the IF project....if only......

I have mentioned previously that I had worked in a prison as an RN for a period of time.  I was working with male patients - the worst of the worst, if you get my drift.

I have worked inside those double barbed wire walls of prison with very little protection than a Personal Protection Alarm....and dozens of male prisoners out of their cells and all around me.....

So I am telling you from experience that I am not naive or oblivious to the manipulations and the emotional immaturity in these places.

Prior to my stint as a prison nurse, when I worked in Labor Delivery, we occasionally had an incarcerated patient accompanied by a guard escort.

Photo credit: here for an interesting
article on shackles in L&D

It also wasn't uncommon to be caring for a pregnant woman off the streets, trying to shake their drug addiction -  and on methadone.

My heart went out to these women.

What was it that led to their present situation? I always wondered.

One time - I did ask.

Along with my other new moms, I was assigned a prisoner transferred from the local lockup, admitted for preterm labour.

A quiet withdrawn little thing, she presented as a tiny pathetic figure almost lost in the mountain of covers on her bed.

On one of my patient rounds I rescued a small bunch of flowers that another discharged patient had left behind.  It would have gone in the garbage had I not salvaged it - and I hate waste. 

I picked out the dead and wilted flowers and brought the little freshened-up bouquet into her room.  Placing it on the windowsill where she could see it, I told her that I would leave them for her to enjoy.

The guard glared at me - but my patient was transformed.

Tears in her eyes,  she thanked me profusely - and unnecessarily - for such a small and insignificant gesture.

It was later on during my night shift that she told me  her story:


Her early married life started out as most....very happy,  living an average life in an average family neighborhood doing what most young mothers and wives do. 

Tragically, her husband died and she was left coping with two young children on her own, a mountain of bills to pay - and no job experience.  

She was at a loss to find a way to provide for her children.   At this point, welfare was not an option.  She was too proud to take handouts.

The money she earned at a minimum wage job couldn't pay the bills.  She wrote a couple of bad cheques and ended up in the court system. 

From there it went from bad to worse.   She lost her house.  

To deal with her depression  over her hopeless situation, she turned to alcohol. 

She was involved in an MVA and thereafter became dependent on pain medications prescribed by her MD.  She couldn't afford to drive and couldn't get to any job that would even look at her for employment now she had a record.

The social system took away her children when she became involved with unsavory persons who provided her with living quarters -  the only place she could afford after being turned down by a series of landlords.

Increasingly addicted, one day she changed her prescription for pain medications and was caught by the pharmacy - and the law. 

She went back to court - and then lockup -  and thereafter,  her life became stuck in the revolving door of prison.  

When I met her she was pregnant by an unknown father while prostituting.

Even if only part of her story is true.....how tragic!

Sometimes we look down at these people, thinking how much superior we are....forgetting that but for the grace of God.......

Are these people salvageable?

Statistics are not on their side but as a society, we are behoven to try.

Recently,  girlfriend that works in a different area of the penal system sent me this link:

The If Project:  Essays from women from Washington State Correction State Center for Women.

Over 240 essays written by the women at this prison when they were asked :

 “If there was something someone could have said or done that would have changed the path that led you here, what would it have been?”

The hope was to find out tangible things they could do or say as officers working on the street that could actually work to change a young person's direction in life before it was too late.

If you choose not to click on any of the links above,  please, at least  take a moment to watch this short video and let the women speak for themselves:


The If Project Trailer from The If Project on Vimeo.


I wonder how many of these women, if shown discipline and love... would have ended up in a different place?

This following video is worth a repost:

Can't Change the World....sung by a First Nations gal that was a foster child until a family took her in and cared for her ....and her life was so totally different than it could have been:

You know you are a Nurse when....

There have been a few of these out there, so I thought I would add my two cents worth.

You know you are a Nurse when:   upon discovering someone used up all your cream you left in the fridge - you use baby formula in your coffee instead.....

Yup. Done that.

Many times.

At least there is some use for formula!

And no, it doesn't taste that bad.

And....according to my mother, it is probably the *first* time I had tasted the stuff......

A Nurse's Perspective can be an odd one

One of my Facebook friends uploaded one of her friend's photo -  taken of a local waterfall.

The picture is amazing and my friend decided to share it with all, not only by posting it on her facebook, but also making it her profile picture.

It's a photo of a child walking out of the cave behind the falls - and the photo was taken just as he was emerging from the water spillage.

I don't know, call me an old Labor Delivery RN who has spent waaaay too much time looking at you-know-what......but at first glance (and second and third for that matter!) it looked like something quite familiar.

If you don't see what I mean - stand back a couple feet from your computer and squint at the photo...it'll come to you eventually.

Ya. I thought so.

Margaret Falls in it's entirety.

you can wander around and experience the waterfall
You can see where the cave is that the kid walked out of
in the very top photo.....

When Babies Cry: think PURPLE

In 2009,  Children's Hospital here in British Columbia,  initiated a province-wide project called "The Period of PURPLE Crying Prevention Program ". 

Research suggests that "colic" is a normal developmental stage rather than a medical condition.  The booklet and DVD distributed explains babies crying in a simple and easy way   - and suggests practical  ways to control parental frustration and anger- that is helpful for parents.



Nurses played an integral role in the distribution process.

Process & Stats:

First "dose"-  Over 90% of new parents in all the hospitals across B.C. are receiving the program materials on each maternity unit.

Second "dose"- Over 93% of Public Health nurses discuss the five talking points with the parents.

- Approximately 80% of the time nurses encourage parents to share PURPLE crying materials with the baby's temporary caretakers.

-80% of fathers are present when PURPLE materials are presented on the maternity unit.
-In addition to listening to presentation by nurses, 75% of parents watch/read the materials given to them.

The results have been astounding.



Outcome measures:
-Statistics show that Shaken Baby Syndrome (SBS) usually happens in the first 6 months of a baby's life,  therefore it is expected that the program will have an effect on those babies 6 months and younger.

-In 2010 there were no definite cases of SBS in infants under 6 months of age.  This was down from 6 cases in the previous year.

