Just one this time. After two weeks of listening to everyone else in my group talk about the deliveries they've seen and how awesome a c-section is and all that cool stuff that I hadn't had the chance to see, I finally got assigned to a laboring mom.
First the history: This was her first baby and she had been in the hopsital for a very long time for a variety of reasons. Details withheld because of HIPAA, take it up with the government. She was supposed to be induced the following day, but her body decided induction didn't sound like much fun so it went into labor all by itself around 9am. When I showed up and got report she was at 3cm and had not received an pain medication. She had said that she did not want an epidural.
Shortly after I arrived, around 3pm, they did another internal check (that means the doc lubes up their fingers and sticks them in the patient's vagina to feel the cervix and the baby's head) and she was 4.5cm dilated, 90& effaced, and the baby was starting to descend into the pelvis. All good progress. Patient requested some pain meds, got an IV dose, felt much better. You could tell when the pain meds started to wear off again because the moaning got progressively louder and her grip got progressively tighter on the hand of whoever happened to be at the bedside when the contraction started.
The baby was in a posterior position, which means that its back was against the mom's back. Normally, the baby should be in an anterior position, facing mom's back, because that allows for the smallest part of the head to go through the pelvis first. When the baby is posterior, the labor pains tend to be concentrated in the lower back, all the way down to the tailbone. That's exactly what this mom was experiencing, and it didn't look like any fun. She did a really amazing job of concentrating on the breathing and rocking her hips and changing positions to try to keep the pain managable. We also tried a birthing ball, which I though looked great. It's just a regular exercise ball, but they put it in a chair-like frame, so there's a backrest. This mom didn't particularly like it , but I kinda want one for myself.
The nurse and I kept checking on her throughout the afternoon. At one point she and her husband kicked the rest of the family out of the room. Around 6pm they did another internal check and she'd progressed to 7cm dilated, 100% effaced. Fully dilated is 10cm. This was when my nurse told me that if I wanted to eat dinner I should do it now. So I did. Then came more monitoring and encouraging and checking vitals. Lots of encouragement for both the mom and the dad. She was still smiling between contractions, so that was a good sign.
Anoher internal check in a couple of hours showed her still at 7cm. The baby was starting to turn around to a more anterior position though, so something was happening. The mom was feeling more of the contraction toward the front and less in her tailbone. The contractions were also getting stronger and more frequent. Sometime around now the husband asked me if I was going to stay through the end. I told him I would if they were okay with that, and they both said, "Yes, please!" I was very happy to hear that they wanted me there. It was the first time for all of us.
Contractions continued, and the mom was obviously starting to get tired. The nurse mentioned that it was not too late to get an epidural, and discovered that the mom's reason for not wanting one was fear of a needle being put into her spine. But she was tired, and in a lot of pain, and said the anesthesiologist could come talk to her about it. So he did, and she decided that she wanted to go ahead with it. Now, having an epidural put in normally is not a whole lot of fun. Having an epidural put in when you're in labor with contractions every 3-4 minutes is downright miserable. We had her sitting on the edge of the bed propped up on both me and the nurse. The husband had to leave the room because he has a problem with needles. It took them four tries and nearly an hour to get the epidural in place and I think that was by far the worst hour of her entire labor.
When the placed the epidural the also gave her a spinal block for immediate relief. Unfortunately that also completely numbed her from the waist down. So we stuck her back into bed, covered her in warm blankets and left her alone to try to rest. She couldn't feel her contractions at all any more. They were happening, because we could see them with an external monitor, but she felt nothing.
More time passed, she was still numb, but the contractions were still going. Around 10pm, the doc did another internal check. This time she was fully dilated and there was already a head in the birth canal. We asked her if she felt like pushing and she said no, so we just left her alone. Contractions were still coming and we checked on her every 5 minutes or so. In about a half hour she said that she could feel some pressure, although no urge to push. So we had her push anyway. That nurses description of it was to, "Push like you're trying to poop out a watermelon." So she did, and it worked, even though she couldn't feel a thing.
