MalgaBSN

Exactly.

i looked into the who recommendations a little further and they came up with the average of 3 minutes as about when the cord stops pulsing. in my practice i have seen various lengths for the cord to stop pulsating.

there is nothing in your birth plan thats unreasonable and, in fact, these requests should be the norm whether a mother has a baby in a hospital, birth center, or at home. i disagree with most responses that racingmom4 provided-- not evidence-based.

Exactly. Just let me add that this is a possibility, people can have that care and you can be involved in it. Its called out-of-hospital birth ! Anyhow, I am also a new grad and when directly into L&D because my goal is to get my midwifery degree eventually. So, I have lots in common with Alisha and CrunchyLaborRN. Here is the deal-- don't change your mind based on the sad realities of hospital nursing, just take it all in as a learning experience. And to keep your sanity and view of normal birth intact take call at a free-standing birth center or work with a homebirth CNM if you can find one in your area. Thats what I did during nursing school and still do now occassionally. Its such a great reality check to how care can be. And just try to give the best care you can in your hospital work.

On our unit our patient satisfaction scores usually come back very low (press-ganey surveys). What are others experiences with patient satisfaction scores? My manager always ask why we think this is the case and it seems that no one has a response-- my only suggestion is that we are always staffed minimally (in my opinion) so if one labor patient walks through the door and stays we have to shift around all the staff or try to call someone in. I'm sure that patients "feel" that we are busy. Also, on postpartum I feel like a run my butt off and don't really have time to spend with the patients. I also think that a lot of the nurses are really damn lazy and do the minimal work (I just started doing PP and I get statements from patients like "I wish you were our nurse the whole time, we never saw our last nurse" etc) Thoughts?

Anyone else had experience with OBs saying "I'm going to check this patient now and in an hour and if there is no change we are sectioning her," and then wondering about the doc lying? I was in this situation the other day and it put me in a horrible spot and when I mentioned it to another nurse I work with she said that at least two of the OBs she knows does that to get someone sectioned when they want to get outta there :angryfire. I am relatively new (new grad-- 8 months in L&D on a unit that does about 1200 births a year) and I don't feel completely secure in my cervical checks all the time. I feel like if I did-- if I had been there longer, I could have felt confident in standing up to this doc more. As another nurse said "you would be blacklisted," but I don't care-- I'm not there to work in the docs best interest, but its such a hard situation.

I'm in the midwest, sadly, I bet our rate is closer to 98%.

I would suggest buying a good OB reference guide like the AWHONN perinatal nursing book (you can order it from their website). I would also suggest becoming a member of AWHONN because thats our specialties professional organization and they will send you journals, etc to keep you up to date. Look up common drugs used in OB (there is a thread already about that somewhere). I got a little notebook I could keep in my pocket to jot down tips to remember and keep a list of things you come across that you want to look up when you get home. You will constantly see new things-- I try to look up something everyday (I started in L&D as a new grad about 8 months ago.) Do you have any other specific questions?

Wildchipmunk~ We do have one of the highest newborn mortality rates in the INDUSTRIALIZED WORLD. In the studies that this information is coming from they are looking at LBW and premature births and comparing our rate to other industrialized nations and we are 25th on the list, right above Latvia. So, that information is correct: Download The State of the World's Mothers from this page (it takes just a couple minutes) and then check out page 42 on the US having a higher death rate than most other industrialized nations: http://www.savethechildren.org/campaigns/state-of-the-worlds-mothers-report/2007/ Its a real realty check.

Beckinben~ I agree. Maybe the inductions are just mostly for control on timing? Most inductions end the day they are scheduled or a c/sec is done around 5 anyway?! And induction schedules where I work are really crazy right before Christmas, Holidays, vacations, etc.

