WORK/LIFE BALANCE FROM A MOM AND NURSE PRACTITIONER

When grief is in the job description

5/10/17
Happy nurse's week to all the hard-working nurses! The theme for this year's nurses week American Nurse Association is balance of mind, body, and spirit so I thought I would write about a relevant topic. Nurses are notorious for being the worst patients, and also for not putting their own health as a priority. I recently read an article about the rates of diabetes and heart disease are alarmingly high among nurses, hence the theme for this year's nurses week. This does not come as a shock to me, as the long and variable shifts, make eating and sleeping adequately difficult. In addition the stress and emotional toll of the job can worsen poor eating and lack of sleep. What I find is often overlooked in the conversation about the health of the nurse, is the emotional toll witnessing trauma and grief can take on nurses. Recently there has been more attention to PTSD and mental health issues surrounding witnessed trauma by military, police, firefighters, and other first responders. It seems nurses, however are left out of this conversation. I can say from firsthand experience nurses do witness trauma and grief frequently as part of the job. As a new nurse I had little experience with trauma, grief or death. Sure, I had experienced loss and had taken psychology courses that discussed the stages of grief and issues around death and dying, but it is a completely different experience first hand. As a nurse, unlike some other professions, you are often the only person at the bedside when a patient dies. You are often the one handling the paperwork, calling the coroner, arranging for organ donation services, and doing post-mortum care all while answering the questions of the deceased's family and expected to be composed and collected. While working as an ER nurse the hardest part was witnessing unexpected deaths, especially of children and infants. As mentioned previously as a nurse you have to keep going about your job, even when there are hysterical grieving family members. Every hospital or healthcare organization has different policies on debriefing and dealing with traumatic situations that occur.  My experience is that most of the debriefing that occurs is informal and between peers in the breakroom or after the shift is over. I remember one particular hard end of the shift when we had the loss of a five month old baby. The image of the grieving mother still brings tears to my eyes when I think about it. After the shift the staff went out for drinks together as we often did, as it was a way to be there for each other after this experience. The majority of my bedside nursing was spent in the ER, however nurses in all settings experience loss of patients and grief on many levels. I remember when I was a nursing student doing my clinical rotation at Children's Hospital, my clinical instructor and preceptor who were seasoned pediatric nurses were telling lots of off colored jokes about the children on the wards. My clinical instructor explained to me later that these jokes were a way to deal with the grief. "Sometimes you have to laugh so you don't cry" she explained. I grew to understand that statement more as I saw more sad cases, loss, and death. The emotional toll does wear on you, and there aren't a lot of resources to help you cope, and thus often to deal with it we use humor or just try to block these experiences out. I think we can do better to support our nurses. I think starting a conversation about how we can support our nurses is a start. I also thought I would share this poem written by an ER nurse I read on NPR on her experience with "compassion fatigue"

Book of the Month Review: How to Party with an Infant

5/8/17

I was supposed to have finished How to Party With an Infant by April, however I've fallen a bit behind on my schedule. The delay in this review however, worked out for the best as the theme of the book is timely for Mother's Day.  This was one of the rare times I chose a book upon the title alone. It came up on an Amazon search, and I thought judging by the title this would be a humerus read about parenting which would help pass the time  during my maternity leave.  The protagonist of this novel,  Mele is surprised with an unexpected pregnancy, but even more so when the baby's father announces he is engaged to someone else. As a newly single mom residing in San Francisco, she struggles to find her place among the affluent helicopter moms who wear Hermes and hire preschool consultants,  but eventually finds a band of misfit parents in the San Francisco Mom's Club that she clicks with that have no problem drinking wine from plastic cups at the park during play dates. The every day struggles of parenthood are cleverly told through stories from her parent group members which Mele uses as inspiration for recipes in a cookbook competition hosted by the San Francisco Mom's club. The is a light read, but candidly illuminates the many challenges of parenting, from teenage rebellion and toddler tantrums, to co-parenting with someone who broke your heart to explaining heavy issues of death and racism to your children.  I appreciated these comical but poignant stories, which often hit the nail on the head on the many paradoxical emotions that come with being a parent. I also could relate to Mele's search to fit in and find a place in the parenting community. For myself finding a group of parents to fit in with hasn't been exactly easy. More on that in this post. As much as I enjoyed the earnestness and humor of this novel, at the end the plot took a real nosedive, in my opinion. Mele ends up starting a romantic relationship with one of the fathers from her parent group. This dad, Henry, is a wealthy retiree and has three kids, two teenagers and a two year old with his current wife (yes still married when they start their relationship). Although Henry's wife is having an affair, he is still very much married and not even near divorce at the time they spark their relationship. I was disappointed with this plot line because it shifted the focus off of Mele's journey into motherhood and becoming a stronger person, and more to her being rescued by a wealthy man. Furthermore, the stories from her parent group were entertaining enough on their own without having to add this cheesy love interest in the mix. The ending was a let down for me, but I would still recommend this as a quick enjoyable read, especially for any new moms.
4/17/17


I've never been high maintenance in terms of my beauty routine, and hence I don't post much on the topic as I am no where near an expert on the matter. However as my birthdays increase in number, and my hours of sleep decrease in number, I have found it essential to up my beauty game to avoid looking like I belong on the set of the Walking Dead.  I still have a very simplistic routine, but have found a few items that help my face look more fresh and alive, even when I've been up all night with my infant or toddler. As a busy working mom I have streamlined the daily routine to a few basic items I find to be the most essential.