After about 3 contractions worth of pushing I could see the baby's head. That's when we called for the docs to come in. They did, and set up all the stuff for delivery. I pulled out her foley, the docs got themselves ready, the husband was trying not to look, and the nurses were preparing the crib for the baby. It took less than a half hour of pushing for the head to come out and then one more push and the whole body followed. The baby was an adorable little girl (parents didn't know ahead of time), wrinkly and blue until she cried and magically turned bright pink. She was small, only about 5lbs, but she was a few weeks preterm, so it was to be expected.
As soon as she came out there was a flurry of activity. They cut the cord, handed the baby off to the NICU nurses, who did a quick assessment, Apgars, and got her warmed up. In the meantime the docs were massaging the mom's uterus to get the placenta out. It came out in about 5 minutes after the baby. The docs also saved the cord blood and the cord itself for research and the placenta looked a little funky so they saved it to be sent to pathology. It was about 15 minutes from the time of delivery until the mom actually got to see and hold her little girl. Then she got to hold her for only a few minutes before the baby got whisked off to the NICU. There wasn't anything wrong with her, she was just a little bit preterm so she had to go for observation for at least 6 hours. Mom couldn't go with her because she still couldn't move from the epidural.
There were many rounds of congratulations and hugs and then the docs left as quickly as they had arrived (I think they were in the room for less than an hour). I then helped get the mom more comfortable in bed and cleaned up. Both mom and dad thanked me again for staying, and I thanked them for letting me stay. It was quite an amazing experience. I got home about 2 hours later than usual from clinical, but it was well worth staying late.
Friday, January 30, 2009
Sunday, January 25, 2009
Babies, experiments, and running
And I'm still bored. Although there are stirrings of projects happening in my house. Oh yeah, and babies. Let's start with babies.
I got to hang out in the newborn nursery this week in clinical. Not a lot happens there, but when it does happen it all involves babies, so I'm cool with that. I got to feed babies, and swaddle babies, and do physical exams on babies, and take baby vital signs, etc. I also saw a baby with a huge conehead because she just wouldn't fit when on her way out the usual way, so they had to do a c-section and pull her back up and out. Fun, huh? There was another baby that looked like she was at a tanning salon because she got to lie underneath special lights that help reduce jaundice with a cute little face mask on. Oh, and there was a baby who was withdrawing from methadone because her mom is in the methadone treatment program. I felt really bad for this little girl, but she seemed like she's doing okay with it. Overall, babies are adorable and I love playing with them.
Okay, on to projects. Jess and I both want to lose weight. Not a ton of weight, but about 10 stubborn pounds that won't go away. Also, I seem to have developed some problems with glucose regulation. Evidence of this includes nearly passing out in clinical and while shadowing Dr. Meyers (I was fine after eating some food and I'm nearly positive that it was hypoglycemia and not blood-pressure related.) Further evidence is that fact that every time I go to the gym, unless I eat a LOT (way more than is reasonable for the kind of workouts I'm doing) immediately after getting home, I end up falling asleep for about 2 hours and then spend the res of the irritable and fatigued. This is annoying and inconvenient and I want to make it stop. So, with this in mind, we are going to change the way our house eats. Jordan is always excited for experiments and is willing to change how he eats to in order to study us :)
The plan is to switch to a low glycemic index diet. If you don't know about the glycemic index, read this. Basically, it means foods that provide a stable level of glucose in the blood instead of lots of peaks and valleys. Starting on February 1st we're going to take all the stuff in the house that does not qualify as low GI and stick them in a cupboard out of sight and then try to eat only low GI foods for the rest of the month and see what happens. I've also bought a glucose meter on eBay so me can get some real quantitative measures of how well this is working. I'm hoping it'll arrive sometime this week so we can all get a baseline reading of how we're doing and then see how it changes. Jess is having a fabulous time in the kitchen experimenting with low sugar and low GI recipes and so far they taste pretty good. The baseline rules are pretty simple: No foods with sugar (or high fructose corn syrup, or honey, or other sweeteners like that) in the ingredients list, and no white starches (basically no refined flour, white rice, or potatoes). This is going to be a very interesting experiment and I'm hoping it will have a good effect on both my mood and my energy level, since both have been pretty low lately.
