos. All of those disclaimers from Part I still apply here, so go refresh yourself once again if necessary. (In a nutshell: I'm not an anesthetist. These posts aren't natural-birthing oriented. Every hospital and anesthetist is unique.) I like to think of this post as really getting down to the nitty gritty. I mean, who cares what happens or if it hurts as long as the pain goes away, right?
Does it really take all the pain away??

If I've lost you already, pay attention to this part: Epidurals may not take your pain away 100%. Let me say it again: It's a widely held misconception that patients with epidurals feel absolutely nothing. Sure, there are those lucky souls that get so numb, they have to be woken up to deliver their baby, but that's not the norm. I even expect my patients to notice their contractions or even become mildly uncomfortable  at some point - it's usually a great sign that delivery is imminent and it doesn't mean your epidural has worn off or stopped working. Sometimes the way the baby is positioned can lead to more discomfort regardless of a well-placed epidural. Sometimes when things change quickly, you just need a little extra juice. (But, feeling some slight discomfort and/or pressure makes pushing much more effective). Before you lose your mind and all, notice I didn't say your pain will eventually be out of control. It's just good to know ahead of time that epidurals aren't a guaranteed, foolproof cure-all. Delivery is.

That all being said, there is just nothing else out there that works as well for labor pain as an epidural. IV narcotics and sedation can suffice during early labor, but for the hard stuff, it just doesn't cut it. Personally, I had a fantastic epidural, it was a little one-sided, but worked well. I felt a tolerable amount of pressure and discomfort towards the end of my labor, and efficiently pushed my 9 pound, 6 ounce baby out.

Another word (er, um... words) about epidurals. There are always outliers. A handful of people have a really difficult time getting an epidural, or have a positive test dose, or end up with a spinal headache, or *shudder* get no relief despite a well-placed catheter. It's pretty uncommon, but these things do happen.

Basically, I just took three blog posts to say that every epidural is completely unique, which is totally vague and noncommittal. Sometimes they work too well, sometimes they don't work quite well enough. There are some funny side effects, which may or may not happen. There are benefits (hello?! I pushed out a 9+ pound baby and the only tears I cried were tears of joy), and there are trade offs. And with each sentence I type, I feel like I could tell 27 stories and follow 6 new rabbit trails. I can already think of like a dozen talking points regarding epidurals, like "What's the latest I can get an epidural?" (I've sat patients up who are 10cm) and "Will it slow down my labor?" (maybe.) and "Can I move with that catheter in my back?" (Yes, but do so gingerly - you don't want to dislodge the catheter) and "Will I have back pain forever?" (The likelihood of long-standing back pain is probably the result of being pregnant and pushing out 7 pounds of cute baby, but a brief period of localized soreness from the epidural placement is appropriate)... I could go on and on, but then I'd probably need to start a Part IV post. There's just a lot to say. It's really easy for me to gloss over so much of this considering I sit with patients through their epidurals every single workday. I've seen probably a thousand epidurals, but my patients have only sat through one or two, so I understand the concerns. My hope is that with knowledge (be it ever so vague...) comes added peace, eased minds, and lessened anxieties.

My tips for preggos who know they want an epidural: Try not to stress too much about the whole process... I mean, the REAL thing you should be afraid of is when they hand over your newborn baby and tell you to go home. Ha! Just kidding.... but really. Familiarize yourself with the hospital policies and your doctor's orders (i.e. who can hold your hand during the epidural placement, is there anesthesia in house 24 hours/day, and how far dilated must you be before getting an epidural), because these things are completely out of your nurse's hands. Be very upfront with your labor nurse about your desires. Don't wait until you feel like death is a great alternative to the pain of labor to ask for your epidural. Be very descriptive with your nurse or anesthesia provider if you have pain after your epidural is placed. Terms like ache, pressure, sharp, crampy, etc. all have different connotations and may be treated differently. Is the pain only with contractions or does it last all the time? Is the pain one-sided, all over, or localized? Telling the nurse that you're hurting is a good start, but telling her that you're having sharp pain that lasts beyond contractions and pointing where the pain originates really makes finding a solution much easier. Lastly, like with all things labor and delivery related, be flexible.