Anyone seen this yet or going to see it? Thoughts? Heres a trailer if you don't know much about it: http://www.thebusinessofbeingborn.com/

I agree with both of you. As nurses, we should be happy to support our patients in the decisions they make-- especially when the decisions they make are actually better for them and their baby! I mean-- thats a no brainer! We should be excited someone doesn't want an epidural because epidurals add risk. I think in OB sometimes we forget that we are supposed to be PATIENT ADVOCATES, not doctor, hospital, policy advocates-- yes we have to work within those constrants, but our ultimate responsibilty is to our patients.

Thats basically how it is for me too. I have to pick up two 4 hour shifts to be on-call every two weeks. I also get a couple bucks an hour to be on-call and if you get called in you get time and a half pay.

The ultimate OB nursing book-- evidence based and covers all perinatal nursing: http://www.awhonn.org/awhonn/product.detail.do?productCode=LPN-3 I have it and it is so helpful.

Sometimes there are positions that are internships in OB-- that would be a good place to start. Otherwise, get a job in a hospital with an OB unit that you want to work in and then transfer from within when an opportunity arises (better odds-- most hospitals hire from within first). You may have to take a crappy shift/hours. While you are waiting do some self study on Perinatal nursing, join AWHONN, and take some contiuing ed in perinatal areas because that will help to show your interest on your resume. Maybe get your certified lactation couselor training done (good healthy children CLC to find more). You may get into mother-baby first and then work your way to L&D.

oh, and here are some must-reads: *ina may's guide to childbirth by ina may gaskin * gentle birth choices by barbara harper * birthing from within: an extra-ordinary guide to childbirth preparation by pam england * natural childbirth the bradley way by susan mccutcheon * active birth by janet balaskas * the thinking woman's guide to a better birth by henci goer * spiritual midwifery by ina may gaskin * heart & hands: a midwife's guide to pregnancy & birth by elizabeth davis *holistic midwifery vol. ii: a comprehensive textbook for midwives in homebirth practice: care of the mother and baby from the onset of labor through the hours after birth byanne frye *birth: the surprising history of how we are born *pushed

Nicky~ We should definitely chat more. I am soon to be applying to get into the CNM program in WI where I am. I have a BSN and just graduated in May and started in L&D. I hope to apply and start about when you did-- so keep me posted on what you think! I also have worked in home birth and a birth center so I would be happy to chat with you about that.

From 2008 Perinatal Nursing Text: Amnioinfusion has been shown to resolve patterns of variable decels, but not late decels or decreased variability. Amnioinfusion for oligiohydramnios is not necessary and does not seem to prevent variable decels. In a recent large study, amnioinfusion did NOT reduce risk of moderate or severe meconium aspiration syndrome or perinatal death. Based on available evidence, amnioinfusion should be limited to treatment of variable decels. Procedure according to the awhonn recommendations in their Perinatal book: Room temp NS or LR is infused into the uterus via IUPC. Initial bolus is 250-500 ml given over 20-30 min using either infusion pump or gravity flow. Both methods are appropriate and seem to be equally efficacious (ACOG, 2006a). It then goes on to explain a continuous infusion ratio and how to check for return.

pirap~ I'm not trying to flame you, but I have to say I am not impressed by your logic or the information you are providing to parents. You are not doing the research, but are instead promoting something based on how much you like your rep (or thats what it sounded like. Heres what the AAP has to say about the new additives: You are recommending something thats more expensive AND hasn't been tested appropriately yet. This is not a true statment. Formula is not close to breastmilk. They have completely different components and there are studies that show even introducing one bottle of formula can impact an infants health, so it really shouldn't be taken lightly. And I really hope you are not telling your patients that the formula with the additives is closer to breastmilk. Infants do not ever have to go to formula. They should be breastfed exclusively for the first 6 months and then to at least 1 year and beyond. No need to supplement. See AAP statement above. Don't recommend things based on what your rep is telling you! Do your homework!

I really don't think formula enhances medical care. And we as professional health care providers really shouldn't be recommending one brand over another. We should just be educating mothers that are formula feeding that its important for them to follow the instructions exactly for the right mixture and that they should buy formula that is fortified with iron. Just because you like the rep doesn't mean you should be pushing his brand, IMHO, because for all you know its the most expensive brand there is and parents think they have to stick with the one they leave the hospital with.