- In 2010 there were 3 cases of possible to definite cases of physical abuse in infants under 6 months of age.  This is down from 18 in the previous year.

- For infants age 0-6 months of age there was a 31% reduction of hospital visits at Children's Hospital's Emergency Department for colic and crying unrelated to disease or injury.

In 3 studies to date in the USA - cases of SBS have doubled during the recession.  Here is a map of those provinces or states that have implemented the program. The US Military has partnered with NSBS (National SBS) to develop materials specifically for their troops.  

Take a look at the map.  If your state/province isn't one of them, the best thing you can do for babies is lobby to implement it.  It's a great tool for parents.

Children's Hospital sent out a thank-you letter to all those Nurses involved, which included us:

"These are preliminary outcomes. More years of evaluation are necessary. However, these outcomes are a tremendous credit to the nurses of British Columbia. We all have a tremendous amount of work ahead of us to make these initial encouraging results permanent. Thank you NURSES of B.C. We so appreciate your excellent work and commitment. Please keep up the great work." signed by Marilyn Barr (director of the SBS BC program) and Dr Ronald G.Barr (head of Developmental Neurosciences & Child Health)

Wow.  The letter almost made me cry.  Amazing what health education can do and how we as nurses can make a huge difference in the community.


Course Information/Course info

Terbutaline for Preterm Labor - Should it be used?

I did my L&D training in the East Bay Area of San Francisco.

One of the routine practices, although not approved by the FDA, was the "off label" use of Terbutaline or "Brethine" (bronchodilator) to treat pre-term Labor.

We gave sub-q injections, followed by oral pill form when stable, as routine practice.

I never really questioned it at the time because that was the standard protocol we would follow for preterm labor in those days.

When I moved back to Canada, I noticed the glaring absence of Terbutaline on the labor units.  In fact, none of the gals I worked with had even heard of it. 

I asked one of the OB docs why it wasn't used in Canada.  At the time,  his reply shocked me.

"Because" he stated, "it isn't proven to be effective in stopping labor."

I can only speak for British Columbia, but as a practice, the primary treatment for preterm labor seventeen years ago when I moved back to Canada,  was the administration of fluids and  Indomethacin  or perhaps nifedipine - in the five different hospitals I worked.  We may have even used MgS04 a time or two before it went by the wayside. "Bedrest" was a joke, really.

I remembered back to my California days when we would care for pregnant moms-to-be in what was classified  as "Preterm labor".   The monitor recorded "contractions" would quickly smooth out with the administration of Terbutaline.  So really, what was it doing, if it wasn't stopping preterm labor?

I suppose a clue can be found in this question - What is the definition of preterm labor?

True Preterm Labor is gauged only by the progressive change in the cervix by contractions (between 20 and 36 weeks gestation) -  not by the contractions alone.  

When a health care worker is assessing contractions, it is necessary to palpate contraction strength with hands on the abdomen and actually feel them.  The appearance of the bumps on the monitor isn't an indication of their strength - and yet how often do we see this as the sole determination of contractions?

There is debate that the contractions appearing on the monitor that were "smoothed out" by the terbutaline were even strong enough to do anything in the first place.  Basically, what we were actually doing with the "Terb", is getting rid of the irritability that was appearing so the mom didn't have to be kept in the hospital any longer than necessary.  No contractions = discharge = less expense.

The truth about terbutaline is that there is a lack of controlled studies that support the use and it may even do harm.

So how do we treat preterm Labor?

In B.C. there has been an increase in the number of preterm births - especially noted in the 33 to 36 wk age group, immature lung development being the most challenging problem as a result.  

Because of the advanced maternal age of the women giving birth in recent years, and also the fact that older moms have a higher instance of multiple births which in turn are also are more susceptible to preterm birth... it makes sense that the statistics have been on the rise.

But - guess what?

"Clinical trials have not been able to demonstrate a reduction in preterm births from the following prevention strategies: home uterine activity monitoring, frequent digital cervical exams, bedrest for twin pregnancies, tocolytics, and education about the signs of preterm labor among women with identifiable risks."


So, as far as tocolytics go, according to our province's policy for Perinatal Services in B.C., "there is no evidence demonstrating that the use of tocolytics to arrest preterm labor  results in a reduction of preterm mortality" - both long and short term administration. 

In our province, the only tocolytic recommended is Indomethacin - and only up to 32 weeks gestation - and the primary aim in its administration is to give Betamethasone a chance to mature a baby's lungs and to ensure a safe transfer to a facility that can adequately care for the premature infant.

I can remember a brief time when Magnesium Sulphate (MgS04) was given for pre term labor. It has since been shown to not only be an ineffective tocolytic, but its use is associated with an increase in mortality for the infant.  It is strongly advised by BC Perinatal Services not to use MgS04 as a tocolytic.

Another medication I have seen used is nitroglycerin.  Apparently there is no evidence supporting the use of nitro as a tocolytic either.

When I worked south of the border, every woman who walked in through the door in preterm labor had an IV started.  Surprisingly, there is no evidence supporting  IV hydration to prevent or arrest preterm labor. 

Definitely it can benefit a woman who is dehydrated, which, when I lived in a very hot area of Canada in the summer, we would see plenty of those.  In the hospitals I worked in North of the border, we were more likely to hand them fluid to drink rather than an IV infusion.

One will find that bedrest is still recommended for those singleton moms in preterm labor,  both sides of the border - either at home or in the hospital.  Interestingly,  there is no evidence for or against bedrest in the prevention of preterm births. 

Even for twin pregnancy - there is no evidence supporting routine hospitalization for bedrest in the prevention of preterm birth - and until there is a study that shows otherwise, BC perinatal policy states there is no indication for this practice as routine.

So, what is left if nothing really works?

Basically, the use of cervical ultrasound and the use of fibromectin test are useful in identifying those moms in preterm labor who need to be stabilized and transported (with infant in utero) to a facility that can adequately care for a premature infant and the results can possibly be used to reduce the number of interventions done to the woman - such as the unnecessary use of tocolytics for those not at risk and more appropriate identification of those who can benefit.   Read here for the discussion on this (5.3 and 7.2).

