Surprise in Labor and Delivery – Part 2

March, 1982 – 12:50 a.m.

I glanced at the white board after we transferred the surprise twins to Neonatal ICU for observation (see Part I of previous post). Bonnie, the health tech, had put a new admission in my other room named Wanda. Bonnie handed me her blood pressure and temperature on a piece of paper, and warned me, “Pam, she is extremely overweight, so I think she will have a difficult delivery.” I walked in the room and introduced myself to Wanda who was accompanied by her equally large husband, Martin. She told me she was 23 years old and this was her second pregnancy. She had a miscarriage at 14 weeks last year. Her last weight in the office was 305 pounds. She said her contractions began about 5 hours ago and were now 5 minutes apart, so her doctor told her to come to the hospital to be checked. I had brought the doppler stethoscope with me which was a very sensitive electronic stethoscope that is more sensitive than the manual fetoscope.

Manual Fetoscope to listen to baby's heartbeat. Curved part is placed on nurse's head for conduction.

Manual Fetoscope to listen to baby’s heartbeat. Curved part is placed on nurse’s head for sound conduction.

Electronic doppler to listen to baby's heartbeat

Electronic doppler to listen to baby’s heartbeat

I placed ultrasound gel on the end of the doppler and began trying to listen to the baby’s heartbeat on her very obese abdomen for an entire 5 minutes. I couldn’t hear anything through the layers of fat. Wanda grimaced and said she was having a contraction as she looked at her focal point and started Lamaze breathing. I placed my hand on her abdomen to feel the contraction, but felt nothing. After she said the contraction ended, I did an internal exam and felt her tightly closed cervix with the baby’s head up high in the canal. I did not have an elastic band long enough to go around her abdomen for the external monitor, so  I asked her to walk around the halls with her husband for one hour and then I would recheck her. This was our standard procedure if we were unsure if the woman was in labor.

After an hour, I rechecked her and there was no change. I called the resident MD and gave him my assessment. “Give her one Seconal now and another to take at home if she is not asleep in one hour.” I went back in her room and told her that since her cervix had not changed in an hour, she was having false labor pains (Braxton Hicks) caused by her ligaments stretching and gave her the Seconal. She was NOT happy to be going home and told me so.

I finished that busy night, and as I was walking out the door at 7:30 a.m., Barb, one of the day shift nurses came up to me. “Pam, they just brought Wanda back up from the emergency room. The ER doctor delivered her baby in the parking lot! She is furious with you for sending her home and said she is going to sue you.” My heart sank and my eyes filled with tears as I walked out the door. Sometimes, nursing is a very tough job.

When I arrived home, I opened my Bible to Psalm 46 and asked God to comfort me.

God is our refuge and strength, a very present help in trouble. Therefore will not we fear, though the earth be removed, and though the mountains be carried into the midst of the sea…Be still and know that I am God; I will be exalted among the nations, I will be exalted in the earth. The Lord of hosts is with us; the God of Jacob is our refuge.

I prayed that Wanda and her baby would be healthy.

October, 1982 – 7:30 a.m.

After we gave report to the day shift, my head nurse came to me. “Pam, the hospital attorney wants to speak with you in the legal department at 8 a.m. about a law suit from one of your patients.” I took a deep breath and asked God to give me a quiet heart. I entered the office and a tall thin gray haired man greeted me and introduced himself as Attorney S.

“I asked you to come review a chart with me because a woman named Wanda S… is suing the hospital for emotional trauma, inaccurate assessment, and negligent care of her when she was in the labor and delivery unit. You were the only one who examined her,  and then she came back later that morning and delivered the baby in the parking lot. Please look at your charting and tell me about what you remember about Wanda.”

I opened her thin paper chart and read my brief notes. I read the verbal order I wrote from the resident to give her 2 Seconal capsules and discharge her home. Thankfully, he had cosigned it. It seemed strange to be reading my handwriting six months later. Attorney S said, “Did you forget to write any other assessment or do you remember anything else about what happened with Wanda that night?” “No, she was only there an hour. She was very difficult to assess because she was so obese. My charting is complete.” He thanked me for coming and I went home.

I never heard the outcome of the law suit. It was a good reminder to me to chart completely and accurately immediately as things occur, especially in a place like labor and delivery where things change dramatically in mere seconds.

