crysobrn

I think that babies physiologically NEED to be at the breast when they are brand new. What I tell my moms is "think about it he/she was just in a nice warm, quiet, dark, cuddly place for 9 mos. Now it's cold, bright, quiet and we throw them in a crib and expect that they will sleep for hours on end" I certainly encourage rooming in but if a mom wants to send her baby to the nursery so she can rest. I make it clear that the only way the baby can truely be content may be at the breast and he/she will have to come back out if I feel like they need to. I've only had ONE mom in the last 6 yrs be upset that the baby had to come back out. My babies never left my side while I was in the hospital and honestly they were nursed almost constantly until my milk came in. But I think that's the way it's supposed to be. I think it helped my milk come in faster. I've nursed each of my kids progressively longer. I'm still nursing my 18 mo old and I'm 25 weeks pregnant... She's never even had a drop of formula. Were there days that I thought it'd be "easier" to just plug her with a bottle... YUP. But I get much more satisfaction knowing she has had her mama's milk this long.

In an attempt to keep our unit in business I am currently pregnant with baby #4 lol. Is it the best time financially for us... NOPE... But we decided to not put our lives on hold. We figure that in 30 yrs it will all blow over at our house lol. Another of my coworkers/friends is due two weeks after me... I'm not sure what they will do while we're not there since we have a pretty small unit. Seriously though we are down almost 25% from 2008!! That is a big difference. It means obviously that there are a lot less nurses needed, and way less extra hours available. I think May is supposed to be busy for us... but then June drops off again BIG time.

I actually felt very bad for this girl because she seemed to be having some major symptoms of withdrawl already. She was very believable once she trusted us enough to tell us what was going on. I just hope she can truely get help. After doing some googling. I see that adderall seems to be pretty seriously addicting. And from what she was saying she needed a bigger and bigger dose just to function.

We seem to have more and more women coming in to deliver that are abusing various substances. We are a smaller facility and do not have a nicu. I'm curious what if any protocol you have for drug dependant mothers and then babies that deliver. The other night we had a patient that was not supposed to deliver at our hospital. She drove almost an hour out of her way to come to us... Then after HOURS of complaining of vague complaints finally fessed up that she was dependent on adderall and had been taking 100+mg every day for the entire pregnancy. She was pleading for "help" stating that she just wanted to get off it before her baby was born. She was only 34 weeks and then starts contracting etc... She ended up being transferred to another facility for the possible need for a nicu. Just curious what your facility does for moms like this and nursery protocols too if you know those.

Hi there mama. I nursed all of my kids successfully for a year (three so far and preggers for #4) and pumped at work. I also have several coworkers that have done the same thing. I work 12's although I only do one or two a week BUT I have never had anyone have an issue with me pumping. Other ppl leave the floor to eat or smoke so pumping is really not seen as a big deal. I make sure to eat while I'm pumping so I'm not taking a break PLUS asking to pump in addition to that. On slower nights I'd sometimes pump twice... there is only one night I can remember for sure that I couldn't pump at all and it's because we were super super busy and there was just no way to do it. I also have a double electric pump so that it doesn't take long (with my oldest I thought a manual was fine and it took me a lot longer). I guess it depends on how important it is to you. For me it was important enough that I chose to pump... there are moms I know that once they return to work give formula when they're away and they nurse when they're with their babies... Whatever works. GL.

We have had this come up several times on our unit. We have a new bed BUT we also have these old beds that we use if we have several kids under lights. Our protocol states (the same as the manual) 18 inches BUT our one pedi throws a fit if it's not super close. He basically says that it just doesn't work as well... Again it's been brought up a lot, our protocol has not changed and his opinion hasn't either.

I'm 38 wks with baby number three and we decided to NOT find out this time because of this very thing. I had a pt about two years ago that was having number three, was told she was a girl and we joked about what if the baby was a boy, he'd have to wear a lot of pink etc... I knew her as she used to live next door to me... Anyway the baby was born and the doc (who had told her that the baby was a girl) announces "it's a boy" and we all laughed thinking he was joking since earlier in the day we had gone on and on about that very thing... Well it was NO joke. They had a bunch of pink stuff and not even a boy name... I still see them at the store every now and then and they still laugh with me about this.

