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.

May 20, 2004

How do women go through labor with out medication?
There are the type of women who have no choice..they come in ready to deliver (8cm or more). Then there are the women who are just plain good! I firmly believe that your mind is the most important "muscle" to use in labor. I once had a woman chant "row, row, row your boat" through each contraction, or music, or humming..whatever works for them. Warm baths and jello with friends..that one was fun. There are the girls that put themselves somewhere else and that becomes very amusing..."the hiking path in rockville..the big tree..climing the tree...sun is shining..." I start to feel like I am almost there. I love this job.

When do you know its time for medication?
Ohh..thats a good one. I have several theories on that question. First of all, if you resemble linda blair in the exorscist..then its time for medication. I mean that with all the humor I can display through my blog. Second, some women just need a little IV medication to "take the edge off". All women have different pain thresholds and one can never tell until your there. The women who tend to say "oh no, here comes another one..I cant , I cant..." are going to need extra support. We have a wonderful medication called the "sufenta block" and it works for approx. three hours. It does wonders when women get it at 5cm. Epidurals are common for first time moms, they can deliver medication through the entire labor, regardless of length. They do tend to "weaken" eventually.
I also use the tear factor. When a woman begins to fear her contractions and tears start coming..its time for medication. It is always good to have an IV put in when you get to the hospital in labor. You can ask to have a "hep lock" so you can walk around with out tubes connected to you. When you get back to bed the nurse can connect the hep lock to fluid and give you medication when you need it. If you have this put in when you first get there then you wont have to be "stuck" again when you are really in pain. I let my patients shower with the hep lock in. It is important as a nurse to know I can give her IV fluid or medication easily if needed.

I have rambled enough...good night
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May 17, 2004

Real life.. 

Not that my career in labor and delivery is NOT real life...but it is the focus of this particular blog. And because it appears that the only blog that has caught on..(thanks to my friends at Stephens Place)...is this blog. And to be honest, this is my favorite blog too. I have great plans for this little site. I want fabulous links and soon I will learn how to put photos on the site....I promise to be good to my blog. BUT!! Real life other than nursing has taken ahold of me lately...and I apologize to all readers who look forward to my stories of triumph and truth in my profession, I am now facing a bit of it outside of the hospital.
We have settled our contract and I have decided to stay at my hospital and see it through it's rough times right now. I have been asked to take hold of a new program we have enlisted in. We are now part of a national stillborn study and we have a lot of work to do to get ready to participate. This will keep me occupied at work.
In life. I have looked at 12 houses in 5 days and let me tell you that this sucks..big time. I live in Rhode Island and for all of you who are not familiar with real estate in new england..it sucks, sucks, sucks. Houses that would cost 100,000 in any other state in the country cost 250,000 here. It is absolutely ridiculous and it forces me to ask myself why I am living here! I have my family and friends here. People love this state so much that the houses are mostly being purchased by people out of state. This is a problem in the long term. Our schools are being paid for by people who only live here in the summer. Their children don't attend our schools and now they don't want to pay taxes for that particular reason. Not to mention that taxes in this state are at a national high. Let me also include that as a nurse, RI is the 48th in the country for medical reimbursement costs. That means that 47 other states are reimbursed more money for the same procedure. This country has some interesting ways of doing things!!
Deep breath. We also found out that I may need to take fertility drugs in order to get pregnant, which means that we could have twins right off the bat. That's a lot to digest, we decided to wait a month or two.
This is why my labor and delivery stories have been few and far between lately. I am working for the next 3 nights so..im sure more stories will come.
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May 12, 2004