So - what do we do when we know that evidence based medicine is best ?  When what we have done in the care of pregnant woman for since forever is not what research shows we should be doing?

Why are clinical trials and research done if it isn't going to change the way we do things?


*********************************
Thanks to the BC Perinatal Health Program for the information online.

The Case of the Missing RN

It's no secret that I have a fascination for nurses of the alternate gender.  When I was in nurses' training, we only had ONE in our class, and he didn't finish (this was a loooooooong time ago). 

When I went to work at my first job at a medium size hospital (approx 260 beds) - we did not have even ONE nurse of the alternate gender apart from psychiatry.   Psych had 3 total - one in the position of "head nurse" and 2 on the floor.  Loved the two that I worked with on the floor.  Wasn't sure about the manager - he always seemed a little odd to me.

Then I started working in L&D.....and there were even less of the alternate gender within the ranks of the Nurses.

 I did work with ONE in Canada....and I thought he was very good - he was actually a midwife trained in another country - but was working in the capacity of RN. 

I enjoyed working with him and the moms had no issues with him, as they shouldn't,  since no one ever had any problems with the fact that Male OB's cared for the patients.  There shouldn't be any difference. 

Unfortunately, however,  he left fairly soon after starting because he felt that he was being discriminated against - not by the patients - but the other RNs.  I couldn't understand that, since his practice was without fault.

I worked with another very special and wonderful RN in a smaller facility.  He was a Jack-of-all-trades - mostly worked ICU/ER but would float anywhere - even worked L&D.  He was an excellent L&D RN.  His patients loved him.  His co-workers loved him.

 He got along with everyone. He drew raves from all patients.

On nights, on our breaks we would visit - and some of the stories he told were nothing short of amazing. He told me about the time an ambulance meandered in sans lights and sirens with an MVA who the paramedics deemed to be "dead".  They had extracted the patient from a horrific crash.

 This RN climbed into the back to check it out.....and found.....a pulse! They quickly hauled that patient out of there and subsequently saved her life.  It took months - but she recovered fully without deficit,  and later came in to thank him for saving her life.

He would occasionally go on travel nurse stints to the USA - for several months - then return.  About the time I was ready to leave, he tried to sell his laptop to me, which I found a little curious because he used it extensively to connect with his family while away.

He had  a wonderful family - three teenage girls - and a wife.  It seemed that they had a good life.  I never heard of any sort of problems or concerns.  He was always a happy person - smiling all the time.  He was a thoughtful, kind person - always helpful.  He was a loving father - this is a letter he wrote to his daughter on her graduation from high school.  He certainly was a very proud father.

He and his wife volunteered with Gideons.   He asked me if I received a Gideon's Bible when I graduated from Nursing, and when I responded in the negative - he gave me one.  

It is a little white New Testament with "Nurse" printed under their lamp on the bottom Right hand corner. Inside is a Canadian flag and the Florence Nightingale Pledge.

Shortly after I moved away, something shocking happened.

 No one knows "why" - but this RN, after having an argument with his wife, left the house and wandered away - never to be seen again.

He didn't ever seem depressed, never mind suicidal. 

Pleas from his daughters "Daddy, come home, we don't care about anything else, just please come home - we love you"  in the newspapers and online were left unanswered.

Some people thought that perhaps he went back to the USA to start a new life, but his American License didn't show any activity. Nothing was found.  He left all ID and his wallet behind. 

It is now coming on Nine Years, and not one trace of him has been found - not even a body.

You can read some of the heart wrenching posts by his daughters, sister, wife and friends here on Facebook.
One of his daughters posted a letter he had written to her upon her high school graduation.

So far, he has missed the death of his father,  weddings of all three daughters and the birth of his first grandchild.

If anyone has seen him, please contact the police.  His family misses him.

The Tapestry

Religion is man-made. Faith is personal. 

I would say I am spiritual.  Faith is a private thing and I am comfortable with what I have,  unencumbered by the rituals and restrictions of the four walls of a building.

I think a lot on what goes on in this world of ours,  the people that perished in the 2004 Tsunami, and then again with the Earthquake last year shortly after New years.  I think of my friend that was killed when his plane went down......and another friend who died years before him in the same way. 

I just couldn't understand the why of it all. 

It was explained to me that Life is like a Giant Tapestry hovering above the Earth.  All we see from our point of view is the underside.....the loose ends, the mish-mash of colors - and no matter how much we try to decipher it - there is no pattern whatsoever.  From where we are, we can't see any design or meaning in the work at all.  In fact, you could almost say - it's ugly.

On the other hand, The Master Planner is sitting above it....looking down on a beautifully woven picture that is complete and makes sense.  All the colors come together to form something that is breathtakingly wonderful and flawless and beautiful. 

I suppose one day, like Danny, we will get to see the whole picture and finally understand.

Meanwhile, born yesterday, there is a beautiful little baby girl- Danny's great-niece and his namesake,  arriving 16 years to the very day Danny made his trip to heaven....a gorgeous, beautiful little bit of  perfection,  Heaven-sent as a reminder that there is some Good on this Earth after all.

January 11, 1995 - Emergency Obstetric Medevac

I still remember Danny as a cute little guy at at age 5 - looking up at me with that freckled face - smiling that wide toothy grin.....holding up a paper with a picture he drew for me....a plane floating in the sky.

Oh, my! Danny...that is gorgeous! Is it for me?? I took the picture and inspected it carefully.

Sparkle in his eye - "yup" he said in his shy little way, pleased that his artwork made a hit.

"Thank you soooooooo much.  I am going to keep it forever."  I gave him a big hug. "One day....I am going to marry you....you are so cute!!  I'll wait for you!! Okay??"

At age 13, you can promise anything.

My dad had been best man at his dad's wedding.  His oldest sister was my best friend.    Every summer they would stay at our Resort and when work was done, us girls would sit on the steps in that warm summer dusk and chatter on about everything from boys to ....well, whatever was important to 13 year olds.