Clear as mud? 

Tuesday, May 14, 2013

You want to put that where??? Part II

So when we left off with part number one, I had talked through the process of getting an epidural from start to finish (go back & visit if you need a disclaimer refresher). I've already heard from a small village of people claiming my last post was terrifying, which totally wasn't the desired effect! I'm hoping that maybe today's post can relieve your fears a bit.

So, here goes nothing.

Now, THIS is terrifying. Source

How bad does the epidural hurt?

Overall, the procedure shouldn't be traumatic or painful (despite the horror stories that float around). The initial shot of numbing medication is often the most uncomfortable part of the entire procedure and I've heard it compared to a bee sting or fire ant bite (but in my personal experience it was hardly noticeable). The stinging usually subsides in about 10 seconds or so. After that, locating the epidural space often means feeling lots of pressure and sometimes some yucky feelings, but ideally no pain.

This is where I got the root canal reference from, and maybe I should've said it's more like getting a cavity filled. You know, the dentist numbs your mouth and it's a sting and a bite for a few seconds before half your mouth is drooping and drooly. From there, you still feel pressure (which sometimes is even a little uncomfortable, but easily tolerable) where the dentist is working but ideally no pain.  

If things DO get painful,  then be clear with your nurse or anesthesia provider about what exactly you are feeling, because most issues are easily remedied. I often find (and this is not with all cases, but humor me here for a sec, ok?), that the fear and anxiety that's associated with epidurals and the unknown aspects of them is the driving force behind a patient having a bad experience. Fear and anxiety can play crazy tricks on your mind when you're feeling bizarre things that are otherwise appropriate and anticipated -- especially when you're already dealing with megapainful contractions. That being said, sometimes there can be some actual pain involved. Repositioning or additional local anesthetic can often relieve some of the typical discomfort associated with epidural placement. As a side note: If you are concerned about preexisting back issues causing problems during your epidural placement, make sure and speak with an anesthetist BEFORE you're clawing the walls. For significant back issues (i.e.: previous surgeries and/or malformations), it would be wise to have your OB set up an anesthesia consult long before you're due to deliver.

A large majority of my patients tell me that the IV hurts worse than the epidural, just to put things into perspective. 

There are a few things you can expect to happen after epidural placement. First -- your entire lower body will become numb and tingly.  I repeat: your legs and bottom will feel warm, fuzzy, tingly, numb, heavy, etc.  It amazes me how many people seem surprised by this, because it IS the desired effect. Usually it takes 10-15 minutes for the anesthesia to fully take effect, so don't expect an immediate response (unless you're getting a combined spinal-epidural, but we aren't talking about that here today). It's a gradual numbing and as the level of anesthetic rises, you should feel contractions less and less. Maybe you can move your legs a little, maybe they're dead to the world, and either variable has patients concerned. So here's what I tell them: "You don't need legs to have a baby!"  Sometimes you'll be more numb on one side than the other, which isn't uncommon. Just like the leg thing, an uneven epidural isn't a big deal as long as your pain is well-relieved.

Some other anticipated side effects: You might experience a drop in blood pressure, which can make you feel dizzy, light-headed, nauseous, and yucky, but can be remedied quickly. If there is a narcotic in your epidural juice (again, provider specific preference!), you might be a little itchy (or a lot itchy).  It's totally normal to get the shiver-shakes at this time too. You may still feel tightening or pressure during contractions... which we'll discuss further in Part 3!

Stay Tuned.

Monday, May 13, 2013

You want to put that where??? Part I

It's L&D 1102 time and I am super excited. I've gotten some pretty awesome questions and am really looking forward to breaking it down for you guys. Today, we're talking about epidurals. It's definitely one of the things that I get lots and lots of patient questions about, so I'm really glad I also got a blog question about epidurals. When I initially sat down and started pecking out some info about mepishmurals, I quickly ended up with something my mom referred to as "textbook-ish" Well, that just wouldn't do, so I'm going to break this down into multiple epidural-related posts!

