Fyreflie 3,762 Views
Joined: May 30, '12;
Posts: 190 (31% Liked)
; Likes: 174
4 year(s) of experience
Best: being labour support through a difficult labour and seeing the looks on the parents' faces when they realize it was all worth it.
Worst: still births and situations in which the patient or partner feel powerless or not in control of their experience.
That's why I love my union!
When you're working in L&D, it would be quite inappropriate to introduce the subject of home birth, as the patient is already in the hospital! The choice, if it came up at all during pregnancy, had been made. Realizing that, a nurse needs to focus on what needs the patient now has with being at the hospital. Most of them want to be reassured about their safety, and the ability of the nurses to meet any expectations of the birth plan. So go over that with them and let them know that giving birth in a bathtub hasn't occurred where they are, ONLY IF THAT WAS MENTIONED AS A PREFERENCE! If they wanted that, presumably they discussed it with their healthcare provider, and were previously informed of its non availability.
Having worked as a L&D RN at several hospitals, and a Lamaze Childbirth Educator in my own home and at hospitals for 35 years, I have seen "pendulums" regarding many concerns of expectant parents and healthcare professionals swing in all directions, back and forth.
I'm enjoying the TV series on Public TV on Sunday evenings at 8, now. Last night there was a side lying delivery that was very tastefully recreated. However according to the story the baby had spinal bifida that diverted attention from that technique, which is usually attempted in home births when a baby's head doesn't rotate to accommodate the birth. In hospital that is rarely seen, unless a midwife (NP) is present. Also underwater births aren't attempted at either place, now. The fear of aspiration and its sequellae have reduced that request (since childbirth classes explain that could happen, as well as intrauterine infection; and if the doctor entertains the question about doing that, it is usually refused. However
Once birth is planned in hospital, unless sporadic attendance or early labor prevent learning about realistic expectations, a patient might still think (or want the nurse to think she believes those options are there). However it can be addressed simply as "we haven't those facilities", when frequent contractions are occurring. Sometimes I've heard that a patient was given a derisive reply to such wishes and lectures about what they "should have done"... which isn't helpful at all. For that reason, it might not be a "good fit" if a nurse wanted to make patients feel uncomfortable about the choices the made, once they're in the hospital, in labor. The tour of the labor suite isn't the time for a discussion of that, either, as the intention of that is to provide visual and verbal reassurance and preparation for being there in labor. So any nurse who thinks working in L&D gives an opportunity for influencing patients to seek home births, that would "shine" a red light on their capability to optimally perform their duties.
I am passionate about low intervention birth and have used to passion to help the women I care for--by doing as much education as I can in each labour room, providing them with information and tools to decide, answering questions honestly and getting really really good at labour support--position changes, counter pressure, massage, and just plain encouragement. I try to keep the lights low and the volumes down and respect each woman's vision of her birth. I think that all can be done in any setting.
Entonox now has special filters and can be controlled by the mother--but I think Entonox way back when may have leaked quite heavily into the surroundings and perhaps been inhaled a bit much by the family, midwives etc, making them woozy and unable to work. That's probably why they stopped using it initially. The hospital I started at in Canada had stopped using it because of personnel exposure (I don't know why they didn't just get the inhalation controlled stuff all the other places are using) and the hospital in NS did make us do yearly exposure testing by wearing a little badge clipped to the front of our uniform with someone using Entonox and turning it in at the end of the labour.
American Pediatric Association I think. You can Google that.
We recover our own sections in a PARR room on the unit. We use a normal BP/SPO2 machine that can hook up to leads if necessary (3 lead only), if there are any concerns in the OR they go to the main PARR. None of us have ACLS but obviously there is a crash cart on our unit and we have our own 24hr anesthetist and OBs.
I still, after 5 years, pay a lot of attention to delivery notes! Something like this:
1526: vacuum applied after bladder emptied by Dr. X.
1529: head delivered and vacuum removed.
1530: delivery of live female, not vigorous, to warmer immediately for assessment by resusc OR
1530: delivery of vigorous live female placed directly skin to skin for dry & stim (insert name of baby nurse here if you want, I don't since they sign our Apgars off).
1535: placenta delivered spontaneously and intact. 2nd degree laceration repaired by Dr. X.
1540: peri care provided and pt continues to hold baby; fundal checks & VS normal (see PP flow sheet for details).
Our oxytocin with the shoulder etc and in/out volumes are recorded electronically as are our post partum vitals. I don't double chart those.
Ultimately it's your practice and you get to decide what works for you!
As baby nurse, I write a more detailed note in the baby's own record:
1530 birth of live female, vigorous immediately, pink with good tone, loud cry, clearing secretions spontaneously skin to skin with mother. HR 150 bpm @ 1 minute, easily palpated at unbilicus. Apgars 9, 9. No interventions required. Remains skin to skin with mother. ID bands applied to baby and mother. Initial VS stable. Continue to monitor.
Up here in Canada I've worked in three facilities with completely different rules. In the first, we had a medical directive not only to manipulate the rate within a set range, but also to give top ups as ordered and to troubleshoot.
In the second, we could change empty bags and prime the initial bag while waiting for the anesthetist but that was it.
In my current facility, we can turn up the rate by 2 or the bolus dose by one and occasionally we have to program the pump to start (as well as changing bags). Anesthetists get called for everything else, including troubleshooting.
First hospital I worked at: 90% epi, 10% nothing (we didn't offer IV narcotics or entonox). 4000 deliveries/year.
Second hospital: 60% epi for primes, 40% for multips, the rest IV fentanyl and/or gas, or nothing. 8-900 deliveries a year.
Current hospital: 75-80% epi, the rest any of gas, IV morphine, or IV fentanyl or nothing. 6000 deliveries a year.
In Canada applying pressure from below in a section is outside of our scope of practice (I would imagine it is everywhere). There have been cases where inexperienced staff have fractured a baby's skull
We can still do it but (while we're gloving up) we have to state to the physician "this is out of my scope, do you want me to proceed?" If they say yes, they are liable if anything goes wrong, good to cover your tush. I've had physicians say no, unscrub, and do it themselves after that statement but most of them just tell us to go ahead.
Morphine for babies is the standard at every place I've worked at, I've never had to deal with a withdrawing Mom. What a tough situation *hugs*
I've never heard anything like that, I'd be interested to know!
We have 3 RNs for every CS--scrub, circulate and patient care (assists anesthetist and recovers patient). It's lovely.
Seen lots! My sister was a double nuchal cord with a true knot. The most memorable one for me was a booked section--there was a true knot but it was a figure 8 knot!! We took pictures. It was bizarre and lucky she didn't labour.
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