Sunday, February 28, 2010

New Nurse Education

This past week I attended several education classes for my new job.
Two were designed to familiarize me with a couple of the computer systems used throughout the hospital.
I have to say, the hospital I will be working at is not techonoligcally advanced in the least, as far as computer tech goes anyway.
There are several computer systems, with many over lapping elements, and the charting is pretty all over the place. The majority of charting is still "paper" charting, with a goal of moving to fully computerized charting within the next several years. But there are several elements that need to be charted via the computer and in the paper chart. Plus, all prescription orders are still done via paper, which leaves a huge margin for error. And guess whose responsible for clarifying the order, making sure it's appropriate for the patient, asking the Dr. to change it if necessary, administering it to the patient (or not), and being responsible for it all????
   No, not the Dr.... The Nurse of course!!!
 This is one of the most anxiety provoking elements of nursing for me, the drug administration. The chances of harming a patient are so large. Medication errors happen all of the time, especially when hand written orders are used! I am confidant I can be a safe clinician, and I know my heightened awareness will benefit me, but I am also not naive enough to believe I will never make a mistake, and that scares the beejeebees out of me!

Anyway, the other two days of my week were spent in Perinatal Nursing classes. Much of the information was familiar to me, thanks to my doula background and my lust for learning.
What interested me the most were the attitudes and perspectives of the other nurses taking the classes and the presenters themselves.These classes are designed for nurses who are new to labor and delivery/OB. Many of my classmates have been nurses in other areas, only a couple of us are new, new nurses.
The presenters are all experienced OB nurses. One of them especially peaked my interest. She is especially interested in High Risk Labor and Delivery and started her lecture the first day by saying something to the effect of,
                         "Now I know you'll all hear that birth is a normal, natural thing, and it is, but I'm here to tell 
                          you that at any moment anything can go wrong!"

Now remember, most of those taking the classes do not have much, if any, experience with birth or laboring women... way to scare everybody! And what a bias to place on birth.
  So I listened to the rest of her lecture that day understanding she may be coming from a particulary biased perspective.
  Then, on the second day, she lectured on intrapartum nursing, and demonstrated ways to support women through labor. She advocated for keeping women out of the bed as much as possible, suggesting admitting laboring women "into the rocking chair, rather than into the bed".  She discussed the importance of staying with the laboring woman rather than watching the monitors from the nursing station.   What an interesting combination of perspectives this woman is turning out to have!
I have several more classes to attend with her and am interested to see what and how she presents next. I am beginning to admire and respect her and believe she will be a great assest to me as I move forward in my nursing career.

Thursday, February 18, 2010

Working Woman

      I started my job yesterday. Arriving at the hospital in the morning I began the day by filling out paperwork and providing documentation to HR. One of the employee health nurses went over my vaccination records and I ended up needing to have a rubella titer drawn. I'll also have to undergo two TB tests over the next four weeks. No big deal.
      Next I went up to the Family Birth Center and met with the unit educator. She provided me with a ton of paperwork, to be filled out throughout my residency period, which will be about 12 weeks, as well as a book on Intrapartum Nursing, We went over my schedule, including several days of classes, hospital orientation, and unit orientation with preceptors. I will spend about six weeks working on the mother/baby unit, with postpartum moms and newborn babies, then I will move on to the labor and delivery unit!
     After meeting with the educator, I spent the next few hours reading through self learning modules and filling out written "tests". There were topics such as Infant Abduction, Magnesium Sulfate, Pitocin, Breastfeeding, etc. All things I am familiar with and excited to learn more about!
    I feel so lucky to be paid to do what I love. To start out attending classes, learning more, reading about topics I'm interested in. I am a blessed woman! I am a woman with a job, a paid job! It's been a long time coming. I can hardly believe I've reached this point in my life, that all I've done so far has led me to this point. That myself and my family made it through the trials and tribulations of my education and insanity to this place of my getting to do more of what I love!
   There is  more to come of course. I still plan on obtaining my Masters degree and becoming a midwife, but for now nursing is where it's at, is where I'm at, and I am so EXCITED!!!