Here's before and after using only the 10 items below. As you see in the before photo the dark circles make me look much older and slightly deranged.


1. Concealer is obviously number one on the list in terms of priority in my beauty routine. I have had under eye bags that are apparent even if I have slept for days for as long as I can remember, but worsen with lack of sleep. As I am quite self-conscious of the bags I have done a lot of research on treatments to correct them.  There are fillers (Radiesse and Boltero) and surgery (blepharoplasty) that can correct these hereditary under-eye dark circles, but these are expensive (several hundreds to several thousands), temporary (needs to be redone every 2-3 years), and of course pose risks and complications. I have done my research and spoken to dermatologists, and there is no under eye cream or topical ointment that can improve the appearance of the circles, so concealer has become my best friend. I have tried many drugstore and department store products. The NARS creamy concealer is my current favorite, as doesn't cake and is easy to apply. I had my color matched at the counter in Nordstrom.

2. After a generous application of the NARS concealer under the eyes and on small trouble areas, I use this light NARS tinted moisturizer. I have very sensitive skin, and also had to experiment with many foundations and moisturizers before finding this one that gives adequate coverage without causing breakouts. I also had this one matched at Nordstrom. This is expensive for a small tube, but I have found it lasts 5-6 months. This also contains an SPF, so it eliminates the need for a daily facial sunscreen.
3. This Chubby Stick Lip Balm by Clinique  moisturizes and gives a subtle matte pop of color for my every day look. I prefer it to lip gloss or lipstick because it's not too gooey or thick.There are many different hues, this one is wild strawberry.
4. I wear mascara probably 50% of the time, simply because I am often to lazy to remove it at night. I have also tried many drugstore and department store mascaras, and have found the maybelline falsies to be the best bang for your buck, and give your lashes definition and does not flake.
5. I find a loose powder gives my face a more finished and even look. Having tried many a powders, I like the mineral powders the best, and find little difference between drugstore and department store products. My current is covergirl trublend
6. As I mention I wear mascara only 50% of the time, but curling my eyelashes can give my eyelashes pop without mascara. The eyelash curler is the best couple of dollars I've spent in terms of beauty items. 
7. This daily moisturizer I bought in a sampler of Langeige, and has become my go-to daily moisturizer as it's light enough for under make-up and doesn't cause breakouts.
8. This [Laneige] 2015 Renewal - Water Sleeping Mask I use when I remember, but leaves a my face noticeably brighter, hydrated and less puffy in the mornings.
9. I have been obsessed with eyebrows for as long as I can remember, and notice them on everyone. I don't wear much eye make-up, but one thing I don't skip are the brows. I use this pencil by benefit,  because color is very natural appearing and easy to apply. I define the arch and then just color in any bare areas with the pencil.
10. This brow highlighter is also by benefit. I use it right under the arch of my eyebrows and it covers strays when I have let me eyebrows grow out for a more polished appearance. 

I love reading other bloggers favorite beauty items, and is actually how I came across several of these products I use. Leave your favorites in the comments below!

First Month with two kids: Fake it til you make it

3/30/17
I've always thought of myself as an someone who is capable of juggling multiple responsibilities and challenges , but having two children in diapers has been a whole new challenge. Hats off to all the mothers of multiple children, and stay at home moms, because I have never been so busy in my life.

To start with, our baby girl, now a month old, is perfectly healthy and amazingly adorable. She has been exclusively breast fed the first month, and has gained all of her birth weight back plus more. The first couple of days when I was waiting for my milk to come in were stressful, however since day three but I have  any issues with my milk supply or her ability to latch. I wanted to put her on a daily feeding and sleeping routine early, as it took sooo long to get my son to sleep through the night, however trying to get a sleep schedule and take care of a two year old, and do literally anything else I might need to do has been impossible. I have also been struggling to keep her awake during breastfeeding, especially at night, which leads to more frequent nursing, and can be exhausting.  The longest stretch of sleep has been four hours at night, but often she wakes up three or four times a night. Once her umbilical cord stump fell off I have been giving her baths every other night, which she loves. Her eyes seem to still be blue and she has two little dimples, but it's hard to say which parent she resembles more closely (my husband says she's my clone).


My son has done much better adjusting to a new little sister than I could have ever imagined. He wants to look after her, picking up her blankets, hats, and kissing her. I thought there would be some jealousy or animosity towards a new sibling, but so far he has been nothing but adoring towards her. This is not to say he is an angel by any means. For the past year he has become more and more of a diva in the morning when I try to get him dressed or feed him. He has become so picky with his food and clothes that it can take so long to get him ready in the morning, which can send me over the edge when I've had no sleep. He talks back to me more than he did before, and he has even learned how to go to one parent to ask for something the when the other told him no. My husband and I have noted that his speech has seems to have become increasingly more advanced in the short month our daughter has been home. He goes to preschool 4 days a week, which keeps him with a routine and gives me a break during the week. We are still encouraging him to use the potty, but not actively potty training him. Once we get settled in with our daughter I want to try potty training again. It's been rough with two in diapers. The days I am home with the two alone I spend the majority of my day changing one diaper as quick as I can to tend to the other one that's crying or throwing a tantrum, only to repeat this scenario with the other child in the next 15-20 minutes.