Danny had always been special.  The apple of his daddy's eye.  His mother had prayed for another little boy after they lost one years earlier.  His sisters doted on him.   As much attention as he got - he never acted "spoiled".

Years passed and I would meet with Danny on occasion - when I was in Vancouver visiting his sister  - we would go out for dinner.  By that time, he had a failed marriage and he was well on his way to fulfilling his dream of becoming a pilot.  He now liked to be called Dan, but I still called him "Danny".  I kidded him about my promise years ago.  He would laugh, and we would talk about what we both wanted in life.

I moved to California and Danny would call on occasion and see if I could meet him for lunch or dinner. By this time he was flying Lear jets for customers all over North America.  When his plane was scheduled for the Bay Area,  usually he would call if he had a stopover.  He was still single and so was I. We would still laugh about "our getting married" and chat about how life wasn't quite what we expected it to be.

When I moved back to Canada, he would still come and visit when he flew into town.  In the fall of 1994 - I had him over for lunch at my new condo and we talked about old times.....he told me how he would fly medevacs all over B.C. - emergency transports - some out of my hometown, and from our unit.

 I told him how I was afraid to fly in small planes, and that he couldn't get me in one of those for anything.  He laughed at me when I told him how relieved I had been, after a patient I had accompanied to the airport to be transferred out by Medevac hadn't needed me after all -  because of the receiving crew of flight paramedics.   He thought it funny - because flying was his life. 

He had just been upgraded to Captain at the company he worked for, after flying Learjet for 5 years. He was described as a quiet, compassionate, meticulous individual,  and regarded as a conscientious pilot, well respected by his peers and supervisors in the company he worked for.

January 11, 1995 - I was working a night shift on our Labor Delivery unit when one of the other nurses came up to me at approximately 3 am.

"Have you heard???" she whispered.

"Heard what?"

" A medevac Lear jet just went down north of Massett.  They were heading there to pick up a woman in labor.....and they disappeared off radar. There was a doctor and two paramedics on board. They think that it crashed into the ocean."

My heart sank and I felt nauseated.  I don't know how I knew.......but I just knew. 

It was Danny.

Investigation reports by Transport Canada later cited possible cause was the possible incorrect setting of the altimeter causing a CFIT.  The details were never confirmed.

Massett airport lighting was only low intensity portable battery lighting that could not be seen at 800 feet therefore there would have been no warning that they were at too low of elevation.  There was no GPWS on the Learjet to automatically warn danger of the aircraft too close to the earth's surface.  There had been a  GPWS on this particular Learjet - but was never replaced after a previous accident with the landing gear years before - because this type of plane was not required to be equipped with it.

Danny's body was the only one of two that they found.

All I can say is that every January 11th, I think back and remember that little boy I once knew, his smiling boyish face looking up at me with drawing in hand outstretched......and a few involuntary tears fall - still - 16 years later -  as I listen to this song:

Number One Reason why I might not Acknowlege a Patient in Public.

True story.

I took care of thousands of new moms in L&D while in California.

It wasn't often that you would recognize a patient out in public just because of the sheer numbers of deliveries, nor would you even run into one due to the immense but scattered population in the Bay Area, but this one time I did.....

I went out dancing with my roommate and a couple other friends in a rural bedroom community outside the area where I lived and  worked. 

Next thing I know, a young gal is waving at me at the next table over.....beckoning me to come over to visit. I smile and wave - friendly person that I am -  and go over to see how I know them.

She gushed - " You were my nurse in L&D - thank you so much!! You were terrific!"

We carried on a little innocuous conversation - very superficial - the usual that you would upon running into a former patient, such as "how's the baby?" and "how are you doing?" or "are you enjoying your new little one?"

Her husband participates sporadically in the conversation and after a couple minutes the new mom leans into me and asks "Would you like to dance with my husband?"

"Uhh...no thanks..."I reply, backing off slightly from the table - glancing over at her husband.

 My motto was always - "Married men are Ugly" - I just don't feel attracted to married men for any reason, much less when the mother of his new baby is sitting right there.

He then goes onto the dance floor with someone else from the table.

Her hand covered mine.  "Well..." she goes on to confide, "we were wondering if you were interested in doing a threesome....with me and my husband?"

"No offense - but really - I'm just not into that.....but thanks...."

 I retreated to my table.

I just wasn't prepared for that kind of pickup line..............at all.

Birth Story: Another Nurse's Baby story

I suppose it's still close enough to Christmas to post a link to this story.

I haven't read her book but if you like a "feel-good" story....you would probably like it.

I am still on Christmas season hiatus.

Precipitous Delivery in a Car

We have all heard the story of the gal who was sent home from the hospital at one centimeter and then she ends up delivering in the car on her way back in.  Not really big news.  Most of the postings on Youtube of these deliveries are "re-enactments" by the husband...or emergency services telling the stories.

This just happened Saturday, December 11..........

Interestingly enough the new dad still had time to pull out the iphone and shoot some footage of himself with the newborn at approximately one minute of age..... at the airport exit.....

They named her "Juno".

Another Birth Story: this time Human but with a mention of Animals

The last story reminded me of a gal I looked after in labor once.

I attended the birth of another very nice couple.   She just happened to be a veterinarian assistant.

The labor went well, the delivery was uneventful and baby was laid on mom's chest.

"Ohhhhhh......does he need to be suctioned??" she asked

"No...he's perfect, just a little mucus....but you can see that he is doing ok....his nostrils aren't flaring - and his color will get better as his circulation improves to his hands and feet....he's a normal little guy."

 She probably had all kinds of experience with animal deliveries.  It got me thinking....

"What do you do when you deliver a baby animal....say -  a puppy - if they are mucusy?"

"Oh - well - we swing it between our legs.....and that helps to drain the mucus....!"

I think I did a double-take to see if she was really serious.  "Hmmm......I can certainly tell you, we won't be doing that today or at any time here....!"

