L&D: I guess it is for me.

I am so emotionally conflicted right now. I wish I could describe how I am feeling, but I don't have a big enough vocabulary or enough time to explain it all, so I will do my best.

Today I was in Labor & Delivery. My sisters and others have always said that they think I would make a good L&D nurse, but I feel like they have been impartial since that is the only exposure they have had with hospitals mostly. And obviously, it's a happy time.

Well today they were right. As I am typing this I am filled with tears because of the things I have seen today are indescribable. Life is truly miraculous and L&D is such a spiritual unit. I was paired with a seasoned nurse who reminded me so much of a woman in my old home ward named Debbie Millward. Both of these women never stop smiling, always have energy, and are just the nicest people in the world. We never stopped running around and from 6:30 AM until 4 PM I didn't get to eat, drink, sit, or go to the bathroom. Even then, this nurse was giving hugs to all of her co-workers and asking who needed help and if anyone needed a break. I kept wondering if people are just born this way or if I should even attempt to be this way. I don't think I could keep it up for very long.

My first patient was primigravida (first time pregnancy/mother) who was scheduled for a Cesarean section at 0730. She had placenta previa (placenta detaches from uterus and resides on the lower section, putting the mom and baby at risk for hemorrhage/premature delivery) and the baby was breech. She is a beautiful 35 year old strawberry blonde holding hands with her smiling red headed husband excited to meet their first child. They have no other concerns, no financial problems, and their neighbor is a neonatalogist that will be with them in the operating room. We prepare everything and get gowned up and soon enough, the surgery has started.

I'm running all around getting different supplies for the surgeons and nurses, and I'm nervous because I didn't sleep much the night before because of my nervousness and I am afraid I will pass out. I don't really know how to react to a human being cut out of another human. Plus, the smell of burning flesh coupled with the surgeons reaching in her stomach and stretching/breaking skin is a sound I never want to hear. After about 30 minutes, the baby is pulled out and placed under the heater. I'm helping wipe off the baby and goop like I know what I am doing, which I don't, and the nurse asks me what I would guess her one minute Apgar score would be. "Hmm...well she's crying now, she's mostly pink, looks like she is moving her arms, like a 7 or 8?" Good, she's an 8. Her 5 minute was a 9. Once we cleaned her up and swaddled the baby, we called the dad over. This is the point where Becca had to bite her tongue because I just felt like crying and hugging him. Seeing a grown man's expression with that much love for this little stranger is so moving. His eyes start watering and the baby girl really is GORGEOUS. Of course, C-section babies do come out prettier initially because they haven't been squeezed in weird ways. I assist in taking pictures of the happy family while the surgical team delivers the placenta and sew her up.

We take her back to her room and get her started with breastfeeding right away. The University of Utah Hospital is a "Baby-Friendly Certified" hospital, one of 30 in the nation. They keep the baby with mom and start breastfeeding within the first hour of birth. The correlation of prolactin and oxytocin within the first hour of birth is highest and contributes enormously to how successful milk production will be. AND, according to my nurse, recent studies are coming back that you should be breastfeeding children at least until 1 1/2 to 2 years old, maybe even up to 4 years!! They have found that the skin to skin contact signals to the mother's body what the baby needs, and the milk composition is altered accordingly so the baby gets the perfect nutrition and medicine from it. "Pumping" does not signal this same response. Pumping tells the body that the baby is not around and therefore does not need to create a nutritionally rich milk. I am not citing any sources here so take what you will from this, but something to definitely think about. I will be researching this a lot more in the coming weeks!

My second patient was 19 years old, admitted for having a baby who had gastroschisis (intestines develop outside of the body) and breech presentation. This pregnancy was unplanned, and when her 'partner' was asked how her last name is spelled, he didn't know. She would be discharging to their trailer, and she voiced great concerns about who would be teaching her how to take care of her child. I did her admissions report, pre-op assessment, fetal monitoring, and taught her, the 'significant other' and her mother how the procedure would go for the day-even though I just learned about it an hour before.

