Was just at the bank across the street from us, standing at the desk talking to the clerk, and I look out the window and see my two-year old walking down the opposite sidewalk in a shirt and diaper. Just strolling, lookin' at puddles. The clerk is talking to me and I'm thinking...um...so maybe my wife notices and will get him...um...okay, nobody noticed he left...er..."Hey, sorry, but can you wait right here? I just saw my kid walking down the street. I think he escaped." I run-run-run and grab him, run-run-run to the house and toss him back in the front door shouting to my wife, and run-run-run back to the bank and in the door and breathlessly thank the clerk for waiting. People probably thought I was crazy. The cop at the bank said "Good deed for the day, eh?" But I don't think it counts when it's your kid!

And here's what transpired last night:
4yo boy: walks into kitchen talking about something, stops midsentence to start waddling funny and letting out loud farts
2yo boy: doesn't look up from reading a book on the floor, says "Baby, dat's gross!"
baby: clueless, unable to defend herself
4yo boy: "That was just me, I was bein' silly and burpin' out of my butt!!"
5yo girl: peals of laughter

My employer is advertising on my user info page! Kinda weird. I should get a bonus for that.*



My two-year-old got into poison sumac which was growing in the more abandoned-to-nature portion of our backyard, and had the most awful blisters on his hands. Poison sumac is like poison ivy, same chemical (urushiol oil), but much more potent. He had blisters like I've only seen on dying kidney failure patients. He doesn't seem to mind them, but doesn't like you touching them. Lots of calomine lotion! My wife was not alarmed because apparently her sister used to get the same hideous leprotic blisters from poison ivy. What I can't get over is the fact that some of the plants had huge root balls or large woody stems. They had to have been there last year, when I was tearing plants out of there. I guess I either didn't have a reaction or had a mild enough one that I didn't notice. But he had to have been back there, too. None of my other children had a reaction. It's strange having one particularly allergy-prone child. Having four small kids is like making a Punnett square but not being sure what your initial genotypes are.

(I just noticed my wife created a plants of doom tag for her post about this.)

Speaking of the wife, Adrienne is making a boatload of chocolate truffles (mint, orange, and raspberry) for the Memorial Day party with her new candy molds.

All of our plants have failed to die so far. I even tore out and potted some chunks of oregano. Anybody want some? Although I hate to say it, but this year it just smells like a plant. Last year it actually smelled like pizza.

*Disclaimer: my employer does not endorse anything I ever say, write, do, or think, except maybe when I'm behaving well at work.

I noticed the two older kids were in the bedroom with the door shut. I came inside and L said in this voice like I was intruding, "Daddy, we're playing WAR." G said "No! We're playing tea." L says "Uh huh. AND war."

Tea and war - good book name?

Poll #1399367 Kids on a Plane
Open to: All, detailed results viewable to: All

You're planning to fly with FOUR...SMALL...CHILDREN. When is the least offensive time to confine 300 hapless strangers in a small metal tube with you?

What would you bring?

Redeeming points

• My kids are reasonably well-behaved 87% of the time
• we've done this before with three kids
• we're flying to Florida in the summer, potentially with lots of other small children who will, I hope, be much more ill-behaved by comparison.

We put our plants in the garden over the weekend—the few sad sprouts which survived our attempt at establishing indoor seedlings, plus a bunch from the nursery. So far in the tally we've got a couple bean plants, eleven basil plants (not sure that'll be enough!), four cilantro, two dill, four zucchini, one cherry tomato, one strawberry, a whole head of garlic, and a chamomile. Also several kinds of lettuce.

A few things survived the winter, which was quite surprising: oregano (which wants to take over the garden/yard/Earth), sage, and rue (never figured out what to do with rue). Several lettuce plants popped up, offspring from when we let our lettuce go to flower late last year. I'm wondering if we should plan for that next time; have a revolving lettuce garden that replants itself. The rosemary, which I had hoped would survive, did not. It had survived until February, when we had a string of way-below-zero temps, so I think I'll try another plant and hope next winter isn't seven years long and imported from Minnesota, like this year's was.

We also have a pumpkin and a watermelon plant. Our watermelon last year produced prize specimens, if you prize softball-sized watermelons that are completely green and white on the inside. The squirrels prized them. I think we're going to do a separate patch, apart from the garden.

