labor nurse has been reborn and shares her experiences as a new nurse-midwife, woman, and blogger

Saturday, August 30, 2008

Second Baby

Fortunately I haven't seen this too often, but it is something that really annoys me. It's the whole second baby syndrome. Symptoms include:

  • Over-compensating with an unusual amount of attention to the first born
  • A significant amount of gifts for the first born
  • Anxiety so thick you can slice the air with a knife when the first born comes to the hospital to meet second born
  • First born flailing and crying and generally fussing when he realizes that he is not the only one getting attention in the room
Now I know that introducing a new baby into a family can be stressful. Hell, I even remember when my brother was brought home back when I was three. I had the vague concept of a baby lurking around in the hospital, but felt a bit displaced once the realization of that baby in the house was staying. But I also don't think much fuss was made about it by either my parents or myself. Perhaps my mother would say differently, I don't know.

And I've met some women who say that they know they'll love their second baby but can't imagine how they could love another child after several years of loving their first born, especially when that is where all their attention was going for several years. Fortunately, most don't do what I witnessed during my last shift at work (on the dreaded postpartum unit).

A woman I'll call Mary gave birth to her second child, a son. Her first born, named Bobby, was 5 years old. A good age, I think, for a child to be excited and have a fairly good understanding about a new baby. When I first went in to see Mary on my morning rounds, she immediately began nervously talking about Bobby coming later that day. Bobby, you see, was refusing to acknowledge that a new baby boy was joining their family. Mary said that Bobby has been the only child in their entire family...including the extended family, and he was very spoiled. He got attention like there was no tomorrow, got things as he pleased, and Mary had even decided to stop working so that she could spend one on one time with him everyday. Apparently he could not tolerate not being with his mother. Mary was very tearful when telling me that her husband reported that Bobby had a meltdown when she didn't come home the previous night, and when it was explained to him that it was because she was in the hospital with the new baby he went into a rage that could not be calmed with candy, ice cream, toys, or a trip to the store for new toys.

You see where this was going, I'm sure.

Mary said that she and her family had spent months preparing for the very moment Bobby would walk into the hospital room and meet the baby. They decided the best approach was to have every single family member be there. So early that afternoon family started to pile into the room. There were some coordinated phone calls between Mary and her husband to say who was there, where they were sitting, and what was Bobby and the husband's ETA.

The tension in that room while they were all waiting was making me uncomfortable. And then came the knock on the door. A few held their breath as Bobby arrived. At this point I was anticipating someone place a crown on his head and roll out a red carpet. Instead everyone just squealed with delight at his arrival and gave him hugs and kisses.

Oh, it would be important to know that it was decided among the family that when Bobby arrived that the new baby be left in the crib untouched and out of the way. No one was to hold the baby until Bobby seemed "okay" with everything.

At this point I left, but needed to go back shortly after. Bobby was standing in the middle of a present pile as high as his head and surrounded with shredded wrapping paper. Just then one of the grandmothers handed him a gift and said, "And this one is from the baby."

Again, the tension and the breath-holding was at an all time high. Mary was almost in tears while she waited to see what he would do.

"I don't want it!" he screamed. And this sent all the family in a scurry around the room, saying things like, "Where should we put it?" and "We need to get it out of sight!"

Are you kidding me? Really, are you kidding me? The new baby, meanwhile, laid quietly in his crib and never woke or made a peep. I sure hope that he gets used to being quiet and on the fringe of the family because clearly Bobby was calling all the shots.

Monday, August 25, 2008

Thiefery

Not sure if theifery is even a word, but it should be.

So how is it that a woman coming in for her regular prenatal visit thinks it's totally fine to permanently borrow a $700 doptone? Like, you know, we might not notice it missing?

What balls.

Friday, August 22, 2008

Hurry Up!

Actual conversation with a patient:

Patient (just turned 16 year old, 34 weeks pregnant with first baby): Do you have any children?
Me: No.
Patient: Why not?
Me: Because life has kept me very busy...you know, school and stuff.
Patient: Are you going to have children?
Me: Yes, someday.
Patient: Well, how old are you?
Me: How old do you think I am? (I always ask this when asked being I've been noticing a lot of grays on my head so I'm paranoid that I am looking old)
Patient: Like, 25?
Me: Oh, what a compliment! Actually I'm thirty-(fill in the blank)
Patient: Oh my god! You're old! You better hurry up if you want kids!
I suppose at 16, even I would have thought I was old. Funny how different our perspective changes as we get older. And I guess when you are having your first baby at 16 anything much older than that must seem pretty late to be having kids.

Monday, August 18, 2008

No Independent Thinking

Yesterday my preceptor told me that I should not have opinions. I have to laugh at this now, because clearly she hasn't really learned who I am. But at the time I couldn't believe that she said this.

The context of the conversation was about my own midwifery practice; she felt that only experienced midwives should have opinions about how they practice. I nodded and went along with this conversation because, frankly, if I disagreed it would just make matters worse. And what I walked away with was that even though I am supposed to be a safe beginning practitioner at the end of this experience, that I should just be doing everything she suggests or asks of me.

So I will, because ultimately my fate is in her hands with regards to passing and graduating. But it is frustrating when I am supposed to be setting my roots down and feel like a competent beginning midwife by the time I graduate that I still have to do things everyone else's way. I'd imagine that this is not a unique experience among student midwives; most preceptors want you to do things their way because it's what they do and it works for them. Or they think they are completely right.

Just a few weeks left.....I think I can handle it. I think....

Tuesday, August 12, 2008

Ferns






One of the coolest things, in my opinion, is amniotic ferning. Amniotic fluid, when dried, creates a fern leaf like pattern that can be seen microscopically. The presence of ferns are a strong indicator that the bag of waters has broken. Two others are looked for: pooling of water in the vagina seen on speculum exam or visualizing fluid coming from the opening of the cervix and a positive nitrizine test (pH paper turns blue).






Its incredible the number of women who come in saying their water broke when in fact they either peed or have a lot of vaginal discharge. Both are pretty common late in pregnancy. I often wonder how many have a "high leak" for days before realizing that perhaps their water broke. I'd imagine that is more common than we realize.






Either way, here is what the ferns look like. Cool, huh?

Sunday, August 3, 2008

The Job Forecast

As it appears right now, there will be no midwifery jobs out there when I graduate. Sure, there are jobs available, but I'm not moving. I live where I want to live for the rest of my life and want to provide midwifery care to the women in this area. Midwifery is limited in my area, mainly because there have been administrative cuts to midwifery practices or physicians do not want to cover CNMs for various reasons.

I've mentioned to two physicians at work from two different practices that I am available for hire. The first physician laughed. The second said she'd love to have another CNM but they just couldn't financially support one. Perhaps somewhere down the road that may open up. Who knows.

I wish that I had more courage to be an entrepreneur. I have no doubts that I'd slowly gain a steady patient base. The women my hospital lost when they closed their midwifery service would come back if a midwife was available to them. The problem with trying to open my own practice would be the politics and road blocks put up by physicians who don't want to be affiliated with a CNM. I know that there are physicians who would have no problems collaborating with CNMs, but their malpractice insurance would go up considerably or would lose their malpractice insurance policy. There is also the issue of vicarious liability, which in my opinion is ridiculous. I don't think physicians who cover CNMs should be held liable for the CNMs care and patient management. They should be responsible and liable only for the patients they care for. But that's a whole other can of worms.

So at this time, looks like I will remain working as a labor nurse after graduation. I guess this is fine initially, because I like where I work for the most part and I have a lot of student loan money to start paying back. But I've also worked so hard to become a CNM that I want to start working as one.