Reflection

One of the huge problems in medical care in the USA is the cost which is driven up by exorbitant malpractice suits against medical professionals. When I took a nursing tour of China in 1986, I was amazed that each patient only had a single piece of paper on a clipboard hanging on the end of their bed. I looked with longing at that little clipboard, wondering what it would be like to only have to write a few characters on each patient each shift. The head nurse explained that since it is a communist nation, the people were not permitted to sue any doctor or nurse for malpractice. Each patient has their personal health notebook that they bring to the clinic or hospital and then take back home. Therefore, there are no departments for medical records or malpractice attorneys.

Minimal charting in China in 1986

Minimal charting in China in 1986

Much of the charting we do is to prove we are practicing nursing according to the standard of care and to cover ourselves if we are ever sued. My college nursing instructor drilled into us, “If it’s not charted, it’s not done.”

The following is an exerpt from “Make Your Nursing Care Malpractice Proof” – January 2012, Vol 7, No. 1 by Deanna L. Reising PhD, RN

Six categories of nursing malpractice claims have been identified:
•failure to follow standards of care
•failure to use equipment in a responsible manner
•failure to assess and monitor
•failure to communicate
•failure to document
•failure to act as a patient advocate or follow the chain of command.

As I thought about the situation with Wanda, thankfully I did not commit any of those “failures.” Babies simply have a mind of their own, and they don’t read a book about how or when to be born. Expect the unexpected in obstetrics.

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Surprise in Labor and Delivery! Part 1

March, 1982- 11 p.m.-Labor & Delivery

Mary Lou, our assistant nurse manager, wrote our assignments for the night shift on the large white board at the nursing station after we listened to report from the evening shift. We only had 5 women in labor so far, so she gave me Helen in the birthing room and the first admission.  Helen had 2 children at home, was 28 years old, and was dilated 5 cm (halfway). She was at 37 weeks gestation, which was technically 3 weeks early, but typically the baby would have mature lungs and be over 5 pounds in weight.

I walked into the birthing room and introduced myself to Helen and her husband, Mike. Helen was a pretty blond lady with large blue eyes. Her dark haired handsome husband seemed quite attentive to her. She looked exhausted from labor and being pregnant. As a contraction began, she began to do her Lamaze breathing as Mike held her hand. I placed my hand on her swollen abdomen to feel the strength of the contraction.

After it let up, I asked, “Do you know if you’re having a boy or a girl?” Helen replied, “No, Dr. J. doesn’t believe in doing ultrasounds if the pregnancy is normal. We already have a boy and a girl at home, so we’re ready for either.” I checked her blood pressure which was normal,  and then did an internal exam. The amniotic sac of water around the baby had not broken yet, so we were not yet monitoring the baby’s heart beat internally. She was further along now.

I looked at the external monitor strip which recorded a normal heart rate and variation at an average of 130 beat per minute. I wrote my assessment and initials on the monitor strip, and said to Helen and Mike, “I’m going to call Dr. J at home and tell him to come in. You will probably deliver in the next hour.” Helen groaned and began her breathing as another contraction started. I left the room, wrote my new assessment on the white board, and called Dr. J. and then assessed another patient in labor whose nurse was in the delivery room.

When I returned to Helen’s room, I found Dr. J with her. He was in his scrubs, and said he just broke her water. Since she was fully dilated, he told her to start pushing. As this was her third baby, she would probably deliver quickly. I pressed the call light and asked the tech, Theresa, to come in and assist. I removed the bottom of the birthing bed, put Helen’s heels in the stirrups, raised the head of the bed, and gave her the steel handles on each side of the bed to grip. Theresa wheeled the sterile table out of the closet and uncovered the instruments so they were all ready for Dr. J.

Helen gave 3 pushes, and the baby’s head crowned, covered with blond hair. Dr. J told her to push gently, and a perfectly formed baby girl slipped into his hands. He suctioned out her mouth, she grimaced, and let out a nice cry. The beautiful sound of that first cry never ceased to amaze me! I pulled the Apgar cord and wrote down the birth time: 11:50 p.m. Her one minute apgar was excellent at 8/10 as Dr. J. placed her in the warmer. She appeared to weigh about 5 pounds, which is slightly small for 37 weeks. I congratulated Helen and Mike on their new baby girl and rubbed her dry with the warmed blanket and put a cap on her head to help her retain her body heat.

As Dr. J massaged Helen’s abdomen to deliver the placenta, he said, “You have another baby in here, Helen. You’re having twins!” Helen immediately began to cry and said, “Oh no, how will we ever pay for another baby?” Mike turned pale. My heart quickened as twins are always a high risk delivery, especially surprise twins. I had never delivered twins in the birthing room before, but it was too late now to move her to the delivery room. I pressed the call light and told the tech at the desk what was happening and asked her to get the resident in here and the Neonatal ICU nurse stat! The room quickly filled with extra staff so we barely had room to turn around.