We planted with little regard to location or sun, since we don't really have our own yard. When we do, I'd like to put together a list of which plants prefer direct sun versus shade. Most of the vegetables and herbs seem to want direct sun. Other things I want to look into when we own a yard and I make more money: organic fertilizers (my mom's recommending fish emulsion), how to prepare the soil for the next year, and how to not slaughter indoor seedlings since our frost season is so late (someone told me never to bother planting till after Mother's Day). I purchased a guidebook to planting in Illinois, but it's 1. not very informative or thorough, and 2. mostly covers flowers and roses and other inedible, and therefore less interesting, plants. There's got to be information specific to Chicago.

Wonder if I could try a tea plant, even though it probably wouldn't survive our winter. Also, rumor has it that a lady at work has been successfully keeping a fig tree alive in her backyard.

For some reason I'm not excited about composting, but I could look into that. I wonder if the contents of baby diapers are compostable, since we seem to have a surplus of that.

My in-laws found all the pieces to their old TI-99/4a home computer. It's pretty sweet, but the only keys that work are 1, 2, Q, D, and the space bar. No sound. The joystick works but you have to really jam the fire button. Anyway, my kids think it's a blast. They love slamming the cartridges in and flipping it on. They usually need help starting the game, because if left to their own devices they end up in the BASIC programming screen—although they're happy to fill up the screen with the above-mentioned characters.

Last night I tried playing Hunt the Wumpus, and my four-year-old daughter is yelling at me "Green circle means you fall in the pit, Dad!!"



They also knew when the Wumpus was coming, but I didn't. I think they were frustrated when I got eaten.

They like Car Wars and A-maze-ing the best, though.

I mean, some of these games came out before I was born! But they love it. I had a chorus of toddlers yelling "Pick the cheese hunt!" I think it's more on their level than, say, the Wii. I'll try to find some DIY repair sites and see if we can get sound and more keys working...

Today I remembered how I used to say, as a teenager, that I wanted to space my children 18 years apart.* I think what brought that memory to my mind was taking all three children (the ambulatory ones) at once to the church bathroom after mass. I had two kids yanking down their pants and trying to butt each other off the toilet at once, and the other child is turning on the faucet full blast in order to fill a tiny little paper cup, spraying himself and everything around him. :) I wasn't mad...it's just funny to think that I used to be that guy (though it was mostly sarcasm, and a little fear), and now I'm...the guy with four small kids.

Then I herd them all out to the car, which is a little bit harder than herding cats, and as we're strapping them in, two of them are happily screaming at each other, I think another one was trying to belt out a song from The Sound of Music but without using the correct words, or indeed English words, and the baby is sputtering and spitting raspberries as hard as she can.

Now they're in the bath together, and the two year old is putting his hand over the faucet because it makes it spray everything, and it makes his brother scream. I've got the baby who's very earnestly trying to smack the keyboard as much as I am.

*I also used to say I'd send my kids to military school for 2, 8, or 18 years. My wife would so not marry me for saying things like that.

Today I left with my mp3 player and my satchel bag thing (MANPURSE!), and rode public transportation to college. It made me feel like a Chicagoan again.

Most of my life is still taken up with school (pediatric rotation) and work, and this summer I'll be working two jobs: the general ICU I currently work in as a tech, and the neuro/surgical/trauma ICU at Christ Hospital as a student nurse. Gonna be interesting: lots of gunshots, motor vehicle accidents, etc. The first question the preceptor asked me was "Ever see an open abdomen?"

It seems all I've been doing at work lately is wrestling drunks. They come in the ER for one thing (say, diabetes complications or stroke), get sent to the medical floor, and then come back to us on day 2 or 3 acting like a complete animal because they haven't had a drink for two days. They don't know where they are or what they're doing. DTs are not cool.

I also got stuck with a dirty needle carelessly left out. I blogged about it and the post was featured in the nursing blog carnival Change of Shift, hosted this week over at codeblog. I expect my readership to increase 7,000%, over the current readership of, let me check, 0. :)

The kids? My children are fantastic. My six month old daughter is super cute and thinks I'm the greatest. My other daughter will be five soon, counts to a hundred to herself when she's bored, and is drawing better every day. My two sons ask questions all day long and get dressed, strip naked, and get redressed several times a day—in their own clothes or in my shirts. They just march in, yank the drawer open (I think the older one, who's almost four, does this), and grab a shirt. My guess is they'll probably keep doing this for the next sixteen years, except it'll probably be my socks by then.