Oh, and have I mentioned that Jordan eBayed an EEG machine? We're going to measure our brain waves. It's going to be awesome. You may be tempted to ask why, but the only answer you will get is that we think it's cool. Yeah, we're dorks.
I updated on my other blog about the Couch to 5K running plan I'm doing a while ago, but I think I'm just going to update more about it here, because I'm lazy and this isn't really cycling related at all. I've finished the first week and the first day of week 2. So far things are going well, and the workouts are getting progressively easier. The weird part is how my knee is reacting to all this new stress. I expected swelling, aching, soreness, all the usual stuff when I ask it to do something new. Instead, I'm getting this strange kind of soreness where the entire area around where the screws are feels like a gigantic bruise. It feels like someone hit that spot with a hammer, but there's no external sign of bruising except for some minor swelling. The actual joint is also mildly swollen, and a little bit achy, but not nearly as bad as I thought it would get. My theory about the bruised feeling is that I'm putting stress on the spot where the bits of bone are connected and the screws enter in a completely new way and so I'm temporarily weakening that connection and my body will respond by laying down more bone. But, in the meantime, that area is inflamed, and there is likely some internal bleeding from around the screw entry points since bone is a very vascular tissue. Which is unfortunate, since there is no way to reduce the pain and speed up the healing time except rest, and possibly alternating ice and heat. If I take NSAIDs for the inflammation that will actually slow my recovery so I'm not going to do that. And if I stop running, my body will lose the stimulus to lay down more bone and strengthen that area. So, I run slowly and carefully, take days off when I feel like I need to, and try to not put any more pressure on that connection than necessary (for example, avoid bending my knee more than 90 degress, something that my coach told me to do ages ago, which really helped, and I sort of forgot to keep doing). On the plus side, my kneecap has not done any wobbling out of place so far and I haven't had any problems with my leg collapsing under me yet. Fingers crossed that things will continue to go well.
I got to hang out in the newborn nursery this week in clinical. Not a lot happens there, but when it does happen it all involves babies, so I'm cool with that. I got to feed babies, and swaddle babies, and do physical exams on babies, and take baby vital signs, etc. I also saw a baby with a huge conehead because she just wouldn't fit when on her way out the usual way, so they had to do a c-section and pull her back up and out. Fun, huh? There was another baby that looked like she was at a tanning salon because she got to lie underneath special lights that help reduce jaundice with a cute little face mask on. Oh, and there was a baby who was withdrawing from methadone because her mom is in the methadone treatment program. I felt really bad for this little girl, but she seemed like she's doing okay with it. Overall, babies are adorable and I love playing with them.
