Content That IrishIzCPNP Likes

IrishIzCPNP, BSN, MSN, RN, APRN, NP 16,546 Views

Joined: Jul 25, '06; Posts: 1,395 (35% Liked) ; Likes: 1,379
Specialty: Pediatrics, High-Risk L&D, Antepartum, L

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  • Feb 20 '16

    I personally have a child with ADHD,LD.... He takes Ritalin at 0630,1030(school) and 1430(school). His 1430 dose isn't for my sanity, it's to get him through the rest of the school day and through homework. It's been his regimen for years, and works well. These doses of Ritalin have a life of about 4 hours

  • Feb 13 '16

    I feel like I joined this site just to share this video link.

  • Feb 13 '16

    Unions had their place and purpose, 40 years ago. Now they just waste time and money and cause problems.
    Plan your vacation.
    If time rolls around and they refuse you your days off, go anyway.
    We don't live to work, we work to live❤️

  • Feb 13 '16

    Quote from Emergent
    Union filth? Them's fighting words!

    You might try discussing things in a less inflammatory manner. Just a suggestion.
    I hate, despise and detest unions. And I make no bones about it.

  • Feb 10 '16

    I had 6 homebirths. Sadly, the American medical system supports interventional childbirth. Home birth is oppressed in most of the nation, making it inherently more dangerous.

    My best experiences were in New Mexico and here in Washington State, where there were guidelines and oversight, and quality, certified midwives. In S Carolina I had a Dr attend. In California we homebirthers had to use lay midwives who where doing their best, but making up their own rules because the oppressive medical establishment there would not allow more legitimate avenues. I saw negative outcomes there as a result, including deaths of babies.

  • Feb 10 '16

    Your stats are wrong for home births, evidence based best medicine states home births have less complications than hospital births with appropriate screening tools for low risk deliveries. Canada and Europe teach and do vaginal breech births, the US is a decade behind in catching up. Unfortunately there are not many OB's left who can teach the next generation of OB's. Watch the movie "Heads Up" it has a lot of the current facts which many OB's will not follow because they never had the training. ACOG has a statement paper that says a vaginal breech birth has a healthier baby than a C-birth baby.

  • Feb 10 '16

    First, I want to add this article to the discuss. It's ACNM's response to the CDC study about home births having 4x higher infant mortality rate than hospital births and includes some good points.

    Also, I'm trying to find the link but ACNM also just recently (like within the last 1-2 years) released data supporting the safety of home birth with a properly trained provider following certain guidelines.

    Now to my personal experience. I've seen terrible things roll into triage when homebirth goes wrong. We had a woman come in who reported her water broke over a week ago but her midwife told her it was fine and to stay home. She was so infected you could barely stand in her room because of the foul odor. And baby was long dead. We had another mom roll in with her homebirth midwife who had been pushing for 12 hours and upon exam was found to have a closed cervix and the fetal heart tones were in the 50s. One more horror story, we had a home birth midwife attempt a delivery that ended with a severe shoulder dystocia which she attempted to resolved herself for nearly 30 minutes before coming to the hospital, at which time baby was long gone and the spinal column was detached from the aggressiveness the midwife had used to attempt to deliver the baby. Unfortunately in all of these situations, the midwives were lay midwives with no license and therefore there was no legal action that could be taken against them (at least according to our laborists).

    That being said, I still support homebirth! However, the general public (in the US) needs education about homebirth, hospital birth, and midwives! People need to know the difference between a lay midwife and a certified nurse midwife so when they are choosing a birth provider they are truly making an informed decision. There needs to be better regulation in the practice of midwifery so that people who have no business delivering babies are punished for their missteps when they inevitably happen. There needs to be better systems for women who desire a homebirth to be transferred to hospitals without all the negativity and tension between providers if necessary. And there needs to be better trust between women and their providers.

    The hospital I work at has recently open a 6 bed natural birthing center. We are finding that the women who desire to deliver here need better information about the guidelines to admitted to the birth center and what happens when they risk out. I think the vast majority of women (at least in my experience) don't realize just how fluid the plan needs to be when it comes to labor and birth. Things happen and change and you have to keep that in mind. Yes, you could be low risk and have a healthy pregnancy but when your labor starts, your baby may be stressed out by something and pass meconium or have Category II heart tones (risk out situations for our birth center and in my mind for home birth). Women need to be educated that if/when things like this happen, it's not a failing on their part or that they have done anything wrong but that at that point, it's safer for them and their babies to be closer to medical interventions that may be needed. I think even though a lot of the blame for poor homebirth outcomes does rest with inappropriate birth attendants, some of it also rests with mothers who have not been educated or who are unwilling to be flexible with their "ideal birth plan."

