"1,2,3,4,5.....

6,7,8,9,10...BIG BREATH! And again!" If you had walked thru the L&D unit two Saturdays ago this is what you would have heard myself and a nursing trainee saying for a good hour as we coached a mom through her delivery!

It was our final day of OB clinical. While I was mentally "checked out" of class, I was excited for clinical since I was in L&D and desperately wanted to assist in a delivery. At pre-conference, Vanessa and I joked about how it would be our luck that no one would deliver again on our shift. But we were wrong! We both were assigned to laboring moms and one of the most incredible days began!

I was assigned to an interesting case. Our laboring mom was considered high risk for multiple reasons. First being she was AMA...advanced maternal age.This was their third time with in vitro, the first two ended in a miscarriage, and they were now preparing to deliver a baby girl. During pregnancy she developed Idiopathic Thrombocytopenic Purpura, a clotting/bleeding disorder where the body has low platelets and blood is unable to clot. She was a high risk for hemorrhaging during and after delivery. Because of her platelet disorder she was not allowed an epidural. Her only choice was a natural birth and I have never seen someone handle one so well. She had a doula. That's all I will say about that. I do have stories & I could go on, but the main point I will say is a doula should not be in the hospital because overstepping a doctor who is trying to save two lives is just not going to go over well!

This mom did fabulous! She was prepared and breathed through the contractions perfectly. It really showed me that a natural labor is possible. My mom did 4 naturally and I always thought she was crazy until now! I've learned that labor is about being a team & your teammate needs to be tuned in on distraction techniques as well as working you through each contraction. As long as you have control of the pain, breathing, and contraction, an epidural free delivery is not a bad idea....this mom proved that! The baby took a long time to come out from under her pelvic bone....over an hour to be exact. I can't imagine the pressure she felt as the head was crammed under the bone. But she managed to crack jokes and smile during it all! The delivery room was full since UCI is a teaching hospital. Therefore, an intern, third year resident, and an attending were assigned to the case. An RN, myself, and a RN trainee were also involved along with the scrub tech to set up the sterile environment. 

With each push the resident and attending were watching the monitor of the baby's heart rate and how it was reacting to each contraction. After pushing for so long the baby was not tolerating labor well at all. In fact, the heart rate was so dangerously low that if she had been already born and had a herat rate of that, CPR would have been performed. It was interesting watching the attending and resident communicate with no words as to not alarm the mom. The NICU team was called because they knew the baby was going to be born in distress. The neonatologist and RN came in an instant. Finally, a sweet little girl was delivered. I have no shame in admitting that tears were streaming down my face during this time. It is such a magical experience and completely overwhelming....and it wasn't even my child! She was born blue....central cyanosis....meaning that the blood oxygenation to her little lungs was really bad as well as in all her vessels. She was whisked to the NICU team before the mom could notice she was blue as it's better to keep the mom out of the loop that something is that wrong until the mom is stable. The doctors went to work quickly to birth the placenta and stitch her up because they were worried about her bleeding out. The baby was put on oxygen and was revived by the NICU team. It was incredible to watch them work. They took this limp, lifeless, blue baby who needed much more than a pat on the back and saved her. Yes, more tears. Watching her be placed on her moms chest, than into her dad's arms was emotional for all as the staff knew how long they had been waiting for their sweet girl. I took pictures of the dad as he proudly cut the cord. 

What a day! It was a great last OB clinical. A experience unlike any other. I will carry that day with me forever! I am so thankful for the opportunity to have trained at UCI and been taught by sch incredible physicians and nurses. 

Hmmmmm, labor and delivery.....will you be my specialty?!!?

Labor and Delivery

Last Saturday I was assigned to the Labor and Delivery unit at UCI. Excited? Yes, extremely! I woke up ready to assist with some deliveries. Vanessa and I had joked that when it was our turn to be in L&D, there would be no births. I didn't think it would actually come true!
 
After being assigned to our nurses we were informed about the patient load only to be surprised to hear that every labor room was filled along with the OBER and the recovery rooms held laboring moms. I was assigned to a great nurse, Linda. She briefed me on our patient and we headed into the room. Our patient was an `18 year old primigravida mom....meaning it was her first pregnancy. She had a history of PIH, pregnancy induced hypertension, and was on a magsulfate drip. While Mag prevents her from having a seizure, it slows contractions as well as there is a potential for toxicity. Her deep tendon reflexes, respiratory rate, and urine output needed to be monitored frequently. She was on a pitocin drip that we increased every hour. While her membranes had been ruptured for hours, her labor was very slow to progress. 

Linda wanted to make sure I saw a epidural so she sent me to the recovery room where a laboring mom was patiently waiting for hers. I was instructed to hold the mom in my arms during the insertion. Her anxiety spiked as she watched the anesthesiologist set up his sterile field. He was an intern and his attending was there to supervise. After trying the first insertion it was not in the right location. So, he tried again on the opposite side of the spinal cord. I got a little light headed but it ended up being ok!