The relationship between my husband and I continues to evolve with the addition of our daughter to the family. There are so many family dynamics now that we are more than a triad. We struggle with disciplining our son, maintaining our own time together, sharing household duties, handling our finances, managing both of our stress levels and our own personal space. My husband has done many sweet things for me in the past month, including getting my flowers, framing a print of Portland, Oregon for which I am homesick, watching the kids while I take naps, and buying me a gel sleep mask so I can sleep during the day. He went back to work two weeks after our daughter was born, but will take more time off when I return to work in a couple of months. The first week he went back to work was rough. He was stressed returning to work, and I was stressed trying to handle everything at home alone, and we were both running on no sleep. Needless to say we had a few blow-ups, but with some communication and empathy on both our parts, we have smoothed out the issues and have been working well as a team. I started pumping at three weeks post-delivery at the advice of my pediatrician (after she saw the deep bags under my eyes in her office) just so I could have my husband give the baby a bottle at night and I could get a break. I try to pump at least  once a day, to start stashing a supply once I go back to work. Most days I only get the chance to pump once.


As for my recovery this past month in the so-called "fourth trimester", it's been a bit of a roller coaster. Physically, I feel so much better than with my recovery after the birth of my son, which I attribute to staying active throughout my pregnancy. I have lost weight quicker, have so much more energy, and have felt very little pain or discomfort after the delivery the second time. I started going on walks and even did I three mile walk with both kids in the double stroller. I have 15ish more pounds to lose to get back to my pre-pregnancy weight. I plan to start working out more intensely in a couple of weeks once I have been medically cleared to do so. That being said, emotionally I have had a much more difficult time. I have had frequent spells of crying, feeling like a failure, and in general horrible moodiness. I've had talks with several close friends, who have been my emotional rocks these past years, and truly keep me grounded in times where I feel I'm falling apart.  I feel that the importance of having female friends standing cannot be understated. Although your spouse is your partner and best friend, your spouse will not be able to understand everything and all your emotions, especially those that come with pregnancy and giving birth. I digress, however I am truly thankful for the female friendships that have lasted through the years. I have been a lot more forgetful and clumsy than usual, which is probably the lack of sleep and stress getting to me. I have realized that my level of organization needs to be taken to an extreme level just to keep my head above water. I now keep a little notepad with me and write down notes daily on EVERYTHING, from lists to do and upcoming appointments,  who I spoke to when I make phone calls, last feedings and sleep times of the baby. I try to get naps during the day when I can, although anyone who's had a baby can tell you when the baby sleeps is your chance to catch up on the to-do list, so it's not exactly easy. My plan was to give up coffee while I was nursing, so as it would not affect my milk supply, and so I would not be so caffeinated that I couldn't take naps while the baby napped. The attempt to give up coffee lasted all of a week. My reliance on coffee, and my general love of the morning routine with coffee outweighs the benefits of giving it up. I usually drink a cup or two of coffee in the mornings, try to get cleaning and other errands done, take a walk with the baby and dogs, and then take a quick shower when I've put the kids down for a nap and then take an hour nap myself if the leaf blower isn't outside and the dogs start barking at him.... FML! The leaf blower every Friday has been my enemy ever since I started working the noc shift five years ago.


This stage of my life with this new addition to our family has definitely pushed me to be a stronger person each day. As I am reminded by a dear friend, this period of the kids being little will not last forever.  This is both a relief and a reminder to enjoy the little things, like my two year old's endearing little toddler voice and my daughter's new baby smell and little baby coos. I'll catch up on sleep eventually, and in the meantime there's coffee.
Stay tuned for my next book review!
3/13/17
It's time again for my monthly book review. I chose Sweetbitter: A novel based on recommendations from several other bloggers and was looking for a good novel to break up my nonfiction choices. I listened to this novel on audible, which I have started using more frequently while I'm commuting, doing chores at home, or on walks, as it's very hard to find time with two kids to read for leisure. As I discussed with a friend just yesterday, audiobooks can be hit or miss just based on the narration alone. A poor narration can just kill a good book. I have to say the narrator's voice on this one was pretty annoying to the point where I almost just bought the actual book because I couldn't take it anymore. If you are contemplating buying the audioversion of this book, I would advise you to think twice. Anyhow, moving along to the story itself. To really put my finger on what this book is about in a simplistic way, I would say it's a story about the maturation of a young women in her early twenties. "Tess" leavers her Midwestern hometown after graduating college to move to NYC for bigger and better things, although she has no idea what this might be initially. She lands a job as a back waiter at a well-established fine-dining restaurant, although she has next to no experience as a server. As she is thrown into the new world of the service industry, she becomes intertwined in a love triangle with the most senior and knowledgeable server "Simone" and the aloof bartender "Jake".  The plot of this novel is not riveting, but I did love the writing itself, and I found the story very reminiscent of my brief time in the service industry. After I moved to Portland in my early twenties I got a part-time job as a hostess to hold me over between jobs, which ended up turning into a full time server job for over a year. Although this was a very short time in my life, it stands out as one of the most formative periods. This novel captured the nature of the service industry, the close-knit culture of the staff, the debauchery, and the reasons people stay and leave in this line of work almost to a T with what I experienced. If you've read this novel leave your impressions below!