Now I know there's a cavernous divide between the natural birthers and medicated birthers and this really isn't a forum to discuss who is "right" and who is "wrong." Remember, these questions come from real people who just want to shed some light on whether or not that darn epidural needle really is the size of a number two pencil (it's not)...among other things. Now that I've gotten that off my chest, lets get started, shall we? Here's the breakdown:

Can you explain a little more about the epidural process? (Part I)

How bad does an epidural hurt? (Part II)

Does it really take all the pain away? (Part III)

Here's my disclaimer though: I'm no expert. I've been in L&D for about 6 years now, and have my inpatient obstetrics certification, but I don't know everything and I'm not an anesthesia provider. Whatever you read here can NOT be used as medical advice. I do not replace your doctor or your anesthetist, so I don't want to hear any, "but Hollie said it'd be this way." I'm simply talking from a nurse's standpoint after a few years of delivering babies in a variety of circumstances. Hopefully I can ease some troubled minds and dispel a few rumors in the process.
For starters, it's incredibly important to know that from hospital to hospital and from anesthetist to anesthetist there are lots and LOTS of differences. I've worked at 4 different hospitals now and they all run slightly different. You might have a Certified Registered Nurse Anesthetist (CRNA) do your epidural or you might have an Anesthesiologist (MD). Some hospitals have anesthetists in house 24 hours, where as some hospitals (especially smaller or more rural locations) have to call in anesthesia. Some facilities do combined-spinal epidurals (CSE), some do regular epidurals. Some anesthesia providers use narcotics in their epidurals, some don't. The point to take home here is that there are lots of variables out there in the epidural world. So, I might mention something here that doesn't happen the same way in your neck of the woods. That's just the way things are.

So lets break down the process from start to finish. Here's what a typical, healthy patient of mine would experience:
  • First things first - A patient is hurting and asks for an epidural. If there is an order for an epidural (some docs want their patients to be so far dilated prior to epidural placement), then anesthesia is notified and an IV bolus (bolus = large volume of IV fluid given over a very short period of time) is started. The anesthetist bee-bops over and spends a few minutes reviewing the patient's chart slash health history and gathers the supplies he needs for the procedure.
  • Because it's a sterile procedure, extraneous visitors are kicked out of the room (I've never witnessed this, but I've heard some hospitals kick ALL visitors out of the room-- check at your facility for their policy) and the patient is positioned for the epidural. The two most common positions for epidural placement are sitting up and side-lying. 
  • With anesthesia at the bedside, the procedure, patient's name, date of birth, and allergies are confirmed. 
  • The patient's back is scrubbed with betadine or chlorhexidine or some sort of germ-busting soap. It's cold, wet, and scratchy. A plastic drape is applied to the back... remember, sterile procedure. It also takes just a minute or so to open the epidural tray, draw up the medications and get everything prepped and within reach. 
  • The patient is helped into an ideal position, which resembles something like shoulders relaxed & down, chin tucked down, and curled around the baby (If you're side-lying, you'll also pull your knees upward, all roly-poly like). Anatomical landmarks are determined by the anesthetist by feeling hip bones and spinous processes. A nice rolled out or slouchy back makes those spinous processes easier to navigate and opens up those spaces in-between. Proper positioning is really important.
  • Local anesthesia is injected at the site of the procedure. Yowzers. This is always the most uncomfortable part as the lidocaine stings and burns for a few seconds before the area goes numb. 
  • The anesthetist then introduces the epidural needle and begins to locate the epidural space. The patient feels some amount of pushing or pressure, may feel or hear popping or cracking. It's a bizarre sensation. This is the part of the procedure where holding still in that "ideal" position is highly recommended. Since one of the characteristics of labor is contractions, the patient can expect to have a contraction or two during this part of the procedure. It's unfortunately just a grit-your-teeth and get through it kind of moment... but the sooner the epidural is in, the sooner the relief comes with it. 
  • Once the epidural space is located, a catheter (cath = flexible plastic tube) is threaded into the space. Anesthesia then tests the catheter to make certain it is in the right location and removes the epidural needle, leaving the catheter in the epidural space. The catheter is taped to the patient's back and the patient can continue to receive medications throughout the remainder of their labor. 
  • From this point, many sets of vital signs will be taken to watch changes in blood pressure and pulse. The patient is assisted back to a sort-of laying down position (think awkward pool chair pose) with a wedge under one hip to displace a heavy uterus. Medicine is pushed through the epidural catheter and slowly -but surely- the patient's bottom, legs, and abdomen grow warm, heavy, fuzzy, tingly, numb and most importantly, pain free.
  • An indwelling catheter is put in the patient's bladder to keep it emptied during labor (plus, you can't walk to the bathroom if your legs are numb) and I generally always check a cervix at this time too.
  • Once the epidural has spread evenly, provided adequate pain relief, and all vital signs are stabilized, the patient is repositioned for comfort and naps are encouraged!!
And that's all she wrote. It seems like a pretty lengthy process, but in all actuality, the procedure itself usually only takes a few minutes. The procedure for spinal anesthesia or a combined spinal epidural is different for your anesthetist, but you can expect the same basic layout of events.

