Doula and Nurse Katherine coming soon...

The name of the blog must soon change to Doula & Nurse Katherine...which is pretty amazing.  I am about to graduate from my nursing program in a little more than a month and I am sucking up the last moments as a student (again).  Over the last 4.5 years in my nursing program I've learned an incredible amount about patient care and I'm psyched to bring this back to the birth community.

Breed 'em and Weep

Check out this moving entry on Jennifer Mattern's award-winning blog, Breed 'em and Weep.

SEPTEMBER 4, 2011 · 21 COMMENTS

She arrives home to me today with cropped hair and even more attitude. Her little sister is growing, too, but Soph is crossing over. No more little girl. This is new terrain for us both, this tweendom.

She saunters ahead while I stumble behind, trying to keep her in my sights. I can’t tell you what’s changed. I could, because I know what’s behind the changes, but I would be betraying her confidence. So ask her yourself, if you cross her path, and you see what I’m talking about. The funny thing is, she just might tell you. She’s self-aware, she’s grounded, and she’s willing to talk. She’s navigating her way into her new thinking and new curves and new smarts and new sass and new emotions bloody gracefully. She freaking knocks me out.

I threw out all the books, when it came to Soph, my firstborn. Within hours of meeting her, in fact, I’d given up on the damn books. This kid would go about things in her own way. I saw it in her blue-gray eyes (now hazel, why should anything stay the same?) as I nursed her. I saw it when she refused to coo or smile at strangers. I saw it when she observed other kids, contentedly, from the periphery. She was and has always been perfectly enough for herself. I wish to God that someday I will be able to say the same about myself, that I will learn this from her.

Please visit her blog and read the rest; it's excellent. breed 'em and weep - i'm not going to blow this

Have a lovely day, readers!

Thriving

My maternity and pediatrics rotations have come to a close. I wish I'd had more time to write about each clinical experience, but posting got away from me.

I would like to talk about my most memorable patient from these past weeks. His name is Bryan and he is 13 months old, but is about half that in age when it comes to mental and physical development.

Bryan was born at 25 weeks gestation (40 weeks is what we hope for). His lungs were underdeveloped and he was, and continues to be, hypotonic; he lacks muscle tone and cannot hold his head up. He feels, in your arms, like a very large, newborn. His arms and legs get stronger by the day, but he still cannot sit upright without your constant assistance or pull himself to stand; these developmental milestones are usually reached by six months, and a year, respectively. In short, this is what they call "Failure to Thrive."

Despite the fact that Bryan is fed entirely through a tube in his tummy and is on oxygen chronically, which might make anyone unhappy, wow, could that kid laugh! When I first met him, he was kicking like a squirmy worm on his back, just kicking, kicking, kicking. I saw his little feet flailing as I passed by in the hall and thought I'd pop in and make sure he was all right. He was content! He slid down from usual propped up position (he is at constant risk for aspirating/choking) and was just having a ball kicking his legs all around. I played with him, cleaned him up, kissed him and when I kissed his feet and gave him zurburts he would let out this amazing laugh! Oh, my yet-to-be-utilized eggs cried out! Have one! Have one! My cramps were the worst I'd had in my life, as if my body was literally aching for this little baby. I wish that were a joke, because I was not ever a believer in the biological urge/surge to have a baby, but OK, I believe it now; at least it's true for me.

I had Bryan as a patient for three days over the course of three weeks. First, he was the patient I took on in addition to my assigned newborn, whose jaundice had improved and was able to go home. On the second week, I did the same; I attended to my initial patient and when they were stable and with their family I went to hang out with Bryan. On the third week, my instructor looked at me and said, "Well, we know who you're working with today."

Finally he was all mine, all day. I was over-the-moon. I learned that Bryan's prognosis was not bad; he was expected to continue to grow and learn and gain strength, but just slower than the rest of children his age. I worked with the resident doctor assigned to him to have his feedings adjusted, changed his diapers (even when he contracted C. Dif. which is highly contagious and makes you have tons of foul-smelling diarrhea). I mean, I really didn't care if this kid pooped all over me, and then made me poop like crazy, and yes, that is a first. To have this connection with such a small human, who could only communicate with the word "ow," or by laughing hysterically, was intense. He really moved me, and my instant love for him was powerful. I feel like putting in a cheesy reference to the Twilight series' concept of "imprinting," but that's a little creepy. I digress...

For someone who spends a lot of time advocating for women and their partners during the birth process, this was my first experience, truly being an advocate for someone who could not speak for themselves. It was profound. What more can I say?? I'm rambling, I know, but this was hugely important. It means...I am in the right field! It means I have a giant heart and that's good! It means that I can love a complete stranger in an instant and want them to be well and to keep them safe, any and every way I can. In a nutshell: it blew my mind and I am forever thankful for this little boy.

In Jest!

Because I can be a birth professional and have a sense of humor, and I need to share this link with everyone. http://www.lets-panic.com/

Maternity Clinical Experience - Day 1

I had my first clinical day of my maternity rotation. I'm working at hospital in downtown Manhattan and loving it. I was worried about coming back to maternity care after extended time away from moms, but I am back in full effect.