Okay, on to projects. Jess and I both want to lose weight. Not a ton of weight, but about 10 stubborn pounds that won't go away. Also, I seem to have developed some problems with glucose regulation. Evidence of this includes nearly passing out in clinical and while shadowing Dr. Meyers (I was fine after eating some food and I'm nearly positive that it was hypoglycemia and not blood-pressure related.) Further evidence is that fact that every time I go to the gym, unless I eat a LOT (way more than is reasonable for the kind of workouts I'm doing) immediately after getting home, I end up falling asleep for about 2 hours and then spend the res of the irritable and fatigued. This is annoying and inconvenient and I want to make it stop. So, with this in mind, we are going to change the way our house eats. Jordan is always excited for experiments and is willing to change how he eats to in order to study us :)
The plan is to switch to a low glycemic index diet. If you don't know about the glycemic index, read this. Basically, it means foods that provide a stable level of glucose in the blood instead of lots of peaks and valleys. Starting on February 1st we're going to take all the stuff in the house that does not qualify as low GI and stick them in a cupboard out of sight and then try to eat only low GI foods for the rest of the month and see what happens. I've also bought a glucose meter on eBay so me can get some real quantitative measures of how well this is working. I'm hoping it'll arrive sometime this week so we can all get a baseline reading of how we're doing and then see how it changes. Jess is having a fabulous time in the kitchen experimenting with low sugar and low GI recipes and so far they taste pretty good. The baseline rules are pretty simple: No foods with sugar (or high fructose corn syrup, or honey, or other sweeteners like that) in the ingredients list, and no white starches (basically no refined flour, white rice, or potatoes). This is going to be a very interesting experiment and I'm hoping it will have a good effect on both my mood and my energy level, since both have been pretty low lately.
Oh, and have I mentioned that Jordan eBayed an EEG machine? We're going to measure our brain waves. It's going to be awesome. You may be tempted to ask why, but the only answer you will get is that we think it's cool. Yeah, we're dorks.
I updated on my other blog about the Couch to 5K running plan I'm doing a while ago, but I think I'm just going to update more about it here, because I'm lazy and this isn't really cycling related at all. I've finished the first week and the first day of week 2. So far things are going well, and the workouts are getting progressively easier. The weird part is how my knee is reacting to all this new stress. I expected swelling, aching, soreness, all the usual stuff when I ask it to do something new. Instead, I'm getting this strange kind of soreness where the entire area around where the screws are feels like a gigantic bruise. It feels like someone hit that spot with a hammer, but there's no external sign of bruising except for some minor swelling. The actual joint is also mildly swollen, and a little bit achy, but not nearly as bad as I thought it would get. My theory about the bruised feeling is that I'm putting stress on the spot where the bits of bone are connected and the screws enter in a completely new way and so I'm temporarily weakening that connection and my body will respond by laying down more bone. But, in the meantime, that area is inflamed, and there is likely some internal bleeding from around the screw entry points since bone is a very vascular tissue. Which is unfortunate, since there is no way to reduce the pain and speed up the healing time except rest, and possibly alternating ice and heat. If I take NSAIDs for the inflammation that will actually slow my recovery so I'm not going to do that. And if I stop running, my body will lose the stimulus to lay down more bone and strengthen that area. So, I run slowly and carefully, take days off when I feel like I need to, and try to not put any more pressure on that connection than necessary (for example, avoid bending my knee more than 90 degress, something that my coach told me to do ages ago, which really helped, and I sort of forgot to keep doing). On the plus side, my kneecap has not done any wobbling out of place so far and I haven't had any problems with my leg collapsing under me yet. Fingers crossed that things will continue to go well.
Tuesday, January 20, 2009
Ugh, winter
The worst thing about winter in Rochester is that I can't go outside. Well, I can, but it's extremely uncomfortable after about 15 minutes and there's nothing that I can do out there because the whole world is covered in snow and ice. Winter activities are too expensive, and building snowmen just isn't going to cut it. So, I'm stuck inside watching TV and pretending to study. Ugh.
Also, the comments I'm getting on my previous post are pretty hilarious. All these people that I've never met that clearly have a pretty strong agenda. Just so we're clear on this, I would not refuse to assist with a circumcision procedure. Even though I disagree with the practice, it is not my place to pass judgment on the choices of other families. I have pretty strong feelings about the law mentioned in one of the comments that allows healthcare providers to withhold services that they object to on moral grounds. But, since I have no plans to ever work as an OB or pediatric nurse, I imagine the issue will not come up during my career.
Now back to reading for the test that I have to take in about an hour. Yay.