Part II is coming soon and we'll talk about whether or not the actual epidural process is painful. I'll also review a few expected side effects and things to watch for. Then, for Part III, we'll discuss whether or not epidurals really take away all the pain. Stay tuned-- there's still a LOT to talk about. Seriously. I just copied & pasted like 4 more paragraphs worth of info into new blogs. So check back again soon!

If you haven't already voted for the Blog Button Design Battle, go check it out and put in your choice! 

Saturday, May 11, 2013

Blog Button Battle: Round 1

Today marks the start of the Blog Button Battle! I'm in the first round running and pitted against 9 other blogs in a fight to see whose button is the cutest! Take a minute to look through the choices (ahem, and pay particularly close attention to the great looking Blog-O-Hollic button!!!) and put a vote in.

Welcome to Round 1 of the Blog Button Design Battle. This week's participants include:

April from Hearts on Guard
Ashley from Wannabe Green
Kelly from The No Drama Mama
Chels from Red Velvet Rooster
Kayla from Kouponing Kayla
Joanne from Creative Mess
***Hollie from Blog-o-hollic***
Krystal from My Life of Travels and Adventures
Rebecca from Caravan Sonnet
Sara from You.And.Me.Are.We

Vote for your favorite and most eye-catching button by clicking on the thumbnail below. Make sure you're voting solely on eye appeal. You can only vote once, so make it count.

Check back next week for Round 2. If you're interested in participating in Season 2 of the Blog Button Design Battle, make sure you subscribe to Peacoats & Plaid for updates.

Friday, May 10, 2013

Show Me Some Love!

First thing tomorrow morning, I'll be participating in Peacoats & Plaid's Blog Button Design Battle!

It's Round #1, so Blog-O-Hollic's button (look over there >>>) will be pitted against 9 other blog buttons to see which one is cutest and most eye catching. There will be several rounds and in the end, there will be 4 overall winners. Of course, I think my button is pretty fantastic, so I'll be voting for myself.... and YOU have the opportunity to vote also!

First thing tomorrow morning, check back here for your chance to vote for the greatest, most fabulous blog button on the interwebz! (ahem. right here)

Tuesday, May 7, 2013

Day In The Life: L&D Nurse

In honor of nurse's week and L&D 1102 question and answer time, I thought it'd be fun to do a "day in the life post." It just so happens that today ended up being one of the busiest, most crazy and chaotic days I've had in quite some time.

Disclaimer: The times are a little arbitrary and I've omitted all names... you know, HIPAA and all. This is also why there are no pictures. Just use your imagination, ok? Me: hair in a ponytail, rocking some teal-colored hospital-issue scrubs. My patients in those awesome butt-baring gowns making cringe-y faces during contractions. I think you'll still get the gist of what my day was like.