My priority, on the first day, was integrity of the uterus in post partum care. Often the uterus can become "boggy" after birth and does not contract properly, and also, can become displaced. With my patient, her uterus was two fingers above her umbilicus, firm, but displaced to the right, which often is an indication that she should use the bathroom as a full bladder can effect the location of the uterus. After a few hours the uterus had shifted to the other side; a pretty incredible thing to feel/realize, and again I encouraged her to get up frequently, every hour or so, to urinate. I also massaged the uterus and encouraged the mother to breastfeed, which is a natural way to help the uterus contract.

Her baby, Sophia, was precious. I unwrapped the baby blankets and her arms shook up and down, as if she was saying, "What are these for???" I tucked them neatly back into her blankets and swaddle her into what I fondly call, The Burrito. I scooped her up and held the snuggly, warm lump. She slept soundly and I was content. Since swaddling, for me, wasn't instinctual, I'm certain there are other people who aren't clear on what it means, so I'm providing a link that has a good video on swaddling technique and one that has great, still photographs. I am not promoting the designs for purchase on the website (you can swaddle a baby with any large baby blanket), and I haven't looked into their other suggestions enough to stand behind them, but this is a nice way to illustrate what I'm talking about. Also, please note how one of the doctors on the show describes the baby...too funny: http://www.swaddledesigns.com/how-to-swaddle and http://www.babycenter.com/how-to-swaddle-your-baby-gallery.

Later on, a mother and father of twins needed help while mom ate and dressed. I jumped up fast, as if doing the Presidential Fitness "Shuttle Run" http://www.youtube.com/watch?v=u8T6A1ETUXc, and ran to Twin B, a tiny baby boy. He was a little restless so we bounced and rocked and he sucked on my knuckle. Mom mentioned that the boys were a little sedated the first two days after they were born by C-Section. She'd had an epidural and complained that she could not feel the strength of her contractions and had much difficulty pushing, which ultimately resulted in her cesarean birth and may have had something to do with the delay in feeding, although more evidence is needed on this topic. Two days later, of course on the day they were leaving the hospital, they were wide awake and HUNGRY! They ate more that day than in the two previous. Mom and dad were exhausted and it was only 11 AM. Here is a good link with general information on epidurals, from Mothering, http://www.mothering.com/pregnancy-birth/ecstatic-birth-the-hormonal-blueprint-of-labor?page=0,3

Enjoy!

Next Steps

The final year of nursing school begins! This semester I study Psychiatric Nursing and Critical Care for patients in the Intensive Care Unit.

My first clinical assignment deals with the treatment of a schizophrenic patient at a New York hospital. I approach this area with interest and some anxiety as it will bring me in touch with an older relative in my family with a similar history. But, the personalization of nursing care, I have found, is difficult and necessary. Delving into my own issues surrounding each illness, previously conceived notions, and personal experience make it possible to provide sensitive care, but it can be intensely emotional.

During the summer I will finally, finally, have the great joy of working on both maternity and pediatric floors. And come fall I will be out in a New York community providing care. Ideally this will culminate with graduation in December, but I may need one more semester to finish up, at which point I graduate in the spring of 2012. Either way this has been a long journey and with thoughts of warm weather in the future and images of budding trees in my mind I feel a new leaf turning.

I want to thank everyone for their continued interest and support in my nursing education. It would be impossible to persevere through full-time work and part-time school without incredibly flexible friends and family.

Be well,

Katherine

It's Been a Long Time

I am so happy that people are still coming to me for doula work! It is terribly unfortunate that I am in the throes of another chaotic semester. I am currently taking Adult Health also called Medical-Surgical Nursing and Pharmacotherapeutics. The summer semester is condensed into 10 weeks, instead of the usual 14, and it is rigorous. My clinical assignment is at NYU Medical Center and it's a blessing to work in such a well-stocked facility. The amount of supplies they have at their disposal, and sadly I mean disposable, would make some facilities jaws drop. It makes your life easier as a nurse, but you do wonder about the incredible disparities in wealth from one institution of care to the next.

After dealing with the immense joys of life during my doula practice, I am starting to see some very different and sad conditions. There are many, many illnesses that I read about, but slowly am starting to see in person, like liver failure, heart disease, and cancer. My aim is not a morbid post, but it's so clear, the importance of good preventative care for when we are lucky and healthy, but also, and often moreso, palliative care when we are very ill.

This fall I am enrolled in Elder nursing at Lutheran in Brooklyn and will continue to see many more issues involved with end of life care. I like that I will have the added knowledge of the care a person needs thoughout life's spectrum, and can bring it to the best, first days of our lives at birth.

Oddly enough my maternity course won't occur until Spring 2011, but you can imagine how itchy I am to dig in! I hear about my cohort of students and their maternity experiences and am yearning to see strong, beautiful mommas again. Soon, soon, soon...

I hope you all are doing well and having safe and happy births.

Please keep in touch.