Bananas

I've had a few days off, thank God! But I go back to work to hear the funniest story ever. Some girl had FAXED us her birth plan last week, which first of all we found to be very bizarre. Usually people just show up with it, they don't fax it to us. But what was in the birth plan was beyond comical. We passed it around the unit to all the nurses and laughed our butts off. I'm not kidding. I saw it and said "well, get her C-section consent ready before she comes in because this just sets her up for it!" She started it out by giving a background on herself and her husband, when they were married, etc. Then she gives the standard birth plan stuff about not asking her if she wants pain meds, etc. Then she says "My code word for an epidural, should I choose to have one, will be 'bananas'."

What?!?! WTF is "bananas"?? YOU'RE bananas, lady! Why not just say "I want an epidural now."

So she comes into labor a couple of days ago while I was off. The nurse taking her is PRN, and only works about 3 days a month. She hadn't seen the humorous birth plan. And evidently banana girl and hubby didn't bring a copy to the hospital because they assumed we got the fax, and never mentioned it to the nurse that we had one.

So labor goes on for awhile, and she evidently decides she wants an epidural. Of course she has a code word (which again, don't use code words, that's stupid.) and the nurse asks if she can get her anything and banana girl says "Oh, bananas." Naturally the nurse has no idea what that means. Every time she goes in the room she says "Bananas." And the nurse thought she was just weird.

Eventually the nurse asks her if she wants an epidural and she says yes. While she was getting the stuff ready she called the CRNA to place the epidural, and someone said "Oh, banana girl is getting an epidural?" and the nurse was confused. Then someone told her about the birth plan and the nurse said "Well that explains why she keeps saying bananas every time I go in the room!"

Moral of story: Just ask for the drugs if you want them. We don't have the time to play games.

And FYI - she did get a C-section.

apology

If you see me out somewhere, or even if you come in to deliver subsequent children and you remember me as your labor nurse, please don't be offended if I don't remember you right away. I work with many, many families. I remember some, but can't possibly remember all of them. If I don't remember you, chances are, you were a relatively normal family with no drama. And that's a good thing.

Call 911!!!

So we get a phone call from the ER saying that a patient was being brought in via ambulance. 27 weeks, her water broke at home, and she is having lower abdominal pain. The ER nurse said the medics sounded very panicky and they were afraid she was going to deliver in the ambulance. Their ETA was 5 minutes. So I got a room set up with a delivery table and an IV pole etc.

The medics bring in this girl about 19 years old, "Megan." Megan had been having some abdominal pain off and on all day, but when her water broke her mom and grandma went into all out panic mode. They started to bring her to the hospital, but halfway there they were afraid she'd deliver in the car. So they pulled into the fire station and the firemen took care of her and put her in an ambulance while mom and grandma drove to the hospital. Megan comes in as expected, laying on her left side, O2 on, and an IV of LR running wide open.

We transfer Megan to her labor bed. I check for Amniotic fluid. Megan's vagina is dry as can be. I can't even get a swab. The midwife comes in and can't find any fluid either. No uterine activity is noted on the monitor or can be palpated. Also Megan's cervix is closed, thick, and high. While discussing out of earshot what might be going on, Megan lets out a yelp. "I just had another big gush of fluid, just like the last one!" The midwife and I rush over to discover a small yellow puddle between her legs.

That's right. Megan came in via ambulance because she peed her pants.

Triage calls

People call with some crazy questions. Case in point.

Me: "Labor and delivery, may I help you?"

Crazy lady: "Yeah I just had sex with my boyfriend, and when I got up my water broke."

Me: "Ok why do you think your water broke?"

CL: "Because a bunch of fluid ran out of me."

Me: "Was it a big gush or more like a trickle?"

CL: "It was just a little bit."

Me: "Ok, was the fluid clear?"

CL: "No it was white, kind of thick and sticky."

Me: "Wait, you were having sex and when you got up some white sticky fluid ran out of your vagina?"

CL: "Yeah."