No, we're not pregnant again yet. And because of the needlestick, you don't have to ask for the next six months! o_0

I've been baking when I should be blogging and ambling around online. I have a sourdough culture in the laundry room (don't worry, it's only there because it's warm) that I began when I discovered that my quart jar full of baker's yeast was completely dead. I've been successfully using it to rise breads, rolls, and English muffins. All it took was a little flour and water in a warm place, and then a little more the next day, and a little more on day three, which is when it tripled in size - ever since then, I've been feeding Curtis (as I call the billions of madly reproducing yeasts and lactobacilli) with flour and water twice a day, or storing him in the fridge. Sometimes he smells good, sometimes he smells alcoholic. Kinda like some people I know. Okay not really.

I want to write a story where the economy collapses, and laboratory-derived factory-made storebought yeast becomes unavailable, and so sourdough bakers, being the only ones who can supply the world with bread, become an elite class.

I've made rye bread, wheat bread, English muffins, English muffin bread (which is the best recipe and the most popular in this house so far). I really want to make bagels. And CINNAMON ROLLS! Go look at those pictures. Total food pr0n. If I can make something that looks like that, I could retire and open a bakery.

I'm also trying to make sauerkraut. It looks and smells rotting but my wife says she thinks it's fine. She's part German.

Incidentally today is the eight year anniversary of the first time I ever ate sauerkraut. That was on my first date (or non-date?) with my wife. I told her I thought it was made out of onions and she still laughs at me.

Paczis are big round danishes, like jelly donuts, that Polish people eat on Fat Tuesday. I suppose they should be called polishes, not danishes. Anyway, after discussing with my mother-in-law about how crummy paczkis usually are—they're like cheap jelly-filled donuts, full of colored goo which probably has the same fruit flavoring used for cough syrup—and how Polish people and other Chicagoans pretend that they like them and imagine they're not just jelly donuts made in a sphere shape...I went and bought some today. The hospital where I have clinical had paczkis filled with real fresh strawberries (in glaze) and cream. Instead of being a whole donut, it was two halves smashed together with the filling oozing out. In fact, they looked a lot like big zeppolis that are made for St. Joseph's Day, and I think Italians must have made them.

I stopped at Wolf's bakery on the way home, but the only flavors they had were prune (my wife said "sounds like a flavor Polish people would make") and apricot. So I went to Naples Bakery. They didn't have strawberry, but they had chocolate buttercream and cream cheese with sugar. Yum.

They're pronounced "poon-shkies" or "pon-shkies" which is why Polish people should have their own alphabet.

For some dumb reason I thought it would be a good idea to start a blog. Now I'm torn between updating here and there. I'm torn because I still like Livejournal's layout, its community environment, and to boot I actually have a chance of being read here.

So if you want to read nursing- and health-related blah blah blah, you can see the blog. I'm not telling you the name because I'm embarrassed about it. It was suggested by one of our midwives, but she probably wasn't serious.

I could use some suggestions. I've been browsing Blogging Basics 101 and others, but I'm the only person I know in real life who reads blogs (except my wife when she reads Cakewrecks) so I welcome advice. I'm a little concerned about blogging in the healthcare profession—I'm pretty sure I know my rights to blog vis-a-vis HIPAA and privacy standards, but I'm a little hesitant to betray anonymity (I'm sure some healthcare employers would rather just fire you than think about whether you really broke HIPAA or not), and less clear on whether I can be construed as giving medical advice.

My bro-in-law was hollering that he couldn't find the sliced onions for the hamburgers we're having tonight, and I told him there's probably half an onion in the door of the fridge, where his family has always stored their cut-up onions. So then he starts barking that it probably wasn't there until I saw it there, and I'm like....so what, Shrödinger (yes I said it with an umlaut) was just this crabby guy who lived with his mom and he was like "ARGH, where's my stupid cat?!" and someone said "it's right there, where it's been sitting all day" and he's like "It probably wasn't there until I observed it there!" and then he made the theory?

Okay, story's not that funny. Whatever. If you look away from this post, it will disappear from your friends page.

