Tuesday, November 26, 2013

This and That (including Pit)

Good morning! It is dark and cold out. How dark? Dark enough that I can’t see a whole lot from inside. Not so dark that if I were to go out, I wouldn’t be able to see well enough to get around. How cold? Not as cold as it has been. Try 26°, feels like 15°. I can handle that; much better than yesterday’s feeling like 0 (as in degrees, not nothing).
Amena just got on the bus and it is time for me to go wake up boys. Such fun the mornings are when there is school. Some days I really wish that we did homeschool because I would let everyone sleep until 7:00 and then we would begin the day. I will be back: threat or promise, you decide.
The boys have all been warned of the impending water to be dumped on their heads if they do not get up within minutes. The darkness outside is due to the very cloudy nature of the morning. What will they bring? Snow? Rain? Nothing? Time will tell.
Yesterday I went to the bank and Staples and the post office. Today I need to go back to Staples because I forgot one thing that I wanted and two of the things I got are not quite what I wanted. At least I found my Rewards card. And I can take the empty ink cartridges I forgot to yesterday.
I also got a big envelope ready to go with cards for Alisha and Imani. Imani’s birthday card is very late and by the time they get them, the Thanksgiving cards will be as well. Hopefully the thought counts for something.
I also got twenty-four invitations to the Young Women in Excellence ready to go and in the mail. I think they are kind of cool and I am very glad for modern technology that allows a person to see something online and tweak it to fit their needs. I ‘borrowed’ an invitation that another ward somewhere in the United States used and I am going to use it for the program as well. I also worked on the program yesterday and other than the information that I don’t have for it yet, it is all done.
Yesterday afternoon Joanna took her Jeep over to Ray’s so he could do the brakes. Paul called and told me she needed something else. I thought he said calipers but he says he said rotors. I told Joanna calipers so that’s what she got. Paul is going to get the rotors when he goes to get his hair cut this morning and he’ll drop them off with Ray on his way to work along with a part that the truck needs. (The truck is almost done, finally, yay!) In the meantime, Joanna is going to need a ride to school this morning. I’ll take her in the Jetta and probably pick her up in the van because Paul ought to be gone by the time she needs to be picked up.
Right now I am going to go print some papers for Cedric. They are printing and I think it’s snowing out and Seth is going to need that glass of cold water dumped on his head. He also needs a good talking to because Joseph announced to Cedric that they were going to get two Halo guys from Logan. “Logan next door?” I asked? Joseph nodded. “Don’t take ANYthing from Logan,” I said. “Nothing.”
They have been instructed to take nothing from Logan and if Logan manages to give them something, to give it to Mr. Hale, the bus driver, and tell him that it is Logan’s. I want nothing to do with that child. He has been nothing but trouble since the day the boys began playing with him.
It is snowing outside. Seth is finally out of bed and Joanna needs to get up. I don’t like being late and it drives me crazy when other people push the limits even if it doesn’t directly affect me.
Anyway, back to yesterday. I made cupcakes to take with me to the Meet the Doula Night because we were having a Fall Festival after any potential patients (I still would prefer to call them clients) left. There were no potential patients so after we introduced ourselves, which took the better part of an hour, we brought out the food and ate and talked and ate some more. Liz hadn’t been able to have the unit specific orientation yet but she was able to after the introductions so she’ll be able to attend births now.
I signed up for the 11-7 last night but I called in to see if anyone was in labor (no one was) and to leave my number in case anyone came in (no one did). It was nice to sleep but I did wake up at least three times during the night and felt compelled to check my phone to be sure I hadn’t missed any calls. When I woke up at about 5:45 I still hadn’t missed any and it was time to make sure Amena was at least awake and getting up because she needed to have a paper printed out and really needed to write another paragraph but didn’t have time for that.
While we were doing introductions, I mentioned that all I have to do to apply for the nursing program at the Mount is take microbiology and that I’ve been seriously considering that. Which is odd because I have. The odd thing is that I’ve been seriously considering it. I don’t like hospitals and I think that most women who give birth in them sell themselves short. Anyway, it is true that I am lacking only microbiology. If I were enrolled in it, I could apply this spring. I think I might take a little trip up to the Mount soon and talk to an advisor. Today might even be a good day if I am giving Joanna rides (which I might be because she doesn’t want to drive the van).
Sometimes I don’t know why I say things. The bit about applying for the nursing program last night is one of them. But then as I was leaving, I had an epiphany. In Massachusetts, a CNM is not allowed to attend homebirths and a CPM is not allowed to attend birth in a hospital. If an RN wants to become a CNM and do homebirth, she is required to give up her RN. The thought that came to me is that I have heard nothing about being an RN and CPM. As an RN, I could work in a hospital and as a CPM I could attend homebirths. The two could work together very well.
It is time to go for now. Joanna needs to leave soon. The boys need to leave soon. I haven’t had time to discuss Pitocin yet but I will before I am done for the day.
11:09 am
Well, here I am again. I just have a few quick bullet points about Pitocin and then I’m done. For now. Promise.
Good news:
*        Pitocin can get a stalled labor going again
*        if mom is really pooped out, a little Pitocin boost may be what she needs to finish up
*        if mom is ‘overdue’, Pitocin might be able to get things going (remembering that if the cervix isn’t ripe, Pitocin will do nothing to ripen it)
*        when the water has broken and nothing is really happening, Pitocin may provide the little boost needed to get things going
Bad news:
*        Pitocin can cause hyperstimulation of the uterus which leads to prolonged contractions which may result in
o   abruption placenta
o   uterine rupture
o   decreased oxygen to baby
o   rapid labor resulting resulting in
§  cervical or perineal lacerations
§  pelvic hematoma
§  trauma to the baby
*        Pitocin is antidiuretic and mom has an IV (that’s how she gets the Pitocin—along with the fluids) so she has a good chance of developing water intoxication which may result in
o   irregular heart beat
o   hypotension
o   nausea and vomiting
o   excessive swelling
o   difficulty nursing
*        for baby, those prolonged contractions are likely to cause a decreased oxygen supply which will result in heart rate decelerations
*        also, baby may end up jaundiced
*        lastly, baby may have a decreased clotting capacity
Sorry, that’s longer than I thought it would be. As you can see, while there are some good reasons to use Pitocin, there are also some good reasons not to use it. No matter what the circumstances, the pros and cons should be carefully weighed before making a suggestion and the next time someone suggests its use because the doctor is going off shift in an hour, I might vomit.

With that cheerful thought, have a great day!

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