strn96

When you're talking about possible preterm labor, it is always better to be safe than sorry. I'd much rather have a pt come in for a "false alarm" than have her stay home and come in dilated to 4-5 cm. It sounds like you just ended up with a nurse who has personality issues or was having a bad night. I agree that it would be appropriate to request uterine palpation (although asking for a 30 minute window of palpation is not necessarily a reasonable request). You could also request that the monitor position be adjusted, or that you change positions (contraction monitors often do not pick up well when a patient is lying on her side).

I have seen this done occasionally, and it sometimes works. I think if statistics were done, however, pts who had this procedure would have an incredibly high C/S rate because they tend to stop dilating again after the bulb falls out, even with other induction meds, ROM, etc. Most likely because their cervix was so unfavorable to start with.

We use it on a limited basis at our hospital...typically for pretermers with questionable ROM. We have used it for a couple of years now, and had a couple of definite false negatives when we first started using them (not sure if this was due to user error or test error since the directions are a bit more complicated than Nitrazine) where AFI was low and + fern with negative Amnisure. Cost is definitely an issue, so we tend to use sparingly and usually in pts under 37 weeks.

We give ours straight. I usually give a few ice chips to "chase it down", but our anesthesiologists would throw a fit if we diluted it.

The magnesium doesn't typically cause diuresis, but as mentioned above, closely monitoring UO is very important b/c both magnesium and preeclampsia affect kidney function. Typically, the eventual diuresis takes place after delivery and is a result of delivery (remember that delivery is when preeclampsia starts to improve), not of magnesium. You may see an increase in UO before delivery, but that is usually due to increased fluid intake (IV), not the mag.

I've actually had "Breast only - no formula/glucose water/artifical nipples" moms complain b/c we brought their screaming hungry baby in for them to feed when it had only been an hour since the last feeding. These are the moms that I tell "you either need to feed your baby or let us feed him/her". I'm a strong advocate for breastfeeding, and will do everything I can to help new moms succeed, including offering to syringe feed, etc with pumped breastmilk or formula, but it just frustrates me when a mom would rather have her baby screaming from hunger (in the nursery, not her room!) than wake up & feed or let us feed.

I have seen both ways of documenting parity for multiples. There is definite disagreement, both among textbooks & doctors. I have heard it explained both ways: that parity is the number of pregnancies delivered which in this case would be G3 T1 P1 A1 L3. I've also seen it where each infant is considered a separate delivery which would make the answer G3 T1 P2 A1 L3. In school, I was taught the 1st way, but since working in OB I've been shown "proof" that the 2nd way of documentation is correct. If given a multiple choice question involving twins or multiples, I would look first at the all the other factors - G, T, A, L if multiples were preterm or G, P, A, L if multiples were term (keep in mind that everyone agrees that the G stands for # of pregnancies, not # of babies - so twins would definitely be 1 pregnancy), and then base T or P on whichever answer fits with the other 4 factors. If there is more than one answer that fits, go with whatever your textbook says. At least you're up to a 50% chance of getting it right. Also, keep in mind that "P" in GTPAL stands for "preterm", not "para"; "para" is total number of deliveries, both term and preterm.

I worked Med/surg for about 1 1/2 years before transferring to OB (where I've been working for almost 8 yrs). OB is sometimes a tough field to break into, because directors typically give preference to applicants who have OB experience. Usually it is easier to get hired to an antepartum or mom/baby unit then L&D, so if you're ultimately wanting to work L&D you may need to apply for a position in a mom/baby or antepartum unit & then bridge to L&D. It will feel a little like you're starting over when you start a new specialty. I remember that my first few weeks I felt like I was "all thumbs" (partially because I was working at a new hospital with very different equipment). But typically you will regain confidence more quickly because you have experienced "settling in" before. And there are a few skill that do transfer. I agree that med/surg is a great starter experience. I will occasionally run into situations in OB (like giving heparin or blood, etc) where the nurses that have only worked OB are very uncomfortable, but I know what to do because of my old med/surg experience.

I work in a rural hospital that only has 2 ORs for the entire hospital. And a lot of days both of those are booked simultaneously with "non OB" surgeries, leaving no open OR in case of emergency. To date, we have been lucky enough not to have a bad outcome b/c of this, although there have been several times that other surgeries have had to be "bumped" so they could do an urgent c/s between cases. But it has always been a cause for concern. Fortunately, we are going to be moving into a new facility next year, and hopefully this will no longer be a concern.

It is frustrating when people steal blankets, etc. At our hospital, staff nurses & volunteers buy sleepers, socks, mittens, etc at yard sales & thrift stores & donate them to the nursery (they are laundered by the hospital before being put to use). Even though we label them, the outfits have a tendency of "walking away". It aggravates me when I am out yard-saling and find outfits clearly marked as belonging to the hospital (small community!). In fact, every time I see that I refuse to buy anything at that person's yard sale. I have been tempted to ask for them back, but so far have never had the guts to do it.

I have seen several in the almost 8 yrs that I've worked OB, with varied results. Had one term delivery with a knot with no issues whatsoever. One 37 wk fetal demise with a knot and the cord around baby's neck. Another 39 wk demise with 3 knots in cord & cord was necrotic between 3rd knot & baby. I've also seen a 33wk IUGR baby with true knot-delivered by c/s for non-reassuring FHT that ended up ultimately doing well, although had to stay a few extra days. Probably my most memorable knot was a 37 weeker that came in with ROM early one evening. Baby's head stayed at -5 station all night. Had a few episodes of FHT dropping to 60s-70s and staying there for several (4-6) min through the night. Finally just after I gave report, FHT dropped to 60s & wouldn't come back up for over 10 min. We did everything, including knee-chest position & brethine, and finally c/s at which time they found the knot. I was not in OR for the c/s (I was trying to finish up so I could go home), but the dad showed me a pic of the knot that he had taken w/ his phone. Baby ended up doing pretty well-needed a little PPV, but 5 min apgar was like 8 or 9.

At our hospital, we consider the time that induction was started as the beginning of latent labor, but do not consider the pt to be in "active" labor until progressive cervical dilation starts. We often have our cytotec inductions come in at 2000. This usually puts their "active" labor hours during the day, with delivery often happening in the afternoon or evening the day after they arrived, and then they can sleep that night.

Sats were only going into 80s, and only with feeding, and NB had good recovery when feeding was paused. Sounded to me more like poor suck/swallow/breathe coordination than really a need for O2. This was a LGA term baby who would absolutely inhale her bottles. The nurse that restarted O2 is very "generous" about giving O2. My real question, though, is why the BB RA per NC was written as a "continous; do not wean" order after echo results showed PFO. As stated earlier, only other findings on echo were slight regurgitation at a couple of the valves.

I hate looking at pictures of myself (I'm also "cosmetically challenged"), but if my patients ask I don't mind posing with mom or baby, because I know that this is an occasion that they want to remember in detail. And besides, I won't ever have see most of those pictures. Since I'm an avid scrapbooker myself, I understand their desire to capture their baby experience on film. I don't like it when people take my picture without asking, though. I think it's common courtesy to ask before snapping a picture, especially since some people do have religious or cultural beliefs against photos. Also agree that photos during resus. should not be allowed. As far as coworkers/family/friends go, I've found the more you resist/complain about having your picture taken, the more likely they are to keep taking pictures of you. So even with them, I try to grin and bear it.

According to the echo report, no PDA and only other findings were slight regurgitation at atrial and tricuspid valves. Only symptoms NB had (after initially needing NC O2 which was weaned after a couple hours) was murmur and occasional desat - mostly with feedings and with good recovery when feeding paused.