Probably the #1 thing I'm taking away from this crash-course in hospital birthing is how unpleasant it would be to be a father at a hospital birth. Fathers are kind of useless spare tires in the hospital delivery room: you're there for emotional support if the mother needs you, but the staff assumes she won't—her emotional support is the doctor and the epidural. Other than that, what do you do? There's not even room by these beds for dads. They don't strap women's legs into the lithotomy stirrups anymore, so a dad might be able to hold up a leg if the nurses let him.

I can't imagine being a dad watching helplessly while my wife is in this big contraption:



Or this:



Or this one, made by a railway manufacturer (see the site):



I think you can drive this down the street and shoot babies at people. It's like a first person shooter. But seriously - look at the physical distance this bed makes around the woman. No one can really approach her except whoever's brave enough to get in the birthing crosshairs.

I'm sure lots of dads have wonderful experiences at the hospital. But after being with my wife, at home, helping into whatever position she wants for labor, I couldn't tolerate just standing there. I tried to find images of dads holding up moms for labor, but they seems scarce. But the last two births, I held my wife while she was laboring standing up. She delivered the last one standing up. I had an actual job to do. I even had to go to the bathroom at one point, but I was afraid to ask! Who else was going to hold her?

I've only seen one dad at a birth, and he was looking unhappy, looking useless, not knowing where to stand, not knowing what to say, crying, unsure if he should approach the bed, and then unsure he should approach the baby - but craning his neck to see her across the room in the heated baby contraption they put her in for the initial assessment. I was with his baby, and he was not. I felt like grabbing him and pulling him over. It was awful.

Dads in the hospital room can be jettisoned by the staff at their discretion, which means they aren't necessary. What does that do to the dad? Maybe this or that dad doesn't care, but this has to affect the male psyche in our country, or any country where this is a common childbirth practice.

AWHONN, the Association of Women's Health, Obstetric, and Neonatal Nurses, just published an editorial against ACOG (the American College of Obstetricians and Gynecologists) and the American Medical Association regarding their 2008 resolution against home birth.

The idea that a normal spontaneous birth is by design the best outcome for a healthy woman and her infant is neither believed nor entertained as a basic concept. Most U.S.-trained physicians and sadly most U.S.-trained nurses have minimal experience with normal labor and birth. Without fetal monitors, intravenous lines, infusion pumps, epidurals, pitocin, endless charting, and rules theses individuals are helpless and unskilled to provide the kind of informed human support and wise guidance that a laboring woman needs while the normal process of labor and birth unfolds.

In fact, knowledgeable women often must fight to defend the normalcy of the process and their desire to labor and birth spontaneously without medical technology or intervention. In many ways it is reminiscent of the 1960s when many of us who were young women at the time fought for our right to natural childbirth without general anesthesia and to have our husbands accompany us into the delivery room.

To pretend that a normal healthy woman cannot give birth safely without the trappings of a U.S. hospital is not only audacious but also uninformed.

Today I saw an epidural insertion. It almost made me pass out. :\ They use a four-inch-long fat needle which is curved at the end to aim the catheter up or down in the space outside the spinal cord. The anesthesiologist inserted the needle at least three inches in and wiggled and moved it around much more than I would've imagined possible, trying to find the epidural space. Meanwhile blood is dripping out the hole. She said she aims it up (toward the head) in first time mothers because she figures labor will be long, and aims it down (toward the butt) in multiparous moms because she figures labor will be short but more intense. She used the 'lack of resistance' to check the placement - she kept trying to inject air through the catheter until she was able to do so, at which point she knew she was there. It seemed like 10 cc or so of air - I wonder what happens to it?

The mom was so passive about the epidural in general. She didn't really want it, and later said she wasn't sure if she wanted it or not, and seemed really reserved. The nurses assumed she would get it eventually. In fact, it mostly happened because the oncoming day-shift anesthesiologist wanted to have the the night anesthesiologist do it, who was apparently sleeping in a room on the floor. So they kinda concocted the idea that the nurse would tell the patient she'd have the night doc "talk to her", and then page him to wake him up. The day doctor decided she'd do it after all, though, so they just kinda started doing it. I'm not saying it wasn't consent, and I'm not saying things like this don't happen all the time in the whole hospital, but it wasn't exactly informed consent. Then after the catheter was put in, the nurse informed her that she'd have to put a urine catheter in. I think I'd want to know that beforehand, since most women I know who've had epidurals have gotten UTIs, but we nurses don't think of these things because we're not the ones who have to deal with it.