Thankfully, the second baby was also head down and came out equally as easily 5 minutes later. She was also a girl! Dr. J placed her next to her sister in the warmer and we quickly dried her off. She also had excellent Apgar scores and appeared to weigh around 5 pounds. We handed one girl to Helen and the other to Mike to hold, and they both seemed to relax a little as they began to get over their shock of having not one, but TWO new babies!

Surprise twin girls!

Surprise twin girls!

I silently prayed that Helen and Mike would realize that God could give them His love, strength, and finances in Christ Jesus if they would only trust Him. I thought of many childless Christian couples who would absolutely love to raise those beautiful twin girls in the nurture and admonition of the Lord. Children are so precious to God because He creates all of us.

Lo, children are an heritage from the Lord; and the fruit of the womb is His reward. Happy is the man who s his quiver full of them… Psalm 127:3, 5

The father of the righteous shall greatly rejoice, and he that begets a wise child shall have joy of him. Your father and your mother shall be glad, and she that bore you shall rejoice. Proverbs 23:24-25

After I woke up the next afternoon, I was glad it was my day off, giving me some extra time to think and pray. I continued to pray for the new twins to be healthy and receive Christ as Savior at a young age. Sometimes it’s difficult to be content and be single since most of my friends are married and having children. I wonder if God will ever give me a husband and children? I know His will for me today is to simply fix my eyes on Him and be content. I opened my Bible and read,

Not that I speak in respect of want; for I have learned, in whatever state I am, in this to be content. Philippians 4:11

It always encourages me to read this and think of the great Apostle Paul who God used to write these words. Apparently he was  a widower during the last part of his life and had to learn contentment also. I decided to get out my cassette tape on “Social Relationships” by Dr Stephen Olford to review Biblical principles of companionship, comradeship, courtship, and singleness. I always feel better after listening to it. Especially when he says, “You dear young people, if God wants you to marry, He will NEVER allow you to miss meeting your life partner!”

Dear Lord, Help me to rest in You in sweet contentment and just live one day at a time. Thank you that I am single today and that Your ways are so much higher than my ways and that You make no mistake. Amen.

Reflection

I was thrilled to find Dr. Olford’s message at the following link:

http://www.sermonindex.net/modules/mydownloads/viewcat.php?cid=426&min=20&orderby=titleA

I think every single person and parent would greatly benefit and be encouraged by this message. The Lord has allowed me to continue to be single. I no longer fear being single as I did when I was younger, because God has been so kind and gracious to me over the years and has provided for my every need. I praise Him for His precious gift of contentment.

Some years ago, God guided me to the wonderful verse in Isaiah 54:1

Sing. O barren, you who did not bear; break forth into singing, and cry aloud, you who did not travail with child; for more are the children of the desolate than the children of the married wife, says the Lord.

After I read this verse, the Lord showed me that there was no limit to the number of spiritual children I could have. How wonderful!

Next week I will continue with the next surprise of that very busy night in Labor and Delivery.

 

S-O-A-P Charting

March, 1978 – 11:30 p.m.

I had just finished walking rounds with the night shift nurse, clocked out, and sat down beside the chart rack to begin my charting before I could go home. I usually was able to complete some of my assigned five patient charts during my shift, but it had been nonstop all evening so I barely had time to gulp down my dinner. Each nurse was assigned five charts and must chart on two of the patient problems before going home. We were not paid overtime to complete our charting.

I wearily began writing using the S-O-A-P format in the heavy 3 inch thick chart under the tab marked “Nurses Notes” with my blue ink pen. Day shift charted in black ink, evening shift used blue ink, and night shift used red ink.

S is for subjective- what the patient says. soap bar

O is for objective – what you observe.

A is for assessment.

P is for plan.

I remembered my college instructor’s words about charting.

“If it’s not charted, it’s not done. Try to paint a concise picture with words of exactly what you did using only approved abbreviations. If you are ever sued, you likely won’t remember the patient several years from now. The lawyers and jury will scrutinize your every word.”

Mrs. K. in Room 515 had had a below the knee amputation two days previously. I scanned her problem list and chose Pain and Diabetes from her list. I began writing using approved abbreviations:

#1. Pain

S: c/o moderate RLE pain. (complains of moderate right lower extremity pain)

O: RLE incision intact. Moderate swelling, slight erythema. VS (vital signs): 99.2-76-18-136/84. (temperature-pulse-respiratory rate-blood pressure)

WBC (white blood cell count) 7.4. Given 2 Percocet.