I love establishing a relationship with a girl who needs help and seeing it through to the end. Today was 25year old Tina's fourth c/s and tubal ligation (tubes tied). Different father with all babies and cocaine positive with this one two months ago. He was healthy...the poor new daddy needed the attention. I taught him everything I knew about newborns..and he was afraid...21. I cant wait to watch him over the next few days. She has already raised three..she's practicly a pro..and that makes him even more nervous. I remind her to teach him how. I walked in one hour later and together they had changed her pads, got her back to bed and changed her dressing. Keep in mind this was a sterile dressing that they put plain guaze and tape in place of...I laughed a bit as I pointed this out to her. Her eyes widened.."shut up"..(we had that kind of relationship). Im not lying tina..but your not going to die...its ok. She smiles. "Will you change it back to sterile dressing?" She is doing wonderful and really loves the little guy..I have faith in her.
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May 11, 2004

How to breath for a baby....101..We call it NALS...aka neonatal artificial life support. It is very serious and we are recertified every 2 years along with a whole heck of a lot of other certifications. Today was my recertification....I dont mess around anymore. The days of being the giddy little graduate nurse are over. I know what im doing and I can go through the ropes. Now?..Now I perfect my style. I tested with sam, I do all my codes with sam. We are known as the dynamic duo...frick and frack. I am the "bad girl" if you haven't guessed. Sam tends to be very textbook and this is important, but I tend to be the critical care nurse. I always answer the ER calls...no one else does. I go down and start an IV on toddlers, and help with codes. I went to nursing school for that shit..I thrive on it!! Other nurses are more comfortable doing only what they know, labor and delivery or surgical patients. I love the hard stuff.
I suppose this is what makes the world of nursing go around. I dont mind taking care of a 3.5lb baby, others wouldnt go near that with a 10foot pole. I hate dialysis, my friend scott loves it.
I am not getting what I want from my current job and so I have applied for other postions. The only one I really wanted was not given to me and infact given to someone with much less experience than me..no labor and delivery experience to be exact. But you need to hear this wonderful rationalization..ok..here I go....
I believe in Kharma..and I know that this happened for a reason. I was going to take a big chance by leaving but it was going to be in the same field but second shift. (Im growing tired of third). I will now work perdiem for the new hospital and get my feet in the door. My mission is to show them what a good nurse I am and slip me in to the next second shift position. I also have some seniority at my current hospital. I am trying to get pregnant myself and also trying to buy a house. I may try to eliminate some of my goals. It seems to be a bit overwhelming. Until then...babies will still come at my hospital.
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May 10, 2004

Stephen and his friends were curious enough to track down my weblog and nice enough to mention it on thiers. I would like to return the favor. The group is funny and very friendly. Tell Stephen that melanie said hello.
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May 09, 2004

Links for moms to be... 

I have a mission to find some great sites that handle labor and delivery well...check them out soon...
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May 08, 2004

trying my blog on for size 

Im trying to find some cool links for nurses..I do have a great research link..It's sort of WebCT with medline and cinhal..I will attempt to put in it the link area..
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May 07, 2004

You have no idea.... 

I think the hardest labor patient to have is the one that comes to the hospital in early labor stating " I plan on on having natural child birth..I rates these contractions as a 4 or 5 out of 10 for pain." That always clues me on one fact..they think they are at the halfway point for pain. Second fact, they think the pain only gets twice as bad...same fact as the first..but different really. Often I will notice that the ctxs are every 5-9 minutes, some bigger than others. I use this time to explain that this is early labor. Active labor occurs when ctxs are regular and 2-4 minutes apart. There are other good signs of labor. Your "water" breaks. This is an automatic admission to the hospital. Then you add on the fact that the contractions are really only doing their job when a woman starts dilating.
Heres my issue with early labor patients as mentioned earlier. Take all factors just mentioned and put them into a set of circumstances. First baby, water broke at home. When the water breaks it tell us two things..one..your cervix is changing and two..it will hurt more. The fluid acted as a cushion for the contractions..and now that cushion is gone. My patient had all these circumstances last night. When I checked her at 3am her cervix was so high I couldn't even reach it. Her contractions were 3-8 minutes apart and some weaker than others. 3 hours later her cervix was still not reachable and this was ok..but she thought her labor was going to last a few hours..she was not mentally prepared and we started medicating her at 6am with IV sedation. She had a small vaginal opening and became very very tense during exams. She did not expect any of it. Her veins were difficult and I stuck her 2 times before I called for help. I was starting to feel bad.
I think I started this entry to make myself feel better. I could have helped her a bit more I think..but maybe not. There are days when you are really in to your job and days when you are not. The longer I am in the field the more I realize why burnout is so common among nurses..and doctors. We all lean on each other so much. The chiefs lean on the doctors, the doctors lean on the nurses, the patients lean on the nurses, the patients lean on the doctors, the nurses lean on....hmm..they lean on.....well. Now I get it. This is a fact more obvious in labor and delivery. If you have had a child I don't have to explain...but I will for blogs sake.
When you come in at 1am we wake the doctor only after we have used our skills to evaluate your labor. We report to him..your cervix, ctxs, allergies, gbs status, pain factor, and any other important issues..there are too many of those too discuss here and now. If needed, we admit you and if needed, the doctors and midwives are close..at home, but close. We keep them posted on your progress until its time to have serious pain medication..or near fully dilated. Some times they will just come in.
We admit you, start the IV, draw labs, track your labor, and keep the doctor informed. It is a wonderful experience with many patients..and when you take away all the other political BS ..I would like to think it would be one of the top 5 rewarding jobs.
I worked all night..I should go to bed. My blog is skipping...thanks for listening..if anyone does.
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May 02, 2004

