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Melanie Bryant was the name, now Melanie Fox. I am a Labor and Delivery nurse working in a rural community hospital. I am the charge nurse on 3rd shift..the shift where the fun stuff happens..and im not talking about IV pole races down the hall way.

April 29, 2004

Come on Dr Wong 

When I arrived at work at 11pm there one only one labor on the board and because I was training sam for charge nurse..I didnt get to have it. The wonderful part about not having the labor is the fact that you get to go in just to "catch" the baby and be the second nurse. You get the experience of watching the miracle of birth yet another time and the glory of doing footprints, bath, weight, etc.. That's the fun stuff. However, there are times that you are called in to a room for what you expect to be a routine situation and you walk in to find that shit has hit the fan. The nurse may be struggling to push shoulders down and out, the doctor may be struggling to use forceps or vacuum, the baby could be on the warmer and not breathing ..yet. The strangest one to walk into so far would be the nurses hand in the vagina demanding to call the OR team and doctor now..cord prolapse. That nurse with her hand in the vagina is holding that baby's head up and off the umbilical cord that has falling down past the head....her hand stays there until the baby is delivery via c/s. In this case I found it particularly interesting that the doctor and nurse actually touched hands through this woman...very interesting.
Last night was a routine delivery with a rather cool set of parents and a very good labor nurse. This woman is what we call a "primapara" or 'primate' for short..meaning it's her first baby. First babies are almost always longer than the rest and it's difficult to assume anything about the outcome of delivery. Subsequent babies are easier to predict based on history. You will get the rare woman who will come in and have her first baby in a few hours...I love this. Last night was almost a case of that..but with a spin, as there always is. Noel and Carl came in to hospital around 9pm 2 cm and contracting regularly. She had been given IV sedation around 10pm but her contractions got stronger instead of weaker. She was 5cm when I came on at 11pm and she was looking for the spinal. We paged Dr Wong at 1110pm. He was in a case in the OR..ruptured appendix. We waited...and waited. I knew the surgeon was out of the case because I saw her talking to the only family in the waiting room on my way in and she was saying "it perforated so we will need to treat him with antibiotics for a while and he will be here for a few days" I only assumed it wasnt coming to my floor because it was a man. However, I knew that she shouldn't have to wait too long. Now her contractions or coming every 1-1.5 minutes and finally at 1150 the doctor checks her and she is 8-9cm....Amazing for her first baby but bad for pain relief. We come to realization that this patient is going to miss her pain relief and we do not believe that to be a good thing...we are very sympathetic and now we get nervous. The OB thinks about calling an anesthesiologist at home and we are in the room with this patient who is having no respite from the amazing contractions. She wasn't even on pitocin...we couldnt stop the contractions from coming.
Just as the Doctor picks up the phone Dr Wong coming running around the corner. He came so fast we all jumped and and literally ran to give this girl "the block". She got the block around Midnight and it was a close call. We usually let the patient stay fully dilated after the block because is allows for "passive descension"...the baby comes down on its own. The mom feels nothing and has no idea. We can usually tell its time to deliver by watching the fetal heart beat. It starts to dip a little with contractions..head compression effect. In this case..the heart dropped more and we didn't know if it was because of the medication (that happens often) or because it was time to delivery. We did all the right things to get the heart beat back up and then let her push for a while. They tend to not push well with no feeling, but this girl pushed like the dickens...and we had a beautiful baby girl at 0058 this morning. It was one of those deliveries where the minute we told her it was ok to touch the head while she was crowning ...she then couldn't keep her hands away. She helped to delivery her own daughter by reaching down and keeping her hands on her while the doctor delivered the rest. The were so happy and the little girl was a doll, 7.10lbs. "We love you so much" "I cant believe how beautiful you are" "im your mommy and this is your daddy" "Welcome to our family rose" " I cant believe that being a grandparent could feel like this".
I have the best job in the world....
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April 27, 2004

My first post has to do with the politics of healthcare in my hospital....contract negotiations. For all of you who are not aware, nurses continually fight to keep what we have, not necessarily to gain more. I am in a field of nursing where we are losing doctors and midwives due to the rising cost of liability insurance, yet the nurse is expected to maintain the same care. Meanwhile, we attend meetings and rally's so that the board of trustee's will show us how the hospital lost all the money and why the nurses should give it from thier salary. They refuse to accept our new contract and then proceed to layoff the most experienced nurses in manipulative ways due to contract wording. We are just one hospital of many that are facing or will face this problem in the future. It is a national problem, and I partly blame the pharmacuetical companies. That is another discussion.
We settled our contract 4 days ago and we took a small hit financially. My healthcare cost went up and my cost of living increases went down..but I still have my seniority, shift differentials and a decent TSA/IRA plan. This only last's 3 years...then we will probably be holding signs on the line again.
I feel the need to add to my first post that I love my job..I love delivering babies more than anything. more to follow later. I have some truly great stories from this job...I promise it will be interesting.
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