A: Moderate post-op pain. Pain relieved with Percocet. No sign of infection.

P: Continue to monitor incision qs (every shift), medicate for pain prn (as needed). Instruct pt (patient) about phantom pain.

I completed my last chart at midnight, put on my coat, walked out to the parking lot, climbed in my car, and drove home through the black night.

Reflection

Charting has changed over the years, but the saying of my instructor still holds true in the litigious American society, “If it isn’t charted, it isn’t done.” After Xerox copies were invented, we switched to black ink for charting so the notes were more legible when copies were made.

When I worked in labor and delivery, I had to write my initials and time on the fetal monitor strip whenever I entered the mother’s room, and whenever I gave any medication or did a procedure. Only once was I called to the office of the hospital attorney to review my charting I did on a mother who we sent home in false labor. She later came back that night, but delivered the baby in the hospital parking lot before she made it to the labor and delivery unit. She was now suing the hospital for sending her home, and I was the nurse who did the last assessment. I reviewed my charting about a year after the incident and my instructor’s words came back to my memory. Thankfully, my charting was complete and I never heard the outcome of the lawsuit. They likely settled out of court.

When I was a visiting nurse in the 1990’s, we used a check list system for the daily visits and left a carbon copy in the home for the next nurse. When I worked in the nursing home as a nurse practitioner, we had a dictation service with secretaries which worked very well. We returned once again to the S-O-A-P format. We used both paper charts and electronic medical records which was confusing at times.

In my final job with the federal government, we only had an electronic patient record. The days of heavy paper charts in racks had ceased. I had machine dictation which was only about 70% accurate, so it took quite awhile to correct all the mistakes. But at least we  could read everyone’s notes and never had to go hunting for lost charts. However, when the computer system crashed, it shut down the whole system because we had no access to the patient records. Thankfully, that didn’t happen often. I felt sorry for the providers who had never taken a typing class and had to spend long hours at home in the evening completing their patient’s charts for the day with the old hunt and peck method of typing.

When I called a doctor’s office to request a copy of a patient’s records, his assistant said she would fax them over, but warned me we would not be able to read his handwriting! Over the years, I’m afraid my handwriting has deteriorated also as I have spent countless hours writing in patient charts. Charting isn’t the most satisfying part of nursing, but it is necessary for communication and a required part of every job, so I always tried to do it thoroughly and above all, honestly, to honor God.

“Not with eyeservice, as menpleasers, but as the servants of Christ, doing the will of God from the heart, with good will doing service as to the Lord, and not to men.” Ephesians 6:6-7

When I toured hospitals in China in 1986, I was amazed that they only had one sheet of paper with a few characters on a clipboard hanging on the end of each patient’s bed. The patients were not allowed to sue their provider, so the documentation was very minimal. A Chinese friend told me each person keeps their own medical record in a notebook and takes it with them each time they go to the clinic for the doctor to write in. It sure seems like a much simpler system!

 

Babe of Bethlehem

“Now when Jesus was born in Bethlehem of Judea in the days of Herod, the king, behold, there came wise men from the east to Jerusalem, Saying, Where is He that is born King of the Jews? For we have seen His star in the east, and are come to worship Him.” Matthew:2:1-2

Bethlehem, Israel – March, 2013

25,000 people now reside in Bethlehem, Israel

25,000 people now reside in Bethlehem, Israel

Our tour group boarded our bus outside our hotel in Jerusalem and traveled 20 minutes to the city of Bethlehem which now has 25,000 residents. We drove past the huge cement wall built between Palestinian controlled Bethlehem and Jerusalem to prevent the Arab snipers from shooting them. At the checkpoint, the security guard waved us through after our driver told him we were American tourists. Our day to visit Bethlehem changed since President Obama was scheduled to visit here in three days. We parked in an underground garage and walked several blocks uphill to the Church of the Nativity, the traditional site where Jesus Christ was born in a cave. We passed Muslim women dressed head to toe in black, brown, or gray burkas.

Church of the Nativity

Church of the Nativity

Construction began in 326 A.D. on this oldest church in the Holy Land which is still in use. It is separated into three different sanctuaries of the Franciscan Catholics, Greek Orthodox, and Armenian Orthodox.

"Mouse hole" entrance to Church of the Nativity!

The tiny entrance to the Church of the Nativity prevented intruders!

We entered through a four foot high door with a foot high wall at the bottom. Our guide told us they built it this short purposely as a deterrent to any enemies! When an enemy entered all bent over, he couldn’t shoot anyone, but the person inside could knock him over or kill him easily.