What else? She's been in the hospital for almost a week because of high blood pressure - they would've released her had she agreed to twice-weekly checkups, but she said she couldn't do that. She had a balloon filled with saline inserted in her cervix to dilate it. She was started on Pitocin this morning. She started with painful contractions that stayed painful even after the epidural, and the anesthesiologist was in there all day adjusting it. She received Fentanyl IV and epidurally and the baby's heart rate, which should speed up and slow down with contractions, went completely straight at about 135/min. The nurse showed me that and said the Fentanyl had sedated the baby. Anyway, she made some progress before I left. I hope she doesn't end up sectioned.

When her water broke they inserted an intra-uterine pressure monitor. Her contractions went up to 95 mmHg - normal contractions are around 40! Which is probably why they were so painful.

Oh, and she was caught having sex with her SO (husband, actually, I think) last night. The nurse put a stop to it. Personally I wouldn't have said anything. Maybe they were trying to kickstart labor?

Got to see and participate in a crash birth today. This is my first labor and delivery in a hospital.

22yo woman comes in with significant other at 0730 saying she's been in labor since 3am. She pissed off the L&D triage nurse (who I was assigned to) by yelling that she didn't know her history or her allergies - we should know that since she was here 3 years ago. (People say this all the time on the medical floor, so I didn't think it was a big deal.) She doesn't know her due date; no prenatal care. The OB comes in already somewhat crabby and re-questions her in a ridiculous tone about who her doctor is. "Well who was your doctor last time?!" She yells "I don't know!" and starts sobbing. I went to the bathroom at this point, and as I'm leaving boyfriend comes in and starts puking. After a while they do a vaginal exam and find she's 7 cm and rush her off to a delivery room. I realized the boyfriend is still in the bathroom, so I brought him a drink of water and took him to the new room.

The room fills up with staff and there's many exclamations of "No prenatal care!" "7cm and 80%!" (that's cervical effacement) and "Get the delivery kit!" The nurse I'm following says "Why don't we just deliver her now?!" Whatever that means - Pitocin I guess? The doc asks her how much her last baby weighed. She gasps "8 pounds" and the doctor mutters something like "My lord" and then starts yelling "Listen to me! Do you think this baby is the same size as your last one? Or bigger?" (If I ever take my wife to the hospital and they ask her that and she says "11 pounds", the doc'll have a heart attack right there.) The woman is screaming that she wants pain medicine, but they can't give her narcotics because the birth is imminent (it will depress the baby's respiratory drive), and they can't sit her up for an epidural insertion because with gravity "you'll give birth right now." (So why is that a problem?) So she's made to lay flat, legs out on stirrups, and they kept having to pull her down to get her bottom to the edge of the bed - so she ends up completely flat. They rupture her membranes, meconium-stained fluid comes out, and they insert a fetal monitor electrode into the baby's scalp and an intra-uterine pressure monitor into the amniotic cavity.

Baby's heartrate rapidly decelerates to the 50's, so they push her onto her side and put O2 on her - and the rate quickly climbs back up to 150's-160's. Which was neat to see that what they told us in class actually works in real life - but also irritating and stupid because if she wasn't on her back it would've never happened in the first place. Incidentally they thought she might be decel'ing in the exam room, but the baby was doing fine other than this one instance in the delivery room. The heart rate was beeping quickly this whole time.

They start lactated Ringer's in the IV, no Pitocin, and an amnioinfusion - fluid into the uterus to flush out the meconium.

Meantime the woman is screaming that she's not pushing, she wants meds, if she doesn't get meds she demands a C-section. The doctor says "You're not getting a section. You have no choice." She argues with the nurses (all four or five of them) and the doc, and they finally say "Fine, don't push - we'll just wait here until the baby comes out." The woman calms down, and then with the next contraction she starts to push and seems to actually feel better. In fact, she seemed okay in between contractions, and even with contractions managed to hold herself together, so I think her screaming for pain meds and c-sections was more from being frightened than anything. Having already had hostile encounters with all the staff probably didn't help.

