3 Heartbeats, 2 EFMs, & 1 Pregnant Mom

After getting report from the previous nurse, I walked towards my patient’s room wondering how I was going to make it through my shift.  The patient I was assigned to was admitted for overnight observation to rule out labor.  My patient was early in her gestation approximately 26 weeks and was expecting twins.  The previous nurse said she had been in and out of the room all afternoon trying to keep the babies on the external fetal monitors (EFMs), but found it difficult.  At 26 weeks gestation, babies have more room to move inside mom’s uterus; hence it is difficult to trace their heart rate for a long period of time.

Upon entering the room, the lights were dim; the patient was resting peacefully.  Since it was evening the only window in the room was illuminating a dark sky.  Bright lights were coming from the monitor and IV machine, near the patient’s bed.  I introduced myself quietly and asked the patient how she was doing, so I could assess feelings of frustration, weariness, or impatience in her voice.  She mirrored my welcome, with a hint of positivity in her tone.  (Side note: I don’t mind getting a one-sided biased report from the previous nurse but I like to make my own decisions on what kind of patient I will be dealing with by hearing from them myself.)  Before I started adjusting the EFMs, I suggested the patient empty her bladder, get readjusted in bed, and even offered a few extra pillows for support between the knees, and behind the lower back since she was lying on her side.

After the patient was back in bed and more comfortable I began searching for baby As heartbeat.  (Another side note: when adjusting EFMs on mom’s with twin pregnancies, it’s best to turn the volume down on the opposite baby’s heart rate so you hear the one you’re trying to locate.)  Now keep in mind this is the first twin pregnancy I've handled since coming off orientation, so I’m not a master at the art of finding two separate heart beats.  After locating baby As heartbeat I forgot to turn down the monitor before trying to locate baby Bs heartbeat. 

All of a sudden I was hearing two distinct separate heartbeats at the same exact time on the monitor.  Now the more experienced nurse might have quickly figured out she needed to turn down the heartbeat on baby A, so she could locate baby B.  But I sat there for a moment delighting in the miracle of not just hearing one heartbeat but two.  I just kept my hand on the monitor and listened.  I looked at the patient and asked if she had ever heard both her baby’s heartbeats at the same time.  She admitted she hadn't.  She too seemed thrilled at what she was hearing.  So we just sat there listening to both heartbeats for a while.  After attaching the strap that keeps the monitors on the patient’s abdomen, I thought it would be neat to grab my stethoscope and listen to mom’s heart rate while hearing both baby’s heartbeats in the background.  Both baby’s heart rates were quick between 140s and 150s, but mom’s heart rate was slower, more powerful in the 70s-80s range. 

Mom wanted to listen to all three heartbeats; she too thought it was a remarkable moment.  I told her that her strong heart was beating and supplying enough blood to circulate to both of her baby’s hearts inside her.  

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After hearing what I said must have registered with her, because her eyes moistened and her voice broke as she tried to get her husband’s attention who was napping in the chair beside her. 

Together the three of us sat quietly listening to the three heartbeats within her. 

Despite the fact that I did have to go back and forth to readjust and keep both babies’ heart rates on the monitor throughout my shift, I didn't mind so much.

I just marveled at the simple beauty of God’s intricate creation of life.

Comfort and Structure

Helping deliver babies is becoming more enjoyable with each work day.  I know that my time spent on L&D consists primarily of standing/moving and going through my checklist.  To-do tasks include taking baby meds out of our medication cabinet and filling out baby papers.  As well as making sure to grab Pitocin and stringing it up to start running post birth for uterine involution.  Of course there is always charting to stay on top of, and ultimately these odd jobs help to keep me busy throughout my shift.

 

I’m learning how all of the MDs are wired on our unit, including their preferences.  Some MDs want nothing to do with being out at the desk other than to stop in briefly for updates, writing orders, or dictating post-delivery.  These same MDs want very little interaction with the patient as possible.  Then there are other MDs spending most of their day at the nurse’s desk or bedside.  They want to perform all of the cervical exams so they can determine progression exclusively.  They want to watch the strip minute-by-minute especially with deceleration in fetal heart tones, so they can judge the best time to intercede.

I’m learning to feel more comfortable in my abilities as an RN in both approaches, which helps me to enjoy my job more.  I’ve learned that more babies are born in the fall, specifically here in the North, because more couples are conceiving in the winter months.  This sheds more light onto why I felt overwhelmed with my schedule this past fall.  This also explains why I was asked twice last week if I wanted to take low-census or PTO because our unit was slow.

Most importantly, as the holidays are now beyond me, I’m starting to appreciate my schedule as an RN.  I’m happy that at most I work (3) 12 hour shifts in a row before getting a day off.  And about once a month, I get approximately 5-6 days in a row off at a time.  For this I’m grateful, because with our current artic cold snap, I’ve been able to spend more time with my family with school being cancelled, than I did on their winter break.

With the extra time on my hands, I read a blog post written by Hannah over at hb called When 60 Days Could Change Your Life.  Hannah started implementing 6 changes/resolutions prior to 1/1/14.

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This has inspired me to start a structure of sorts in my own life.  It’s no lie I haven’t written a blog post in a while mainly because I was getting used to my new career.  But I’ve also be trying to decide on continuing this blog.  While I love my career and the route I’ve chosen to get where I am, I’ve lost focus on my ambition to write.  I’m not sure what to write about now-a-days, and it seems harder to disguise my experiences with the reality of disrespecting patient confidentiality.  Since I’ve mastered school and getting my degree, I’m not sure what motivates me that I can write about.  I’m taking suggestions if anyone wants to help me figure it out. 

However, I will do my best to keep you all informed of my decision if and when it comes to that point.  For now, I’m taking Hannah’s cue on getting more structured, with a goal in mind.  Happy 2014 everyone!