L&D.RN

We give Cytotec orally for induction purposes, never lady partslly. We give 100mcg q 4-6 hours. Contraindications are grandmultip, prior uterine surgery, concomitant use of pit, non-vertex (duh), non-reassuring fetal status, presence of regular painful contraction q 5min or closer and/or patient refusal. They do have to read a handout first and sign a consent. It does make rapid cervical change when it kicks in, but most of the time it ripens very well and works great. I've never had to give more than the second dose and they are in labor. Some of our docs won't use it, but one group swears by it.

We use it, and it works well. Sometimes it really moves things along quicker than we're used to with our good ol' cervidil. It's great with a cervix that isn't ready for pit. We give 100mcg q 4-6 hours, but there are stipulations such as if they're contracting >2 in 10 min with some pain, we hold off. There is also a list of contraindications that would restrict our use in certain patients. Some of the nurses don't love it, but I like it a lot better than cervidil, and it's much easier to administer!

I'm of the opinion that it is a good thing, both medically and socially. I also don't want to debate personal opinions, but after lots of research, I had both of my boys circumsized and watched the procedures. They hated being held down and screamed more about that IMO than pain because they were "numbed" prior. I also watched circs without meds, and the crying was about the same.

Today I ran to the Verizon store really quickly to grab a phone...didn't take time to shower and had greasy hair pulled into a ponytail. As I was dickering with the store employee, a couple came up to me and asked if my name was XXXX, I said yes, (embarrassed about my appearance!!) and they said we knew it...you delivered our baby. The ladies eyes welled up with tears and she reviewed her experience with me. (The FHR dropped into the 40s and we couldn't get it to come up with interventions, Doc wanted her rushed to the OR for a crash and by the time the Doc got there, FHR was up so we watched her and ended up taking her back to her room later where she delivered a healthy little girl!) She said that she was so grateful, and that "even when you were running down the hall pushing my bed, you were completely calm and reassuring, and you'll never know how much you meant to me, I'll never forget you!" Whew, what a compliment!!! I've walked on clouds all day long! I guess I've always wondered if people remember you after the experience if over a while, and this was 8 months ago. Sorry it's long, but I had to share that one!

A couple more questions...are you guys doing your own exams, or are you having an ER doc do the exam. We heard it both ways at the conference and I'd just like to hear other views. We do our own exams, but if we question anything or think that they need to be seen by a doc for something medical, we have the ER doc take a look.

EMTALA states that you have to treat every same patient the same way...so if every pg pt is sent to L&D for the MSE, there's no problem. Our ER is the opposite, they send everyone who is pg, was pg, or ever will be pg up to us, like the pg pts have the plague!

Who else out there is a Sexual Assault Nurse Examiner? I have been doing this for about 6-8 months and just went through the week long core SANE training that was put on by a major hospital and several SANE programs in our area. We heard from the coroner, police detectives, state crime lab, and various other Nurse examiners. I'd like to hear from others and compare notes on your programs in your areas.

I can tell you haven't been at our hospital today if it is slowness that you liked, lol!! Sheesh. When it rains, it pours!

Deb - There's a 2 day prep course in Seattle May 1&2 that we're going to attend, you should think about it! I'm just curious how much the class will help, that's why I brought the topic up here. One of the nurses I work with studied from the materials from a prep class and Williams Obstetrics to get her RNC. She said the exam was tough too. It's a whoppin' 80 cents extra per hour here if you're certified. Wow, Littlemack, sounds like lots of study time! Good for you for working that hard and staying that dedicated.

Anyone and OB RNC? Did you take a prep course? Was it as difficult as I'm hearing? I'm thinking of taking a prep course in May, and then taking the exam after that (and after lots of studying!). I'd like to hear from others that have gone through this or are considering it. Thanks.

Our high epidural rate isn't from the OB's or the Anesthesiologists pushing them, it seems to come from the community word of mouth. Like I said, they come in thinking "when can I get my epidural" when some of them aren't even in labor yet, and they haven't had a chance to talk to the docs yet. They tell about their friends getting them and how great it was, and they seem to think that is the only way. Talking can't convince them otherwise. I like natural births and I like epidurals, but sometimes it's frustrating when they want one and they're 1 cm, and not yet breathing through the cont, or hysterical and climbing the walls already!