Me: "That's not your water breaking that was sperm."

Birth plans

Ahhh, the birth plan. By definition: a written description from the parents to be of what they would like to have and what they would like to avoid during their labor and delivery experience. Sometimes people come in with a short one, for example "I'd like to have the baby placed on my chest as soon as she is born, and I'd like to nurse as soon as possible. Also please do not give my baby the Hepatitis B vaccine." And sometimes they come in with a birth plan that is 4 pages long. These are the people that you might as well get the OR ready for their C-section. Such is the case of "Jill," a 34-year-old primip (first pregnancy).

Jill and her husband "Brian" took the Bradley classes. If you don't know what those are, Google it. Her birth plan was so complex that we could about guarantee she wasn't going to get everything she had requested. It just wasn't possible. Included was that she wanted nothing to induce or augment labor, she wanted everything to go totally naturally. Ok. So when she finally went into labor, 3 WEEKS past her due date, against the strong advice from her midwife that it wasn't good to still have a baby in there that long, we were expecting a rather large child. Nonetheless, Jill's birth plan insisted on no medication, no IV's, no anything to help things along. It was reasonable until after she was in labor for 24 hours. We said "Jill, we understand your birth plan, but now that it has been 24 hours and you aren't making any progress (she was 3 cm dilated) perhaps we ought to think about starting an IV to get you some fluids and maybe a little Pitocin just so that we can get your baby here a bit faster."

You'd have thought we suggested a C-section with no anesthesia. She freaked out on us. So that was the end of that suggestion. Also I should mention in said 4 page birth plan we were also instructed "medical staff is not to address Jill directly as her relaxation is of the utmost importance. All questions will be directed to Brian." which is ridiculous and not legally possible. We have to have the patient answer certain questions for us, we aren't allowed to take what the husband says as an answer for many things. So we continue on with Jill's contractions coming every 3-4 minutes and not much change in her cervix. Another 24 hours later (we're now at 48 hours since she got to the hospital) Jill is now about 4-5 cm dilated. We thought maybe we could address this and suggest the possibility again of starting some Pitocin or perhaps breaking her water. Sometimes that helps. Jill also hasn't slept in over 48 hours, remember. Again we got resistance and were asked to not ask her about anything to speed up her labor again. Hopefully, her baby was doing fine and wasn't in distress, but it was difficult to tell as we weren't allowed to monitor her baby, we could only dopple for fetal heart tones once an hour. Which by the way is totally against our protocol, but patients can refuse anything they don't want.

Now any other patient would have already had a C-section before 48 hours of labor and only being 4 cm dilated. But since there wasn't an emergent need for one she wasn't taking one. We didn't even suggest that to her! Around hour 62, Jill's water broke. Around about hour 64, Jill was finally completely dilated. Amen to that. Jill was coached on pushing. She started pushing. 3 hours later, she still hadn't had a baby. She was pushing effectively, it's just that the baby was so big, he wasn't getting very far. Jill refused a vacuum extraction, forceps, or an episiotomy. So she continued to push.

Thankfully, an hour later, Jill delivered a 10 pound baby boy. Jill also suffered a 4th degree tear, which means she tore all the way from the vagina through her rectum. So she got to go back to the OR to have that repaired. It was so bad we had to have a colon/rectal surgeon come assist. When I assessed her afterward, she looked like raw hamburger meat. Bet she was wishing for that epidural now, huh?

Welcome!!

Welcome to my blog about my experiences on L&D. A little background, I have been a nurse for over 5 years now. I have seen some really entertaining things from women in labor, and their families. I look forward to sharing these stories with you! I welcome any and all comments, even negative ones. While sometimes it may seem I am making fun of my patients on here, and in reality, that might be, please note that I am always a caring, attentive, and professional nurse. My comments from my patients reflect this. I will never give a patient's or family member's real name, I will always change this if I need to use their names in a story. Feel free to comment or send me an email any time you feel I have violated any HIPAA laws, and I will immediately remove or revise the post. Thank you for reading!