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Perinatal only!
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mollyaqua has 14 years experience and specializes in Perinatal only!.

14 years labor and delivery experience

mollyaqua's Latest Activity

  1. mollyaqua

    Doulas: love them or hate them.

    Ditto. My sentiments exactly. I'll try to do my own narrative later, but I've had very mixed interactions with doulas. Some good, some neutral and some I could have throttled.
  2. mollyaqua

    Pre-eclamplsia: BP on left side?

    I agree with you if the patient has already been admitted. If the patient is here to rule out preeclampsia, then I let her move around in bed at will. (This is assuming that she is not an obvious, severe PIHer just waiting for confirmation). If there is a chance that the physician is going to discharge the patient to home, well then, I want some evidence as to what her blood pressure is going to be when we discharge her to home. I don't want "falsely decreased" pressures if we are going to send her home to normal activities.
  3. mollyaqua

    Transportation of the deceased neonate

    I thank you all for your quick responses. Good food for thought. Please continue to weigh in on this very sensitive issue, I would like to ascertain "best practices"from your input.
  4. mollyaqua

    Transportation of the deceased neonate

    One of the sad truths of this job is that we are occasionally responsible for the transportation of fetal demises to the morgue. I would like to hear from you as to exactly how you do this. Is the baby wrapped in blankets? Chux? Do you carry the baby in your arms? Some other sort of carrying receptacle? Our management team has created an "angel basket" that I personally am uncomfortable with. I have always carried babies in a very nonobtrusive way so that the occasional member of the public that I may meet would have no idea. This new tulle and ribbon festooned basket feels (very) wrong to me. Management members feel that carrying a baby in a small plastic utility crate or other unobtrusive container is "very disrespectful". Opinions? Input or suggestions?
  5. mollyaqua

    Long-term Antepartum Care in the Hospital

    This thread is exactly what I was looking for when I logged in tonight. Our long term antepartum population has grown steadily over the last year, largely due to the now oft diagnosed "shortened cervix" and the greatly increased number of multiples. We have some nurses who have really taken on the mission of coming up with new ideas for meeting the physical, emotional and practical needs of thisl group of women. We have initiated an "All About Me" sort of poster that includes notes about the patient's family, with photos of her children, extended family and pets. She can divulge as much as she wishes on this poster. The unit has also instituted a scrapbook that is shared with antepartum patients. Patients that wish to share their story with future patients are invited to create scrapbook pages to add to the book after they are discharged. Journaling excerpts are wonderful gifts to share with the next mom admitted with a high risk pregnancy. I've taught a couple of our long term moms how to knit a simple baby blanket, and a few of the moms have also made up baby hats for the unit to use with stockinette and yarn ties. Some moms become very quiet and withdrawn, and some are just so lonely. Each one handles the confinement in her own way, and the nurses challenge is to ease the stress as best we can. We have nurses that are trained in Healing Touch that visit our patients on a regular basis. One nurse even helps with manicures and pedicures, and helps patients arrange for hairdressers to come in for a quick cut and style. I would love to hear what is happening on your unit. Are you providing PT or OT visits for your patients on long term bedrest? Does anyone have some sort of option for massage therapy? Do you have any lists or suggestions for online resources for antepartum mothers? Maybe we could start a list of online resources...some directly pregnancy related and some simply diversional. Freerice.com and Boxerjam.com are two that come to mind. I look forward to hearing what you are doing at your facility!
  6. mollyaqua

    Do birth plans grate on your nerves?

    Oh, honey, come work at my hospital! We encourage immediate skin to skin contact between new born and either parent. Bare chested men with sticky, vernix covered little ones all snugged into the chest hair is an everyday sight around my workplace. The nurses call it a "man nest". :icon_roll
  7. mollyaqua

    Do birth plans grate on your nerves?

    No problem with a reasonable birth plan. However, I have read birth plans where the couple want to have intercourse in the delivery room to naturally induce labor. Ummm, no, I'm not comfortable with that. I understand from some of the birth plans that thumb sucking may also stimulate contractions and that ones no problem for me. I also bristle a bit at the birth plan that dictates "The nurse shall not use the word "contraction" or "pain". I guess it's a "surge" and "pressure". I respect the effort by the couple to "own" the process, but insisting on vocabulary changes is just tough to remember to do.
  8. mollyaqua

    Vag Exams & Dilation

    Here's my two cents about cervical examinations for new nurses. When you are beginning your practice, focus first on just ballparking the cervical dilation. Is she three, seven or ten cms? Then go for finesse. In the end, it doesn't matter if I say she's eight and you say shes nine. (Keep in mind that if I say she's eight and you says shes ten, one of us is wrong. ) The one crucial examination to be certain of is 10 (or "complete" or "fully" depending on what region you work in) AND low enough to start pushing. I know that the textbook definition of station is where is the cranium in relation to maternal ischeal spines. Two thoughts on this one. I bet most experienced labor and delivery nurses never think about an ischeal spine. Second, the epidemic of obesity in this country makes the notion almost obsolete. I can't palpate an ischeal spine on more than half of my patients! Minus three is "pretty high", 0 is "we're making progress", plus two is where I will consider starting to push if patient is epiduralized, plus three means that I'm thinking about how far away the Doctor lives and crowning means I'm putting on gloves and wishing I had called the doctor sooner. And what really matters is "did you feel that small piece of pulsating cord" during the exam.
  9. mollyaqua

    What do patients say that irks you?