I was informed in a recent staff meeting that our friendy formula rep will be stepping up her involvement in our unit (as if she wasn't there enough). She now will be attending every staff meeting and bringing cake to celebrate the birthdays of the month :angryfire I used to be able to avoid the fancy optional dinners, but now I will be forced to be involved! Also, I found out that Babies R' Us are going to be involved in our facility as well because according to our manager 'they are not trying to sell anything they just really care about babies :barf01: .... Its just wonderful and they offer free classes to parents, blah, blah, etc. This disgusts me. Am I the only person that believes this is wrong? Is my manager just so clueless to think that this is all out of the goodness of the companies hearts and that it doesn't have anything to do with getting new, vulnerable business!!!! None of the other nurses seem to care, they just like the free food. A friend of mine is a social worker in a crappy, old nursing home and they don't accept gifts from anyone (drug reps, etc) because its unethical, hmmmmmmmm!

Never. And even if you did once-- is that a good reason to ALWAYS have an IV. It is an intervention with risks. Thats like car accidents happen, so will I never drive a car again. People shouldn't practice fear based medicine, instead we should use evidence-based practice. If the patient is not high risk and has no reason to need an IV-- why start one?

babyktchr & bagladyrn~ I'm sorry, but you read that statement completely different from the point I was trying to get a across. I wasn't bragging by any means. What I was trying to say is that I didn't just work my a$$ off day and night for 4.5 years to just accept the old school way things are done and stop learning. I am fresh out of nursing school, but not new to birth work or healthcare. And I work with other newbies that don't question their own practice or things they have learned at all. I don't come across this strong on my unit-- this is a website that I often use for venting. I get along very well with my nursing colleagues. I agree with that statement to a certain extent; but many things in OB are done a certain way because thats how they have always been done. Here is a EBP example: "Although it is generally thought that practioners with more experience have accumulated more knowledge and clinical skills and, therefore, provide hight quality care, researchers recently found the opposite to be true. Physicians with more experience have less factual knowledge, are less likely to practice based on current science and standards from their professional associations, and are more likely to have a poor patient outcome when compared to physicians with fewer years of experience. Although this study was about physicians, likely the same implications apply to nursing." (Creehan & Simpson Perinatal Nursing 2008).

Jolie~ Yes, thats what its probably going to come to. In school and clinical it was just expected that EBP was always your ultimate goal. Where I work now, it seems to be frowned upon. And I am in a rural hospital (I actually worked in a birth center while I was going to school and worked in homebirth before that-- so I knew it would be bad, but it gets so ridiculous). I just feel like its so sad to just move. Many moms come through this hospital from my community (they do 1500 births a year) and the misinformation is so deep that moms don't even know how things could be more beneficial for them. Its also my first job out of school so I don't feel like I can just pick up and move yet. I'm hoping to somehow make a difference. I'm trying to work on an EBP group, so we will see how it goes. Its just interesting to me that most of the nurses I work with spend a great deal of their time at work, but they still don't ever pick up a book about birth?!

I feel frustrated by the fact that most of the nurses I work with don't take their jobs very seriously. Most don't seem to think about anything past their 8 hours (like what happens to this patient when she gets home with this baby-- are they setting up follow-up when needed). I just graduated with a BSN from a very good school and I definitely consider this my career not just a job (even though for me its a step on my path to CNM). Evidence-based practice was really pushed in my school and I try to stay on top of the latest evidence and I am a member of AWHONN, I read the latest lay books coming out about birth (like Pushed; Birth-The Surprising History of how we are Born; Ina May's Guide to Childbirth etc.), I try to stay on top of anything related to my field. I swear I am the ONLY person on my unit like that which blows my mind. I am frustrated that we work in healthcare, but many of the nurses I work with don't seem to think they need to continue learning! Almost all of the practices in my hospital are outdated. All someone would have to do is open one evidence-based practice perinatal book and see that! So I just don't get it! Anyone else notice how OB is the least evidenced-based!?