I always wondered about that....so I looked around to see if I could find  information on this.....and found the information that confirmed my suspicions about this practice:

"At birth, resuscitation efforts were instituted because of a lack of spontaneous breathing and bradycardia. In an effort to remove amniotic fluid from the airways, the puppy was "swung" by an experienced attendee in an arch from mid-abdomen height to knee height while cradled in both hands with the head stabilized. Initial evaluation of the puppy revealed normal blood glucose and no ultrasonographic evidence of hydrocephalus. Because of continued seizure activity, euthanasia and necropsy were elected. At necropsy, there was gross evidence of subdural hematoma formation. Subsequent histopathology of the brain, liver, lung, spleen, small intestine, colon, and kidney revealed subdural and intracerebral hemorrhage. Findings were consistent with high-velocity deceleration trauma ("shaken baby syndrome"). Traditional neonatal resuscitation via "swinging" is a dangerous and potentially lethal practice capable of inducing significant brain trauma in the canine neonate."

Seems there is a lot we have in common with our animal friends....

The Worst Delivery I have seen: Graphic story Warning.

I once dated a guy - let's just call him "Farmer MacDonald" -  who subsequently owned a farm and subsequently -  lots of animals of the bovine type.  Knowing that I was a Labor and Delivery RN, he thought he would show off his skills in the delivery area. 

I should have known better.

He told me that he had a mother cow in the barn obviously in labor for several hours.

"You came just at the right time" he shouted over his shoulder. "Let's go!"  He strutted off in the direction of the barn and pompously ordered about a few of the Hispanic workers for good measure. (yes, he was a bit of an ass...)

I followed him into the barn and stayed my safe distance on the other side of the corral fence,  ready to watch the show. Having once owned 4 Morgan horses, I tend to steer clear of ginormous animals with feet that could be weapons.  Especially ginormous animals with weaponous** feet in pain.

The poor cow was mooing and moaning......Farmer Mac reached inside her up to his elbow and pulled, trying to help the calf out.  Apparently she had been in labor for a while, and he was impatient to get it over and done with. (sound familiar?)

Anyway, it seems that the calf was "stuck" and he needed help getting it out.  He got out a rope and tied it around the leg of the calf.  Pulled.  Nothing. Yanked on the feet. Nada.

By this time several more farm workers gathered around, trying to help him out.    The poor cow, by this time was bawling away, creating a restlessness among the other cows in the barn.   She was in obvious distress, and the group of men around her were making her extremely jumpy.

Chains with handles were secured around the two front feet visible and Farmer Mac pulled on them with all his might (not unlike some OBs I have seen do, only without the chains....)

The poor cow shied away and rammed up against the fence and I jumped out of the way.  Shouting and pushing ensued....and the workers scrambled to get a foothold..... (not unlike what I have seen happen in some deliveries)

A bar was placed between the parallel fence boards and under the cow's abdomen and the farmer pushed down hard on the end of the bar on the outer side of the fence, trying to use leverage to move the calf up and out (supra pubic pressure anyone?)

Finally, after approximately an hour of scuffling around and still just the legs hanging out and no head to be seen....it was determined that the calf was dead.  Apparently, the nose, which usually follows the front feet with delivery, was twisted so it pointed toward the feet.  A malpresentation.  At this point, Farmer Mac was clearly pissed off, and continued to bark orders in the direction of the migrant workers.... (again -sound familiar??)

A wire appeared from his "Vet cupboard".   He looped  around the calf's head in utero and Farmer Mac proceeded to saw OFF the head with the wire and remove the calf in bits and pieces.

When it was all over and done with he said "Well, I guess you really didn't need to see that, did you".   Matter of factly.

Me: slightly in shock. ( ya think??)

"Ummmm.....well....it definitely isn't the way we do it......." I stated, rolling my eyes.

The guy had too much of an attitude ( like many of the OBs that I had worked with in the past.....) and his total disregard and lack of respect for animals (in general) spoke volumes to me.

 I punted him soon thereafter.
>>>>>>>>

This is, btw, the way it is supposed to happen.

This is what he was trying to do.   (although the actual way is to alternate pressure on each leg to walk it out)

Sometimes they use "forceps" - or a "rocker" in farm language.  :(

Look who comes in to help resuscitate....!

Applying support to the perineum in an odd way.



**is this a word?? :)

Birth Story: What is in a Name?

Some people give their babies the strangest names.

I am quite sensitive to it, because I myself have a name that is so unusual, I only have to write it down and everyone knows who that person is. Google my name and you get all information related - mostly -  to me.   I have had stalkers find what hospital I work at and the unit I work in because of that.   It can be a liability. 

Never mind, no one ever gets the spelling right.  Imagine having to go through life  having to spell it constantly.  I have yet to see anyone get it right the first time.  Even when I spell it out s-l-o-w-l-y, for some reason people still don't want to write it down it correctly.

For some reason I still have to tell them, "no - there isn't a space there and it is spelled with a "XXX" as in "XXXXXX" - and they STILL don't get it right.   I usually give up at that point and let them write it the way they like.  On the other hand, when people hear my name, they often tell me it's a pretty name. (Although not so pretty that anyone wanted to name their baby by MY name - except ONE!)

 My father, on the other hand,  is lucky. Same last name as myself,  but he just happens to have the same name of a notorious celebrity and if you type in his name in Google - any information about him is lost in the plethora of celebrity gossip.  I am envious.

I have also been envious of my brothers and sisters and friends who ALL could buy that mug or pen or whatever sweet item off the shelf that has their name printed on it - as stock - without having to special order and then wait 6-8 weeks only to find the company decided I didn't spell my name right and took the liberty to correct it for me! Arrrrgghhh!

I think I have somewhere already told the story about a young Chinese couple - new immigrants - who were going to name their baby Petunia - (or some other flower - I can't quite remember the exact name)....and I had to intervene on the baby's behalf and explain that it was not a suitable name for their baby. Explain to them that the name they had chosen was a girl's name - not a boy's name - and they might wish to rethink it, for their baby boy's sake.   Having immigrant grandparents with the difficulty of language comprehension definitely gave me sympathy for those  I looked after that were in the same boat.

