Yesterday in L&D... cesarean sections/breast feeding (Don't read if you're sensitive to TMI)

Wow, yesterday was one of the busiest days in L&D! We had 3 scheduled cesareans right away, and lots of mothers laboring LOL

I got there to find out I had 0730 and 1330 cesareans! YAY! I love watching cesareans, especially observing the role of the circulating nurse. It's very interesting to help out in the prepping process and working in PACU.

I helped prep both patients. I watched the computerized admissions process, and pretty much have that down. It's pretty self-explanatory. Then it's on to starting an IV and giving medications to prevent a reflux situation and decrease the acid. We also give Alka-Seltzer. By now the pt has been NPO since midnight or earlier.

We give them Chlorhexidine bath wipes to clean up with and then we shave their belly/pubic area. A foley has to go in, but we wait until they have received their spinal. So when the OR is ready we contact the dr and take the patient to the room. We assist with the spinal administration (keeping the patient still and in the right position). I always joke with my patients when I'm holding their head down to help ease their tension. I usually say something like "Well I'm glad I decided to wear deodorant today". That always puts a smile on their face. Then I talk to them while everything is being done.

Once everything is set, we lay them down on the bed and the Foley is inserted. It's good because the patient doesn't feel it. Compression stockings that are pumped up with air to prevent DVTs are applied to both legs. We cover them up with blankets from the warmer (the OR is always real chilly) and then we strap their arms and legs so they won't fall. Then the bed is tilted at a slight angle to prevent vena cava compression by the enlarged uterus. They also have a Bair Hugger blowing warm air on them as well.

That's when the dr comes in after scrubbing and gets gowned up and sterile gloves applied. Sterile drapes are applied and curtain is raised. After the dr draws the line on the stomach where the incision will be we go and get the father/significant other and sit them next to the mother behind the screen.

I usually stand back here and watch as the dr cuts through each layer. The creepiest part is watching as the dr & asst grab the abd muscles and rip them open. Ugh LOL I won't forget that now when I have my next cesarean!

Then they get down to the uterus. This is where it starts to get a little bloody. Fortunately blood doesn't bother me at all. Soon you see the amniotic sac bulging and that's when you step back cause once the dr punctures it, it can produce quite a jet of fluid! Sometimes it's just a trickle, but it's funny to watch. Then you see that head! Baby is all snuggled up inside it's mother. It's awesome! That's when the asst starts pushing down on the mothers abd and the baby slowly starts coming out of the incision into the drs hands. Finally the baby is delivered and they suction out the mouth and nose. The umbilical cord is cut and the baby is placed in a sterile crib.

The NICU team takes the baby and wipes it up real good and gives it a little oxygen, if needed. They suction it out and do 1 minute and 5 minute APGARS. The dad is allowed to come over to take pictures and trim the umbilical cord. The baby is wrapped up and taken to the mother real quick. She gets to see the baby for a little while, how stable the baby is dictates how long she can see the baby. Then they put the baby in the crib and take it to NICU where the baby is further assessed and interventions are taken, if needed. The baby gets it's first bath and then is footprinted.

If the baby is doing good the baby meets the mother in PACU or back in her room. If she wants to nurse we try to get the Lactation Consultant to meet with the mother to show her the best ways to do it. Or rather observe and then if there's problems with the technique, she helps them out. I've learned so much that I will use with my next baby. Unfortunately with Colin being in the NICU and being tube fed I didn't get to nurse him right away. But I did pump and for a week I would bring breast milk to the NICU for them to give him in his tube feeding. So he did start out with the best milk possible. But when it was time to try nursing him it was hard.

After he came home I continued to pump. I would still try to nurse him and it worked to some degree, but it hurt like hell the first minute or two. I know that means he had a bad latch but I couldn't do anything else. When he was hungry he got hysterical when I tried to reposition him.

Eventually I would go back to the bottle (with pumped breast milk). I was SOOOOOOOOO sore! But it meant the world to me to give my son breast milk. But damn it was always so messy HAHA He would nurse from one breast and the other would be leaking. I would go through breast pads like they were tissue paper.

I still remember going back to church. All it took was one hour in church and my pads would be soaked and it would go through my shirt. So I would have to carry Colin over the wet areas and pray people didn't want to hold him. Ugh. It was so frustrating but I stuck with it. Especially with him being premature I knew breast milk was crucial.

Unfortunately the pediatrician recommended that we suppliment with formula. Colin couldn't handle regular formula and had to take Nutramigen. It was like KILLER expensive. We don't qualify for WIC so we paid full price for it. (Boy it sure would be nice to get some of our tax money back that we pay an arm and a leg for LOL) Eventually he was able to take Prosobee when he got a little older.

After 3 months my milk totally dried up. I'm happy knowing I tried my hardest and I did give my son a good start in life with the breast milk :-) I didn't get to breast feed Cody because my ex felt breasts were "sexual". So I missed out on that. But fortunately my husband is all for it. And I look forward to trying again!

Anyways, since I think I'm coming down sick (sore throat and stuffiness) I need to take it easy today. And I had to much cleaning planned today. Wednesday and Thursday I work 12 hour shifts and then class Friday. Saturday we are watching the Georgia Bulldogs and then Sunday Easter. Back to work Monday morning for another 12 hour LOL