Lets get started, shall we?

5:20am: Alarm goes off and I'm out of bed. I get myself dressed and ready, throw back a Spark, and have a date with my breast pump. Oh boy its early. I shouldn't have spent so much time reading Sparkly Green Earrings last night.
6:14am: In the car and on my way.
6:33am: I'm not quite to work yet, but I realize I've taken the car seat and left my cell phone. Whoops. Already off to a good start.
7:07am: Clocked in, changed clothes and hitting the floor running. My patient is 7cm dilated and is ready for an epidural. The CRNA is hanging out nearby reviewing her chart and gathering the things he needs. I get report from the off going shift and assume care of my patient. Because she is more advanced in dilation, she's the only patient I have for now. But the floor is already almost full, so that will surely change soon. Within the next few minutes, we're moving forward with her epidural placement.
7:40am: Epidural is in, foley catheter is in, and the contractions are "gone" according to my patient. Never fear, they're still there though, and she's now 9cm dilated. Her water hasn't broken yet, so I encourage her to take a quick nap until her doctor comes by. I fluff her pillows and head out to catch up on some charting. The Alexis retractor rep is on the unit and brought us all doughnuts. #winning
8:51am: My patient's doctor makes rounds, checks her cervix and she is now completely dilated!
9:09am: Her water breaks spontaneously (All on my arm. Ew.) as we begin the pushing process. For now, I'm alone with my patient and her family, but once she can push that baby to the "crowning" point, I'll call in the rest of the delivery team.
9:30am: Delivery team is called and within the next few minutes, we have a baby! The nursery attends to the baby while I attend to mom and over the next hour, I'm checking to make sure she's stable and helping her breastfeed.
10:45am: The baby is taken to the nursery and the new mama is loaded onto a stretcher. In the time between getting report and now, the floor has gone from almost full to busting at the seams. Since my patient is stable, it's time to transfer out to postpartum.
11:10am: I make it back to the unit to find I already have a new patient waiting on me. This patient came up from the emergency room and believes her water has broken. I start her admission process, which includes like a bajillion screens worth of health history, obstetrical history, and head to toe assessment. A quick cervical exam leads me to conclude that she is not in labor and her water has not broken. Unfortunately, this patient's doctor is doing a surgical procedure and so I'll wait until she's finished to give report..... which means I've got a few precious minutes of down time.
11:46am: So I use that down time to pump! I pull up my current and previous patients while I'm pumping to catch up on charting. Once I'm finished pumping, I shovel down half a sandwich and bottle of water before I see the doc walking down the hall and scurry out to give report.
12:20pm: I have another patient coming and discharge orders for my non-ruptured patient. I serve her papers and wrap up the last bits of her charting, just as my new patient rounds the corner. She's been contracting for the last few hours sitting in triage waiting for an empty room. Oh, and she wants an epidural... but so does a majority of the other patients on the unit. It's a madhouse today and we've only got one CRNA free at the time. Not only is the labor unit busy, but we also have a pretty full surgery schedule, which means we have 2 staff nurses and a CRNA rotating patients through the OR also.
13:10pm: After tucking my patient into her labor room and setting up all my supplies, I wrangle a CRNA into her room and it's epidural time. I make the mistake of comparing an epidural to a root canal (not exactly a great correlation between the two-- in fact, that's probably the most frightening thing EVER to compare an epidural to). I don't think the anesthetist will ever let me live this down, even after explaining my reasoning, but we're both laughing over my ridiculous comments. Note to self: just stick to the routine spiel. Soon thereafter, the patient can laugh at me too, because she's smiling again and her family is breathing a sigh of relief. She's 5cm dilated.
14:40pm: My new patient's doctor is making rounds and swings by to break her water. Unfortunately, the fluid is meconium stained, so I get suction set-up at the bedside and notify the nursery personnel. Regardless, my patient is comfortable, her strip looks reassuring and she's now 6cm. I fluff her pillows and fill her ice cup and hope she takes a quick nap.
15:00-17:00pm: My own patient is stable and "cruising" but the rest of the unit is hopping. Leaving my phone at home turns out to be no big deal, since I have zero time to do anything leisurely like check email or text my husband(all in non-patient care areas, of course...). Babies are popping out in almost every room. There aren't enough labor nurses or nursery nurses to keep up with what's happening, so I'm running from room to room doing whatever I can to help out. Printing paperwork, relaying messages, helping out in the OR, catching up charting, assisting with breastfeeding, transporting patients, rubbing funduses... or um, fundi? transporting babies, checking cervixes...or um, cervi? Anyway, everyone is doing the doggy paddle and we're hardly keeping our heads above water. Somewhere in the middle of all this, I'm also routinely repositioning my patient, who is now 9cm. Because most of my coworkers are delivering their patients, I'm keeping a watchful eye on two other ladies, one of which is 9cm, and the other is 10cm. We're doing a lot of delivering and a lot of laboring down around the unit. Deep breaths.
17:35pm: My patient is uncomfortable, so anesthesia gives her epidural a little extra juice. While I'm waiting for her to feel some relief, one of my coworkers gives me the green flag to take care of some business. In other words, the "girls" are feeling extra full. Surprisingly, despite the chaos, I carve out like 8 minutes to get some pumping in.
18:00pm: My patient is feeling the pressure and is 10cm dilated. Her doctor is close by, so we get the room set up for delivery and begin the pushing process (again, pushing alone until crowning). She pushes like a champion and just a few minutes before 7pm, I call the delivery team and baby arrives! #readyforshiftchange
19:17pm: I give report to the oncoming shift. It just so happens to be the nurse I got report from this morning, so we talk about our mutual patient for a minute and then I whine about how busy the day has been. I get wrangled back in to my patient's room to help her breastfeed, but I had formed a fun little bond with this new mama, so I was happy to be of assistance.
19:43pm: Licked my wounds, changed my clothes, clocked out, and in the car. My big comfy couch can't come soon enough!

