Friday, August 23, 2013

Birth Plans, Nurse's Perspective

This post is written with sympathy to all expectant mothers. Giving birth is beautiful, empowering, and certainly the most special day of your life. It seems, however, that many of you come to the hospital with certain expectations that I would like to analyze. These "rules" are sent to you with love from labor nurses everywhere, in the spirit of sisterly sharing. These guidelines apply to full-term labor and delivery, and only touch on key points. This should not be taken as any medical advice, but merely sister-sharing from someone who has been in the trenches! Here are recommendations from someone with 10 years of experience in Labor and Delivery, and three births of my own:

We can do it!  Image copied from

  1. The first rule of motherhood is to stay flexible, and it starts before birth. The goal of every childbirth from your health care provider's viewpoint is a SAFE and HEALTHY delivery for both mother and baby. THIS IS NOT NEGOTIABLE. Get your head around that for a second, because while you may want to use Lamaze or Bradley methods to labor and push out your baby it becomes a moot point if your baby is not tolerating labor (or if you have a necessity for induction of labor). Things change so quickly; we do our best to explain what's happening but we like to act quickly for your safety and your baby's.
  2. If you have never pushed a human being out of your body but want an unmedicated labor and delivery, DO YOUR HOMEWORK. Practice the method of your choice all the time, make it second nature--do it on the toilet, or during lunch, or when you have your daily run of Braxton-Hicks contractions. Plan on doing it alone, because unless your baby-daddy is Mr. Awesome, he is going to need a break and you might end up breathing through many contractions alone. Get your focal point and use it early. If you tell the nurse not to offer you pain medication, don't blame her for following your wishes. And don't feel guilty if you change your mind.
  3. Understand that labor is a MARATHON for most people, with a SPRINT at the very end when you are the most exhausted you have ever been. (And then after that you get to take care of a baby...more on that later).  We are going to be "coaching" you through every contraction during pushing, so don't hold back and give us all you can.
  4. If you have medical conditions like preeclampsia, gestational diabetes, or other chronic pre-pregnancy conditions, please make room to accomodate them in your birth plan. It is likely that pitocin will change your mind about things, and so will magnesium sulfate. Refer to rule one. If you have preterm labor with an infant born and sent to Neonatal Intensive Care (NICU), we will encourage you to pump shortly after delivery, visit baby often, and will support your care of the baby as much as possible. Refer to rule one. This may be completely opposite of what you expected.
  5. If you look up a birth plan to borrow from online, please pick only the five most essential options. If you pick more than five options, and you are very rigid, we will see you in the operating room. It's nothing personal, but Murphy's Law tends to dictate those cases more often than not. Again, see rules #1 and #2 above. Flexible and prepared. This mainly refers to the big things--pitocin, pain management, food, movement, etc. The little things like when and who cuts the cord are usually easy to accomodate in any birth.
  6. You have been with your OB/GYN for some time now. It's your job to build a rapport, to understand their dictates and preferences, and to accept them as they apply to your own birth experience. We know your doctor quite well, and we will advocate for you as needed, but you have had 8 or so months to propose and agree upon a plan for this baby, while we just met you. If you don't trust your care provider-- get it worked out sooner rather than later! 
  7. If you plan to breastfeed, have your OB/GYN take a look at your nipples. While this is very personal and private during pregnancy you can rely on the fact that some nurse is going to have her hands all over your boobs trying to get your baby to latch, and it's a lot easier if your nipples stick out. Wearing nipple shells during pregnancy can help. Rule 2: Prepared.
  8. In the end, if you are healthy and your baby is healthy then MISSION ACCOMPLISHED. Do not look back and dissect how things went, you are somebody's Mother and that is no small thing! Get sleep while you can, enjoy your baby, and take good care of yourself.
With love, from a Labor Nurse.

ADDENDUM: #9 (recommended by a friend) If for some reason your labor is really fast, and you wanted an epidural but couldn't get one in time, quit complaining. You have been blessed, the pain is over now, and we are happy for the safe and healthy delivery on your behalf. There is no need to write a letter of complaint to the hospital blaming us, we have no control over your labor unless we are running pitocin...and even then, honestly, it could go in any direction.

ADDENDUM #10: Please stop scaring your friends, neighbors, sisters, and distant foreign relatives with your birth story. It is what it is, hold your baby and be glad. Save the drama for your husband, he should be the only one you are scaring with that story. There is no need to make a first time momma feel more frightened of labor and delivery than she already would normally be. With that being said, women do this every day and while it is a rite of passage, and sacred, be realistic. Tomorrow you have to get out of bed and start caring for yourself again no matter how you gave birth. Keep your perspective and get on with life.

(This blog will return to its usual topic at a later date).

Monday, August 5, 2013

This Old, Busted Ass is HURT.

Boy am I having trouble with this blog tonight. All my pictures are out of order and orientation and everything. Not much of a story this way! I was going to slip this photo in last as a reminder of the moments I miss when I am doing all those extra shifts (see below). Me and Big G snuggling on the couch before I got called back to work last week. The weight loss has been VERY disappointing in the last week, between hormones and lack of sleep, working too much and eating a boatload of crap. I have lots of setbacks and I keep telling myself that I am doing this for my own physical fitness not to be "skinny" so why worry so much? Because. I am a woman, and we worry about things that guys never have to even process.

Seriously. Most guys never have to think, evaluate, and make a decision before they have a bite of something. It's pretty much "Mmm, cookies, om nom nom". In the meantime I am supposed to push a bowl of chips away in favor of greek yogurt. How does that even correlate? So as the family were enjoying molasses cookies the other night, I ultimately ate two after giving myself a complete complex about the consequences in which I now find myself--that of having gained back 3.5 lb which is most likely water. And the ugly truths of how I eat and why, how I don't want that pattern handed down to my three little loves, and how I don't need to be responsible for my DH's own food issues. He has to deal with them himself, but we still have a chance to teach the younguns about fitness, healthy eating and snacking, and why special treats need to stay special (and only occasional).

So the running. I finished Week 2 of C25K and my left knee is screaming, all up behind my patella, and I am thinking that even though I can scarcely call myself a runner I nevertheless find myself suffering from what is likely a case of Runner's Knee. Apparently I have been pushing way too hard after being way too sedentary for pretty much the entirety of my adult life. It has been suggested to me that I try to rest it for a month, which actually might be okay since it's canning season.

I have already started, with the bulk of my recent cucumber crop in yonder jars soaking up the tasty bread and butter juices. I can just about imagine crunching into one of those babies as it nestles atop a freshly grilled cheeseburger...(I have no idea why this photo is sideways, or how to correct the matter, or why these last two paragraphs were suddenly centered instead of left-justified). 

Beautiful, sweetly crunchy tangy pickles. 4-6 weeks until you are all mine.

In other news you may not be aware that I have disappeared from the world into the void that is my workplace. I worked 66 hours a week for the last two weeks and on Thursday, it will all be worth it. I made up in two weeks all the cash we were missing in July. And as you might notice in the photo below, I will be making it happen again if the flow of business allows. By the time my kids board the school bus in September I will probably croak from exhaustion. It has been suggested by the people who love me the most in life that I am overdoing things--the job, the exercise, the canning/gardening. I promise we will get to the point where I am feeling more like my Wench self soon. But for now, affairs of state must take precedent over affairs of State (with thanks to Mel Brooks, I have always loved that quote). Ah I see we are back to the left-justified margin. Very interesting indeed. It's almost like I have no control over formatting tonight.

This here is the demon schedule. Only two extra days this week, but check out next week. This is in additon to my regular shifts!