We use Stadol a lot, but I find that for most people it doesn't really help with the pain at all, but it takes the edge off and helps them relax so they can stay in control of and on top of the pain of the contractions. One patient described it perfectly, "It didn't help with the pain at all, but it made it so I didn't give a shit that I was having it!" Some of the docs will even let pts have Stadol when they're complete and have a little pushing to do. The babies haven't been affected, but it worried us. In CA, we gave Fentanyl, seemed to work way better, but no docs to it here in WA. We still give Demerol or Morphine (w/visteril or phenergen) if they are in early labor, gets them rest and relaxation through the night and they wake up more dilated. I was impressed with someone's 35% epidural rate. Ours is much higher. Pts come in with their minds made up that is what they want, and the first contraction that is painful they start asking for it. Its pretty hard to do anything else without them having an open mind.

I agree with you on that! Their choices are just that, their choices, and I would not treat my patients any differently in the care that I give them regardless of their choices. I won't participate in the actual abortion procedure itself, just as I wouldn't participate in the host of other stuff, such as "doing drugs" that you mentioned either. I have cared for many addicted mothers and treated them with respect as well.

I agree with you on that! Their choices are just that, their choices, and I would not treat my patients any differently in the care that I give them regardless of their choices. I won't participate in the actual abortion procedure itself, just as I wouldn't participate in the host of other stuff, such as "doing drugs" that you mentioned either. I have cared for many addicted mothers and treated them with respect as well.

I worried about the same thing before I got my first job. It wasn't talked about all that much at school, and when I interviewed it wasn't mentioned, but the director said that I would "help cover the acute side" which is women's surgeries. I guess I thought about it after I went home because I'm pro-life, and I didn't know a great way to call back and ask, and to me it was important enough that I wouldn't have taken the job if I was expected to help. I believe, as several others have mentioned, I wouldn't want to participate in the procedure, but I would have no problem caring for the patient otherwise. I finally worked up the nerve to ask a nurse from there...she felt as I do, and no, they don't do abortions there. Whew. Most, if not all of the L&D nurses that I work with now are pro-life, and it was the same at my last hospital. You'll be fine!

I worried about the same thing before I got my first job. It wasn't talked about all that much at school, and when I interviewed it wasn't mentioned, but the director said that I would "help cover the acute side" which is women's surgeries. I guess I thought about it after I went home because I'm pro-life, and I didn't know a great way to call back and ask, and to me it was important enough that I wouldn't have taken the job if I was expected to help. I believe, as several others have mentioned, I wouldn't want to participate in the procedure, but I would have no problem caring for the patient otherwise. I finally worked up the nerve to ask a nurse from there...she felt as I do, and no, they don't do abortions there. Whew. Most, if not all of the L&D nurses that I work with now are pro-life, and it was the same at my last hospital. You'll be fine!

Ours has: name/date/time, OB, EDC, Last vag exam/result, contractions/frequency, how they are tolerating the contractions (good, fair, poor), intensity per patient, fluid leaking/color, bloody show/amount/color, lost mucous plug, GBS status. Those are all fill in the check box or blank. Then there's a spot for "Other problems". Then there are several lines for "Advice Given" and at the bottom of the sheet are check boxes for patient teaching on: hydration, pain relief measures, fetal movement, nutrition, when to come to hospital. It takes just a minute to fill it out, and most patients give you a lot of the info when they initially tell you why they are calling. Then we ask what is left. It works real well. If you still want a copy, let me know.

We don't use CNA's in L&D here either, but if you're interested in working in OB, the postpartum units utilize CNA's where I've worked.

I'm just curious why you don't wear comfortable clothing that you already have and save the $$? The doulas that I have worked with here and in CA wore normal comfy clothing that they already had. Some wore stretch pants and comfy top, others sweats, others jeans, skirts, etc. I guess I've never seen a doula wearing scubs and I'm curious why you feel that you need them?

We've been using Cytotec orally and it works well! We only use it lady partslly for IUFD's, but we place it instead of the docs. Our senior RN's refused to give Cytotec orally until a policy & procedure was in place...turned into a big spat, and the doc came and placed it herself...we now have a P&P in place.