Arrival of our Baby Girl

3/3/17

Someone once told me the last two weeks of pregnancy and first two weeks post partum aren't pretty, and that has been spot on in my experience, but all part of the beautiful process. I wanted to share my recent labor and delivery of my baby girl. I apologize in advance, as this post will be long, and may be TMI for some that are squeamish.

I had been experiencing Braxton Hick's contractions sporadically in the last trimester, however, nothing regular, and no other signs of impending labor. My OB and I had discussed an elective induction at 39 weeks based on my first baby's large for gestational age (10 lbs 2 oz) and my group strep B + status requiring antibiotics before membrane rupture. I agreed to an elective induction, although we scheduled only two days before my due date and I was hoping to have labor occur naturally before then. I really wanted to experience a spontaneous labor, since my last pregnancy I was also induced, and tried all the common "old wives tales" to naturally induce labor with no avail. Despite my reluctance to be experience an induced labor again, I also did not in any way want to go past my due date and have another 10 lb baby. At 38 weeks I had an ultrasound to get more accurate measurements of the baby, and to make sure all was developmentally with the baby to induce labor. The perinatologist estimated the baby's weight at 8 lbs 11 oz at 38  weeks, so I already knew I was in for birthing another baby giant. As the day approached I became more and more anxious, as I remembered the horrific labor pain with my first labor. I tried to calm myself, and focus on what I could control, such as getting food prepped at the house and cleaning, but I still became more moody and anxious as the due date approached. On the day of my scheduled induction my mom adrrive to watch our son when we left. My son woke up with a low grade fever and was lethargic, which also lead me to be more anxious about leaving him. I kept him home from daycare, ran some errands, packed up some last minute items, did laundry, and squeezed in a quick nap. By that evening, my husband and I said goodbye to our son, checked his temperature (it was normal Thank God) and drove off to the hospital. The hospital was an hour away. To give you the back story of why we chose a hospital so far from our home, my last OB doctor retired right after the birth of my son, and I wanted to select a new OB I really trusted. I also previously worked at the hospital where my son was delivered, and thus received a discount on the hospital deductible. Now that I didn't work at that hospital I would be incurring roughly the same out of pocket costs regardless of where I delivered. The OB I selected came highly recommended and was in our insurance network, but unfortunately came with a long commute to both office visits and the hospital. My husband and I were both cranky as we drove in, and I had us going to a wrong hospital with the navigation, which sent my husband into a tailspin and led us to start bickering. When we finally arrived at the correct hospital, found parking and our way up to the labor and delivery unit we were told we had to register. The registration clerk also informed us that we wouldn't be able to check into a room until midnight since we would be charged an extra day for the room if we checked in at 10 pm, the time the  induction was scheduled. Another clerk then  promptly me if we wanted to pay any now towards the $500.00 deductible for the hospital stay, (It is a new year after all, she said cheerfully). Talking about hospital bills before any of the process had even started, was not exactly anxiety-reducing an already stressful situation, but that is the state of our for-profit health care system. Once we were checked into the room, and I had the IV started and was hooked up to monitors somewhere around 1:00 am we became more relaxed. The nurse was really nice, and once she found out I was a former ER nurse we started talking nursing. My OB had ordered to start a low dose pitocin infusion, ampicillin every four hours,  along with the insertion of a balloon-tipped catheter into the cervix to manually start dilation. After the pitocin infusion had started a nurse midwife on staff came in to insert the catheter. My OB had said I was dilated and effaced enough when she had examined me in the office the week before to allow for a catheter to be inserted, however after a very painful attempt, the nurse midwife was unable to insert the catheter as I was only at 1 cm. The plan was then to titrate up on the pitocin until I became further dilated and then try the catheter again. It was past 2 am at this point, and my husband and I were both exhausted. He fell asleep on the pull out cot provided, and I attempted to get into a comfortable position with the fetal heart monitor and IV hooked up. I was way to anxious to sleep and with the contractions starting, I just closed my eyes and tried to relax. I had brought headphones and I put on an album by my friend Emily Holmes a musician and former labor and delivery nurse who actually writes music for women in labor (Her album is available on itunes and is called "The Arrival" for any that are interested). The music actually calmed me down and I slept for maybe an hour before the nurse popped back in to check vital signs. At about 6:00 am the nurse explained to me I could receive three doses of IV Fentanyl for the pain while I was in early labor. After I had used my three doses of Fentanyl the next option was to receive an epidural. I wanted to hold off on getting an epidural for as long as possible, as last time I was unable to move my legs and had the epidural for about five to six hours, which led me to be extremely anxious. The next shift was coming on at 7:00 am and the plan was to attempt the catheter again at this time. I requested to get a first dose of the Fentanyl before they attempted the catheter again, as it was so painful last time. At change of shift the new nurse and nurse midwife introduced themselves and after I had been medicated with the Fentanyl the nurse midwife swiftly inserted the balloon catheter (I was still only 1.5 cm dilated) and simultaneously during the process my water broke. The nurse reassured me that labor should progress rather fast now that the water had broken and the catheter had been inserted, which was encouraging. I was supposed to be on a clear liquid, but I hadn't eaten last night so when the nurse stepped out of the room I quickly ate a protein cookie I had packed in order to keep myself going. My husband went down the cafeteria to get some breakfast, and when he came back we started joking because the cafeteria charged 10 cents per butter. The Fentanyl made me very drowsy and took the edge off the regular contractions, so I was able to fall asleep