Also, the comments I'm getting on my previous post are pretty hilarious. All these people that I've never met that clearly have a pretty strong agenda. Just so we're clear on this, I would not refuse to assist with a circumcision procedure. Even though I disagree with the practice, it is not my place to pass judgment on the choices of other families. I have pretty strong feelings about the law mentioned in one of the comments that allows healthcare providers to withhold services that they object to on moral grounds. But, since I have no plans to ever work as an OB or pediatric nurse, I imagine the issue will not come up during my career.
Now back to reading for the test that I have to take in about an hour. Yay.
Friday, January 16, 2009
I'm back
School started again on Tuesday. I'm taking only two classes at the moment: Women's Health and Management of Care. Management of Care is going to be boring and you probably won't hear me talk abou it much. Women's health, on the other hand, means I get to play with babies. Oh, and women, most of them pregnant. You'll hear about that a lot (disclaimer for the parents: Yes, I adore the little babies, and no, I do not plan on getting pregnant any time in the near future.)
I've had two clinical days so far on the OB floor. The first day we were jsut there to observe for a couple of hours, but I still got to hold a couple of newborns and see a bunch more. And their moms. Can you tell which I'm more interested in? The second day I go to use a doppler to find fetal heart beats in pregnant moms and watch two circumcisions. (Disclaimer #2: I'm going to go into detail about the circumcision procedure. Skip the next paragraph if you don't want to know.)
Before I start, I should say that I don't really like circumcision, because there is no proof that it has any benefit whatsoever. Recently a study came out about how circumcised men have a lower chance of contracting HIV during heterosexual sex, but the most current literature reviews say that there is no significant benefit (trust me, I just checked). That's how I felt about circumcision before I'd ever seen one. Now, what does an actual circumcision look like? First they give the baby some sugar water (which somehow calms them down) and then inject lidocaine into the nerves that run along the top of the penis. Then they let the lidocaine do it's thing for about 5 minutes so the area is numb. The baby is then put on a little tray thing with slots for his legs, which are held in place with velcro. A kicking baby would be a very bad thing during this procedure. One nurse holds down the baby's top end while the doctor takes some forceps and separates the foreskin from the glans of the penis. Naturally, the foreskin may not separate from the glans until he is 5 years old. Once the foreskin is separated, a cut is made so that it can be pulled back exposing the glans. Then they put a little plastic bell shaped thingy (called a plastibell, shockingly) over the glans to protect it. The doctor then ties a piece of string as tightly as possible around the base of the glans to cut off circulation to the foreskin. The foreskin is then cut off close to the string and the plastibell is removed, leaving a little plastic ring between the remaining bit of foreskin and the glans. Over the next 7-10 days the foreskin will become necrotic, turn black, and fall off, along with the string and plastic ring. For the most part, the baby doesn't feel anything during the procedure except for the initial lidocaine injection. The painful part is urination and diaper changes for the next week or so while he heals up.
Okay, so that's how it's done. Why is it done? We got a little history lesson from the doctor who did the ones we watched. She was Norwegian, where almost no one gets circumcised, so she went and looked up the history of it when she arrived here. Apparently it gained popularity in America after WW1 when many men developed infections because they were unable to clean themselves properly underneath their foreskin while in the trenches. I don't know if that's true or not, but that's definitely the time period when circumcision took off in the US. Now 80% of American men are circumcised. In the rest of the world, the cultures that circumcise are mainly Muslims and Jews and only 30% of the total male population is circumcised. None of the national medical associations in the US recommend circumcision and most families say that they do it because they, "want him to look like his father." Anyway, I'll get off my soapbox now and go back to my usual blogging.
I haven't really been doing anything since I got back except school and sleep. It's been freezing cold here for the past couple of days, about -10 and frequently snowing. I'm mostly hiding out inside and trying to stay warm. I did manage to get to a blood drive yesterday, which was good. My hemoglobin is still nice and high (12.9!), which I love to see, and they only had to poke me once. I even got a free movie ticket and coupon for coffee. Also, I discovered that hospitals that use blood from the red cross get charged based on how much blood is donated at their facilities, so support your local hospitals by going to their blood drives! I may be going with a couple of other students to donate platelets sometime in the near future too. I haven't done that yet, but I've been wanting to give it a try.