    Just my two cents.

  • Feb 10 '16

    Quote from MrNurse(x2)
    That is fair, given your experience, both professional and personal. The overwhelming truth that goes through my head reading this thread is that we are an arrogant society, thinking that the reason our infant mortality is low is because we are so advanced. It is low because we have overwhelming majority acute setting births! Home setting births will maintain third world mortality rates because, although the homes don't have dirt floors, the emergency support is identical. I have no experience with these practitioners, but I doubt that that figure is brought up when selling their services. I am sure it is very difficult to work in an area where these tragedies could be averted and have to see the result of a choice they may not have made, but that is what must be kept in perspective, these women, families, made the best choice that they believed at the time. Just like someone can not fathom the logic behind someone who has opposing political views.
    I'm sorry but what you're saying just isn't true. Our infant mortality rate is NOT low in the U.S., it's extraordinarily high compared to other industrialized nations. Even when you adjust for the fact that we save younger premies than most other countries, we still lag behind, in something like 38th place amongst industrialized nations. Home births in the U.S. do NOT have the same infant mortality rates as home births in 3rd world countries, that's completely false. Most home births in 3rd world countries are completely unattended, which automatically puts women and babies in enormous risks. And finally, as has been brought up before, skilled home birth midwives do bring emergency equipment like O2, hemorrhage medications, IV fluids, and suction kits for babies. If there are midwives out there not practicing with all of these supplies, as I've stated, they should be reported and prosecuted. But what you're describing is not the norm for home birth in the U.S.

  • Feb 9 '16

    An interesting read: For Her Own Good: 150 years of experts' advice for women, by Barbara Ehrenreich and Diedre English.

    It's a history of, among other things, the growth of modern obstetrics from a feminist/sociological point of view. It's by no means gospel, but it can provide some insight into how non-medical women might be less than impressed by conventional health care

    As previous posters have pointed out, there is misinformation, fear-mongering and frank malpractice on both sides of this equation.

    Lay people have no idea of just how very wrong pregnancy and childbirth can go. So, they happily follow poorly informed, credulous or self-serving alternative providers right off the cliff, leaving the NICU, Ob/Gyn and psych nurses to pick up the pieces when the worst happens.

    Medical people have no idea how biased we are in pathologising perfectly normal processes. Which can be just as self-serving as any snake-oil sale. We are trained to foresee/prevent the potential or treat the actual complications of pregnancy and childbirth. It's easy to over-treat, over-medicate and over-control our patients out of an over-abundance of caution. And when the worst happens, you guys have to pick up those pieces, too.

    I've worked on both sides of this divide and the deeper tragedy, to me, is that there is a divide in the first place.

  • Feb 9 '16

    [QUOTE=LibraSunCNM;8885892]We need a better plan for integrating home birth into our health system. We need standardized guidelines for what is and isn't appropriate at home. We need better informed consent in ALL birth settings so that patients truly understand their choices. We need to radically change the way obstetrics is practiced in the hospital. We need way, way more licensed midwives so that they can be the standard of care for healthy, low-risk women in this country, to promote a much more judicious use of interventions in obstetrics. And we need to recognize that sometimes interventions are absolutely warranted and we need to be grateful that we have them.[/QUOTE]
    I agree completely. Especially with the bolded statements.

    In addition, I would like to add that many of today's common comorbidities are changing the face of L&D as we know it. Increasingly obese and unhealthy moms are having larger, unhealthier babies. It is common for me to see a mom with a BMI >50 at least once per week when 10 years ago that was a once a year or once every five years type of thing. Gestational Diabetes causes many issues with infants, not just increased size (cardiac anomalies to name a few). Many of these cases are poorly controlled.
    I would say infant hypoglycemia after gestational diabetes went untreated is one of our top term infant admissions.
    I also just read a CDC report that incidences of gastroschesis are on the rise and we have no idea why.
    I would like to give people the BOD when it comes to putting their infant at unnecessary risk by making responsible choices.
    Unfortunately, many times that is not the case. But, as previously stated, in the NICU we see the 1% that need help, not the 99% that don't.

  • Feb 9 '16

    Quote from 24gaDalek
    Just got out of the shower and had to get a few more points in, lol

    We NICU personnel are the end of the line for the birth trauma/bad baby scenario. When the questioning begins from the parents it is typically, "Why can't you save my baby?" instead of, "Where did this all go wrong?" We are the bearers of bad news and wholly the advocate for the baby and the baby alone. We can look like the bad guys.