The surgery began and I held her hand while the spinal block was being put in. It was weird to look at this girl who is younger and less educated/experienced in child care than me and try to get her excited about meeting her first child. The spinal block was successful, and pretty soon the resident was pulling out her baby. Thank goodness I was wearing a mask because I couldn't control my facial expressions at this time. They pull out this blue/red baby with about 3 feet of intestines dripping out of the body, there is fecal matter squirting out of the baby, dropping INTO the sterile field, the surgeons are trying to control the mother bleeding while clamping the umbilical cord, and my preceptor grabs the baby who has crud all over its face and isn't making any sounds. In my head, I am just screaming, "Oh my gosh oh my gosh....what is going on...this is so crazy!!"

Prior to the baby coming out, my nurse had informed me that I would not be touching this baby or doing an assessment, and that she would give the baby directly through a sliding glass window in the OR to a highly skilled set of NICU nurses that would start treatment immediately for the baby with bowels outside of its body. I look through this window, and standing with a blanket in her arms ready to 'catch' the baby was my friend/classmate, Marissa. "Um...you guys are going to give this critically ill baby to her??" I chuckled. "She's as experienced as I am!" Later, I talked to Marissa and she remarked, "Ya I was shaking before they handed me that baby but the nurses weren't worried and they told me to just not let any of the intestines drop on the floor." This is why I love the University Hospital. Maybe I scare some readers of my blog by saying this, but it never ceases to amaze me the confidence they put in students and how little doctors actually know. So NEVER believe that the doctor always knows what they are talking about! Always question what they are doing because human error will always be present.

The rest of the time I took care of this 19 year old was pretty uneventful, but I was surprised at how much people forgot about emotional needs of this group. I was the one who kept going back to her and told her that her baby did come out (since she couldn't really feel it or hear it) and the status of the baby. Then I realized no one had thought to update her mother. I quickly went back to where her mother stood in the hallway pacing around and told her everything. Now much more relieved, the mom took a seat and thanked me for informing her. I still haven't gotten over the peculiarity of educating people older than I am. You would think that I would get over this by now, but it is still hard for me to take that position. Sometimes I don't know how much I should assume about their knowledge. Do I always dumb down information? Should I not give them specifics because they wouldn't understand? Should I assume that every mother would be like one of my sisters and read many baby books and google any medical questions they may have? Something as simple as educating a mom about not giving your baby free water may offend the knowledge of one mother, but may be brand new information to another (as evidenced by one of my pediatric clinical days).

After discharging my patient to Postpartum, I spent the last hour of my day taking notes from my patients' charts for my care plan that is due every week and chatting with some residents. There had been a delivery that morning of a mother who was pregnant for the second time via in vitro fertilization and had lost the first pregnancy. She was pregnant with quads, but 5 weeks before when I saw this woman in the Antepartum unit, she had lost two of the babies. The babies that were lost were monozygotes (identical), but the dizygotes (fraternal) had survived. I asked the resident how the surgery went and if there is an increased risk of infection to keep two deceased monos in with 2 living babies. "Uhhhh...I don't know. Not really. You want to see them?" Ummm...okay. Rather nervous, we walk in and I hold these two babies who look quite normal, for being dead for 5 weeks. (P.s. Sorry if this sounds rather gruesome...but it's a very unique experience that I want to share and remember) The boys had quite good color, but just seemed deflated. How weird for the two babies that survived to grow up and learn that they had 2 brothers that died next to them in their mother's tummy. It was sad to see the boys that didn't survive, but thankful that the mother was able to have at least 2 other boys that lived.

I called my mom on the way home and told her everything. A few times I choked up for no reason other than that my mind was spilling over with too many emotions and I didn't know how to feel or what to think. The contrast between these three women touched on every aspect of life. Mother #1 was a beautiful, educated, happily married woman who cuddled her healthy baby and it was apparent that she was going to be a great mother. Mother #2 came from unfortunate circumstances that led to unfortunate decisions that had difficult consequences and will probably translate into her daughter having a difficult life as well. Then mother #3 who experienced a funeral and a birthday at the same moment, who is rejoicing and cuddling her first children but also is mourning the loss of two others. I am happy for the new lives. I am sad for the lost lives. I am relieved that everything went smoothly. I am depressed for some of the lives people lead. I am tired from the running around. I am starving for not eating for 10 hours and running a marathon. I am spiritual for holding these identical bodies whose spirits reside with heavenly parents for now, and then witnessing two brothers and two baby girls who have just started their lives. I am grateful for the health in my own family that now seems rather rare compared to all the other situations I have seen. I am speechless.

I am switching with one of my classmates to be in Labor & Delivery again next week.