    Just home from a 16 hour shift and one "nurse controlled delivery". It makes me grin from ear to ear to log and and read these responses. The only other people in the whole world who understand this life are other labor and delivery nursese. For some reason I get great pleasure from reading your responses and seeing just how universal our lives and responses are. Thank you for sharing.
  10. mollyaqua

    computer or paper charting? what program do you use?

    We use Watchchild for strip interpretation and Meditech for everything else. The only paper charting we do is for the signed consents. Meditech is not, let me rephrase that, NOT, user friendly. We call it a "hostile program"and the installation phase was painful beyond description. I think the current programming has me documenting a pain assessment Q4 hours in FOUR different screens and God help us if the patient has pain in more than one place.
  11. mollyaqua

    What do patients say that irks you?

    What irks me? I get irked when the patient's family asks me for the seventh time, isn't it time to call the doctor? "Um, no, the doctor does not want to sit here and wait for you to dilate from six to ten centimeters and then push for two hours" left unsaid of course. I get irked when the grandmother asks for the seventh time if we should proceed to Cesarean Section because she had all six of her kids in two hours and her daughter is still in labor with her first baby four hours after arrival. I get irked when the patient doesn't want me to place a fetal scalp electrode despite persistent decelerations and difficulty keeping the kid on the external fetal monitor.....but plans a circumcision tomorrow. I get irked when seventeen year olds come in with a six page birth plan that dictates what WORDS I can use to describe a contraction ("the nurse shall not use the word contraction or pain, but rather surge and pressure"). But my favorite is the 41 and 5/7 week gestation 17 year old patient refusing pitocin induction of labor in favor of more natural methods of induction like "thumbsucking and sexual intercourse". For real, folks. Oh yeah, I get irked when patients put their tray on the floor in the hall outside their room. Hospital, hotel, hospital, hotel they both start with H, but that's where it ends. Thanks for the vent! Don't worry about me--when patients inevitably thank me and tell me I did a great job, I always tell them that I am so blessed to have the coolest job in the world.
  12. You day sounds very familiar. We do about 200 deliveries per month. Minimum staffing is five RNs, a unit secretary and a tech, but we are often missing the secretary or the tech. Staffing ratio should be 2:1 unless it's a preterm patient on magnesium sulfate or other very high acuity patient. Our hospital pays us the equivalent of 1.5 hours of time if we get no lunch, which is very often. That comes out to 30 minutes for the time I worked and a 1 hour "penalty" to the hospital for No Rest Period. I'd rather have lunch! If I do manage to get away for lunch while my patient is "covered" by another nurse, you can be certain that no charting was done in my absence--the other nurse answers call lights and responds to emergencies only. I don't call that a "break", if I have to come back and catch up on what I missed.
  13. mollyaqua

    Do you continuously monitor pregnant surgery patients?

    Yep, we too are being asked to sit in the OR and continuously monitor fetal heart tones. Seems like some of the new young anesthesiologists are spearheading this change. So during a craniotomy what are we going to do with a big dip? It's a conundrum that I have no answer for. An OB and a perinatologist were not IMMEDIATELY available, so what would a neurosurgeon do if the heart tones were in the sixties?
  14. mollyaqua

    What's The Weirdest Name You've Heard A Patient Name Her Baby?

    How about twin boys Cosmo and Chaos? I kid you not.
  15. mollyaqua

    Video cameras banned in L&D

    I work in a labor and delivery unit that does not allow video taping of the birth. I have seen rare exceptions, usually for military families, when the dad is deployed. Our instructions to the family are that video cameras are to be turned off when the physician enters the room and may be turned on when the baby's toes are "out". We also request that no photos be taken or video taping be done during any resucitative efforts. I've been in some ugly situations when someone was taking flash photo after flash photo while Skilled But Very Grumpy Neonatologist was attempting to intubate. Ugly. I've also been asked to stop my bagging efforts so the father could pick a pubic hair off the baby's cheek before he took photos. They are excited and just don't get it. We tell patients that the camera must be in their hands during filming--no surreptitious videotaping from cameras that have been set on a shelf etc. We also do not allow tripods at any time. We have had several instances of people not following this rule and setting the camera's up right in front of the privacy curtain. Unsuspecting nurse comes in, tramples the tripod and the hospital finds itself in the position of reimbursing (YES!) the family for the cost of the ruined camera. Tripods were done away with once and for all when a nurse tripped over one and broke her arm. I think that when the dad is busy videotaping he is totally removed from the intimacy and miracle of the birth. Banning videotaping encourages him to really be mom's coach and support person, not the sidelines recorder. I use every bit of knowledge and strength and wits that I possess during a difficult delivery, but I am thankful that the camera is not on me. The job is stressful enough without having a tape to Monday Morning Quarterback review after.