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Monday, January 30, 2017

Random Thoughts from a Labor Nurse

Ok, so this is basically just an "I'm a labor and delivery nurse and these are some things I need to get off my chest" post. :) Let's start with how much I love my job. I mean, I have the absolute honor and privilege of being present at one of the most incredible moments in a person's life. How cool is that?!?! The gift of that is never lost on me. Having said that, there are a few things that might be helpful to those who don't have that privilege every day.

First of all, let's talk gestation. Listen, if you're not at least 38 weeks pregnant, don't even consider saying the words, "I just want this kid out." Here's the deal, most of us know exactly how you feel. We've been there, too. It is incredibly uncomfortable past 36 weeks. Everything is uncomfortable. Sleeping? That doesnt happen anymore. Breathing is difficult, and pretty much every movement brings with it some sort of joint pain (thanks hormones). And we can even sympathize with each of these aches and pains as many of us have indeed been 38, 39, 40 and even 41 (GASP) weeks pregnant. BUT, you know what we've also seen? We've seen babies born too early who, best case scenario, have to stay in the hospital much longer than the average stay so that their lungs can develop more fully, and so that they can start gaining weight. You think you're uncomfortable now? Live in a hospital for even just a week. You'll want to tear your hair out. And that's if things go well! We've also seen babies have to be shipped to another facility to receive the care they need to become strong enough to go home, and this is while mom sits in our hospital until she is deemed OK to be discharged to go be with her baby. Talk about a crappy situation, and one that we don't wish on anyone. I can't tell you how many times I've heard "my baby can come any day" when mom has just barely reached 37 weeks. Any ob nurse worth her salt will tell you that we often see 37 weekers that do WORSE than their younger counterparts. Why? Who knows, but it happens.

Obviously, there are exceptions to every rule and some babies must come before they're due. I get that. I'm not an idiot. I realize that there are some very specific reasons for that and that in those situations, delivery benefits outweigh the risks. But, if you are healthy, and your baby is doing well, let that thing bake as long as it can! It will be worth it in the end. I promise. And while we're on this subject, if you say, "my doctor says I won't make it to my due date" just go ahead and plan on being induced on or after that due date. The truth is that none of us know when a baby is coming. Babies come when they come. Let's leave that timeline up to the big dude, ok?

Alright,  now let's talk about a few myths out there that seem to be accepted as fact.

First, "I lost my mucous plug. My baby is coming." Ummmmm, well, that's not exactly how it works. You need to be in actual labor before we can say that your baby is coming. And the mucous "plug" can shed different parts for several weeks. The truth is that we have all kinds of fun, disgusting substances surrounding that cervix of ours and the closer we get to delivery, the more it comes out. Is it gross? Sure. But does it mean a child is about to wave at you from your vagina? Nope. And just for the record, if you think you've lost your mucous plug, I don't need to see it. I promise I believe you. Please don't bring it to me in the hospital in a plastic container. (Yes...this has happened)

While we're on the subject of yucky substances coming out of places you think they shouldn't,  let's talk about water breaking. It's actually more rare for water to break on its own. The doctor usually has to do that for you during labor. However, it does happen. And this is actually one area where I encourage patients to come in and get it checked out. The truth is, not all water breaking looks like an epic flood. Sometimes it just slowly trickles out. And how are you supposed to know if it's fluid or urine? Honestly,  it's very difficult to know. So, just let us help you figure that out. Even experienced nurses and doctors who are pregnant wonder the same thing at times. And could you have totally just unknowingly pissed yourself? Sure. But why not know for sure? If you're ruptured (water broken) for too long before delivery, you risk infection to your baby. And you know what? If you did, indeed, pee yourself, that's OK too. Any woman who claims not to have done that at least once at the end of pregnancy is just lying.

How about this one? "My baby hasn't dropped yet." Girl, that's not real. Ok, can a kid settle lower into the pelvis as birth becomes more imminent, sure. But if you don't look like you're about to literally crap a bowling ball, don't sweat it. If you've had more than one child (multip), that thing can sit in your tonsils until about 2 seconds before delivery and then come flying down like it's being shot out of a cannon. We don't care where that kid is hiding. As long as it's head down and you're in actual labor, we can work with that.

Now let's talk breastmilk. Does everyone breastfeed? No, of course not. And I'm not going home with you, so you can feed that baby any way you'd like! Formula is not poison. However, if you have any interest at all in breastfeeding, I will work with you until we're both exhausted. I believe in it. I respect it. And I do believe it's worth trying. So, there are lots of fears surrounding breastfeeding, including "not having any milk". You have milk. You do. And I can show immediately after birth that this is true. It's not the thin white stuff that you're used to, but it's there. In fact, it's better!! It's thick, liquid gold. The truth is, a good breastfeed lasts about 15-20 minutes and has periods of sucking/swallowing that alternate with periods of rest. The kid just got here! Let's give him a minute to figure out this suck/swallow/breathe thing. He'll get there. Initially he's only going to swallow once per every 9-10 sucks. Why? Because that first (awesome) stuff is colostrum and it is THICK!  So, don't stress if your kid isn't a hoover, the second we hook him up to the trough. Sometimes it takes time. Usually the initial feeding ROCKS, and then they kind of appear to lose interest and want to sleep. But think about what just happened to them. Their heads just got squeezed out of something orginally the size of a grape. Let's maybe be OK with them taking a nap or two...not to mention, that kiddo is fed until that cord is cut and then it will use its own glycogen stores for the next 12 hours or so. All good here. Be patient. We can help.

Also, "I can't breastfeed because my milk hasn't come in." Ok, this isn't a "thing". It takes about 4-5 days for the milk to start changing from colostrum to that thinner substance we're more accustomed to. But that doesn't mean that you don't have milk. In fact, right now you have the good stuff! So again, patience, my friend. We'll get there. (Again, obviously there are exceptions to every rule and breastfeeding isn't always possible or even just not the best fit for everyone).

Now let's move on to epidurals. They're not the devil. They're not a white flag you wave as you "give up" or "give in". They can be totally awesome! And actually beneficial to the labor process for several reasons. Having said that, I love laboring with someone who doesn't want one. It challenges my abilities as a labor nurse and I enjoy that. I just never want people to feel like they've failed if they've gotten one. You're bringing a human life into the world, hopefully to love and care for it in the best way you know how. If that's your intent, you can't fail. So, epidural or no epidural, just be proud of what your incredible womanly body is capable of doing. It's pretty damn amazing either way.

I could wrote an entire book on this subject, but these are just a few of the things I see and hear often.  I do love my job. I truly believe it's what I was born to do, and I'm so grateful for the privilege of getting to fulfill that dream. So whether you're a first time mom or this is your 10th kid, I look forward to meeting you and cultivating that unique relationship that only a patient and nurse can have. Remember there are several tests we can do during that process, including one that let's me know your water broke....just don't ask me to smell your underwear... ;)

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