Then we wandered from one sanctuary to the other. It was quite interesting to compare the different architectural styles, the Armenian one being the most ornate. We waited in line about 20 minutes to see the glass covered hole in the floor that is supposed to be the actual birthplace of Christ.

Traditional birthplace of Christ.

Traditional birthplace of Christ.

Our Hebrew Christian guide, told us that in 1948 when the State of Israel began, Bethlehem had all Christian residents, but now there are only about 40 families remaining. The Muslims won’t hire them, so all the Christian young people are leaving.

We went to a gift shop that an Arab Christian started to support these remaining families. The believers carve nativity scenes out of olive wood which are very intricate. I treasure the one I purchased that portrays Mary and Joseph gazing at the Christ child in the cave. I also learned the typical manger was made of stone, unlike the wooden mangers usually portrayed in America.

My olive wood nativity scene carved by Christians in Bethlehem.

My olive wood nativity scene carved by Christians in Bethlehem.

Reflection

As I recall my days in Labor and Delivery helping those babies into the world on Christmas morning in 1981, I couldn’t help but wonder if anyone assisted Mary during her labor other than Joseph? It simply states in Luke 2:7  And she brought forth her first-born Son, and wrapped Him in swaddling clothes, and laid Him in a manger. This is what the midwife or nurse would typically do who assisted the mother.  Midwives are mentioned in Exodus 1:15-22 who feared God and preserved the Hebrew male babies from Pharaoh’s wrath. “Therefore God dealt well with the midwives; and the people multiplied, and became very mighty.” I do not think God gave any details about Mary’s labor or delivery because He wanted all the emphasis upon Jesus Christ, the Savior of the world.

Shepherds of Bethlehem.

Shepherds of Bethlehem.

The common shepherds were the first ones who learned of the Savior’s birth and came to worship Him, their Creator, who “took upon Him the form of a servant, and was made in the likeness of men; And, being found in fashion as a man, He humbled Himself and became obedient unto death, even the death of the cross.” Philippians 2:7-8. Emmanuel, God with us, who left heaven above, and came to earth to be my Savior. Born to die. Thank You, Lord Jesus, that You love me so much!

Charles Wesley captured this thought beautifully in the fourth verse of “Hark, the Herald Angels Sing”.

Mild He lays His glory by, Born that man no more may die,

Born to raise the sons of earth, Born to give them second birth.

Hark, the herald angels sing, Glory to the newborn King!

I pray you all may have a Christ centered celebration of the birth of our dear Savior!

Christmas Babies!

December 25, 1981 – 2 a.m. Labor & Delivery Staff Nurse

I finished my night shift orientation in September and am feeling much more comfortable in my skills as I don’t need to think so hard about every little thing. Since it is my first Christmas in Labor & Delivery, I am required to work. Management designated me as charge nurse since the Assistant Nurse Manager is off tonight.

I glanced at the large white board in the nurse’s station which listed all the patients by name, stage of labor, and doctor. We still had six women in labor with four empty labor rooms. We had already done four deliveries since I was called in early at 9:30 p.m. to help the busy evening shift. I glanced at the fetal monitors which displayed each baby’s heart rate. All of a sudden, I saw one baby’s heart rate go dangerously low to 50 and stay there. A normal full-term baby’s heart rate is 120-160 beats per minute. Cathy, another nurse, stuck her head out the door of the woman’s room and yelled, “Call the doctor and nurse anesthetist, Pam! We have to do a stat C section (surgery). This baby is in trouble!”

The operating room technician, Teresa, ran to the prepared operating room (OR) while I called the two doctors. The nursing assistant helped Cathy wheel the huge bed down the hall to the O.R. Cathy had the mother lie on her left side to try and take the pressure of the baby’s body off her mother’s blood vessels so the baby could get more blood.

Newborn Baby!

Newborn Baby!

We worked quickly. As soon as the anesthesiologist nodded that the mother was asleep, the resident doctor cut her abdomen and lifted the baby out of her womb. He  cut the cord that was wrapped tightly around the baby girl’s neck, and carried her to the warmer. Her own cord had choked her as she came down the birth canal. The baby girl let out a weak whimper.  I suctioned out her mouth and placed the oxygen mask over her small face. I dried her off quickly and she took several gasps of air! I silently prayed, “Dear Lord, Please touch this baby girl’s body that she may live.”  She let out a louder cry and the delivery room staff exhaled a sigh of relief. Her tiny body began to turn pink. The Neonatal ICU nurse wheeled the baby girl down the hallway to keep a close eye on her until she stabilized.

