mom2mnaj

I worked for CMS for 10 years in the 1990s. They are like any other organization private or not, there are some people that are better managers/administrators than others. I would not have worked for them for so long if I did not feel that the company was not fair/equitable/ethical overall. I only left their employment because of personal reasons and needing to move to another part of the country then where I was living at the time. I was always rewarded for my hard work with promotions and new positions when I qualified. I could not find fault with the company itself. Like I said sometimes people get into management that should not be. That happens with any company.

I have had an experience similar with the tachycardia but without the rapid deceleration. For the tachycardia, our docs may treat with digoxin for mom (after consultation with peds cardiology). Some of the physiology was explained to me after witnessing tachycardia. There are potentially 2 causes. One being electrical or it can be because the flap from the foramen ovale flips up into the atria causing irritation and the tachycardia. Similar to when something in the adult ventricle will cause ventricular tachycardia. However, a definitive cause is usually not identifiable until after birth. If it is caused by mechanical (foramen ovale) birth will eliminate the issue because of the changing pressure gradients associated with the change from fetal circulation to independant circulation. If it is electrical, the tachycardia will continue post delivery and cardiology will treat and manage based on the assessment after delivery. Depending on the duration of the deceleration, I would say that it almost needs to be looked at seperately than the tachycardia. It may have absolutely nothing to do with it. I would think interventions and treatment would be based on whatever you would do in any other case of FHR in 80s. Sorry so long of a response.

My experience has been that generalizations can not be made regarding wheather or not epidurals prolong labor. I would say in my experience, it is 50/50. Some seem to prolong, but I have also seen the young primip, writhing in pain at 2-3 cm, get an epidural and within the span of an hour or two, go to complete and deliver lady partslly. These women usually are able to nap a bit, and have a much more pleasant experience regarding their delivery. Also, please do not disregard a patient's pain just because she is not dilated far enough. There is a current lawsuit (I believe in Chicago) where a patient is suing because her epidural was delayed and she experienced unnecessary pain. I can't remember the specifics but one of our clinical managers shared the article with us. Just something to be aware of.

Medical Terminations are performed on our L&D unit. However, everyone is asked during orientation if they have any objections to participating. Anyone who does not wish to participate (regardless of reason for their personal choice) do not have to take care of these patients during the process. From my experience, there has been no repercussions or backlash towards anyone wishing to excuse themselves from these.

We have a couple of sizes. The one that seems to work the best is the red 50 cm one.

Those balls are exactly what we use. So essentially using same theory as birthing ball (opening pelvis) for the patient that can not or will not sit on a regular ball. Somewhat off topic (but on topic), I am amazed at the number of women who come in saying "I want a natural birth" but don't want to get out of the bed and change their positions frequently. Of course these are the same ones that end up with a long labor process and can't believe how much it hurts or they end up getting an epidural as soon as the contractions really get started. I am not a strong advocate either way for my patients. I try to explain all the options, the risk/benefits, and then do everything in my means to support their decision. However, it is tough when they think that I really have anything to do with their length of labor (and their pain). I wish they would realize that when I say, I support and can guide, that is truly all that I can do. Laboring and delivery really does have a lot to do with the mother. As far as the pain goes, when you tell them that movement and positioning, really does help the pain and the entire process, then they look at you like you are nuts! Oh well......

A peanut ball is an excercise ball that is shaped like a peanut. When the patient is lying on her side, the ball is placed between her legs. The upper leg is positioned towards her front, the bottom leg is bent at the knee. We use blankets to support each end of the blanket. This helps the pelvis open up because the ball holds the legs open. I always warn the patient that it may feel like she is falling forward (depends on the patient) but with a couple of blankets to help support the ball, it is stable. It can be a little more difficult for our petite patients because of their shorter legs but it can be done. One of the nice things is that it is perfect for the patient with an epidural because it doesn't require standing or for them to position in any uncomfortable way. When I go to work later this week, I will see if I can find some of our information that we use in orientation and post it.

In our facility, we use a "peanut ball" for positioning to assist in rotation and decent of the fetus during labor. I know that one of my co-workers has been compiling research regarding use of the peanut ball. I have been amazed at how much this has aided in successful lady partsl delivery. It also has been a method of pain relief for the patients. It doesn't seem to be successful 100% of the time but any time it is successful, it is great!

Although I am still fairly new in L&D (I have been a nurse for over 20 years), my coworkers and I have had the discussion a number of times. In presenting various scenarios for us "newbies", we have discussed swelling, time of epidurals, differing cervical checks. As far as the cervical checks, as some say "it happens". I have had a discrepency with a resident and felt horrible. But even my preceptor had the problem after me with another patient. I believe there are just so many human variables that the differences will continue to exist. No one is perfect. We should all look at these as learning opportunities and not beat ourselves up about them. Timing of epidurals is entirely an individual thing. I think that if there is a patient that is so uncomfortable that other things are not working an early epidural may be necessary. I have seen patients in tears with cervadil, contracting to beat the band, and still not dilated very far. IV meds did not work. An epidural was the only remaining option. Things progressed nicely after that and the patient had a more positive labor experience with healthy baby at the end. Just depends..... I would definitely support what others have already posted... don't take it personal. You can only do your best and continue to keep learning and honing your skills.

At our facility, we have to be on-call 12 hours every 4 weeks. We can choose to go ahead and work if we want and the need is present. We get compensated double time for this... We can do this in any block of time we would like.

I want to share with you that I worked in corrections for over 10 years with the Correctional Medical Services. While there were definitely times of rough bumps (which job doesn't have them), I look back on those years with great satisfaction. I left corrections because of the need to move closer to family. At the time I moved, CMS did not have a contract in the state I moved to otherwise, I would have just transferred. (Perk of working with a large experienced company). I moved 5 years ago and to this day have moments when I really miss working corrections. Someone said earlier that either you love it or you don't . I have found that to be especially true. During the years I worked corrections, we worked very hard to improve the image of correctional nursing and I think we made great strides. Correctional nursing is unlike any other. You must know acute and chronic care, emergency care, clinic work, in cases of working with females, obstetrics adn gynecology, dialysis, etc. You never have the same day twice. I definitely encourage other nurses who are looking for something different to at least consider it. In the 10 years I worked, there was never a staff member injured or harmed in the unit I worked. Everyone needs to remember, you are their nurse, not their friend and they are not in prison for missing church on Sunday. You can be professional, empathetic and yet maintain the distance required to avoid manipulation by the inmates. Best wishes for everyone who gives it a shot!:) :)