    It is hard not to get angry when parents who choose to forgo a hospital birth because of the big, bad medical establishment suddenly want us to do "everything medically possible to save my baby" regardless of how detrimental it is to the infant and in some cases completely futile. The hospital is spending millions of dollars to put their baby on ECMO and body cooling for a baby that is, without a doubt, going to be dinged (a NICU term) and possibly unsaveable when perhaps a few quiet conversations and some different choices could have resulted in a 2-3 day hospital stay and a healthy infant. We get frustrated because we see what could have been and are only left picking up the pieces of what is.
    I can't imagine how sad and frustrating that must be. I really do see what you're saying and feel for you. Again, however, I offer another perspective---I get frustrated almost every day seeing birth outcomes that "could have been" different were the patient not subjected to unnecessary interventions in the hospital. Dismissing women's concerns about interventions in their birth by saying "a healthy mom and healthy baby is all that matters" doesn't prevent women from lifelong emotional scarring from their births.

    We need a better plan for integrating home birth into our health system. We need standardized guidelines for what is and isn't appropriate at home. We need better informed consent in ALL birth settings so that patients truly understand their choices. We need to radically change the way obstetrics is practiced in the hospital. We need way, way more licensed midwives so that they can be the standard of care for healthy, low-risk women in this country, to promote a much more judicious use of interventions in obstetrics. And we need to recognize that sometimes interventions are absolutely warranted and we need to be grateful that we have them.

  • Feb 9 '16

    Quote from CBlover
    The OPs post and the example she gave specifically mentions that physicians warned the mother she needed a C-section due to a breech baby. Her point is that the home birth should not have taken place in this instance and you mention "anticipated complications like breech should be in a birth ctr or hospital." This is her point in the post. I did not take her post as some did that home birth should not be an option, but more that she's angered at the mothers who have complications like you mentioned and still pursue home births and have a not so happy ending. I agree women should have a choice myself. I don't agree that they should attempt a home birth if they knew they were at risk due to complications like you mentioned. Surely that's common sense?
    Yes it is common sense, and it is a good midwife that refers to the OB/hospital setting for the situations and conditions referred by the OP and some others in this thread. It may or may not have been the intention of the OP but the overall theme of this thread quickly became home birth is irresponsible.

    We cannot mitigate all risk no matter what setting we elect. I have been first witness to many situations where the interventions "offered" were supposed to decrease morbidity and mortality and yet were in themselves the cause of another entire set of complications. Medical professionals are all educated in how to present interventions in a manner that it is very difficult and in some cases nearly impossible to refuse.

    Out of hospital birth is a huge multifaceted topic. Healthcare professionals throwing their opinions around in a way that serves only to support biased and often flawed opinions about intervention and restrict options for a healthy birth should have no place in healthcare.

    Anyone that claims to know that hospital birth is always the safer option has not practiced in an average medical birth facility with standard orders and your typical informed consent and is denying the obvious inherent potential complications.

    I'm not in any way dismissing the frustration any NICU nurse must experience when faced with the outcomes of malpractice. But I would suggest that improving options for appropriate care would be a better focus if we as a profession wanted to increase trust and ultimately improve outcomes and patient satisfaction.

  • Feb 9 '16

    A well trained provider with a low risk mother can make for a safe environment for a home birth. That being said, as with anything in life, things can take a turn for the worst, that is why there are generally considerations in place... how close are we to the hospital? what is the providers transfer rate? for what reasons has the provider transferred? how is their relationship with the transferring facility, do they work with any providers at the hospital with whom they can communicate in the event of an unplanned transfer?

    Most people don't realize that midwives do carry emergency equipment with them and can resuscitate if need be. It is not as fast as being at a hospital, this is true. But as far as I understand it, many "emergency c's" that women have been on oxytocin and epidurals which may/may not have precipitated the need for the c. Undoubtedly, this won't be occurring at a home birth.

    I've seen my share of home births (mom was a midwife), and as an ED nurse I've seen/heard of some that have gone wrong. But these have been: a woman who had a midwife refuse to deliver her at home because she was a first time breech... unassisted because of concerns because mom was on rx painkillers... meconium staining, family asked to transfer and the midwife brushed it off. All different problems. All could have had very different outcomes. We know that worldwide home births are working, right now we just don't have the kinks work out of the system to have the best of outcomes. We can and should do better. The c-section and induction rates in this country are atrocious.

  • Feb 9 '16

    My second child was a planned home birth. There is a lot I want to say to those of you who say I'm "selfish" but it would get me banned. I might return to this thread when I'm feeling more rational and not about to blow up at the ignorance demonstrated in this thread.

  • Feb 9 '16

    The study cited isn't even published. It's a story in the lay press about a non peer reviewed study. It means as much as my grandma's opinion on home births.