I actually oriented to our unit at the same time as an older nurse that always thought she wanted to do OB... After our fetal monitoring course she quit and went back to med surg. I talked to her at great lengths about it and she basically said this. 1)She always thought Ob was a happy place to be and it just ended up NOT being like that... There are sad situations that you send baby's home to, then there are emergencies that may or may not have bad outcomes, there are fetal demises etc... She had a pretty rough delivery for a patient one night and although the baby was fine in the end, seeing that baby lifeless and being resposible for her was too much to handle. 2)Unit politics, docs, budgets, coworkers, etc 3)The liability and responsibility in general. We are a smaller unit, we triage our own pt's we have no doc in house. We do our own r/o labors, r/o rom, r/o basically everything... Then the docs are provided with our assessments and they make a poc depending on what WE say... That was too much for her also. All in all I love my job also. There are certainly days that I wish didn't happen but overall it is a great place to work.

For us it depends on where the doc is... I mean if they're in house we can wait til delivery is pretty close before we call... Generally if they are in surgery for example they call to check on the pt before they scrub so they are aware that they are getting close before they start a case. On the other hand if I know that our doc is at home sleeping I'd probably call and say "she's complete, we're gonna start pushing" and they can make their way in... If things go faster than usual I'd page again and then they know to make their way to the unit faster. For multips on the other hand it's generally so much faster that I would call when 8 like you're saying, or even faster if I don't think I'll have time and things seem to be really progressing quickly. I just try to keep the docs informed. For what it's worth I've never precipt a primips baby but honestly those multips are so fast that it's been known to happen more than I'd like...

We have standing orders for ephedrine at the bedside... The docs generally only stay 15 minutes to MAYBE a half an hour. We only have anesthesia in house during surgical hours so as soon as they are done they're off... Especially if it's nights. I am pretty sure that they sat down at an OB comity mtg to do our standing orders. That way the OB's have a say in what anesthesia is ordering.

Wow, I'm sorry. I have a nurse that works days that is always wondering what we did all night... If I get a pt at 6:50am she'll ask, "why didn't you check her (or spec her or get her IV going... or whatever)... If she gets a pt at 6pm she doesn't do a thing with her. It's such a double standard. We seem to get a lot of the nights vs days...One of the girls I work with on nights always says something to the effect of "if working nights was a piece of cake and all we do is sit around and cross stitch... they pay us a differential... and you are still working days... you are the one with the problem" Hang in there.

Oh no. I also work in a small unit... The docs are occasionally NOT very fun to work with and since there are only 2 (right now anyway) it's not like you can get backup from a doc necessarily if you need it... Our director also has no clue about OB, the unit sort of fell in her lap so she is also not much help... Fortunately for us, the docs realize that we can make their jobs easy or hard. I mean if one of them questions me about what I'm doing or my assessments, I have to ask them to come in... They cover call for themselves 24/7 so they either trust us or come in and check after us. There are no residents, no interns etc... We do our own checks, our own spec exams, sometimes end up delivering our own babies since we have no one in house... I'm guessing it's the same where you are. As a pregnant woman myself I would never let a nurse check me every 30 minutes. I keep my checks to a minimum on my patients. Not sure what else to say... Have any of the OB's been informed of the way this doc is treating the staff... Sometimes they can make more of a difference than the actual nursing staff. We did have a doc not too long ago that was seemingly bipolar. She'd order something and then deny it, she'd yell for no reason etc... We started having two nurses available for ALL orders as well as writing up every incident involving her. She eventually was asked to leave by the other OB's they were just sick of her being the way she was.

We don't readmit to our unit. Once a pt is discharged she would be admitted to med/surg if she needed to be readmitted (we once had a pt readmitted to ccu who was 7 days pp and pre eclamptic). When they are re-admitted they are provided with a crib from OB and given the option to care for their own baby with the help of family... they are kept in a private room with the option of a family member being present for assistance.

I think it's pretty common in smaller hospitals since an OB unit is made up of all aspects of OB... We do either L&D paired with triaging our own pts, or we do couplets and often have antepartums on our floors as well... We no longer split pp and nursery, unless we have a bad baby and that opens up another whole can of worms.

I work nights and prefer it that way. I have a 10 and a 5 yr old and new baby on the way in about 5 weeks here. Right now, my kids go to school all day, I sleep. Dh is home. He also works nights but we work alternating schedules so that one of us is always home. When I did work days... On orientation four or so years ago I didn't like it... I saw my kids from like 8-8:30 and then they had to go to bed. I'd be gone in the morning before they were even up. Working nights I can eat dinner with them, go to work, dh puts them to bed I'm home to drive them to school in the morning (or on weekends just eat breakfast with them) then I get up about the time they get out of school (or a little earlier if need be) and go pick them up, hang out, make dinner etc. I do not work full time though, I'm sure if I did it would be a little harder to balance everything. Also with the new baby, hopefully by 12-13 weeks when I go back to work he/she is sleeping most of the night, then I can nurse during the day while "sleeping" or "resting" It worked well with my last baby honestly. I can't imagine being away from my kids for full time days... too much time away imo.