I support the perineum 

I have this pin in my room that my husband finally got around to inquiring about. It states "i support the perinuem". It has been in our room for over a year now and he is prompted to curiosity today. "what exactly is the perineum" he asks. I tell him with out batting an eye lash.."Its the 'taint' honey, the space b/w the vagina and rectum". He looks at me..Bewildered for a moment. I am unsure as to whether his look is related to my response, the fact that I have a pin stating I support this area or maybe it was just plain confusion. I proceeded to explain the meaning without him asking for an explanation. "You see, if you support this area in childbirth with pressure then you lessen the chance for tears, rips or episiotomy"....now..you may find this interesting. He doesn't cringe at these words and infact he asks very approp. questions regarding the labor process..but this one floored him. "Why would you have a pin that states this?..I dont have a pin that says..I drive a truck". I responded with the fact that midwives have, in the past, been assoc. with less vaginal trauma due to the fact that they support the perineum and take their time with the delivery process..allowing room for stretching. (not that SOME doctors dont). He understood this only after he explored the rationale behind why doctors and midwives deliver differently...and this exploration continues in my house..the pin has not moved and I think he feels a little wiser for asking. Man, I am going to be in trouble when kids are in the house...
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May 01, 2004

where is my midwife? 

Bad, bad, terribly bad news..the midwives are leaving my hospital. One is entering into the peace corps and the other was offered another job at a local hospital. My hospital is making what I feel to be a very big mistake. The hospital had the chance to hire another midwife ..but they chose not to. They are only 2 out of 6 staff members and they deliver almost half of the babies each month (OBGyns deliver the rest). I dont know what this world is coming to..I dont know what my hospital is thinking. A midwife is a terrible thing to waste..I foresee great changes in the future however and I am thankful to be young and in the game, even if this particular hospital doesn't know how to play.
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Sometimes I feel so lucky to be able to see and do what I do in my job...but other times I feel not so lucky. I know for a fact that some of these women leave the hospital and think "oh my god..that was strange". They feel sorry for how they behaved in labor or the postpartum depression and hormone fluctuations start early. Im not talking about the healthy woman who starts crying at MN for no seen reason..thats normal. Its a pleasure telling them that they probably will be a little more sensitive because its a new emotion to them...depression. The ones that have a history and sink into a listless kind of sleep walk after they have the baby..they worry me. I can only hope that the shock of whatever is shocking them wears off at home..Im sure it does..it has to. Ok..I know it doesn't sometimes. Im getting to the point where I see them coming in for baby number 2 or 3..and this can either be refreshing..or depressing. I apologize for my sullen mood this evening. I promise to not be like this in the future. I have numerous things on my plate today. Until the next good story..
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