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 ...

I know a little something about all of those hospitals as I've either worked there, been there as a student, or have good friends employed there. CMH would be my hands down favorite but then that's because I work L&D and I am most "in tune" with how they run their OB unit. I would guess that each hospital has it's pros and cons depending on the unit and shift that you want to work. St Johns Regional (Oxnard) has a $10,000 sign on bonus for nites, $7,500 for days. CMH has a $7,500 for nites and $5,000 for days. Not sure about the other ones off the top of my head. I rarely check this forum but feel free to PM me if you have more questions!

Cienna, I would love to have you ask other PTL moms on Mag what would've made the stay more bearable. Please ask them and then return here with your information to share ... And I'd still love more input from others ... keep it coming! Thanks!

I work at a hospital that sees about 300 deliveries per month with mostly health moms (good prenatal care, easy pregnancies, etc). Every now and then (and more often lately) we are seeing moms coming to stay with us for extended lengths of time due to PTL, complete previa, oligo, and/or multiple gestation. We do not have a "standard of care" so to speak on how to deal with the non-medical side of their care. Of course we call social services and get a NICU consult but I know that there is more that we can do. What do you and your hospital do for these moms? A poster in the NICU forum recommended a small group of the same nurses taking care of the patient which I think is a great idea. For now, the L&D nurses rotate through "ante-land" and most dislike doing it. What other recommendations do you have for making their stay easier on them? Especially for those on MgSO4 who can not focus on reading or watching television because of the headaches, dizziness and light intolerance. Thanks for any and all advice!

Thanks so much for the input ... your reply gave me valuable ideas that I will present to both the MD and the patient tomorrow. I've spent all weekend thinking about her and wondering how we can help her get through as far as possible. I'm going to start simple and go from there and hope that we can get her healthy twins a few weeks down the road! :biggringi

I have a patient on L&D (antepartum) who has been on complete bedrest for PTL for 30 days now. The doses of Magnesium Sulfate that we have to give her to stay out of labor are so large that she is constantly sick and miserable and she is now ready to give up. She feels that she just can't stay pregnant any longer or she'll lose her mind (hx of depression, first child at 29 wks - now healthy). An ultrasound first showed the AFI of Baby A to be 3 so she was going to be having a c/sec but a subsequent u/s showed the AFI to be 7.4 so she is in a waiting game yet again. She is now 31 4/7 wks pregnant with twins. I have searched all over the internet looking for something to give her that states a day by day benefit of keeping them in their longer. Does anyone now of such a thing? I'd love to be able to visually show her the benefits to the lungs, the GI tract, the Brain, etc, etc. I'm hoping you wise NICU nurses can help me ... I really want to help her "want" to stay pregnant ... altho I can't say that I know how miserable it is to be on MGSo4 for this long of a time! Thanks for your help!

Nurses who care like you do, Rae, are a true blessing when things go bad in our happy land of L&D. We had a mom come in today ... 27 week fetal demise. Her wails as we got her settled in and labor started won't leave my head tonight no matter how hard I try. I don't think I've had one sob so hard in a long time. Most of our patients grieve quietly, waiting to go home to deal with the bigger pain. This patient was crying from the depths of her soul and we all felt it. It's gut wrenching to listen to when you know that the only thing that would make her stop is the one thing you can't give her. She kept asking why ... she went to a funeral yesterday and she somehow thinks that's why this happened. All we could do was administer meds and hold her hands and let her cry. I hope that was enough.

Yep, COL is high but buying a house is going to depend a lot on how you manage your money here. I currently rent a house in Ventura, lived in Ojai up 'til three years ago and my parents still do live there. And since I was born in Ventura some 32 years ago, I'm just a little familiar with the whole area. So ... a nice 3bd,2ba house in Ventura will run you $600 and about the same or a little more in Ojai. Take into account that if you live in Ojai, prices in general are higher at the store and gas station and the one hospital in town doesn't do a lot of hiring (altho it has recently joined forces with the community hospital in Ventura so things may be changing). Of course, there are less expensive homes but if you want a decent house in a decent neighborhood, bet on $600k minimum. (If you want advice as to what specific neighborhoods/areas are good/bad, let me know.) A two RN family will earn a little less than what my husband and I do and we could definitely afford to buy if we'd just stop eating out 6 nights a week and get rid of the toys (motorcycles, dirt bikes, etc, etc). We have such a great deal on our rental that there really is no reason for us to leave it at this point. If you, or anyone, needs more info, please let me know. I live and work and breathe in Ventura and Ojai on a daily basis! :)

One of the reasons that I became a L&D RN was to help patients throught the trauma of miscarriages and fetal demises. And one of my deepest sorrows is that our hospital, as most, does not let any mother under 20 weeks come up to L&D for this loss. It kills me that a mother can miscarry at 19 6/7 weeks down in the ER, where the nurses hate OB cases even when they are healthy, and where the traumas take priority, and where it's loud and crowded with sick people and children ... I wish, wish, wish that they could come up to our floor to be taken care of. Because that is what they need more than medicine, they need to feel comforted and not alone. Maybe someday our hospital will allow a L&D RN to go down to the ER and talk to the mother (and father and family). Just one more thing to put on my list of things I'd change if I were in charge. My heart breaks for those that felt so alone in the ER. Please know that there are nurses who are thinking of you even when they can't be with you. For those nurses who wish to learn more and help these patients, RTS is a great program/service and we utilize its components with every fetal demise we take care of. Not only that, but my mom knits hats and blankets to give to the parents after pictures have been taken of the baby wearing the items (my mom makes two sets so that the parents get an exact replica of what the baby wore in the pics). Not many parents have clothes for a 24 week old baby and this gives them something "tangible" to take home with them.

You might also look into lacation through Healthy Children at http://www.healthychildren.cc ... best of luck to you! :)

I'm a pretty new L&D nurse, as well, and I think that it will be years until I feel "comfortable" (I use that term loosely) in L&D. Most seasoned nurses that I work with say that it was at least two years of working L&D before they felt competent to deal with the majority of the situations that present themselves in our department. Every day that I work gives me a broader base of knowledge and experiences to draw from and there isn't a day that doesn't go by that I don't learn new things. There is just so much that books can teach you ... L&D is really a "learning by doing" sort of place. Best of luck to you ... L&D is a GREAT place to be! :)