I was working in the USA in a brand new (to me) hospital - night shift - and some of the nurses in L&D were talking about strange names.    I chimed in - "Ya.....I remember one gal who named her baby Melena....." [with drama]

Big Pause.

 *crickets* 

 The nurses all looked blankly at me.   It clearly didn't register with them.   Deeply offended, one of the nurses said "What do you mean??? That's my daughter's name!! What's wrong with it?"

Not exactly how to win friends and influence people - especially when one is the "new" nurse on the block.

But one thing that would really get me going were the mothers who had separated  from their first husband but didn't change their former married name for whatever reason - and would come in with their new partner and baby-daddy of the new little one.   I am pretty sure no forethought was given at all to the possible complications. 

The policy of most hospitals, in order not to have any baby switching or medical errors, is to put the legal name of the mother on the baby's bands as well as the new father's band.   All the paperwork has to match up to ensure that the proper baby stays with the proper mother.....and that if the baby is wheeled in the cot down the hallway with the parent other than the mother  and  a security check was necessary - we would have a way of ensuring the baby wasn't being snatched.

After all, there had been a baby-stealing incident in the city recently.  No hospital wanted that liability.

I can't tell you how many irate baby-daddies demanded the name of the ex be removed from their baby.  It was difficult to explain to them that legally - and for their baby's safety - this is the way it had to be done.

I suppose a home delivery would avoid this problem......  wouldn't it?

Birth Story: The Best Wedding Gift Ever

They were the cutest young couple. First baby. Doting Boyfriend.

She came in at 3-4 centimeters and they spent the morning walking around the unit hand in hand - the occasional doppler reading between trips per protocol.

By noon, the next doppler check was due, she and her husband were nowhere to be found.

 It wasn't unusual to have couples in labor walk around the unit or down to the cafeteria....or even out the door in the neighborhood for a little walk.  

An hour later I spotted them in the hallway.

"Hey -  there you two are!" I waved at them and smiled.  " I thought you had disappeared on me! I need to hear what your little one is up to.....how are things going - are you doing ok?"  I led them to their room.

They looked slightly flushed and a little bit sheepish. 

She handed me admission papers.

I took them from her and looked at them, not able to compute what they were for.  We already had her admission papers......and here were some -  with a totally different name on them.

"Oh....so the other admission papers weren't done correctly?" I asked.

"Ummm.  Yes they were.  Ah.... we just went out and got married.  Just now. My boyfriend......I mean husband [ he was grinning ear to ear at this point] didn't want our baby born without him being his legal daddy......" she explained between contractions.

Of course, all the nurses and docs had to congratulate them,  and we were wishing that we at least had a bottle of bubbly to give them!

Their best Wedding Gift ever came approximately 5 hours later.

ID Bracelets: and Babies Mix up

This past spring when I was at my folks' house, I made an interesting discovery.

As I have often done through the years, I was looking through my mom's old photo albums - and I found an old photo of some little girls that I didn't recognize mixed in with some of our own family photos.  Curious, I asked my mother about them.

 "Who are they?" I pointed to the photo of the 2 little girls, one approximately 7, the other maybe age 10.

Mom leaned over and pushed her reading glasses up further on her nose. "Oh....their mom was in the next bed to me when I delivered you. Every Christmas we would send each other photos of our children."

A few minutes later: "So....do you still  keep in touch?" I squinted at the photo, trying to make out the faces.

"No - they moved to Washington State and over the years we lost track of each other."

"So...?...I still don't get it. Why did you keep the photo? " I was curious.

Thoughtful pause.

"Well ....when you were born, you looked so different from the rest of the family, we were certain they switched you at birth - so we kept in touch over the years - just in case....." She shrugged.  "But....after a while it didn't matter."

This was the first time hearing this story.  Incredulous to say the least.

"It didn't matter after a while - you were ours.  We didn't need to keep in touch."

I continued to stare at that old photo.

Yes, I guess it really didn't matter, I thought.

Not anymore.

This was my family, for better or worse, and I am not sure that I would even want to look into Other Possibilities.



I did work for a few years at the hospital at which I was born.   They still had the ancient birth record books. I suppose I could have looked up my name.  Not that it would prove anything.

My mother had given me my little ID necklace with her name on it that they would put on babies in my birth hospital  55 years ago.  The beads were strung onto a very strong thread and then secured around the baby's neck with a blob of lead. (!)

 At the time I worked at that hospital, they were still making the same necklaces - only they were using the wrist/ankle plastic banding method as well.   The beads were more of a souvenir.

 They were reluctant to give up the old tradition -  they still would tie the beads around the neck.  I questioned them on the wisdom of that (or the lack thereof) - since we were instructing our patients never to tie anything around a baby's neck- safety reasons.   

I just handed them to the parents since they weren't used for actual ID-ing.

 I made another one with my name on it.  You can see that I have photo-shopped most of the letters off the white beads so my name is not legible.  It almost makes the beads with letters look like pearls.  The original and actual baby ID necklace I wore as a baby is on the right, the one I made up myself is on the Left.

Whether my ID necklace was put on right at birth....I will never know. My mom was a little foggy at the time...they did the "twilight sleep" back then for deliveries....and babies were whisked away to the nursery.  Mothers were alone in the delivery room back then, so my father wasn't able to confirm that I was the correct baby either.

Oh well.

Still, even though some things are not great in some delivery rooms now,  it's awful to think what they did to mothers back then......to not even know whether the baby handed to you was even yours......and not even feel that you could question the nurses or MD....?

You just Never Know: Birth Story

True story.

She walked in casually, nicely dressed and makeup - immaculate.



Random photo from an ad

 No heavy breathing, no stopping to have a contraction, nothing.  She smiled at me - and plopped her little suitcase on the floor by the bed.

"So what's going on?" I asked her as I welcomed her to the assessment room.

"I think I might have started labor" she replied.

"Are you having contractions?" Trying to get a take on what's happening.

"I think so." Still smiling.  " I kind of felt a little pressure and thought I would come in to get checked"

That little key word: Pressure.   She didn't look in any way distressed.  Didn't look like she was in labor - yet she felt "pressure".

