Catching Up

"The Burning"

Sorry for the break in blogging. The last few weeks (months) have been very busy with the typical bullshit busywork that signals graduation is near. The good news is I made it. On May 20th, I will be mailed my diploma and will officially have a Bachelor's of Science in Nursing or BSN. I won't be a real live nurse until I take my boards, called the NCLEX, sometime in June (there's a bureaucratic process of paperwork and scheduling that has to take place).

 last day in this god awful uniform

The truth is I feel a little lost, as usually happens to me with such an abrupt change in routine. My first day off, I slept about 16 hours, and have slept in everyday since. I feel like I have to to make up for the 4:30am wake up calls, late nights and 8 hour days of classes. Also I think it's necessary to take advantage of these days because once I start working 12 hour nights, a common new grad shift, sleep will be a luxury.

I took this week off and allowed myself to do nothing, but it's time to start studying for the NCLEX. I don't really know where to begin though. Looking over notes, practice tests, studying over coffee. They sound like a good start until my KAPLAN prep course in early June. At the same time, I'm going to try to enjoy my "last" summer" until I start working and become a real adult.

In other news:

Mike got his Bachelor's degree in Criminal Justice (with honors), and received a departmental award. I'm so proud of him.

I got rear-ended and my car had been in the shop for 10 days. I just got it back yesterday (yay for other people's insurance!)

We tried a juice fast and decided it wasn't a good idea. Now, what to do with all that produce!


We're planning a roadtrip to Niagara Falls.


Our house has not sold. We're trying to figure out the next step.

Critical Care

I have my first critical care clinical rotation today and I'm a little nervous. It's the usual clinical nervousness that accompanies a new hospital and clinical group. But because we're spending time in the ER, I'm worried I'm gonna see some mangled car crash victim and find myself hiding on the far end of the unit until he's safely in the ICU.

But wait, I'm also gonna be in the ICU, with mangled car crash victims and other really sick people, and I'm gonna have TWO patients, and I'm going to be doing all their care, including charting and it's the 3-11 shift which is weird because I've only ever worked day jobs and the thought of "working" until 11 pm seems fundamentally wrong. Sorry, enough panicked rambling. I'm sure it'll be fine, and I'll walk away chomping at the bit to work critical care, right? Right?

Hello?

Still Here

Things have quieted down a bit around here due to my constant stream of 10 hour clinicals, exams every other week and ubiquitous busy work.

Only one semester left.

Natural Family Planning

Image copyright CycleBeads.com

Check out my contributing post on Natural Family Planning over at Sustainable Baby Steps! But be advised it contains some detailed information about fertility testing, so I know it's not everyone's cup of tea. : ) I'm glad I was able to combine writing and nursing, something I hope to do more of in the future.

More Thoughts on Labor & Delivery

This post is a follow up to the original post titled “Labor & Delivery”. I received a comment from one of my good friends, Temple, offering her thoughts from the point of view of a mother. She has provided some interesting and thought provoking information. I followed up her comment with some more information regarding the culture of childbirth in this country:

Temple wrote:

I love this post. While we've talked about this many times, it was great to see this topic carefully and fully laid out.

I would like to offer an expectant mother's viewpoint. Unlike a nurse, midwife or other ob practitioners the vast majority of 1st time mothers not only know nothing about giving birth, they know less than nothing about pregnancy itself - or the enormous changes their bodies, minds, and emotions will go through. I did a lot of research before I got pregnant and during my pregnancy - still reading or hearing about it is NOTHING like the real thing.

On your 1st baby appointment, you have to get up on a table and have your innermost self examined -sometimes with a vaginal probe (uncomfortable and incredibly embarrassing).

From that point on, you have to get used to at least three different people touching you (everywhere), inserting a needle in your arm, you've got to pee in a cup, and are expected to freely discuss every aspect of your personal life: from what you eat to how you have sex. It's invasive, uncomfortable to downright painful, and can cause feelings of helplessness and anxiety. I was lucky, my ob was/is wonderful as were most of her nurses. She had midwifes and doulas on her staff - who were great about talking and taking any and all questions. They made me feel safe and comfortable. But I am well aware that my experience is the exception, not the rule.

