seemerun

It's hard to say without getting a feel for how the unit as a whole runs but that seems like overkill to me too. Here, whoever has been laboring with the patient stays as the mom nurse. Our team lead comes as baby is crowning to transition baby. RT and NICU only come for a bad strip, forceps/vacuum, preemie, shoulder dystocia etc. if its a C/S, then the nurse assigned to the patient is circulator, the team lead nurse is extra hands in the OR to assist with spinal, place foley, do the scrub etc. NICU and RT are always there until 5 minute APGARS. If baby is fine they leave and baby care goes to a post-partum nurse or the team lead if post-partum is unable to attend.

I don't know what a STAN monitor is? Sorry,still relatively new to this specialty. :-) There always what ifs. I mean we have crashed a patient before and then had 9/9 APGARS, but obviously that's a whole lot better than "what if" we had done this section 2 hours ago urgently but emergently, instead of going round and round with the unpredictable labor and having a poor outcome.

Before I started in Labor and Delivery I pictured myself being the nurse who was an advocate for natural labors and not rushing to c/s. But reality is...different. Maybe my view is tainted by my work experience. I love where I work but it is a large tertiary care center with the highest level NICU. So we get all the high risk patients. Anyway, my tolerance for sitting on sketchy looking strips is becoming quite low. There seems to be a theme - I notice it more with a particular provider but I know he's not the only one. There is all this pressure to reduce the c/s rate. So basically he won't section unless it is a category 3 tracing and this is crazy to me. With a lot of patients you can see the writing on the wall pretty early. I can understand wanting to give mom the benefit of the doubt, but waiting UNTIL it's an true emergency seems so risky. I am tired of seeing babies born with APGARS of 2/4 and having to go on cooling protocol. :-( Whats your comfort level?

We always keep at the bedside throughout the labor and delivery - 800mcg cytotec, 500cc of pitocin, terbutaline and lidocaine.

I have been on nights almost 2 years. Started on 8's and changed to 12's in January. It seems so much easier on 12's - I am more tied when I come home so i get to sleep sooner and the fewer days at work seemed to help too. But since summer started my sleep pattern has been really messed up. Can't get my usual six hours of sleep for the life of me! Also can't seem to get back on a day shift very easily during my time off. Not sure what the problem is? I still go right to bed (even though I want to play in the sun!) and I have a room in the basement so I don't think it's an issue of too much light coming in.

I definitely would not. A) I hate watches. I mean I like the way they look but I don't like the way they feel and I never remember to look at them anyway. I just use the clocks in the room - they show the seconds. B) 300 is expensive for a watch! I mean its fine - people spend that on other stuff - a tattoo, boots whatever. But it's a good chunk of change and I would feel a little awkward wearing it. C) I work in L&D and I envision water breaking during an exam. :-) yuck! Yes, I know - you could wear it on your other arm or whatever but it's still a funny gross visual...

I have been a nurse for 10 years and I can say that I am proud! I mean it is definitely "just a job" many days. I get tired of the BS and tired of being tired. But I worked really hard to get here, I am glad I went down this path. My job is interesting to me and interesting to others. When I get an easy patient I enjoy those moments. When I get a tough patient or tough situation....well it sucks but they often make great stories later. I have gone through periods where I wanted out but try as I might I can't think of anything else that holds my interest AND pays the bills.

Thank you all! Every birth is different and a slightly new experience. But I feel a lot better about things. Sorry L&DRegisteredNurse! That was my morning yesterday too. :-(

Well that helps a little. I hadn't thought about that. That wasn't an issue, but obviously it COULD have become one.

One placenta/2 sacs

I think you can hate med-surg and yet do really well in L&D. However, in my experience you will need recent hospital experience before being considered for any L&D position. I applied for what felt like a thousand positions but it wasn't until I sucked it up, took a med-surg hospital position for a year and half that I was able to transfer onto the unit. The two floors are very very different but I can see why my time in med-surg was helpful. I got re-acclimated to the hospital nursing culture, fine tuned my multi-tasking ability and assessment skills, and brushed up on things like communicating with doctors, processing orders - stuff that I didn't do much of when working outside of the hospital.

So glad you got on! I was going to pipe in and say there's really nothing special about PP. Except for the fact that it is low turnover so not as many openings. Plus, it's a fairly "desireable" unit so when the openings do come up there's lots of competition. But I am glad you there! I FINALLY started L&D about six months after years of trying and I love it too. It's intense, I feel like a new grad all over again and there is just so so much to learn. But I look forward to being there and I don't have that I don't want to go to work tonight" like I used to. :-)

I had my first twins experience and I have to say I didn't like it much. Once A was born everybody immediately were all over mom. Hands up inside feeling for presentation (mind you no epidural) pushing on her tummy to make baby "descend". Then when a shoulder presentation was identified it was immediately section. It was basically treated as a crash even though baby looked fine on the monitor. I am not a crunchy granola type at all but even I didn't understand why if baby was stable, everybody couldn't chill the heck out for a few minutes, see how baby B descended on their own (without the pushing and torquing on the tummy) maybe let mom hold and bond with the first one for a few minutes. It just seemed so needlessly chaotic and I am sure scary for mom and dad.

It seems they are most often planned sections. But if A) is head down they can attempt lady partslly. They are required to push in the OR to expedite a c-section for baby B if they don't come head first. They are not allowed to try for lady partsl for any more than 2 in there.