for a few more hours. The nurse continued to come in every hour to titrate the pitocin, monitor vital signs, and put traction on the balloon catheter, but not much was happening in terms of impending labor. As the afternoon rolled around, and I still hadn't started active labor, I began to get disheartened. I really didn't think I would be going into another long labor. I received another dose of Fentanyl and ate some Italian Ice, as I was still on the damned clear liquid diet. By around dinner time my husband was sick of the cafeteria food (I was sick of him eating in front of me) and went across the street to get some empanadas. He gave me a few bites when the nurse wasn't looking (after not eating for over 24 hours they tasted more delicious than anything I had ever eaten) and we attempted to watch some netflix to pass the time. By this point the catheter had been removed by the nurse, and this indicated that I was at least 3 cm dilated (they didn't want to check my cervix frequently to prevent infection since my water had broken already). My contractions were getting worse, and I couldn't really focus on anything else.  As change of shift came around again, I requested the epidural, as I was feeling absolutely defeated. I was going on 24 hours without a real meal, in the same room, and without more than a couple hours of sleep. The contractions were now severe to the point that I couldn't talk through them. The nurse checked my cervix, and pronounced that I was at 4 cm. The new nurse prepped me the epidural and the anesthesiologist came in to start the epidural. I got what is called a "walking epidural" which is a lighter cocktail of fentanyl and anesthetic that does not incapacitate you to the point where you can't walk. I felt relief shortly after the epidural was inserted, but soon began to itch all over from the medication. I was told I could receive a dose of benadryl for the itching, but I wanted to wait to see if labor was progressing so I wouldn't be lethargic. A few hours passed and I hadn't still started active labor, so I requested a dose of benadryl.  At this point with the fentanyl, benadryl, and lack of sleep, I could barely keep my eyes open. I went in and out of sleep and  chatted with the new nurse (who I loved) but still labor was not moving any faster. The nurse had to take the pitocin level down as the baby's heart rate had significant drops twice, which may have been part of the reason active labor still hadn't progressed. At some point they inserted a monitor to more closely monitor the contractions. At around 3:00 am, which was now over 24 hours since the induction had been started, my OB came in to see me. "You're going to have the baby this morning one way or another" she said. She said they would try one last increase with the pitocin, but if the baby was not tolerating the increase (aka if the heart rate was decreasing) then we would have to do a C-section. My OB said she was stay in the hospital until we either delivered or had to do the C-section. At this point I was so tired and foggy I didn't really care, but obviously I wanted to avoid a C-section. She instructed the nurse to "get out the peanut." The peanut is much like it sounds a big peanut-shaped bouncy ball that is put between your legs to help position the baby. The nurse went up on the pitocin after I had the peanut, and I felt a huge increase in the pain. By that point the pain with contractions were so bad even with the epidural they took my breath away. I grabbed onto the railing of the bed and my husband's hand and tried to breath through them the best I could, and recited the Lord's Prayer in my head, because that was the only thing I could think of to calm myself.  I was getting the urge to push, but I didn't say anything because I wanted the stronger epidural on board first. I told my nurse I wanted to increase the epidural and it took about 20 minutes for the anesthesia resident to come in and adjust the dose. By this point I knew the baby was coming soon. As soon as the epidural was adjusted I told the nurse I was having a lot of pressure. She asked " Like you are about to have a baby?" and I responded "yes" The nurse checked, and I was dilated to the complete 10 cm. At this point a swarm of people came in the room. There were two labor and delivery nurses, two pediatric nurses, the OB, and an OB resident. They positioned me up for pushing, set up the warmer for the baby, and my OB ran through how I should push. I could still feel the pain and pressure immensely and move and feel my legs completely, but the epidural definitely took the edge off the pain. I pushed for what seemed like 20 minutes until someone told me the baby had crowned. My OB had been trying to avoid an episiotomy, but informed me she would have to do one. She quickly made the incision, and and after one last great push our daughter was delivered! My OB stated " She pooped on my shoe." and I of course thought was referring to me (I didn't poop during delivery, which was one of my fears naturally) but my daughter had passed her first meconium stool right on my doctor's foot. From my view my daughter looked blue and had not cried, and she was quickly handed off the peds nurses and placed in the warmer. As the nurses assessed her, I kept asking " Is she okay?" and no one answered me. When I heard her first cry I felt a huge wave of relief, and tears welled up in my eyes as well my husband's. Apparently she had had the cord twisted around her shoulder, but her APGAR scores were good and she was completely healthy. She weighed in at 9 lbs 3 oz, which was right on my predicted weight for her. My husband was then ushered over to the warmer while they assessed her, and he cut her cord. In the meantime, my OB delivered the placenta and repaired the laceration. My daughter was then placed on my chest, and couldn't stop marveling at how beautiful she was. She immediately started suckling, and I initiated breastfeeding her without any effort. Overall the active labor phase was only about two hours, and felt like a breeze in comparison to that of my son's. I felt so supported by the nursing staff, my doctor, midwives, and my husband during the delivery, and that also made all the difference in the world. Approximately an hour after delivery we were moved to the post partum unit, and I was able to clean up, eat breakfast, and get a little sleep in between all the staff coming in and out of the room. Since I was recovering well, and our daughter had passed all the newborn tests with flying colors, we were able to discharge home the next day. With my son I had to stay a total of three nights in the hospital after delivery, so this was a very different experience. Coming home and the transition has also been a very different experience in contrast to my first, but I will save that for the next post.