You finally get to baby-birthday - you're excited and terrified. I had no idea what to expect and I trusted the nurses. I had been very clear what I wanted, but no one explained to me what those choices would mean in labor and delivery. In fact, no one told me what to expect at all.

I HATED the iv in my hand, the monitoring band around my belly. I didn't want an epidural but when I asked about other methods of pain control I was told that there weren't any. I was VERY upset that I was not able to walk around or sit up and bear down when it came time to push. And I couldn't b/c I didn't have any feeling in my lower body. I felt that I had been punished for wanting my pain controlled. From my discussions with other mothers, the primary worry is about pain/pain management.

With my next child it was much different. I knew what my body could and could not do; I knew how to 'firmly' articulate what I wanted and how I wanted it. I had my daughter w/ very little medical intervention. I was able to feel her moving down my body and into the world - fabulous! Labor was 3 hours (start to finish) - 4 pushes. I firmly believe that less medical intervention had a direct link.

Exectant mothers like me are in a difficult spot. In reality, the ONLY way to give birth like you're discussing is to NOT do it in a hospital. But how many 1st time mothers would/could do that? Because, in the end, we want a healthy baby and fear of something going wrong is equally up there with fear of pain.

It sounds to me that you need to either be a midwife, a doula or both. Or maybe become a consultant for Doctors who are willing to truly offer an alternative birth experience. I just wish that I had known you (now) when I was pregnant (then). Don't give up - expectant mothers need you.

Peace & Love,

Temple

Amynonymous said...

Temple,
I can understand that pregnancy and childbirth is an entirely new and scary time for not just first time mothers, but all mothers. Although I haven’t had children, I have seen the fear in mothers eyes and voices when they hear their babies heart rate is dropping. It’s true, they don’t know that their Pitocin augmentation could have caused this, or that position changes can help bring the babies heart rate back up. They only care about their baby; that they come into the world healthy and safe. Mothers truly will do anything for this. The problem with the U.S. maternity system is not with the mothers but with the culture of childbirth. When the country sees Rachel from “Friends” giving birth on her back in a hospital or Katherine Heigl scream through natural childbirth in “Knocked Up”, that is what they know. Women have had intensively medically managed births in hospitals for so long that it has become the norm, not only for patients but for providers. Women trust their providers to keep them safe and inform them about risks, benefits or alternatives. For example, I witnessed a wonderful physician tell a second time mom who had been laboring for 3 hours “let’s get you some Pitocin and get this baby out” and she said “whatever you think we should do”, in this situation, the mother trusts the doctor and trusts that a medication that is ordered is the best for her. The doctor should have asked whether the mother wanted Pitocin (because in this case there was no actual medical need), and explained the risks and benefits before asking the nurse to start it. The doctor had been on call for 55 hours, and wanted to deliver the baby so he could go home to his family. This is the norm. Mom comes in contracting, break her bag of water, labor a little more, start an epidural and Pitocin, up, up, up that Pitocin until Mom is ready to push, direct her through the pushing (count to 10 while she pushes), call the doc to catch the baby and your done. Unfortunately, physiological birth is not that streamlined and organized, and it’s hard for medical providers, who are used to controlling everything, to wait patiently through the stages of labor. Healthcare providers are not truly the problem however, many of the problems associated with medically managed births and the culture of childbirth in this country; the rigorous control, the rushing, the interventions, stems from the insurance system. The pay schedules, liability, and malpractice insurance, instituted medically managed birth and ensures that it stays that way.

In your situation, you were told there weren’t any alternatives to an epidural, and in this case I say shame on the person who wasn’t willing to inform you of alternatives. One of the nurses I followed on my rotation had a patient that was thinking about trying an unmedicated birth. The nurse explained to her that if that was the way she would like to do it that there were many ways to help labor progress and to manage the pain, and she would help her the whole way.

I have to disagree that the ONLY way to give birth the way I described was to NOT do it in a hospital. Even the hospital I rotated through, with its 95% epidural and Pitocin rates, had natural births. Specifically one “hippie” doctor helped a women give birth unmedicated while squatting on the floor in her hospital room. It's about finding the provider that will work with you.