We have hired a new grad in each of the last three summers. Personally I think that they should all have had some med/surg experience first. I just see a big difference between them and someone who has some background somewhere else. We are also a smaller unit and we do all our own L&D, antepartums, evals/triage, nursery, intermediate nursery etc... often there are only TWO nurses working (once they are off orientation)... I feel more comfortable with the girls that have some other sort of medical background, than those that came right out of nursing school and rush to L&D. We are hoping that our director listens and stops hiring those right out of school.

Personally the best thing that I've found is the moisture therapy from avon. It's cheap and nothing beats it in the long cold, dry, michigan winters.

The nurses assign apgars where I work. We rarely have RT at deliveries and if we do they never assign apgars. If we do a c/s then there is generally a pediatrician present and for the most part they assign... but honestly they often ask the nurses what they were. We have one OB that on occasion will stretch the truth and give 9/10 to a baby that wasn't doing quite that well. I think that they do case reviews in our dept for every apgar less than or equal to 6 so generally the docs get a little testy if they get one like that.

Thanks for the replies. I mentioned something to the director at our meeting this week about needing to come up with a protocol and she said "oh yes I know" I thought she had said something at one point about waterproof monitoring system but she says that she can only find a waterproof doppler so I guess we may be getting that. Well I'm hoping to use the tub myself in october so I may be the first to actually get in the thing at the rate we're going! Thanks again!!

We recently had one of our labor bathrooms remodeled to include a birthing tub. We have a protocol for cleaning it but somehow our director has not been too particular about the actual use of the tub during labor. The only thing she has said is it cannot be used after they deliver If you have a tub where you work what is your protocol. Can women use it if they are ruptured... One of our OB's said she's fine with that, but like I said there is nothing written to say that. Is there a certain point at which your moms have to be out, like if they are dilated to ____ we no longer let them in? What is your protocol on fetal monitoring? Do you have special gloves for the tub if someone that needs an sve? I'm thinking they'd have to be "bigger" or longer or something to protect the healthcare workers? I have a hard time believing many of our patients will be able to use this tub because so many of our patients are scheduled inductions. And then they are arom'd early in the day so they not only need constant monitoring but they cannot use the tub secondary to ruptured membranes.

Right. I usually have more pertinent things to be discussing during the laboring process than vaccinations... I mean there is already the whole admission process, monitors, relaxation, pain options etc... We are a combined unit so if it's not signed during labor it's the same nurses that can get it signed afterward. We generally labor and deliver and keep our same couplet thru the shift. Unless there's something crazy going on.

A lot of our nurses have the moms read and sign before they even delivery. There are times when it's totally innapropriate. There are certain nurses that I work with that get upset if they take over on a patient for you at the end of the shift and it's not signed...

I'm jealous of all the $6-$8 shift diffs. I'm in a smaller town and it's truely the only hospital setting for about an hour SO, there really isn't any competition... I think our new RN's make about $19 and hour, we get a 6% shift dif for nights. No incentive for weekends. Our cost of living is pretty decent and I can't imagine raising my kids anywhere else so I guess I can't really complain. We could easily get a new (or newer) 3/2 home for under $150,000. We bought new a few years ago and actually paid well under that so I'll take that over some of the other places we've looked easily.

I don't think you should feel guilty at all using WIC. I mean it's there for a reason. I think more people could actually get it if they knew the qualifications. When I was pregnant with my last baby we were doing breastfeeding coalition meetings with the WIC girls. The one suggested that I apply even if I knew I was going back to work. She said that even if I qualified for the 12 weeks I was off it was still a good idea. And they liked to get their numbers up. I ended up getting "disability" pay though so between my husband and I we didn't qualify.

I think that the peds really need to talk to the patients more about vaccinations in general. I don't like to get consents for it if there is any question in the parents mind... I give the info sheets from the cdc and then let them keep the consent and let them discuss it with their pedis... We get a consent signed either way, they either check "I want" or "do not want" and then sign. I've heard nurses say "the docs like the baby's to get the shot before they leave" well if I were the patient I'd say "why" I skip it in the hospital for my babies. The only advantage I saw before was when our peds office had the comvax the kids got less pokes because they got all their 2 and 6 mos immunizations in one shot... But our office didn't have them for a long time. I think our protocol is that they have it within 12 hrs with immune glob if the mother is pos... But other than that our orders say "hep b before discharge with parents consent."