In the back of my mind...

Working as a nurse, any nurse, but especially l&d nursing, where the litigation rates are astronomically high, you care for patients while subconsiously holding your breath, crossing your fingers (what good does that do?!!) and for me, fervently praying.
Throughout school and then during your internship you are constantly coached on the "123s of emergencies" and what to do "IF", I remember being drilled repeatedly by both my preceptor nurse and doctors. Terrifying experiences - hated being put on the spot!! However, when situations arose, I was able to mentally go through my checklists.
You are also drilled on the "policy and procedure" business, "this is how we do a. b. and c., this is how often you are expected (as a competent nurse) to assess, take vs, etc."
I think that is where a lot of nurses get muddled up, we are so driven to follow the rules/guidelines we are trained in to prevent problems that we can, at times, forget that we are caring for people, human beings, not just "patients". A nurse can become inflexible and not able to "see the forest for the trees" surrounding her/him.
Anyway, I digress!
As I have evolved and matured as a nurse I have learned where and when I can "bend the rules" and allow my patients to be "human beings with families and feelings". For example, during the recovery phase following a vaginal delivery, we are supposed to take blood pressure readings (bps) and assess fundal tone, placement and lochia (vag bleeding) q 15min. This close attention can be frustrating for patients and their families occasionally. Especially when mom is trying to breastfeed and/or eat and we have to pop in every 15 min to lay their beds back and mash on their bellies (ouch!) and that darn blood pressure cuff keeps squeezing the life out of their arms as they attempt to master "football/cross cradle" holds while awkwardly attempting to latch babies to ofentimes non-compliant breasts that haven't ever been used for this function!
Many times we allow our moms to spend some "extra" time bonding with baby and dad, letting one of our checks slide by, this I only do if I my initial assessment of mom's status was very stable and she is not experiencing any complications. But, every time I let 15min slip by I start inadvertently watching the clock, in the back of my head I am thinking "I hope she isn't bleeding too much... just HOW firm did her uterus feel to me when I checked her last?"
99.5% of the time nothing goes awry and everyone, especially mom, is happy and blissfully unaware of their flirt with trouble.
The other night at work I had a rude reminder of why I start biting my nails as the minutes tick away!
My patient was a young, healthy G4P3, all spontaneous vaginal deliveries (SVD), her last being a 9lb+ that she "screamed" out in 1 hour! She was going natural again this time and warned us, "I scream my babies out, I hope you brought earplugs".
After "screaming out" a beautiful 8 1/2 lb baby girl, she was on cloud nine! Her blood loss (or EBL) was minimal, around 200ml, had only a tiny "skid mark" tear that required no suturing, fundus was firm and below the umbilicus on first check, her pitocin bag was bolusing and all was fine. She was happily sitting up breastfeeding and drinking juice when I left the room, her husband brought her dinner and she was munching away. 20 min later she calls out to the nurses' desk, "...umm, I am cramping and a lot of blood is coming out...".
I quickly went to the room, grabbing a couple of vials of pitocin as I ran by the desk. As I came in the room, I noticed she looked a "little" pale, she smiled weakly at me as she pushed back her bedside table and said, "... I-I don't feel so good... a little dizzy". I pulled back the sheets as I began lowering her head, blood was soaked through the pads she was sitting on and it ran all the way down to her ankles, huge clots were sitting between her legs. As I grabbed gloves I heard the sound of a faucet rushing and realized in horror that I was hearing blood spurt out of her!!
"Yeah, okay then!!" I hit the call bell while trying to find her fundus, "...I need some help in here, NOW!!"
2500ml EBL later (that was probably being nice and think about it - we only have 6000ml of total blood volume!!), multiple, multiple medicines, iv fluid boluses, foley catheter, and 40 minutes of manual exploration and extraction per doctor finding numerous pieces of placenta and membranes - "Oh, the culprit of the bleed" - we had a very exhausted and sore, but FINALLY, stable patient.
Needless to say, she kept me very busy that night, bought herself an extended stay on l&d but she ended up doing just fine. Thank God!
So, to all the patients out there - we nurses are not trying to be hardnose about things when we make you pause in your cuddling moments to check your belly and bleeding - we simply want to make sure that you LIVE.