Lastly, I will say that the resources for realistic information about birth, hospital or otherwise, is out there. There are plenty of wonderful websites, blogs and books that provide this type of information. Not the “What to Expect When You’re Expecting” variety but the information for women to research the risks, benefits and alternatives to the “normal” hospital birth. Yes I’m in nursing school, but a lot of the information that has shaped my opinions and view about childbirth were entirely outside of my nursing education.

I'd love to hear more thoughts on the subject.

Labor & Delivery

For the past few years I have been reading books and blogs immersing myself in the world of natural childbirth. It seems like the right fit for my profession, working with women who share my views and opinions on not just natural childbirth, but natural living. At this point, I'm sure people are already tired of hearing the benefits of co sleeping, babywearing and cloth diapering. So, as you could expect, I went into my labor and delivery clinical rotation with anticipation. I knew hospital birth was more medical; a lot of epidurals and continuous monitoring with maybe a few unmedicated births, maybe some women laboring in the whirlpools, which were in every room, or pushing in positions other than on their back. My expectations seem so naive in retrospect. 95% of women had epidurals, and/or narcotics or came in pushing and didn't have a choice. It's not that there is a problem with epidurals or other types of pain relief. The problem is that women are not being educated or supported in other forms of pain management or really explained the risk factors of different types of pain medications. Similarly, every patient that I or my fellow students attended had Pitocin, with a nurse confirming the "pit" rate probably equaling the epidural rate at 95% and being "upped" at the maxiumum frequency of every 15 minutes, causing contractions so much more intense that an epidural is almost a requirement. Every woman had monitors wrapped around her belly, an epidurals in her back, a catheter in her bladder, an IVs in her forearm, a pulse oximeters on her finger, and a blood pressure cuff around her arm, invariably tethered to the bed.

Birth is not a medical condition. Preeclampsia and gestational diabetes are medical conditions, and require physician intervention and more extensive monitoring. Further, medical management of birth is vital in high risk women, and c-sections can be life saving in many conditions such as placenta previa, placental abruption, cord prolapse, true cephalopelvic disproportion, and other complications, but these are rare.Women are able to give birth safely at home with a midwife, in a birth center or in a hospital without constant medical intervention, and should be informed of the risks, benefits and alternatives of such interventions.

I'm not sure what specialty I will practice in following graduation, but I'm no longer certain that I will be a labor and delivery nurse. It would be unethical as a nurse to participate in medical care that I find unnecessary or even dangerous. My only hope would be for women to take the time to research, weigh the risks and benefits and choose the type of birth and medical interventions that they are comfortable with , to not be afraid to stand up for what they feel is right, and trust their bodies.

Just in Case

I failed my most recent OB test, which is astounding to me as I'm the person reading OB books and watching birth videos for fun, and at first I thought "I'll be fine, I just have to get a 75 on my next exam for a passing average", but then I thought "there is a small chance I won't pass this course" and instead of blowing that thought off and staying positive I settled into that small chance and began to think about what would happen if things didn't go the way we planned. The thought of dropping to the traditional nursing program (I'm in an accelerated track), and graduating in 2013 is more than I can handle. Plus, with my clinical experience sort of turning me off of becoming a labor & delivery nurse (more on that later), I don't think I would do it. Yes I want to be a nurse, but I want to move to Michigan and start having children more. Maybe I could be a doula (my sister in law Kate and I could do it together), maybe I could become a lactation educator or childbirth educator. Maybe I could somehow find a way to turn this blog into a business of sorts. Thinking about this alternate path is scary and exciting at the same time and I guess, now that I'm half way through nursing school, I'm a little burned out. Nobody in my family read this and panic. I'm sure I'll pass this course (see? optimistic), but if I don't, I think it only makes sense to prepare myself for the possibilities, and be willing to let go.

image via Pinterest, original source unknown.

Happy Friday

Well, this is it. My first clinical in the hospital. After 13 weeks of theory classes, I'm finally heading to the hospital to work with patients. I'm nervous. Not to mention, I have a math test this evening. These last few weeks of school are going to be really busy, with 7 tests, 4 clinicals and a patient care plan to be completed in the three weeks before the end of the semester. But it'll be alright, I'm still just taking it one week at a time until I get a month break from my nursing program. To give me a little reprieve this weekend, I'm grabbing Olive and heading up north a ways for Jingle Paws. Yeah, I'm that person who brings their dog to such events. Hey, it gets me away from homework and studying and Olive a break from pouting while I do said studying. Anyway, I hope everyone has a wonderful weekend. Any fun plans? Any end of semester homework? Or are you planning on spending this weekend decorating for the holidays? Leave a comment and let me know...