Friday, February 12, 2010


     Okay, so I know not everyone is interested in evidence based practice. I also know that most people aren't aware of all of the "evidence" that is out there. Who has time to look it all up? Do all the research? And then integrate the information into how we live our lives?
     Evidence based practice is a whole string of blogs yet to be tackled, for now I am thinking about the evidence our children are presenting to us everyday.
     ADHD, ADD, food allergies, obesity, behavioral issues, mental health diagnoses', children commiting violent acts, suicidal two year olds... I hate to state the obvious but....
     Something is wrong here!!!!
    There are many many issues at play here. A million and one theories, tons of therapies, medications, treatments.
   I have a question. What would the world be like if we paid attention to our children from the beginning, from conception, from preconception?
   For those who look to science for proof, etc. there is a growing body of "evidence" indicating that what happens to babys in the womb effects them throughout there lives, even that what their moms experience prior to their conception effects them.
   For me it seems obvious. Duh!
   We know emotions have chemical and physical manifestations. We know mom's hormones mix with baby's, they share the same blood!
     Everything that "happens" in the womb effects the baby, that's where they are formed! Where their brains, hearts, and integrated systems are created! The chemical structure of their nervous systems founded. Of course their environments have an effect!!  And why wouldn't this effect them for the rest of their lives, it's their body after all, that stays with them!
  People are amazing, bodies are amazing. People are adaptable, maleable, their capacity to withstand trauma, to grow, to flourish, to live thru incredible experiences despite incredible defecits is hardly believable. We are truly miracles, each and every one of us.
   Yet I can't help but imagine the possibilities. If every baby was wanted, loved, adored, and respected prior to conception....
              There is a tribe in Africa where the birth date of a child is counted not from when they've been born,  
              nor  from when they are conceived but from the day that the child was a thought in its mother's mind.
             And when a woman decides that she will have a child, she goes off and sits under a tree, by herself,   
             and she listens until she can hear the song of the child that wants to come. And after she's heard the  
             song of this child, she comes back to the man who will be the child's father, and teaches it to him. And
             then, when they make love to physically conceive the child, some of that time they sing the song of the
             child, as a way to invite it.
             And then, when the mother is pregnant, the mother teaches that child's song to the midwives and the
            old  women of the village, so that when the child is born, the old women and the people around her
              sing  the child's song to welcome it. And then, as the child grows up, the other villagers are taught the 
             child's song. If the child falls, or hurts its knee, someone picks it up and sings its song to it. Or perhaps
             the child does something wonderful, or goes through the rites of puberty, then as a way of honoring this
             person, the people of the village sing his or her song.
            And it goes this way through their life. In marriage, the songs are sung, together. And finally, when this  
            child is lying in bed, ready to die, all the villagers know his or her song, and they sing--for the last time--
            the song to that person.

   "You may say I'm a dreamer, but I'm not the only one. I hope some day you'll join us, and the world will be as one" - John Lennon "Imagine"


Monday, February 8, 2010

Consider this......

You are about to have sex with your partner...

You have to choose someone to watch...

Who will it be?

Birthing a baby is one of the most intimate experiences of your life, much like having sex.

Who will you allow to share this intimate experience with you?

Think about it!

2010 REACHE conference

The topic for this years REACHE conference is:
"Changing Birth Practices: From the Inside Out and the Outside In"
Several speakers will present topics such as:
  • Tools for changing standards of practice
  • using social media to present evidence based information
  • synthesizing conference information and bringing to your work
  • and a panel of Nurse Managers discussing changing practice on the labor and delivery floor
For more info visit:

Thursday, February 4, 2010

In The Beginning... Continued....