I returned to my other patient, Marie, and checked her progress internally. She was ready to start pushing the baby out. She was totally exhausted after 16 hours of painful labor. After an hour of pushing, I saw a patch of the baby’s black hair peak out! We wheeled Marie in her bed down the hall to the delivery room, helped her transfer to the narrow delivery bed, placed her heels in the steel stirrups, and her hands on the steel handles. I had her husband, John, sit on a stool beside her.

She gave several more pushes, but wasn’t making much progress. Dr. D. instructed, “Pam, give fundal pressure during the next contraction to help her out.”  I looked at Marie over my mask and warned, ” I’m afraid this is going to hurt you.” As I felt her large abdomen harden, I reached across her, grabbed the steel handle with both my hands, and pressed my forearm into her belly with all my strength. She screamed and I felt like screaming as my back went into a muscle spasm. At last the baby’s head popped out and his slippery body slid into Dr. D’s hands.

“Congratulations, Marie and John! You have a nice big healthy boy!” announced Dr. D. I pulled the string on the Apgar clock and wrote down the time — 3:03 a.m. Christmas morning.  Dr. D.  quickly suctioned the mucus out of the baby’s mouth with the blue rubber bulb syringe, and the baby let out a loud strong cry. Dr D placed two clamps on the umbilical cord and laid him on Marie’s abdomen so she could see him. “John, would you like to cut your son’s cord?” “Sure!” grinned John as he took the sterile scissors in his hand and snipped the cord.

Dr. D. carried the baby to the warmer and the Apgar timer buzzed at one minute. I gave him a score of 8 out of 10 which was excellent! His trunk, hands, and feet were still tinged blue. I suctioned the mucus out of his mouth again, wiped off his body with the soft, warm, cotton blanket and put a little hat on his head to keep him warm. The 5 minute Apgar time buzzed and I scored him 9 out of 10. His body was now pink, but his hands and feet were still slightly blue. I wrapped him tightly in another clean warm blanket and greeted him, “Merry Christmas, Timothy! Welcome to the world!” John watched his new son with amazement.

A woman, when she is in travail, has sorrow, because her hour is come; but as soon as she is delivered of the child, she remembers no more the anguish, for joy that a man is born into the world. John 16:21

I carried Timothy over to Marie and placed him in her arms. All the fatigue vanished from her face as she gazed at him tenderly and kissed his forehead. After Dr. D. delivered her placenta and stitched her up, I put a warm blanket on her and wheeled mother and son to the recovery room.

The remaining hours flew by as we did two more Caesarian surgeries and two more normal deliveries. Eight babies were born that  Christmas night shift! I sat down twice for ten minutes during my ten hour shift. I was so happy to see the day shift staff walk into the nurse’s station at 7 a.m.! We gave them report, went to the locker room to change out of our blue scrubs into our street clothes, and walked wearily out the door into the bitterly cold Christmas morning sunshine.Christmas morning

Reflection

My severe back pain continued, and I was diagnosed with two injured back muscles. My doctor ordered me to take a month leave of absence while I went to physical therapy to heal and strengthen my muscles. He said I was in poor shape physically and needed to exercise regularly if I wanted to continue to work in labor and delivery. So I joined the local indoor pool and began swimming four times a week. I happily discovered that swimming was also a great stress reliever and helped me sleep better!

The babies that were born that early morning will celebrate their 36th birthday this Christmas and likely have children of their own by now. I wonder what kind of choices they have made in life? They share the same birth day when we annually celebrate the birth of Jesus Christ, King of Kings and Lord of Lords. I pray that each has chosen to receive Him as his/her personal Savior.

“For unto you is born this day in the city of David a Savior, who is Christ the Lord. And this shall be a sign unto you: You shall find the babe wrapped in swaddling clothes, lying in a manger.” Luke 2:11-12

Jesus – Born in Bethlehem

“Now when Jesus was born in Bethlehem of Judea in the days of Herod, the king, behold, there came wise men from the east to Jerusalem, Saying, Where is He that is born King of the Jews? For we have seen His star in the east, and are come to worship Him.” Matthew:2:1-2

Bethlehem, Israel – March, 2013

25,000 people now reside in Bethlehem, Israel

25,000 people now reside in Bethlehem, Israel

Our tour group boarded our bus outside our hotel in Jerusalem and traveled 20 minutes to the city of Bethlehem which now has 25,000 residents. We drove past the huge cement wall built between Palestinian controlled Bethlehem and Jerusalem to prevent the Arab snipers from shooting them. At the checkpoint, the security guard waved us through after our driver told him we were American tourists. Our day to visit Bethlehem changed since President Obama was scheduled to visit here in three days. We parked in an underground garage and walked several blocks uphill to the Church of the Nativity, the traditional site where Jesus Christ was born in a cave. We passed Muslim women dressed head to toe in black, brown, or gray burkas.