That's about all for now. I'm sure there will be more to write about soon. A lot of the next 5 weeks is going to be OMG BABIES!!!!! so consider yourself warned.
I've had two clinical days so far on the OB floor. The first day we were jsut there to observe for a couple of hours, but I still got to hold a couple of newborns and see a bunch more. And their moms. Can you tell which I'm more interested in? The second day I go to use a doppler to find fetal heart beats in pregnant moms and watch two circumcisions. (Disclaimer #2: I'm going to go into detail about the circumcision procedure. Skip the next paragraph if you don't want to know.)
Before I start, I should say that I don't really like circumcision, because there is no proof that it has any benefit whatsoever. Recently a study came out about how circumcised men have a lower chance of contracting HIV during heterosexual sex, but the most current literature reviews say that there is no significant benefit (trust me, I just checked). That's how I felt about circumcision before I'd ever seen one. Now, what does an actual circumcision look like? First they give the baby some sugar water (which somehow calms them down) and then inject lidocaine into the nerves that run along the top of the penis. Then they let the lidocaine do it's thing for about 5 minutes so the area is numb. The baby is then put on a little tray thing with slots for his legs, which are held in place with velcro. A kicking baby would be a very bad thing during this procedure. One nurse holds down the baby's top end while the doctor takes some forceps and separates the foreskin from the glans of the penis. Naturally, the foreskin may not separate from the glans until he is 5 years old. Once the foreskin is separated, a cut is made so that it can be pulled back exposing the glans. Then they put a little plastic bell shaped thingy (called a plastibell, shockingly) over the glans to protect it. The doctor then ties a piece of string as tightly as possible around the base of the glans to cut off circulation to the foreskin. The foreskin is then cut off close to the string and the plastibell is removed, leaving a little plastic ring between the remaining bit of foreskin and the glans. Over the next 7-10 days the foreskin will become necrotic, turn black, and fall off, along with the string and plastic ring. For the most part, the baby doesn't feel anything during the procedure except for the initial lidocaine injection. The painful part is urination and diaper changes for the next week or so while he heals up.
Okay, so that's how it's done. Why is it done? We got a little history lesson from the doctor who did the ones we watched. She was Norwegian, where almost no one gets circumcised, so she went and looked up the history of it when she arrived here. Apparently it gained popularity in America after WW1 when many men developed infections because they were unable to clean themselves properly underneath their foreskin while in the trenches. I don't know if that's true or not, but that's definitely the time period when circumcision took off in the US. Now 80% of American men are circumcised. In the rest of the world, the cultures that circumcise are mainly Muslims and Jews and only 30% of the total male population is circumcised. None of the national medical associations in the US recommend circumcision and most families say that they do it because they, "want him to look like his father." Anyway, I'll get off my soapbox now and go back to my usual blogging.
I haven't really been doing anything since I got back except school and sleep. It's been freezing cold here for the past couple of days, about -10 and frequently snowing. I'm mostly hiding out inside and trying to stay warm. I did manage to get to a blood drive yesterday, which was good. My hemoglobin is still nice and high (12.9!), which I love to see, and they only had to poke me once. I even got a free movie ticket and coupon for coffee. Also, I discovered that hospitals that use blood from the red cross get charged based on how much blood is donated at their facilities, so support your local hospitals by going to their blood drives! I may be going with a couple of other students to donate platelets sometime in the near future too. I haven't done that yet, but I've been wanting to give it a try.
That's about all for now. I'm sure there will be more to write about soon. A lot of the next 5 weeks is going to be OMG BABIES!!!!! so consider yourself warned.
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