    I was closely monitored during my first pregnancy. I had frequent appointments with my OB, the diabetes educator, and later, when I developed hypertension, I became part of a study, which increased the number of visits I had, as well as the number of caregivers and number of lab draws, diagnostic testing, and worries.
    Honestly, I think my naivete reduced my worry. I don't even remember if N and I attended childbirth classes. I do remember that I knew very little about pregnancy and birth, and that I did not know enough to question many of the "routine" tests, etc. that I was subjected to. I did know that I wanted to be as healthy as I could for my baby, and I did a better job of managing my diabetes during my pregnancies than I have at any other time in my life so far!
    I wanted to have a natural childbirth. I did not want to subject my baby to unnecessary interventions or drugs. I wanted to breastfeed, to care for my baby on my own terms, but I did not have as many tools then as I do now. I was young, underprivaleged, and treated as though I didn't know anything, and mostly as if I was not to be trusted with my own body.
    At my 37 week appointment, on Friday, April 14, 1995, I was diagnosed with preeclampia ( I don't recall how my doctor explained it to me, whether or not I was offered any "choices" regarding how to proceed, but I do remember the interventions started with an amniocentesis to determine if my baby's lungs were mature. (
     The test came back, determining my baby would likely be able to breathe on her own, so my doctor proceded with an "emergency" induction. I was in a tiny room by myself, lying in bed, bored out of my mind, anxious, scared, and stunned, like a deer caught in the headlights. N made it as soon as he could, and I remember my friend and her husband stopping by to visit. It was a very long process. I was given a cervical ripening agent, though I don't recall which one. (  (
    Late Friday evening I was started on a pitocin drip, (, ), and on Magnesium sulfate (, ).
 I don't recall either of these drugs being thouroughly presented to me, in terms of indications, possible side effects, or even what they were intended to do. Nevertheless I received them.
   I do not recall when my contractions began. I do remember I maintained a sense of humor and the ability to communicate with those around me for hours. I also remember wishing I could sleep before active labor began, but being distrubed by the nurses every hour for vital signs checks, blood sugar checks, etc. To this day I believe my labor would have progressed differently if I had been allowed to sleep that night, but that's not the way it happened.
   I  continued to labor without pain medications, despite the pitocin, mag. sulfate, and immobility ( I was not allowed to get out of bed. I had an IV in each wrist, a baby monitor, and a contraction monitor attached to me). Sometime on Saturday my labor had progressed to a point that my doctors wanted to break my water to help "speed things along". I was at a teaching hospital so I had several residents, interns, fellows, and other types of doctors visiting me and directing my care throughout the day. I only saw my OB for a few moments on Saturday morning.
    As soon as my water was broken my pain increased beyond my ability to tolerate it. I requested an epidural block be placed. ( I was given a very strong epidural, so that I could not move my legs on my own and I felt very little pressure with the contractions.
      Sometime around noon it was time for me to push. I only knew this becuase I had been told by the doctor who had examined my cervix and found it to be completely dilated. So I began pushing. I was already exhausted from getting no sleep, the anxiety of an unexpected induction, laboring for hours and hours, and not having any significant calorie intake in over 24 hours. I was put on oxygen as I, and my baby, became more and more tired.
   So I pushed, and pushed, and pushed. Not very effectively if the comments I received from the careproviders were any indication. (Of course I couldn't push effectively when I was exhausted and couldn't feel anything!!) One resident in particular was very aggressive in the way she spoke to me, basically threatening me with a cesarean  (,%20   if I didn't get to work and push more effectively.
   I know now I was lucky in having a vaginal birth. It was a very different birth culture when my daughter was born. If the same situation were to happen today I'm confidant I would have had a cesarean for her birth.
   After nearly four hours of pushing (unheard of today), I was exhausted (of course), my baby was showing increasing signs of  distress and exhaustion, and it was decided that I needed help getting the baby out. I was given an episitomy ( and forceps ( were used to pull my baby down, through my bony pelvis, through my vagina, and out into the world. As her head emerged, my episotomy tore, leaving me with a fourth degree pelvic floor injury. (, ). There were no less than 15 people in the small hospital room when my daughter was born. Students, interns, residents, fellows, maybe on offical OB, nurses, and some friends and family. Like I mentioned before, it was a teaching hospital, and what an interesting "case" I was!
   N, was horrified when our daughter emerged. He remembers her being blue, almost purple, and floppy. She did not cry for a few minutes and he believed her to be dead. I was so exhausted and overwhelmed I don't remember feeling anything for several minutes after her birth.
   My pelvic floor repair was performed by an intern, who did not know what he was doing, and I suffered from the effects until just this year when I had a pelvic floor repair surgery performed. The repair took nearly two hours, during which time my baby was taken from me, given oxygen, suctioned repeatedly, scrubbed and rubbed with roughness and force. And worse of all, for me, she was given a bottle of sugar water when I specifically told the nurse I did not want her to have a bottle. I wanted to breastfeed her.
  This was particulary disturbing to me, and still is, because it was one of the few times, if not the only time, during that birth experience, when I spoke up for myself and my baby. And I was ignored. How infuriating!
    I don't remember how long it took for me to have my baby placed in my arms, but it felt like an eternity. She was red and her face was bruised. When she cried she turned almost purple. My mom said she looked like a "beefsteak tomato".    N and I stared at her with awe and such incredible joy and love. Truly amazing!
     She and I had a difficult time establishing breastfeeding. I could not even see her clearly for the first 24 hours of her life due to the side effect of blurry vision that magnesium sulfate had so generously provided. It took months for my pelvic floor to heal, though as I mentioned above, it never did heal properly.
  So that was my first birth experience, in a, not so small, nutshell. I experienced many interventions, many medications, many side effects, and what I consider to be traumas, and I have taken those experiences and applied them to my second birth and to my work as a birth doula, lactation educator, prenatal yoga instructor, and I will bring them to my work as a birth nurse, and, in the future, as a midwife.
   Thankfully my daughter recovered from her birth, though I know she carries the traumas she suffered deep inside her and they are unexplainable with words. But she and I have talked about it. She has watched her birth video, and I have held her, apologized to her, and rocked her while we both cried.

   My second birth was very different from my first... but I'll save that for another time.

"The Baby Whisperer" A midwife's Blog

I just discovered "The Baby Whisperer" blog this morning. From what I've read so far I am a fan!
Wanted to pass it along, share the wealth, so to speak!

Monday, February 1, 2010


       It seems as if my job search may be at an end. Nothing is set in stone of course, but today I had a a wonderful interview with the hiring manager for a Family Birth Center at a Tacoma Hospital that will be a wonderful fit for me. After two hours of talking, and meeting with two other staff members, one of whom said she was happy to meet me in person because she'd heard of me, I indicated I would love to have the job and that manager told me she would like to offer me the job.
     So from here she contacts the nursing recruiter who will contact me to provide me with an official preliminary offer, contigent upon my passing a urine drug screen, background check, and reference check. I won't receive the preliminary offer until next Tuesday when the position is officially posted, but I've been assured I will be getting the call.
      Then I will be an employed RN! Working in Mother Baby and in Labor and Delivery. My dream job for this point on my path. I feel so blessed. I can hardly wait to begin working, to begin learning, and to share what I know!