Sunday, April 4, 2010

A good day

     During my last shift on the L+D unit I attended the birth of a couple who chose to birth without medications. They had taken a 12 week series of childbirth classes and were working with midwives. The patient and her husband arrived early in the morning after several days of laboring at home. She was 7 centimeters. The few hours I spent with them were wonderful.
    I got to integrate my doula skills with my nursing skills and provide direct care to the patient and her husband. He was wonderful, supportive and present. The midwife was calm and unobtrusive. My preceptor and I worked well together. She allowed me to do what I could do, checked in with me periodically, and took on the roll of "baby" nurse when the baby was born.
    My patient spent some time in the birth tub during her labor. I used a doppler to listen to her baby's heart tones and used my hands to palpate her contractions. I performed a few cervical exams to check her dilation. She had the urge to push for quite awhile, while she still had a bit of cervix left. Not too long after I performed an exam my patient was saying she had to push so I asked the midwife to come in and check her, with the patients consent of course. The midwife examined her and and her exam was the same as mine. This was very validating for me!
    You may or may not know that cervical exams are very subjective. Women's cervixes do not dilate in perfectly concentric circles, care providers and nurses have different sized hands, perform exams differently, and have different interpretations of 0-10cm. Baby's do not apply the same kind of pressure, in the same spots, and cervix's can feel different from exam to exam, actually when a woman is in labor you hope that they feel different, change is good, but it can be tricky when you have multiple examiners. (The topic of the necessity, or not, of cervical exams is for another day!)
  That being said, as a new nurse, and a new cervical "examiner" it is helpful for me to know my exams are "accurate", although accurate may not be the right word. So the few times I have had providers do a check after me I have been glad to know they come up with the same results as me.
    It was a great birth, a great way to start the day. Things went well for the patient, her baby, and her husband. They were happy, glowing, and exhausted. They kept telling me what a wonderful nurse I was!
   So wonderful! How gratifying and validating. I made a difference for them. They had the birth experience they wanted, in fact, at one point, she told me her experience in the hospital was better than she had hoped for! How amazing is that!
    It was a good day!

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