Summer Farewell

I've been feeling a bit melancholy about the inevitable end of summer. Today is the first day of classes for my 21 month, accelerated nursing program. In the past I preferred Autumn over summer, but now saying goodbye to summer feels like I'm saying goodbye to my "youth" instead of part time jobs and carefree summers, I'm trading up for a career and working holidays. August just flew by, and I feel I did really well filling up every spare minute of my social calender. All in all, I have to say that this has been one of the best summers that I can remember.

At one point this summer, during our summer getaway in June, I thought about putting together a list of words to describe each day of our trip. I never completed said list but thought it would be fun to compile a list of words to describe the summer in it's entirety. Some are inside jokes, but most can be taken at face value. Here goes:

Trailer Park Boys
Fenn Valley Rosé
Deck Sprayer
Last Hurrah
Thunderstorms
Catfish
Serrano Peppers
Butter Pecan
True Blood
Life changing decisions
Mosquitoes
Campfire Chili
Air Conditioning
Lunchtime walks
UV Blue
Half Sticks
Detox
Eclipse
Kiddie Pool
The Lonely Walk
S'Mores
Tarp City
Farmers Market
Beer Steins
Power Outages
Puppy Play dates
Guacamole
Summer Shandy
Twelfth Night

Hey, we still have Labor Day weekend...

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Falling into place

Everything is finally falling into place. After a 5 1/2 year bachelor's degree and numerous changes about my future; from fashion merchandising (I don't know) to nursing, to physician assistant, to doctor, back to PA, back to nursing, back to PA and finally settling back on nursing.

I really wanted to be a PA, it seemed that they had all the benefits of being a physician with none of the drawbacks. They weren't on call (false) , they didn't have malpractice insurance (some do) they could choose to work part-time, school was only two years and half the price, all while maintaining autonomy. The truth of the matter is that PAs work long hours, are on call, and sometime male PAs are hired over females because they weren't going to go on maternity leave (which I'm pretty sure is illegal by the way). Also, now that I work on the back end of medicine doing referrals for a large medical group, I've become a bit disenchanted with the whole managed care, bureaucratic bullshit end of medicine. Additionally, getting in to PA school is no easy task. I really only had one option and I put everything into that one school. I worked as a PT tech for patient experience, I joined all the honor's societies at school, I maintained a 3.8 throughout college. I thought I had everything they could want, but apparently I did not. When I didn't get accepted, I was devastated. I had been planning on being a PA (waffling a little) for the past three years. I took all the prerequisite coursework, I even choose a degree path that would allow me to finish sooner, I didn't see myself doing anything else. I didn't want to do anything else. I had worked so hard for this one career. See my problem was that I just wanted to get everything done before we started having kids, because ultimately that's the job I really want.

Since I decided to go into medicine I knew I wanted to do obstetrics and gynecology. No matter what specific profession I was doing I wanted to work in women's health. Although I'm still not planning on having kids until after I start my career, I already look online at baby gear and clothing and other baby paraphenalia. During one of my many sessions meandering around the internet I came across a blog about one man's story about the building of his family. He was a freelance writer and photography and spook candidly about his wife's pregnancy. From his site I came across numerous blogs about pregnancy and childbirth and attachment parenting. Each site offering different experience and resources. On a couple of these blogs I found a recommendation for a book on childbirth: Pushed. I read it and it seemed to confirm in me something that was there all along. I wanted to work in obstetrics and I was going to become a midwife. It was one of the only times that I can remember just feeling it was the right decision. Once that decision was made everything fell into place. I withdrew my application from the PA program and found an accelerated, 18 month nursing program for students who already had a bachelor's degree. Although I had to take an entrance exam and be put on the waitlist, I rocked the exam scoring in the 90% on both sections (not like the GRE, yikes) and got through the waitlist to reserve a spot in the program for the Fall of 2010. Now I just have to finish my prereqs and get through the program. I know there is still bureaucratic bullshit in nursing but I also know that I can be there for the patient, to support and advocate for them, and some day, after I get my CNM, help them bring their babies into the world.