I regret to say I loathed the changes in my body and discomfort during pregnancy, and was dreading labor, the lack of sleep, and the post-partum recovery so much, that I hadn't been excited for the arrival of my baby girl. When people would ask me if I was excited about her arrival, I would muster an unenthusiastic "yes" but secretly was thinking "hell no" in my head.  After she has arrived I feel so much differently and so blessed by the experience to have had two healthy pregnancies. I'm amazed that my body is capable of all the transitions that come with birthing a child. I'm amazed by our baby girl daily, and holding her is the best feeling in the world. My children are what I am most proud of thus far in my life, and every minute of discomfort was well worth it.

The day before my induction 39 weeks and 5 days. I was soooo sick of people telling me I looked like I was going to pop!

My daughter and I one day old after I had some time to rest.

Book of the Month Review: Across That Bridge

2/21/17

Today is the birthday of Congressman Lewis, which is fitting that I share this review today. I chose Across That Bridge: A Vision for Change and the Future of America on my 2017 reading list after seeing an interview with Congressman Lewis on a talk show sometime last year, however I did not know much about the book or Lewis' life. I chose to read this book before Lewis recently called Donald Trump an illegitimate president and refused to attend his inauguration. That being said, this book was also written before Trump was elected president, however, much of Lewis's writing and insight in this book seems to be more timely than ever with the current political climate. I also chose to read this book in February, Black History Month, thinking the book focused more on the civil rights movement. Across that Bridge is not so much an account of his life or detailed work in the civil right's movement in America, but more the lessons he's learned along his road and in his work with nonviolent resistance in particular. Lewis shares his deeply spiritual beliefs that he attributes to his ability to participate in the nonviolent resistance, sit-ins, freedom rides, and protests. His writing reads like a sermon, and I found to be extremely inspirational. I particularly appreciated his chapter on "Truth"  which is so relevant in our current administration's world of "alternative facts." This was an uplifting read from a truly inspirational and intelligent man, that is not too dry or heavy, so this definitely gets two thumbs up from me! Share your thoughts below.

The Final Countdown to Baby!

2/16/17


I have reached the last week of my pregnancy, and have been taking some time in my last week to finish all the tasks on my to-do list. This pregnancy has flown by, and since I am not one of the women who relishes each minute of pregnancy I am grateful for that. Although there were some tough moments during these past nine months (and I'm sure labor will be #1 on the list) I'm pleased to say this time around has been world's easier than with my first time. Also, everyone keeps telling me I look so much better than with my first pregnancy (Thanks, guys I know I turned into a blimp last time). Here's what I've been doing to some what prepare for the arrival of our daughter (although I don't think you can ever really 100% prepare for the chaos of a new life in your family). 
1. Buying a few baby items. 
Most baby gear I already had in storage, but there were a few items I bought that should help out with having two children. I got a new diaper bag I had been eyeing that I had seen on instagram. This bag by Fawn Design works as a backpack, and is stylish enough to use as an everyday bag, and even a work bag. I also bought a double stroller that fits a convertible infant car seat, so I will be able to take the two kiddos on walks together after she is born. 




2. Pack the hospital bag and baby overnight bag
I think the hospital bag topic is a bit overdone on blogs, and I don't think it's as an essential piece of preparation as some people make it out to be. Nonetheless, here's what's in my hospital bag.

For Husband:
*change of comfortable clothes
*toothbrush and deodorant
*red bull and Lenny and Larry's protein cookies (his favorite)
*ipad and charger

For Me:
*sweat pants, PJs, robe, nursing tank tops and bras, flip flops, socks and underwear, zip up hoodie
*lanolin cream
*headphones
*dry shampoo, deodorant, face wash, toothbrush, lotion and chapstick, hair tie, a few pieces of makeup

For Baby:
*swaddle blanket, zip up PJs, one outfit for first photo (hat and bow)

Other:
*Thank you cards for nurses
*SLR camera and charger

Everything else should be provided at the hospital.