I quickly put her on the monitor to do a short strip.   "Would you like me to check to see where you are at?" I asked.

"Why not? I am thinking it won't be long"  It wasn't her first.

The thing about mom's in labor, you never really know what you have.   I always believe the mom.  I listen to her.    That word "pressure" triggered something in my head - even though her behavior was nothing like that of most women in labor.  You just don't know.

I checked her.

"Wow - congratulations! You're fully dilated!"

She laughed.   " I thought so.  I was really quick the first time!"

Moral of the story:  Always listen to what the mother says.   Never discount anything she tells you - even if you think otherwise.  Although there are similarities generally speaking - there are always the exceptions.  Pay attention to the mom -  the monitor won't tell you the whole story in labor.  Let the mom be "Queen of the Room" and allow her to dictate what she wants and needs.  Every mother is unique in her needs and wishes - so listen to her!

You just never know.

Red Headed Babies and Teeth at Birth

One thing you don't often see in the Delivery room is a crowning head of BRIGHT RED HAIR.  That little bit of light in a darkened room, shining on the head as it is coming out is like a glowing ember of fire......

Wow. That is impressive.   I have only seen it a couple of times, it is so rare. Usually, the red hair evolves later....but when it comes right at birth in it's full glory....it's amazing.   I love red hair.

The other thing I found amazing was the couple of babies who at birth -  had TEETH.  Their poor moms.  As if it isn't painful enough starting out breast feeding .........

Ouch.

The "Midwife Doc"

When I moved back to Canada from the USA - it was a bit of an adjustment to what you can and can't get off the shelves at the drugstore.

I remember in the early 80s, telling the MD I saw in Hawaii on vacation, that I would just go to the drugstore to buy the benadryl for my swollen eye  - and he looked at me like I just told him I was a drug abuser. 

"You can't get that off the shelf - you need a prescription for it" he told me. 

That was news to me - in Canada, at that time, you could just get it off the shelf, just as you could the ibuprofen.

Same with codeine. You can still buy acetaminophen with 8 mg of codeine over the counter without an Rx.  Mersyndol is one of my favorites.....it has an antihistamine in it as well as the codeine. Expensive at $23 a bottle of 100's but a very good medication for migraines.

So,skipping back to the move home to Canada:

 I was in the local pharmacy, and after waiting the 2 or 3 persons ahead of me in the lineup to speak to the pharmacist - I asked the ill-fated question:

"Where on the shelves do you put the Monistat?" - not realizing that it wasn't available except by Rx in Canada at that time. 

I had spent a good half hour looking down every aisle for that life-saving medication.

Loud enough so the entire drugstore could hear, he announced:  

"Dear - you need a doctor to prescribe you Monistat - it's NOT an OTC..."

I was humiliated.  I started to back away, embarrassed to the point of wanting to run.

 Then - He stepped forward.

"Hi" He said. " Would you like me to write you a prescription?" 

I looked over at the kindly face and recognized him instantly as one of the docs that occasionally came to do deliveries and must have recognized me from the Labor Delivery unit.  He had been in the lineup behind me, and -  along with the rest of the crowd - overheard the conversation with the Pharmacist.

"Uh. Oh sure! Thanks so much! " I was relieved and mortified at the same time.

Later, back on the Labor Delivery unit at work,  I asked him if he was taking on new patients. 

"Certainly - for a colleague " he replied.

And so our relationship began.

He was the best MD.  You couldn't ask for a kinder and thoughtful MD.  He was soft-spoken and meticulous in his practice.  AND - his deliveries were always so quiet and relaxed. 

We called him "the Midwife Doc" because the deliveries he attended were so lovely.

I can still picture him sitting on the lowered foot of the bed as he was getting ready for the delivery of a baby on our L&D unit.  The lights in the room were off - except for the soft glow of a portable lamp next to his elbow.  

There was a warm quiet  in the room.  He spoke softly and encouragingly to the woman as she pushed in her own style -  lying on her side on the unbroken bed, husband next to mom, holding her leg during the little pushes.   Midwife Doc patiently waited, supporting the perineum as the baby's head slowly pushed it's way through - crowning ever so slowly. 

Each 5 minute interval Doppler tone had a reassuring - *dop*dop*dop* - as we encouraged the mom. 

No loud noises. 

No counting. 

Just mom and quiet words........

He never panicked. He didn't see the need for an episiotomy.   He looked up me and then over at mom and said casually, "Well, nurse, how is everyone doing?"  Twinkle in his eye.

I looked at the mom - face glowing with sweat, but a serene smile on her face.

"Perfect.  Just perfect" I replied.

In the next few minutes,  the baby easily slid out.....






A month later - it only took one little mistake to change everything.

On the way home from attending a delivery, Midwife Doc was talking on his cell phone as he drove along one of the little town's streets.

He didn't see his red light at the intersection. 

His sturdy car was T-boned, and he was thrown half a block away, through the side window and out of his car - unconscious.

As talk in the town would have it - his GCS scoring on arrival in ER was the lowest it could be.  There wasn't a person in the entire hospital that didn't feel sick about the accident.   

He had little kids - and in fact, I still had the thank-you note from when I had attended at the delivery of his baby that same year.

People that had never prayed before, prayed fervently for this kind doctor. 

Miraculously he did recover, but unfortunately, never to the point where he could go back to his practice. 

I saw him in passing in the community several times.   There was a blank look in his eyes.  Not even a little sparkle.  No recognition of me, or anyone else.  Still the same kind face - but no longer the man I knew.

You could tell he was trying to remember, but he just couldn't quite get there.

His entire life - as he and his family knew it - was destroyed. 

He no longer had a means of employment. 

He was alive, yes.  He still recognised his children and wife....but he no longer had the same joy and was no longer able to follow conversations or remember ..... and definitely all knowledge of his medical training had disappeared.

This tragedy happened at the time when cell phones were just emerging,  and no thought or concern was given to talking on a cell while driving.  It was just the beginning of many such accidents to come in the community and the country.
  

Although there are some people who are in opposition to it and say the statistics don't prove cause and effect - my hope is for every state and every province to make talking/texting while driving illegal.  

