SC RN

Not me!!! I teach Prepared Childbirth classes and I tell my class that this is NOT a big deal, and for Pete's sake, please, please, please do not fish it out of the toilet and bring it to L&D with you ... we don't want to see it!!!!!

Having just recently graduated (15 months ago), I think I can give some perspective here. I always thought of my first year out of nursing school as actually my THIRD year of nursing school. I wanted to continue learning all I could and if it had to be on a floor or unit that wasn't my first choice (or even my second or third or fourth choice), at least I was getting experience and knowledge that I could use when I was ready to transfer to the unit that I truly saw myself as working on and enjoying. If you can think of your first year out in the real world as just an extension of nursing school, maybe you will better be able to adjust to a floor (just as you have continued to adjust to nursing school). With that being said, I actually DID get my dream job in Labor & Delivery but only because I spent two years as a CNA during school on the Post Partum floor and showed what a hard worker I was to all of the managers. It's not easy to walk into a L&D position and it shouldn't be ... L&D is hard and there are times that I wish I had more of a med/surg background to build from. Women in labor bring with them a whole lot of other problems .. all of which need to be acknowledged and treated appropriately. If you do end up going to med/surg first, you will come to L&D better prepared than I was. Best of luck to you!

Out of habit, I always put a pulse ox on the mom to get her heart rate whenever I have even the slightest doubt about who's heart rate I am tracing. Takes only a sec and clear up quite a bit of wondering. On another note, a "flat" heartrate is not reassuring. Even though you are seeing nothing negative (decels, dips, etc) you are still seeing nothing positive ... therefore it is a nonreassuring FHR. I always compare a tracing to what we would expect to see on a NST ... and if it doesn't pass the NST, then something needs to be looked at closer. Don't ever second guess what you did, though, because it's done now and can't be taken back. Learn from it and you'll be a better nurse. Period. :heartbeat

Mothers can be a wealth of information and support for laboring patients ... as long as you are there for HER, you will be fine. That being said, the majority of problems with moms coaching daughters is when the moms say "well, I never thought it was that bad" or "I didn't need any pain medication and my labor was 3 days long and I pushed for 4 hours" and so on. I'm sure you won't say these things but be careful to not insinuate anything about your labors on to her labor. This is true no matter who the support person in the room is ... the patient just needs to be supported through HER feelings, HER labor and HER experience. Best of luck to you ... and hopefully the bf will pass out and you and your daughter can have a wonderful experience together!

Well, after a full year of working L&D as a RN, I can say that I rarely tear up anymore unless I've really bonded with the family and the situation is special in some way. What "Maternity Ward" doesn't show you is that the nurse most likely has another patient she is caring for, she is giving breaks to other RN's, triaging on the telephone, charting the same thing for the 4th time on some other piece of paper that JCAHO requires, searching frantically for a cable for the FSE or IUPC, etc, etc. Don't get me wrong, I love L&D and will never leave but sometimes you just don't get the opportunity to bond with a patient that you would like to when you are having a crazy day. Those patients that you do bond with, however, will make you remember why you work in L&D in the first place. :blushkiss

What do most hospitals do in their OB departments with these types of calls? Our most common call is: Hi, I think I'm in labor. No, my water hasn't broken. Yes, the pain is unbearable. Definitely 10/10. Yes, I'm having one right now (still speaking clearly with a happy tone). They are about 10-20 minutes apart. Yes, I can feel the baby moving in between UCs. No, no bloody show. Yes, it's my first baby. (And so on). How does your hospital (speaking to all in this forum) handle these calls? We give the standard "UC's q 3-5 minutes X 1-2 hours, then come in" line .... is this putting us at risk? (Yes, I realize it is indeed but we can't possible have all primips come in each and every time they feel a single UC). What do you all do? Do you have a log book? Do you have a standard line of questions? Of course, most of these calls are coming in when the docs offices are not open (altho sometimes they are open and they call us but then we refer them to their doc if it seems appropriate). I'd like to see it streamlined where I work but the management seems almost afraid to tackle this problem!

JOGNN had a great article on this ... I believe it was the Nov/Dec 2005 issue but I can't seem to find it in all of my piles of magazines right now! It was titled something like "Spontaneous Vs. Directed Pushing" ... fantastic idea ... now if we could only get our docs to read the article and go along with it! :roll

One of the main points with nipple stimulation that is being done to induce production of Oxytocin, is that the nipple must be stretched, not just rubbed. The breast pump does exactly this and works beautifully. And mom should stop touching her nipple (or using the breast pump) once a contraction starts, being careful not to "hyperstim" her uterus with all of that oxytocin. It is a very effective way to induce or augment labor ... the hospital does the exact same thing but we put the hormone in a bag and give it to you in an IV! If it is "time" for your friend (knowing that due dates aren't an exact science), she should have success with this method. Best of luck to your friend! ?

Herpes is a great subject for this. And more women than we realize carry the HSV I (yep, the kind usually found on your lip during a cold sore breakout) lady partslly. Interesting at what point the mom acquires it (before or during pregnancy) and the effect on the fetus. Then at delivery, if there are open sores, she is suggested to have a c-section. Of course, there are suppression meds that she can take prior to delivery to decrease the chance of outbreak. Just some food for thought since "cold sores" aren't usually thought of as dangerous to a newborn ....