I also packed a little overnight bag for my son with diapers, wipes, clothes, snacks and his blanket in case we need to drop him at the neighbor's if I go into labor at night or early morning.
3. Catch up with friends and family


Last time it became quite chaotic after my son was born, and I want to become a hermit for a bit after the new baby is born. Because I anticipate seeing less people and going out less frequently after the baby comes, I wanted to make an effort to catch up with those I hadn't seen in awhile. I had a small baby shower, which was fun to see friends and family I hadn't seen in some time. 
I've also been trying to make an effort to spend more quality time with my son, as this is his last week as an only child. I am trying to make time to take him to the park, out to lunch, and the library.

My husband and I are also trying to catch some alone time when possible. We got out to my friend's wedding together last weekend. I caught up with several friends from nursing school I hadn't seen in several years (who some were a bit surprised to see me about to pop nine months). Besides seeing the groom and bride so happy, the best part of the wedding was the course upon course of Mediterranean food served, which is my favorite! My husband and I are also hoping to catch a early breakfast and movie this week while my son is at preschool, if I have not gone into labor yet.


4. Clean and Nest
Dishes and laundry are a full-time job at my house, so I've been spending a good portion of my day trying to make a dent in the piles of laundry and dishes accumulating each day. I've yet to set up a nursery, as we plan to have the baby sleep in our room for the first few months to make nursing easy. Our son is still in his crib, and so when our daughter gets big enough she will inherit the crib, and we will transition our son to a big boy bed. At that point I intend to fix up the bedroom with some personal touches for our daughter. The current bedroom is a neutral gray, so it will go with any color scheme. I have also yet to organize her clothes. I have only washed a few clothing items and blankets, because last time there were many clothes my son didn't wear due to his large size, and I want to be able to return what she doesn't wear.

5. Pamper myself
After giving birth I felt like a huge slob and it was also hard to get out of the house to get my hair done etc. I got my hair cut short knowing it may be some time until I go back to the salon. I also got a pedicure since I can barely touch my toes at this point and got my eyebrows threaded, partly in hope the pain would stimulate labor!

6. Stay Positive
The greatest challenge next to labor during both of my pregnancies was maintaining a positive attitude. The changes in my hormones, body, life, sleep and freedom wrecked havoc on my mood both times around. This time around I also had the anxiety of the anticipation of labor pains, since I had such a hard labor last time. I can't say that I did much better this time with keeping my mood up, but working out and staying busy have helped tremendously. My good friend who recently had a baby has given me the advice in preparation of labor to write out positive affirmations to myself to say during labor and to imagine a happy place during contractions. I've been working on that as well, and will report back on how it goes!

Safety for the Pregnant Healthcare Worker

2/7/17
As someone who has worked in the healthcare field during two pregnancies, I wanted to shed some light on safety of the healthcare worker during pregnancy. I have no solid research on increased adverse pregnancy outcomes for healthcare workers, however I do have plenty of anecdotal evidence while working in various healthcare settings which has lead me to write this post. There are several hazards in the healthcare field to pregnant women I wanted to address:

1. Infectious Agents-When I worked in the ER unfortunately you often don't know what a patient may walk through the door with. This makes a pregnant person susceptible to contact with many infectious agents, some which can potentially cause harm to the developing fetus, many of which present with vague symptoms, such as fever and malaise. Zika has received a lot of attention, however there are other such agents, such as  Rubella and Listeria which also have the potential to cause teratogenic effects.  The CDC website has a list of infectious agents that are dangerous to the developing fetus. What can you do to protect yourself? For one, make sure you are vaccinated against varicella (chicken pox) and Rubella before pregnancy, since you cannot receive these vaccines after becoming pregnant. Second familiarize yourself with the signs/symptoms of persons that may be infected with these agents, and the modes of transmission so you may wear the appropriate protective equipment or avoid these patients all together. Some women are not comfortable telling their employers or supervisors about being pregnant right away, however I advise if you are in the healthcare field to at least tell your direct supervisor as soon as you know because the risk of miscarriage and birth defects is highest during the first trimester. If your supervisor knows you are pregnant you should be able to have patients reassigned if there is the possibility you may be exposed to a patient with one of the above mentioned infectious diseases.


2. Heavy Lifting-As the obesity epidemic in our country becomes worse, lifting and transporting heavy patients is commonplace among healthcare workers. Again, letting your supervisor know you are pregnant early on can allow for you to have modifications when it comes to certain heavy lifting. Make sure to let your OB/GYN know about the amount of heavy lifting required for your job, and if you need a note to excuse you from some of these duties get it sooner than later.


3. Radiation -Most areas of high radiation, such as x-ray and CT imaging room post signs warning about radiation hazards to pregnant women, however there are areas of hospitals and clinics where x-rays occur on the floor. Letting x-ray techs know you are pregnant ahead of time is a good idea, so they will be able to give you an extra heads up to keep your distance when a bedside x-ray is being shot.


4. Other Hazards- Stuff that may not immediately come to mind, but to be mindful if you are expecting are some other hazards of long shift work and working in the health care setting. Dehydration is one. Often with 12 hour shifts we do not drink enough water or give ourselves adequate periods of rest. I made the habit of carrying a 40 oz. stainless steel water bottle that reminds me to keep hydrated.


Another potential hazard among pregnant women are potentially combative patients. As a former ER nurse, having a patient that required restraints or was assaultive to staff was also commonplace. Being aware and communicating to your potential situations where a patient could be come combative is imperative.