All I know is - if that someone I knew hadn't been distracted by a cell phone - there would have been one darn good MD still practicing.

What are we teaching our children?

Labor Delivery in a Rural Hospital

I did a stint at a small country hospital that had only 5 beds for post partum moms and one labor room.   The usual count of babies per month was around 24 to 26 - give or take.   It was a sweet little hospital, all on one floor, and as the the Night Shift RN - I was the only L&D RN on from 10 pm to 7 am.  

 

My patient load would often be a couple of post partum moms (maximum of 5) and perhaps one mom in labor....and if it was quiet, I would get an "easy" patient that wasn't critical or in need of a lot of attention to fill up the extra room....because when things got hopping in L&D - there was going to be very little attention shown to anyone else.

Occasionally there would be another mom in labor and there was an extra room just in case, that was set up for deliveries if need be....in a pinch.  It had everything needed for a delivery - but due to the population numbers....it was rare that you would have two deliveries at once, although it has happened.

The small town I worked in had a good number of moms that were what the nurses in the hospital I worked in in California called "Berkeley types"(....and hey, if you are from Berkeley - no disrespect meant, that is just the way they referred to the sandals/long hair/au naturel types down there).  They seemed to deliver their babies with no problem and little effort.  It was amazing.

There were several GPs that did anesthesiology that would come in to put epidurals in.  Now, some RNs  might not be familiar with GPs having the training to do epidurals and give anesthesia might give pause at that bit of info, but the truth is, this is a commonplace thing in rural Canada where the access to anesthesiologists is limited.   It has been shown that it is quite safe to have an epidural put in place by one of these GPs and in fact studies have shown there is no difference in complications and no life threatening incidents occurred when compared to a university affiliated hospital. (these GPs do not do complicated cases - only ASA class 1 or 2)

We did not have obstetricians at this small town hospital.  I looked at that as a positive thing.  Coming from a hospital in California that only had OBS specialty docs and Midwives, I was suspicious at first.   But, I was soon to find that the GPs in Canada are quite competent and usually -  if they knew you were an experienced nurse - they would treat the nurse as a peer rather than someone beneath them.

The GPs I worked with were very capable and did lovely deliveries with less intervention than in the larger hospitals I had worked in - and in fact - were comparable to the midwives I worked with in California.  Mind you, most of the moms were low risk types.  Anyone complicated would go to the next town over.

It was interesting to work at night. Alone. There was a float RN available at home that you would call in if you needed help - if a second laboring mom walked in, or if delivery was imminent.   Of course, not really knowing when a mom was going to deliver had it's challenges.   After the multitude of deliveries I had done up until that point which was in the thousands....one has a little bit better idea as to the timing.  It is just something you *know* after a while....based on a combination of the behavior of the mom in labor, mom's delivery history and intuition..... and somewhat on the dilatation, believe it or not. 

It was nice to have the woman in charge of her labor as opposed to the MD or the nurse.  She was allowed to mobilize at her leisure and only have intermittent monitoring with a Doppler.   I saw very few care plans because there was really no need for any.  Everyone just knew that whatever the woman wanted, or requested, we did our best to fulfill.  There were never any objections to anything that I knew of.    The birthing beds were rarely, if ever, broken down.  I never saw a scalp electrode or a pair of forceps the entire time.   Sometimes babies would go home without the "newborn bath".

I find it interesting that when you google "laboring moms"
they are all pictured in a supine position......

I can remember one winter night one of the GPs phoning up to let me know that she was going on a cross-country ski Christmas excursion put on by the town.   She told me she "might" be out of range with her cell at certain times, so if one of her patients went into labor and she doesn't answer right away - don't worry, she would pick up the message at some point.  As luck would have it, one of her patients did come in and, sure enough, I wasn't able to get a hold of her for a good 2 hours.  I almost had to deliver the baby myself, which wouldn't have been a panic at all, really.

When a laboring mom came in, the practice was to wait until approximately 1 hour before she delivered (!) then have one of the other nurses from another ward would call the "2nd pair of hands" to assist with the birth and I  would pick up the phone in the delivery room to notify the GP to come in. 

Most of the time they would get there in time.   Like I said, you develop a 6th sense after a while, and at that point I was at 4 to 5 thousand births and counting.    If they or the backup nurse didn't get there on time, the RNs from the Med/Surg side of the hospital would come and "help out".  Mostly all they did was stand at the door with eyes wide open - they all hated L&D.  Most of them wanted nothing to do with the deliveries - and when they asked if all was OK....and they would give me an expression of relief at my "no thanks" - and run off.

By the time I had worked at the country hospital, I had been fully conditioned to the way most hospitals delivered babies in BC.   It was easy to orientate to the new place -   the same "Partogram" or delivery record is used for monitoring labor and immediate post partum throughout the province.  It didn't matter what hospital you worked at  - the charting was all the same.   Basically, it was just getting used to the MD's routines and where stuff was kept.   Being alone on nights had it's advantages in that I could develop my own routines without interference.

The nursery was another ball of wax entirely.    There was a room beside the nursing station that the moms could wheel their baby into if they wished.  There was no nurse - just a baby monitor that would have the other listening end at the nurses station.  My problem with that system is that sometimes there would be no nurses at the station if it was busy on the Med/Surg side.

 I always encouraged moms to keep their babies with them at all times, and if I did have a baby between feeds if a mom was desperately in need of a rest and wouldn't take "no" for an answer,  I would take the baby with me on my break - I couldn't ever bring myself to leave a babe unattended in the "nursery". 


All in all, a great experience.  I would work there or at any other small hospital again in a minute.   Anyone contemplating working in a very small hospital such as this....I would advise that you be very secure in your OB skills.

The one other piece of advice? Listen to the mom.

She knows her body better than you do.  If she tells you something - listen!  I don't understand those stories I hear that some moms have told me: "the nurse didn't believe me when I told her I felt like I was going to deliver....."

The one thing I can predict about L&D ?

                             - it's unpredictable.



(all photos googled and borrowed from "wikihow" and employment sites)