AlaskaKat

First of all - congratulations! One thing that pops into my head is that if you went to 41 weks last time the odds of going into spontaneous labor at 36 weeks this time is fairly low. So I wouldn't think your OB doc would be faced with that decision, though knowing what might happen if you did would be a good thing. I'm assuming your OB must feel like this is a fairly large baby as well or he wouldn't be suggesting a C-Section. I guess if I were you I would ask him if he felt like an induction at about 38 weeks would be a good idea. Odds of baby problems due to prematurity are largely gone by then, and your baby would (hopefully) be somewhat smaller than 9 lbs by then as well. I'm sure you'll make the right decision for you and your baby! Considering your history, I don't think an elective section in your case would be a bad thing!

AWHONN says it doesn't matter which side - just not on the back.

When I went back to work with my last one she also refused a bottle. It took many long days for my husband to finally convice her. He would bring her to me to nurse when she would refuse (and also just so I could see her). What finally worked was after she was exhausted from crying so much and just about asleep her would lay her down and lay down with her and give her the bottle with his head turned away. Poor guy, he felt so bad, but it worked. Good luck...It is SO HARD! Katrina

I've been looking at this school for a long time and it does seem solid. They DO require at least a year nursing experience for admission, which I think is a good thing. CNMs are nurses, they should not forget that background. They are not doctors and generally don't follow a medical model. I'm not saying that there are not midwives that induce like mad and monitor everyone, but I have to agree that there are a lot of us labor nurses out here that still remember how to birth without drugs and how to support people in their decisions. I think people going into birth without any trepidition are foolish. Things happen. You know it and I know it. A good midwife knows it and can still provide very good very low intervention care to her mamas.

Does anyone know how hard it is to get in? Someone told me there was a waiting list and that I should apply now if I want to go in the next few years even if I don't quite have all my ducks in a row yet. Any ideas?

Those first few moments after the baby is born, laying there on mom's belly, looking up at her mommy... Mom looking at her baby, it is love at first sight...Mom is crying, dad is in shock, they look at each other and kiss... It's not always like this, of course, but it often is and I just love it...makes me remember why I do this.

I live in a small town, we do about 20-30 births per month and are set up as LDRP. We went to computer charting last June for everything except ICU babies and bilibabies. We were all very apprehensive about it but truly it has gone very smoothly. I Really like it, especially for labor as it is faster for me to type than write. It isn't the best system in my opinion since you do have to click through a lot of screens, but once we got it figured out it's OK. We use Lastword. When we went to central monitoring about 5 years ago we thought it would take us away from the bedside but I don't think it's true, and now I can't imagine working without it truly.

Hi there! small hospital LDRP here, no we don't have seperate nursery nurses. We are staffed with 2-3 RNs and we all do it all from labor through discharge. As far as roomning in goes, we do most cares in the room but do take the baby to the nursery for bath, PKU, and hearing screen.

We give it to most babies along with the vitamin K shot after delivery. Mom has to consent to it, but most of them do. I was told the rationale is because that's what the CDC recommends because some kids may not come back for their immunizations at well child checks. However lately I've been wondering about the whole pediarix thing. It does contain hep B, and it is a 3 shot series. Therefore the babies that get hep B at birth are actually getting 4 shots of hep B. It's OK, doesn't hurt them and the CDC still recommends the birth dose. (It is not correct that only babies that didn't get the birth dose can receive pediarix, at least not per the manufacturer or the CDC). But it is an extra shot! Now, for a high risk population that is one thing, but to blanket give an extra shot of vaccine to all babies has me wondering a bit.

How can you not have straight pit on the floor? Don't you ever give it IM?

Sounds to me like your problem has more to do with inadequate staffing than with the lack of central monitors. I also work in a small hospitals, about 20 births a month and we just got central monitoring about 4 years ago. I do love it and can't really remember how we got by without it, but we did... BUT, pit inductions without central monitoring should be 1:1. You just have to be able to watch that strip. However, low risk stuff that can be done with intermittent monitoring does not require that. Also, there is no reason that all pts with ruptured membranes need to be monitored contiuously. That's just crazy... Do I understand you correctly that you don't have another RN there with you when you have somebody in labor? You are staffed with just 1 RN and an LPN for backup? This is the part that worries me most! Even if you had central monitoring, who is going to see the strip and come help??? We staff with just 1 on if there's nobody in labor, say just 1 mom/baby but if there is anything at all going on we always have 2 RNs that can do labor! Sounds like you need to work on your staffing... and that your NM doesn't really get it...