Our OB manager (both asst managers and head honcho) have many, many years of OB experience. When they are on the unit, they should be able to look at a FHR tracing and understand why the patient is going for a section or why the patient is now one-to-one. They need to be able to jump in and help in the middle of a crisis without thinking "how the heck do I know how to resuscitate a newborn?". Not that you can't get this experience and knowledge, but I would think that it would be difficult to gain the respect of your nurses and staff if you can't even perform the daily tasks that they accomplish each and every day. Perhaps you could spend some time as an RN on L&D and Postpartum and NICU and see how it goes ... you may fall right into step and love every minute of it or you may realize that it's just not the place for you. Either way, you've learned something new. And as far as staff and patients go ... it doesn't matter if you're a guy or a girl or a alien .. as long as you are a great manager. Look how many male docs work in OB ... why would a male manager make any difference? Just my two cents ...

Okay, so I think we've come got two things going here: 1) If the patient shows an O2 sat of 99%, it may not actually be so (inaccurate reading of a finger pulse ox), so additional oxygen makes up for any deficiency. Thus, the reasoning behind applying O2 when we see fetal distress ... extra 02 to mom, more to the baby, better outcomes. 2) If a patient has a TRUE oxygen saturation level of 99-100% (proved by an ABG draw - which is not going to happen in L&D), then additional oxygen would be unnecesary as the patient's hemoglobin would be carrying a full load of oxygen and would be unable to carry more to the baby. So, to answer my own question, giving 02 @ 10L via mask is based on the asssumption that mom may not actually be satting at what we see on the monitor and we give the 02 to ensure that the baby has the biggest oxygen supply from which to draw from, especially when facing distress. Thanks for the discussion! :)

I've done some more reading and research and I'm still in need of more info. Here's where I am at: If mom has an O2 level of 99% then her hemoglobin is carrying 99% of its potential capacity. The only way the fetus gets oxygen (since we can't put a face mask on in utero) is via the mothers blood being perfused through the placenta to the fetus. By optimizing maternal cardiac output (IV open, mom left lateral) we are giving her maximum volume to perfuse the placenta. So ... what is the additional oxygen going to attach itself to if the hemoglobin is already carrying 99% of its capacity? Am I missing something here? It seems that opening the IV and maintaining a lateral position are what truly improves placental perfusion rather than the supplemental oxygen. Now, taking an additonal leap, we could look at giving mom blood which would increase her hemoglobin levels allowing her to carry more oxygen (not that I'm suggesting this is possible, just throwing it out there as a "devils advocate" type of comment). I hope you don't mind that I'm wanting more discussion regarding this. It is extremely interesting to me and I'm too stubborn not to figure it out. Thanks for all the comments!

OKay, I guess I am just being dense about this subject. Just looking for facts to back up my thoughts. Thanks for your help and input! :)

Ah yes, forgot to mention that I also turned the pit off and provider was notified, as well (we'd been on the phone off and on for 20 minutes). I do understand the theory behind putting 02 on the mom for the baby's benefit ... but still do not understand the science behind satting at 99% and additional need for oxygenation (for either mom and/or baby). If you have 99-100% of your total oxygen capacity, does more oxygen actually help? Maybe I'm just being dense here but I've never taken "that's the way we've always done it" as an answer. Anybody have a study or more info on this? Edited to add: I'm going to research the Oxyhemoglobin Curve for more info .. I'm thinking that with a low H&H, less hemoglobin to carry O2 ... I'm not sure I'm even following myself at this point. Anymore ideas?

I've spent the last few nights pondering this question ... let's use a "hypothetical" patient: Primip, induction (cytotec X2 then Pitocin), Pit is up to 6mu, FHR baseline 140-150bpm with average variability and accels up to 175, UC's q 3-6 minutes, 60-90 seconds long. Late decels are noted, first deep then more subtle (understanding that it is not resolving but that the baby is having more difficulty with the UC's). Patient is repositioned to left lateral, HOB flat and IV open. Mom shows 99% oxygen saturation on RA. FHR return to baseline with no further problems. Would you put O2 at 8-10L via mask on this patient? Why? My first (new nurse) thought would be to apply oxygen but when I saw her O2 sat at 99%, I hesitated. Another RN came into the room and immediately applied the oxygen mask. After the day was over, I spent some time online searching for evidence proving that oxygen administration would have helped the mom and/or fetus. Interestingly enough, there was nothing that I could find that was definitive regarding supplemental oxygen when mom is already at 99% on RA. What do you all think? I'd love some other input. Are we applying O2 as a habit without evaluating the moms current O2 saturation? Is it beneficial when she is already at 99%? Would love to hear what you all think about this! Incidentally, went to the OR for a c/sec (hours after the lates resolved themselves), mom was tired of being in labor and doc was tired of listening to her ask for a c/sec. Bummer, too, since the patient was obese making her post-op recovery harder. No nuchal cord found, placenta looked great and baby labs all WNL. Thanks ...