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Friday, April 6, 2012

I turned to mush by the end of the day

This semester is just flying by I feel like I have no time to spare anywhere along the way! I already had my three weeks in my OB rotation and I'm half way through my mental health rotation too!! So let us catch up:

My OB rotation was so different from what I expected. In ways I felt like it was a let down and in other ways I learned a lot about myself. However, before I get ahead of myself, let me tell you how this rotation works...There are so many different aspects to OB. People just assume that it's only labor and delivery, but there's also mother/baby, the nursery, OB specialty (high risk) care, OB operation room, OB triage etc. We had a chance to kind of rotate as much as possible through these different units in the six days that we were there. 

My first day I was in the specialty care unit. That's where they have women that need close monitoring during their pregnancy. That can include (but is not limited to) women that have preeclampsia, heart disease, kidney problems, cancer...the list is endless. That floor was boring. Just saying...maybe it was just because there wasn't much for me to do, but I don't know if that's the floor for me. You just go and ask each mom, "Are you having contractions? Do you have any vaginal discharge? Have you been feeling the baby move?" and that's about the extent of your assessment. Then they have someone come in and do a non-stress test on the baby's heart rate. So first day was kind of a bust. 

Second day my instructor sent me to labor and delivery thinking that would make up for the boring day on the specialty care floor. So I was extremely excited for the chance to finally get into the field that I'm wanting to go in. The nurse I was with was phenomenal, but my patient was not progressing. She had been on pitocin for several hours and nothing was happening and she wasn't having any change. She already had an epidural so she couldn't get up and walk around to try and help get things going so they decided to strip her membranes, stop the pit for 4 hours to give her uterus a chance to relax and to allow the pit to completely clear out of her body and then after 4 hours they were going to work it back up and hit it hardcore! Unfortunately for me, after her four hours were up I only had one more hour on the floor, so I again, didn't get to see anything. There was a mom that was delivering down the hall, but another CNM student was already in there (and let me just say at UNMH which is a teaching hospital your room ends up being filled with residents, attendings, students, and family). So since it was so full they said I couldn't be in there. So I stood outside the door and listened to the mother. I could hear by the sound/tone in her voice when she was crowning, you could tell when she was doing a good job at pushing, and then there's one huge yell and then the cry of a baby. Even though I didn't get to see anything it was still fun being with an amazing nurse, and getting to listen in on someone else's experience! 

Day three I got to go and be on the mother-baby unit. That's where momma and baby go after the delivery and stay until they're discharged (baring no complications and that baby isn't in the NICU). I was with the charge nurse that day so I didn't get to see anything too exciting. Something that's crazy about that unit is that you have 4 rooms, but 8 patients. Because you're having to assess both mother and baby and provide education, make sure mom is doing okay feeding baby...basically the needs on that unit are endless. 

Day four I was in the nursery. I got to give IM (hepatitis B) injections to baby, do the PKU (heel pricks), and hold babies. I also got to watch a circumcision, which surprisingly, wasn't as traumatic as I thought it would. For those of you mom's out there...baby hardly even cried. The only time he cried is when they're tugging on the foreskins and that's not really because it hurts (since they're numbed up), but more because they feel the pressure of them tugging. When he got the snip there wasn't even the slightest cry...so there you have it! :) Something sad about the nursery (or just OB for that matter) is how much drug abuse you see. Especially with  UNMH being the hospital that takes anybody and everybody you just see anything and everything. There are constantly babies in the nursery that are going through withdrawal. They come out and some of the babies are put on methadone and then tapered off. There were moms that would come in to delivery that had just shot up with heroine before coming in. There are moms that are treated with methadone throughout their pregnancy and the baby will come out and need to be tapered off. Methadone is an opioid pain reliever and is used to treat withdrawal symptoms in people addicted to heroin or other narcotic drugs that cause a "high" associated with drug addiction. So you have babies that come out and they get scored and based on their score they may or may not need methadone to help them with their withdrawal. 

What does a methadone/withdrawaling baby look like? It's very sad, but they have tremors, an extremely high-pitched cry, rapid breathing, poor sucking, yawning, stuffy nose, sneezing, they have raw chins from itching their chin, they sweat. It's just a very sad situation and picture. For me, that was the hardest part of this rotation. It's so hard to see women come in that way and it's terrible to see infants who have no control over their situation come into this world already addicted to a drug. For me that was so hard to see and I found myself with this anger that surprised even me. I had to remind myself that I didn't know what that woman was going through and I had to remain objective to her situation, but at the same time you can't help but just cringe at the thought of her having a child. 

While we're on the lows of OB I also just want to mention how sad it is to see children having babies. I saw an age range from 13-40 years. I would say that over half of the population having babies are under 17 years old. It breaks my heart to see girls that haven't even lived, that don't even know what it is to be a kid having babies. It breaks my heart and it just blows my mind the thought of someone my baby sisters age having a baby. One of the younger mothers said, "so it's like okay if I like put the baby in the shower right? Like the baby will be okay in the shower?" That's another thing that just makes me cringe just at the thought of these children having babies. 



So nursery had its ups and its downs...on the upside I got to hold babies for hours...I turned to mush by the end of the day. There's nothing like having a newborn on your chest and having them fall asleep as you rock with them. Their tiny little hands and tiny little feet...it's all you can do to not just squeeze the living day light out of them! By the end of that shift I was going to have a baby for everyone in the world...

Quick side note on the PKU...it's all about making gravity work for you and being patient. Wait until there's a huge drop and just let it drip onto the paper. Otherwise you're milking that baby's leg and trying to get them to bleed and fill in the circle, but all you gotta do is gently hold that leg/foot and let gravity work its magic. 
 
Day five I was back to labor and delivery to try and see some babies be born, and I was lucky enough to see two deliveries. One was completely natural and the other momma had an epidural. For both mom's it was their first babies but neither pushed for more than 30 minutes. I was hoping to see the delivery of twins, but her labor wasn't progressing and they were starting her up on pitocin...I would have stayed if I could have, but I couldn't, so I didn't! But let me just tell you there's something awesome about experiencing and being part of a woman's delivery. It's such an awesome and natural thing. There's so much raw emotion that goes into it. Watching the different phases that the mother (and father) go through..there's just no words to describe it. The smell of the delivery room is like nothing that can be described. You just walk into a room and you know...you can feel, hear, and smell it. All your senses are involved and it's such an emotional and simply amazing thing to be able to witness and help a woman through. I'll be honest though the nursing aspect of labor and delivery is cool. I like it, but I'd much rather be the one getting dirty and delivering the baby...just saying...nurse midwife sounds like fun to me! 

Day six was more of a reflection day. We went over a case study that we had to do, we talked about the experience and what we thought about OB overall. And that was about it...that was my OB rotation in a nutshell.

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