Church of the Nativity

Church of the Nativity

Construction began in 326 A.D. on this oldest church in the Holy Land which is still in use. It is separated into three different sanctuaries of the Franciscan Catholics, Greek Orthodox, and Armenian Orthodox.

We entered through a four foot high door with a foot high wall at the bottom. Our guide told us they built it this short purposely as a deterrent to any enemies! "Mouse hole" entrance to Church of the Nativity!

“Mouse hole” entrance to Church of the Nativity!When an enemy entered all bent over, he couldn’t shoot anyone, but the person inside could knock him over or kill him easily.

Then we wandered from one sanctuary to the other. It was quite interesting to compare the different architectural styles, the Armenian one being the most ornate. We waited in line about 20 minutes to see the glass covered hole in the floor that is supposed to be the actual birthplace of Christ.

Traditional birthplace of Christ.

Traditional birthplace of Christ.

Our Hebrew Christian guide, told us that in 1948 when the State of Israel began, Bethlehem had all Christian residents, but now there are only about 40 families remaining. The Muslims won’t hire them, so all the Christian young people are leaving.

We went to a gift shop that an Arab Christian started to support these remaining families. The believers carve nativity scenes out of olive wood which are very intricate. I treasure the one I purchased that portrays Mary and Joseph gazing at the Christ child in the cave. I also learned the typical manger was made of stone, unlike the wooden mangers usually portrayed in the USA.

My olive wood nativity scene carved by Christians in Bethlehem.

My olive wood nativity scene carved by Christians in Bethlehem.

Reflection

As I recalled my days in Labor and Delivery helping those babies into the world on Christmas morning in 1981, I couldn’t help but wonder if anyone assisted Mary during her labor other than Joseph? It simply states in Luke 2:7  And she brought forth her first-born Son, and wrapped Him in swaddling clothes, and laid Him in a manger. This is what the midwife or nurse would typically do who assisted the mother.  Midwives are mentioned in Exodus 1:15-22 who feared God and preserved the Hebrew male babies from Pharaoh’s wrath. “Therefore God dealt well with the midwives; and the people multiplied, and became very mighty.” I do not think God gave any details about Mary’s labor or delivery because He wanted all the emphasis upon Jesus Christ, the Savior of the world.Nazareth shepherd

The common shepherds were the first ones who learned of the Savior’s birth and came to worship Him, their Creator, who “took upon Him the form of a servant, and was made in the likeness of men; And, being found in fashion as a man, He humbled Himself and became obedient unto death, even the death of the cross.” Philippians 2:7-8. Emmanuel, God with us, who left heaven above, and came to earth to be my Savior. Born to die. Thank You, Lord Jesus, that You love me so much!

Charles Wesley captured this thought beautifully in the fourth verse of “Hark, the Herald Angels Sing”.

Mild He lays His glory by, Born that man no more may die,

Born to raise the sons of earth, Born to give them second birth.

Hark, the herald angels sing, Glory to the newborn King!

I pray you all may have a Christ centered celebration of the birth of our dear Savior!

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Christmas Babies!

December 25, 1981 – 2 a.m. Labor & Delivery Staff Nurse

I finished my night shift orientation in September and am feeling much more comfortable in my skills as I don’t have to think so hard about every little thing! Since it is my first Christmas in Labor & Delivery, I am required to work and they designated me as charge nurse since the Assistant Nurse Manager is off tonight.

I glanced at the large white board in the nurse’s station which listed all the patients by name, stage of labor, and doctor. We still had six women in labor with four empty labor rooms. We had already done four deliveries since I was called in early at 9:30 p.m. to help the busy evening shift. I glanced at the fetal monitors which displayed each baby’s heart rate. All of a sudden, I saw one baby’s heart rate go dangerously low to 50 and stay there. A normal full-term baby’s heart rate is 120-160 beats per minute. Cathy, another nurse, stuck her head out the door of the woman’s room and yelled, “Call the doctor and nurse anesthetist, Pam! We have to do a stat C section (surgery). This baby is in trouble!”

The operating room technician, Teresa, ran to the prepared operating room (OR) while I called the two doctors. The nursing assistant helped Cathy wheel the huge bed down the hall to the O.R. Cathy had the mother lie on her left side to try and take the pressure of the baby’s body off her mother’s blood vessels so the baby could get more blood.

Newborn Baby!