They go to our antepartum wing til mag therapy is complete

I work at a big busy hospital in WA and we do not have nitrous. However, I just found out that a very small hospital in a rural part of the state HAS started using nitrous with positive feedback. They say it has to do with high Hispanic population and their general fear of epidurals? I do not know if that's a true statement but it's how it was presented.

Absolutely true about epidurals. Which is why I like laboring down until hopefully getting some sensation back. I am supportive ofnatural birth if thats what the patient wants but that's not what I am getting at with this post. Everything I am hearing since starting in L&D talks about this being scientifically better for baby as well. i.e. less vagal response during pushing and better overall tolerance of the second stage. I am just finding that no matter how many times I hear it - it isn't matching up with what I'm seeing in practice.

In my area there is a pay difference between nursing homes, home care, clinics and hospitals but if you are in the hospital it doesn't matter what unit you are on you make the same amount. I seem to be among the few (on a national scale) that feels I am fairly compensated. If you have the option I would suggest: working for a hospital with a strong union that has fought for fair wages, precept new staff or train to charge or get certification in your specialty. At my facility those all come with extra pay.

Why is this one hard to come around on? There are so many things that we have come around on. In my facility we have ended all elective inductions prior to 39 weeks, no longer no the pit to distress and many other things as well. I am new in Labor and Delivery but it's kind of weird - every class, every article all state that that it is OK and better for baby to allow mom to make noise during pushing. Yet every time and I mean EVERY TIME this never happens. And it's everybody - nurses, doctors and nurse-midwives. It's hold your breath, count to ten, 3-4 times with every contraction. In truth I do see more effective pushing this way - but I am guessing this is not so much an issue of how quickly you can push baby out but an issue of how well oxygenated baby remains through the process. Is this just my facility or does everybody run into this? How can I help make change?

Thanks so much. I don't plan on going anywhere. I just really really can't wait for the day when everyone knows me and trusts my judgement. Heck for that matter I will be happy to trust my own judgement!

I have been a nurse for a good while but 5 months ago I switched from the med-surg arena to L&D. I had 8 weeks of orientation and have been on my own for 3 months now. I have spoken many times over with nurses who have been around and the thing I keep hearing is that I won't feel comfortable for about 2 years and won't feel good and proficient for about 5. I am OK with that. However I can't shake this feeling that even for only 6 months in I'm just not doing well. I feel like there are some pretty basic things that I know to do but it's not on auto pilot yet and often have others reminding me to do. The other day I had a pt come in. 5cm. I was only about halfway through her admit process (luckily IV in and labs sent) when baby had a significant deceleration. I did the normal IU resuscitation. Turned one side and then to the other, started fluid bolus and 02 which did not resolve it. I hit the staff assist button because I knew I needed more hands. Coworkers were awesome. Had several people come right and fly into action. My team lead did a cervical check, placed a scalp electrode and got her in knee-chest position all the while calmly talking to pt about what was happening. Other people called the midwife and set up the tray for delivery. All I did was chart at that point - albeit there was a lot to chart in these situations and someone needed to so it but I felt so stupid that this was MY patient and someone else was doing all the hands on/patient care. If I could have stopped time for 2minutes I could have thought through all the specifics that needed to be done and implemented them but of course you can't stop time. In the chaos I got all scatterbrained instead of focused. Can the "perform under pressure" trait be learned or this just a thing some people have and others don't? Also because the pt went so fast not everything was set to go at delivery. My bag for pit wasn't ready to run after the delivery of placenta. Not the biggest deal ever I guess but with so many other people helping, you think I could have remembered to do some of that basic stuff. We generally have 2 nurses in at time of delivery. One for mom and one for baby. It seems like I often find the baby nurse jumping in and helping with mom stuff. I.e. coaching on pushing, updating stuff in computer. I don't mind the help - and I am fine if it is done in the spirit of teamwork but I get the feeling it's because they feel like I am forgetting or not doing a great job. I don't know. There's other things too but you get the jist. I have not been "talked to" by management to say I am not performing to expectations but that is certainly how I feel. This is what I have always wanted to do and I feel so honored that after all these years I am finally able to do it. But if its not a good fit for me I suppose I need to know when and how to bow out gracefully. In every other field of nursing I have always felt nervous but found things came together just fine and I was "better" than I gave myself credit for. But here it feels the opposite...

Interesting...Obviously since they are going into surgery it makes sense to place the foley after anesthesia. No need to make things any more uncomfortable then they have to be. That being said...although I work in L&D now I came from 9 years in med-surg. We place foleys all the time with the patient awake and aware. It's uncomfortable but not that big of a deal. No worse than placing an IV typically.

I know this is an old thread but I just wanted to chime in. I just started on L&D (4 weeks in) and I just was in on my first C-section. There was a true knot plus a loose nuchal x1. Not known prior to delivery and mom/baby are fine. The cord was long - 80cm! So I'm sure that had something to do with it.

I think the first year out of nursing school is always tough no matter what unit you are on. If L&D is what you have always wanted to do I would stick it out. Do not worry about how people will react to the pregnancy. You are not the first nor will you be the last to be in this situation. If you don't like it then by all means - change units! But if you do like but are just stressing over how much there is to learn I say stay put. :-)

I have heard the 10 year statistic a few times but I suspect it is either plain old exageration or else it is not factoring in the people who choose to stay on nights. I have 3 kids as well and I actually think it will work out great long term if my hubby can transition to days soon. We will see. Only a year and a half until my youngest is in school fulltime and that will make things easier too. I have worked nights on an ortho floor. Even though the hours were rough EVERYTHING else about the night shift I love.