I would recommend communicating with coworkers, supervisors, and OB/GYN early regarding pregnancy if you do commonly encounter any of these hazards frequently at your workplace. The safety of your child, especially in your first several months, should take precedent over all other work duties.

Book of the Month: The Tools

1/25/17

In the spirit of self-improvement with the New Year, I chose a self-help book, The Tools: Transform Your Problems into Courage, Confidence, and Creativity as the first book on my book of the month reading list for 2017. I am not generally a self-help book enthusiast, but after I read an article by one of the authors, I was intrigued enough with the concepts developed in this book to give it a shot. I was not necessarily looking to make any huge changes in my life, but I think everyone always has room for improvement, so why not. The book is authored by two psychotherapists with impressive credentials and patient testimonials. The "Tools" were initially developed by the Phil Stutz to help his patients cope with some common situations holding them back in life. I will make the disclaimer before continuing my review that I do not believe these "Tools" will work for everyone. In my personal opinion these Tools will not work for the following persons, and then I will explain why: 1) atheists 2) those without personal insight 3) those with undiagnosed, under-treated, or untreated mental illness 4) general close-mindedness. First, the techniques behind the tools rely on the belief in " higher forces" albeit not necessarily religious, but still requires the person using the tools to have the ability to believe in something greater than themselves. For this reason, I don't think a true atheist can benefit from these techniques. 2) The authors present many different patient cases who have used the tools and had major life changes. The common theme with each of these patients was they recognized a behavior or thought process they wished to change and were already seeking help through psychotherapy for change. I don't think if a person is able to look at themselves and identify the need for improvement or change, the Tools or any other intervention for that matter will truly help. 3) I believe many of the problems addressed with these Tools could be symptoms of undiagnosed or untreated mental illness, such as depression, bipolar disorder, anxiety, ADHD, etc. True mental illness should be addressed with a multi-disciplinary approach, including a medical practitioner or psychiatrist in addition to psychotherapy and other approaches. 4) These techniques outlined in the book are simple, but can seem cheesy. The tools will not work for someone who cannot be open-minded about trying this approach to self-change.


In a nutshell the authors, Barry Michaels and Phil Stutz outline five "Tools" which are essentially visual imagery exercises that are to be performed when triggered by a "cue" which is usually some form of negative thoughts. Barry Michaels becomes intrigued with Stutz's methods after he experiences some limitations to psychotherapy with his patients. Michaels found that although psychotherapy was helpful to patients in identifying root causes of behaviors and thoughts, it often was limited in the ability to stop irrational and negative behavior and thoughts in real time. The authors present a variety of patient cases who have used and benefits from these exercises as well as their own personal journey with these "Tools".


What I liked about their developed techniques are they are easy and quick to use. I do agree with Michaels that identifying the root cause of our problems is not enough, but that other interventions, such as these can be the catalyst for behavioral and thought modification. The belief in  "higher powers" may not be everyone's cup of tea, but has been proven effective in other self-change programs such as AA. The belief in a "higher power" does not necessarily require a religious affiliation, but simply a spiritual belief, which I believe can be beneficial for many people without a concrete religious orientation.


I myself have used these techniques as directed, and believe they can be effective. However, like anything it requires consistency, commitment and a readiness for change.

Women's March 2017

1/21/17
As the name of my blog suggests "left coast" I lean politically to the left, and I do not make this any secret. I was completely disheartened not only by the results of the election and the racist and sexist rhetoric spewed by Donald Trump, but more by Trump's  supporters willingness to overlook and excuse these damaging comments again and again. Today my family and I took to join the Women's March in Downtown L.A. with almost 500,000 other concerned citizens, which was truly an uplifting experience. Initially it was my husband's idea to go to the march, and I am so glad we followed through and got up at 6:00 am on a Saturday to participate in the march. It was truly inspiring to see so many men, women, children of all ages and races making their voices heard and to raise up from much of the doom and gloom rhetoric in the news etc. The election has brought uncertainty and fear into the hearts of many Americans, including myself, but events such as this reminds me that the majority of Americans around the country want to continue the fight for equality not only women, but for all. I was extremely pleased to see so many men marching with signs and shirts supporting equality for women.

I am so proud my whole family, and unborn daughter could participate in the march. It's important to me that our children see and participate in activism. The first train we tried to catch at 7:00 am was completely filled and so we had to drive to catch another train on a different line, which ended up filling to capacity with protesters. 

Our son loved the train ride to downtown. I spoke to a woman who had on one of the over 1.7 million knitted pink hats, who said "In my seventies I never thought I would be protesting the same thing as in my twenties."



Overall it was a beautiful hopeful day, although completely exhausting at 8 months pregnant!

2017 Book of the Month List and a Giveaway

1/11/17
As the New Year approaches I have resolved to review a book a month. I've compiled as list of a mix of 12 nonfiction and fiction I would like to finish and review this year. I hope you readers will read a few and share your thoughts with me as an informal book club. As a thank you to my readers and kick off to the New Year, I also am promoting an Amazon giveaway for one book on the list, How to Party with an Infant. To enter follow the link and then also follow me on Twitter @KitEliseNP. Happy reading in 2017!

January



February



March



April


May



June



July



August



September



October



November



December