The staff is telling her she needs to push the baby out soon to save it, and they ask what the baby's name will be and she yells it's for adoption. They take this seriously, and don't really encourage the mom or dad to look at the baby, but I thought it sounded more antagonistic than serious. (Since they were trying to use the name to persuade her to cooperate.)

So the baby crowns and EVERYONE - four nurses, two residents, and the OB - is screaming at her to push. Not in unison - just a cacophony of people yelling at her. Then the doc says "Fine! We'll wait for the next contraction." WTF? I couldn't believe they wanted her to push without even contracting, but they were panicking. So with the next contraction and everyone taking up the hollering again, she blows the baby out in one push, head & shoulders & body. It's a girl. Cord was wrapped three times around her neck, and I will always remember everyone counting in bewildered unison "1...2...3" as the OB unwrapped it. The baby is gently handed to the NICU nurse at the radiant warmer and they suction her and laryngoscope her to look for meconium. She didn't aspirate any that they could tell. Triple vessel umbilical, good color, Apgars were 8 and 8, weighed over 6 pounds. Born at 8:38 (one hour post admission).

Mother in the meantime passed the placenta in about 20 minutes without anyone tugging on the cord and without Pitocin (I was surprised). She then got Pit and methergine for some bleeding (not hemorrhaging, though). Oh, and she had a 2-degree laceration (for a 6 lb baby!). The OB kind of yelled at the resident for not knowing the signs of imminent placental expulsion (bleeding, cord lengthening) and what methergine was. We nursing students, of course, did.

In the end the baby seems okay, put on supplemental oxygen in the NICU but in kind of a 'just because' manner (for mec-stained fluid, probably), and the mom changed her mind and decided to keep the baby.

I was in the NICU today. It was a little slow, but we had a 2 pound 30 week old baby there. He was really little but doing very well. Whatever issues his mother had (maternal hypertension?) depressed his placental bloodflow, which ironically (or fortunately) matures a fetus's lungs faster. The nurses said normally he'd be intubated and on a ventilator, but he was off oxygen and breathing room air on his own when I took care of him. He'll probably be there a month, just to gain enough weight to leave.

The meds! Such tiny doses. He received 15 ml of blood last night - a sip! Crazy. And everything, down to the saline flushes for the IV lines, has to be double-verified by another NICU nurse. Oh, and they give the premies caffiene - little bottles by IV to stimulate their heartrate, breathing, and alertness. Hopefully it doesn't give them ADD.

I could see myself working there. It's like ICU, except simultaneously quieter AND more intense. It makes you realize how much adults can handle. Adults even in the ICU can usually withstand receiving the wrong doses and wrong meds, and they can sit around with low blood pressure and dropping oxygen saturations and give you plenty of time (and notice) before they code on you...but apparently not babies. At least not premies.

I still plan on working ICU as a nurse, of course. But PICU and NICU might be neat.

The NICU also needs a sign on the door saying "COLOSTRUM PLEASE!"

My son showed me a picture he drew of what he said was a giant shark with a little guy catching him. He said "It's a really big shark. And we'll cut off the tail, and wipe the blood off [makes little wiping motion], and then cut off the head, and wipe the blood off [wiping motion], and then we'll take out what's inside, and then cook it in the mico-wave!"

Geez, I'm going to end up posting after every clinical and class. I hope for your sakes they aren't all this long.

So today, the happy couple and baby I took care of yesterday who were all set to go home hadn't gone home because they were awaiting a circumcision and discharge by the OB, who didn't get there till late at night. In the morning they took a routine bilirubin and it had jumped from 5 to 12.4. The high cutoff is 12, so out came the lamps and the baby has to sit in the box for 24 hours at least, only to come out for feedings - mom's crying, dad's a little bewildered by trying to stay calm. All of this is precautionary - the baby's not critically high. But it's horrible on the parents. However, the baby was not really feeding enough, and breastfeeding is really the best way to move the bili out. The mom only had one guidance session with the lactation consultant, two night shift nurses have encouraged bottle feeding (the day nurses are strictly discouraging it), and the OB gave the baby a pacifier while doing the circ. All of this would make the LC flip her lid, but she was off today. So that was a little unpleasant, but I hope I helped them make the best of it.