It took me over 2 years to get pregnant with my first and I can't recommend this book highly enough...it taught me a lot about getting pregnant that I didn't know, and I'm an OB nurse! Read this book, talk to your doctor, good luck!

Totally ridiculous! You are on your own time, they can't tell you what to wear on your way to work!

Depends on the State...

What is the reason that your doctor wants to induce you? Is there a medical reason or is it just because you're contracting. Many women have lots of contractions before labor starts and, while it can be annoying, it is very common. Do they hurt? Can you sleep through them? As far as things to try to get things going, I often advise the "three hots": Hot pizza, hot shower, hot sex, repeat as necessary. Unless there is a medical reason you shouldn't be doing this, you could give it a try! As far as the induction, ask you doctor why he thinks this is advisable. If it is not medically indicated and you don't want to do it then don't! However, having said that, if there is a medical reason then you should follow your doctor's advice and take the pitocin. I've had it, it's not so bad...

I've always thought that would be one disgusting job! One time I started to tell my hygeinist that I thought it would be pretty gross to have my hands in people's mouths all day long, but then I remembered what I do for a living (I'm a L&D nurse)

I've always thought that would be one disgusting job! One time I started to tell my hygeinist that I thought it would be pretty gross to have my hands in people's mouths all day long, but then I remembered what I do for a living (I'm a L&D nurse)

I'm not sure but I think if you have finished school and can work as an RN and have your green card all you need to do is pass our licensing exam to get your RN license in New Mexico. Then I'm sure you could get a job. Contact the New MExico Board of Nursing for more information: New Mexico Board of Nursing 4206 Louisiana NE Suite A Albuquerque, NM 87109 (505) 841-8340

I'm not sure but I think if you have finished school and can work as an RN and have your green card all you need to do is pass our licensing exam to get your RN license in New Mexico. Then I'm sure you could get a job. Contact the New MExico Board of Nursing for more information: New Mexico Board of Nursing 4206 Louisiana NE Suite A Albuquerque, NM 87109 (505) 841-8340

Yup, we do. Also we place cervidil and prostin gel.

This is the part that's hard for me also. Why do people seek care when they are going to refuse it or be noncompliant? I think in this case, she probably is too ill to be competent enough to understand what she was refusing, or perhaps I'm just being optimistic. We had a similar case a few years back, only this woman had no mental illness that I know of. She had severe pre-ecclampsia and was hospitalized but refused Mag. I don't remember her reasoning exactly. She also refused to be transported to a bigger center with a NICU, though she really was sick enough that she needed to be delivered. She did accept some apresoline (I think), since it was PO, and agreed to transport herself to the other city where there was a big hospital (think really tiny remote town). She left AMA and was going to get on a commercial flight the next day or so. Sadly, she abrupted at home and came in to us with a dead baby. Just about put all of us over the edge, becasue it shouldn't have happened, I think wouldn't have happened had she followed medical advice. But, the thing is, that is their right. Don't you guys all have to talk about this with every admit? You have the right to help plan your care...You have the right to refuse care...You have the right to an advanced directive... A free country and all... Can't tie people down and do surgery on them.