Reading a fetal heart monitor and contraction strip is new to me. Linda sat down with me and broke it down. She was a great teacher and I learned alot from her that day. By the end of the day not one of the patients had advanced in their labor. Seriously?! Yes, no lying here. Go figure it would happen on my day! But I did get to help my patient as she went through her epidural. Although this time I had to hold the fetal monitor on her belly while she was hunched over on the side of the bed. There I was for 20 minutes in a squatting position with my hand holding the monitor on her belly. Needless to say  my hand fell asleep and it was numb up to my shoulder!

Although I did not actually see a birth that day, I walked away with more knowledge than I had learned in lecture that week! That is the best part about UCI being a teaching hospital. Vanessa and I will be back in L&D next Saturday.....pray we can see one birth!!!

Post Partum

For clinical two weeks ago I was placed in the Post Partum unit. I really didn't know what to expect but I figured I probably would not be doing much. I was wrong. It was a wonderful day and I wished I could have stayed even longer. 

Vanessa and I were both assigned great nurses to work with. L & D was busy that day and as we were arriving two babies were just about to be born. Meaning......new admins in post partum! My first patient was in the antepartum unit, considered a high risk pregnancy. She was only 28 weeks prego but her amniotic sac, "her water", broke at 22 weeks. Because of this she will have to stay in the hospital until the baby is born. She is bedridden and has non-stress tests performed daily to make sure the baby will be able to handle labor. Because her membranes ruptured prematurely she is at a high risk for infection and will be treated with antibiotics. She was an absolute doll. She was young, probably my age or a year or so older, and had an 18 month old who came to visit. I can't imagine what it is like for her to be cooped up in a hospital room with a toddler and husband at home.

Another patient I worked with was s/p c-section and ready to have her staples taken out. You can only bet Vanessa and I jumped to take them out. Neither of us had ever removed staples before but it was incredible to say the least! We each did half of the removing and half of applying steri strips. Our instructor made fun of us for treating it as artwork since we were making sure each steri strip was the same width apart, same height, and perfectly smooth. What can I say, sometimes these anal tendencies come out! The new mom let me snuggle her baby boy and he was just too cute for words. Did I ever snuggle him! She wanted to shower so I sat in her room and rocked her baby so she could freshen up. Yes, I was in heaven.

 Throughout the day I performed multiple newborn assessments....checking reflexes, fontanels, heart sounds, suture lines, hip placement, and more. It was such a blessing working with these sweet lil lives and the excited new parents. I snuggled, rocked, and soothed newborns. I talked with new moms and comforted their concerns. It was an absolute joy to work in this unit and I love love love being around babies! 




To others, that day was just another day of class, but to me it was a treasured gift. I can't wait to be in the labor and delivery ward this Saturday!

 

A day in the NICU

   


This term, I am in an OB clinical as well as med-surg. For our OB rotation we are at UCI medical center and it is GORGEOUS to say the least! Have you seen the "Grey's Anatomy" episode where they find the Dermatology unit and are so in awe of how peaceful it is? Well, the lobby of UCI is identical to it. I want to take a magazine on my day off, grab a latte, and just relax. During OB clinical, we spend each day in a different unit. I started out in the NICU with my friend Vanessa. I fell in love at first visit. 

          




         NICU is like walking into a whole different world of medicine. It is highly specialized and an average nurse cannot float to the unit. Everything is small. I know, sounds funny, but I am used to dealing with "large" tubes, large people, and a completely different environment.  At first glance, it seems to be a room full or tubes and machines that are so foreign but when taking a closer look they all start to make sense. 

I had a fantastic nurse, Jen, to work with. She was a great teacher and thought out loud the whole day so I would learn. I wasn't able to do much but she kept me as involved as possible. We had two babies for the day and she did an assessment on one, than had me do the other. We gave meds, changed diapers, fed through a bottle and oral gavage, and loved those lil premis.  

My niece, Zoey, was in the NICU when she was born. While she wasn't as critical as most of the babies there, I did get a feel for the unit at the time and I remember loving it than as well. 




I really fell in love with the NICU. My heart tells me that working in pediatric oncology is where I am supposed to be but I've never been in the unit, so I realy have no idea what it is like. However, should that not end up being in the Lord's plan for my nursing career, I pray that a door into the NICU would open up because I think I could make a huge difference there. My cousin, Rochelle, and I had a long talk about nursing, the NICU, and oncology. She is one of few who doesn't think I'm crazy when I say oncology is my passion, instead she replies with " I totally see you there." We were talking about how in the NICU and Onc units you become a huge part of the patient's stories because you build relationships and you don't just see them one day to have them discharged the next. I think that is one of the big reasons nursing is for me. I want that relationship with my patient's. I want to be their advocates, their teacher, a counselor to them or to the family, a listening ear, smile, or gentle touch, and a caregiver. I'm not sure where I will end up next February, but I am very excited to step into this role.