We keep having patients who had first- or second-degree lacerations pushing out little six pound babies. (First degree is through skin, second is through skin + muscle.) This really illustrates how much the mother's position matters. I hate to trot my wife out like this, but she's pushed out up to 11+ pounds without tearing. She's not a large woman. She doesn't possess some kind of robovagina. Every patient I've had is a larger woman than my wife and yet has torn having babies almost half that weight! Sometimes badly - one said it took an hour to sew her up. I don't get it - who in the profession can't see how this happens? If they trialed letting women have the expulsion stage of labor in any position they wanted, they'd probably drastically reduce their tear rate.

On the other hand, I suppose, the epidurals can't get out of bed, and now that I think of it all my patients with tears have had those too.

The nurses were so busy today. One shouted that she needed a Foley urine catheter taken out and would a student like to learn to do it. I finally volunteered, not to learn but because I already know how to from my job. It turned out the patient who needed the Foley out was the poor young lady who another student had yesterday - she had described an episiotomy and horrible tearing - what the teacher said they unofficially call a 'vaginal C-section'. We had asked how big the baby was, and it was only six pounds. The nurses are like "The poor girl's never going to sit the same again." So I go into the room, tell her what I'm going to do, that it's fast and pretty painless, that it can be done without really uncovering anything, and then I wash my hands and put on gloves. When I come back to the bedside, the girl is SOBBING. Completely crying and shaking. She was so afraid it was going to hurt, because of how she had already been hurt. I was so upset after that. They completely butchered this girl, as far as I feel. It's her first birth. She'll spend her whole life remembering this.

There was also a mom with a bulging bag of waters who looked right at the age of viability. She gave several different possible due dates and really didn't know when she was due; she first denied any old ultrasounds but then it turned out there was a six-week ultrasound, and the hospital did one, etc etc. Long story short, she's 23 weeks 4 days, and the fetal age of viability is 24 weeks; on the other hand, 500 grams is the cutoff weight for viability, and the baby looks 514 g. Then she got the urge to push, and they told her not to, but she had such an urge she did anyway and broke her water. It looks like they'll try to keep her pregnant as long as possible and give her antibiotics for the open membranes. There's a lot more to the story, but the point is I caught a glimpse of how weird hospital obstetrics must be, especially in the city, although this could certainly happen anywhere.

My maternity nursing classes have been interesting. I've never talked so much in class! I'm the only person in the class with any home birth experience, and I'm also the only male student (out of 3) with any recent birth experience. I think there's 37 women in the class. So I have a weird perspective on things.

For instance, we went over the different positions a woman may labor in - but the teacher said "I have to teach you this, but I also have to tell you you'll never see any of these. As soon as the water breaks, they're in bed until that baby is born." She asked if anyone has seen a woman laboring standing up - I raised my hand, and she said "Well, sure, you have. Your wife had home births, which was great because she could do whatever she wanted." :) She also asked if we felt more empowered giving birth at home. She's repeatedly said that lithotomy is the worst position from which to push a baby out.

She's also thinking of showing The Business of Being Born.

9 out of 10 complications we're being taught about are caused solely by the obstetric process - maternal fever from anesthetics, constricted placental bloodflow from Pitocin, urine retention from spinal blocks, babies with poor respiratory drive and suckling reflexes from opiate use. The most common problem is called supine hypotension syndrome - if a woman labors on her back, her uterus squishes the blood vessels supplying the lower body. This causes a reaction where her blood pressure and heart rate drops, which drops blood supply to the fetus. This shows up as heart decelerations on the monitor. Nursing response? Turn the woman on her side, slap some oxygen on her, start IV fluids to increase her blood volume. If that doesn't work, try the other side - if that doesn't work, prepare for a c-section. The cause? Laboring on her back - so she can be hooked up to an electronic fetal monitor. And the only reason she's on the EFM, as they've repeatedly told us in class: lawsuits.

There's not much emphasis on real pregnancy problems - placental abruption, placenta previa, eclampsia, etc. I have a feeling that OB nursing is all about complications of treatment, not complications of labor. A midwife or an obstetrician has to think about physiological complications, while an OB nurse has to think about treatment complications.

Oh, and the nurses were irate because one of their cases was found to be breech three days ago - mom came in for scheduled C-section, and when she was opened up the baby was head down.