ABC News reported it slightly different. It put much more of a slant on her being mentally ill, and also reported that the surviving twin has been adopted out and she does not have custody of her other children (at least there's that). I agree that this is a terrible tragedy, but, unfortunately it probably can't be called murder. If it is then we can start prosecuting all the women who blow their placentas off with cocaine and come in with dead babies... Here's the ABC story: Utah Woman Charged With Murdering Fetus Utah Woman Who Refused a Caesarean Section Is Charged With Murdering Fetus The Associated Press SALT LAKE CITY March 12-A woman accused of murder because she allegedly avoided a Caesarean section that could have saved her unborn twin has denied the charge, saying she already had scars from earlier C-sections. Her attorney, meanwhile, said she had a long history of mental illness. Melissa Ann Rowland, 28, was charged Thursday of showing "depraved indifference to human life," ignoring medical advice to deliver her twins by C-section because she didn't want to be scarred. One nurse told police Rowland said she would rather "lose one of the babies than be cut like that." Rowland told Salt Lake City radio station KSL from jail that "I already have a pretty nasty scar, it doesn't matter at all now," The Salt Lake Tribune reported. Her attorney, Michael Sikora, called a C-section major surgery and told the Tribune "it would come as no surprise that a woman with major mental illness would fear it." The documents allege that Rowland was warned numerous times between Christmas and Jan. 9 that her unborn twins would likely die if she did not get immediate medical treatment, the documents allege. When she delivered them on Jan. 13, the twin girl survived but the boy died. Shortly afterward, Rowland was jailed on a child endangerment charge involving the surviving twin, who has been adopted by a family Rowland knows. Rowland told the radio station she has two other children who live with their grandparents in Virginia. Sikora said Rowland moved to Utah with a boyfriend and is either divorced or estranged from her husband. She lives in the Salt Lake City suburb of West Jordan. A spokesman for the district attorney, Kent Morgan, had said earlier that Rowland was married. The case could affect abortion rights and open the door to the prosecution of mothers who smoke or don't follow their obstetrician's diet, said Marguerite Driessen, a law professor at Brigham Young University. "It's very troubling to have somebody come in and say we're going to charge this mother for murder because we don't like the choices she made," she said. The woman sought medical advice in December because she hadn't felt the fetuses move, documents said. Regina Davis, a nurse at LDS Hospital in Salt Lake, told police that during a visit there, Rowland was recommended two hospitals to go to for immediate care. Rowland allegedly said she would rather have both twins die before she went to either of the suggested hospitals. On Jan. 2, a doctor at LDS Hospital saw Rowland and recommended she immediately undergo a C-section based on the results of an ultrasound and the fetus' slowing heart rates. Rowland left after signing a document stating that she understood that leaving might result in death or brain injury to one or both twins, the doctor told police. The same day, a nurse at Salt Lake Regional Hospital saw Rowland, who allegedly told her she had left LDS Hospital because the doctor wanted to cut her "from breast bone to pubic bone," a procedure that would "ruin her life." LDS Hospital can't comment on the case because of medical privacy issues and the pending court case, said spokesman Robert Pexton. The doctor who performed an autopsy found that the fetus died two days before delivery and would have survived if Rowland had undergone a C-section when urged to do so. It was not immediately clear how far along Rowland was in her pregnancy. She was charged in Salt Lake County with one first-degree felony count of criminal homicide. Rowland was being held on $250,000 bail at the Salt Lake County jail, and was scheduled to appear in court Tuesday. If convicted, she could be sentenced to between five years and life in prison. "We are unable to find any reason other than the cosmetic motivations by the mother" for her decision, Morgan said. Caesarean sections usually involve delivery through a surgical incision in the abdomen and front wall of the uterus. Dr. Christian Morgan, a family practice doctor who regularly performs C-sections at the University of Utah Health Sciences Center, said he had never seen vertical skin incisions performed at LDS Hospital for a first-time C-section. "Even when you need to get a baby out in minutes, it can still be done in the bikini incision," Christian Morgan said.

My small community hospital is needing to upgrade our central monitoring system, and I am trying to gather some data. What brand of fetal monitors do you use? Do they have maternal vital sign and pulse ox capabilities? What central monitoring system so you use? Is it user friendly? Do you use it for charting or just for surveillance?? Do you like it? Would you recommend it? Does anybody have fetal telemetry capability as in cordless transducers?? Do they really work in a jacuzzi or does the water and or jets mess up the signal? Any other info would be much appreciated!

I passed! Thanks for your help, the test focused on Indomethacin, Morphine, Pavulon, fentanyl, vancomycin and gent.

I have to take a NICU med test tomorrow and am trying to prepare. Which drugs do you use the most often? I have been focusing my studies on: Dopamine, Amp, Gent, Vanco, Indomethacin, PGE, & Aminophylline. What else should I know??