Newborn Baby!

We worked quickly. As soon as the anesthesiologist nodded that the mother was asleep, the resident doctor cut her abdomen and lifted the baby out of her womb. He  cut the cord that was wrapped tightly around the baby girl’s neck, and carried her to the warmer. Her own cord had choked her as she came down the birth canal. The baby girl let out a weak whimper.  I suctioned out her mouth and placed the oxygen mask over her small face. I dried her off quickly and she took several gasps of air! I silently prayed, “Dear Lord, Please touch this baby girl’s body that she may live.”  She let out a louder cry and the delivery room staff exhaled a sigh of relief. Her tiny body began to turn pink. The Neonatal ICU nurse wheeled the baby girl down the hallway to keep a close eye on her until she stabilized.

I returned to my other patient, Marie, and checked her progress internally. She was ready to start pushing the baby out. She was totally exhausted after 16 hours of painful labor. After an hour of pushing, I saw a patch of the baby’s black hair peak out! We wheeled Marie in her bed down the hall to the delivery room, helped her transfer to the narrow delivery bed, placed her heels in the steel stirrups, and her hands on the steel handles. I had her husband, John, sit on a stool beside her.

She gave several more pushes, but wasn’t making much progress. Dr. D. instructed, “Pam, give fundal pressure during the next contraction to help her out.”  I looked at Marie over my mask and warned, ” I’m afraid this is going to hurt you.” As I felt her large abdomen harden, I reached across her, grabbed the steel handle with both my hands, and pressed my forearm into her belly with all my strength. She screamed and I felt like screaming as my back went into a muscle spasm. At last the baby’s head popped out and his slippery body slid into Dr. D’s hands.

“Congratulations, Marie and John! You have a nice big healthy boy!” announced Dr. D. I pulled the string on the Apgar clock and wrote down the time — 3:03 a.m. Christmas morning.  Dr. D.  quickly suctioned the mucus out of the baby’s mouth with the blue rubber bulb syringe, and the baby let out a loud strong cry. Dr D placed two clamps on the umbilical cord and laid him on Marie’s abdomen so she could see him. “John, would you like to cut your son’s cord?” “Sure!” grinned John as he took the sterile scissors in his hand and snipped the cord.

Dr. D. carried the baby to the warmer and the Apgar timer buzzed at one minute. I gave him a score of 8 out of 10 which was excellent! His trunk, hands, and feet were still tinged blue. I suctioned the mucus out of his mouth again, wiped off his body with the soft, warm, cotton blanket and put a little hat on his head to keep him warm. The 5 minute Apgar time buzzed and I scored him 9 out of 10. His body was now pink, but his hands and feet were still slightly blue. I wrapped him tightly in another clean warm blanket and greeted him, “Merry Christmas, Timothy! Welcome to the world!” John watched his new son with amazement.

A woman, when she is in travail, hath sorrow, because her hour is come; but as soon as she is delivered of the child, she remembereth no more the anguish, for joy that a man is born into the world. John 16:21

I carried Timothy over to Marie and placed him in her arms. All the fatigue vanished from her face as she gazed at him tenderly and kissed his forehead. After Dr. D. delivered her placenta and stitched her up, I put a warm blanket on her and wheeled mother and son to the recovery room.

The remaining hours flew by as we did two more Caesarian surgeries and two more normal deliveries. Eight babies were born that  Christmas night shift! I sat down twice for ten minutes during my ten hour shift. I was so happy to see the day shift staff walk into the nurse’s station at 7 a.m.! We gave them report, went to the locker room to change out of our blue scrubs into our street clothes, and walked wearily out the door into the bitterly cold Christmas morning sunshine.Christmas morning

Reflection

My severe back pain continued, and I was diagnosed with two injured back muscles. My doctor ordered me to take a month leave of absence while I went to physical therapy to heal and strengthen my muscles. He said I was in poor shape physically and needed to exercise regularly if I wanted to continue to work in labor and delivery. So I joined the local indoor pool and began swimming four times a week. I happily discovered that swimming was also a great stress reliever and helped me sleep better!

The babies that were born that early morning will celebrate their 35th birthday this Christmas and likely have children of their own by now. I wonder what kind of choices they have made in life? They share the same birthday that we celebrate the birth of Jesus Christ, King of Kings and Lord of Lords. I pray that each has chosen to receive Him as his/her personal Savior.

“For unto you is born this day in the city of David a Savior, who is Christ the Lord. And this shall be a sign unto you: Ye shall find the babe wrapped in swaddling clothes, lying in a manger.” Luke 2:11-12