Whew! We aren't quite that busy every day, but I think I can safely say that Labor & Delivery is always interesting, keeps me on my toes, allows me to use my brain, and sometimes reminds me that I can hold my bladder for 14 hours. I love delivering babies.

Monday, May 6, 2013

It's Nurse's Week!

It's Nurse's Week! Bring on the hospital-logo emblazoned umbrellas. A worthy gift for the crazy hard work days, long hours, and minimal pee breaks. I love delivering babies!

Apparently, it's also teacher appreciation week. Thanks a million for getting me to this point (couldn't do it without you), but seriously... can't you celebrate next week? You're stealing all my thunder. 

After doing a little web researching, I found that May is also:
  • Asian Pacific American Heritage Month
  • National Strawberry Month
  • National Don't Eat Cheese Before Noon Month
  • National Asparagus Month (celebrated that one last night!)
  • National Salsa Month
  • Allergy/Asthma Awareness Month
  • Older Americans Month
  • National Zombie Awareness Month

Wait, asparagus gets a whole month, but my "noble" profession only gets a week? That's baloney! (Bologna...or baloney-- if you will-- only gets a day. It's October 24th.) Also, what qualified a person as being an "older" American? I'm older than my sister Casey, does that mean I get to participate? 

Anyway, back to Nurse's Week. In the spirit of all things nurse-y, and because I actually worked full time hours last week for the first time since coming back from maternity leave (thank you low census.)...

I am bringing back the Labor & Delivery 1101 question and answer time!

[Cheers & Applause]

You know you have all sorts of questions regarding labor and delivery... so ask away! It's been almost 2 years since I last opened up the blog to all things labor related, so I guess it's time enough to do it all over again. It's like L&D 1102. Leave a comment with your question and I'll give you all the hilarious and often gory details. I can't wait to hear what you've got for me this time around!  

Check Out the L&D 1101 Question and Answer series:

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