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RootedRedwood

RootedRedwood

Antepartum, L&D, Postpartum
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RootedRedwood specializes in Antepartum, L&D, Postpartum.

RootedRedwood's Latest Activity

  1. RootedRedwood

    Hanging a Mag Bolus?

    we do the same
  2. RootedRedwood

    What's The Weirdest Name You've Heard A Patient Name Her Baby?

    We had an infant named "Country Creek" a few weeks back.
  3. RootedRedwood

    Why is there a nurse when you have a midwife with hospital birth?

    Not totally on topic to the OP but just an FYI, I worked for a small community hospital in N. California that did give privileges to a non-nurse midwife to deliver in the hospital. This midwife is a CPM and has never gone to nursing school. I think it is up to the hospital and the MDs that would be backing you up, and there just aren't many that go the non-nurse midwife route here in the US. Rare but not non-existent. To the OP, it sounds like it really varies a lot geographically. The two places I have worked the midwives always have an RN assigned to their patients to do much of the patient care (meds, fetal monitoring, vitals, assessments, labor coaching, education, waitressing, etc). The main difference for us as RNs if we have a midwife patient vs an MD patient is that the midwives tend to spend more time labor sitting and pushing with the patients and do most of the cervix checks/placement of internal monitors if needed. When I have an MD patient, I do everything except AROM and catching the baby (unless they don't get there in time :). Safest for mom and baby to have a few sets of eyes and minds watching as labor progresses and definitely best practice to have two people with skills to resuscitate the infant if needed - hospital or at home.
  4. RootedRedwood

    Cytotec for PP hemorrhage

    Dearest L&D nurses, Just wondering if anyone knows the best route for Cytotec (misoprostol) being used in PP hemorrhage? Our docs/midwives order it given PR, PO, and sublingual/buccal...all in various doses from 200mcg-800mcg. I have mostly read about it being given PR for PP hemorrhage and am wondering if this is supposed to be the fastest-acting/best way to give it? What do your docs/midwives do the most? Is this a provider preference kind of thing or is there some research behind it? Thanks for any input!
  5. RootedRedwood

    Ukiah Valley Medical Center

    Anyone know if this hospital is unionized or not? Couldn't find it anywhere on the web. Thanks.
  6. RootedRedwood

    What's The Weirdest Name You've Heard A Patient Name Her Baby?

    Latest interesting ones: "Rebel" "Jubilee" "Harvest"
  7. RootedRedwood

    Post c/section diet

    We only have two providers who do C/S where I work and they couldn't be more different with the post-op diet orders. We have one provider who writes orders for advance as tolerated- and we usually start with clears for the first "meal" and then if no N&V we move on to full liquid and on and on as tolerated. Some of these patients will do fine on clears and then just go straight to the burger and fries without any problems at all. The other provider (very old-school) writes orders for clears and then requires a BM before the patient can have a regular diet. He helps them along by writing a list of orders for meds (not prns) like dulcolax suppository, colace, and cytotec. Many of this provider's patients end up with the runs after this medication regimen, so usually they get to eat by 24hrs post op. I haven't seen an ileus yet (but i only have 1.5yrs under my belt so far).
  8. RootedRedwood

    Postpartum Nursing Question

    We don't have any NPs (nurse practitioners) working on our unit, which is antepartum/L&D/postpartum all in one. We do have CNMs (certified nurse midwives) though- these are masters prepared RNs trained in midwifery. They are not hospital staff but are part of a private practice who has delivery privileges on our unit. They catch babies and then will follow the mother/babe throughout their hospital stay... but most of the postpartum care actually comes from staff RNs who are prepared at the Bachelors level. The CNMs act similarly to the MDs in the postpartum area- the staff RNs at the bedside do all the assessing and care and call the MDs/CNMs if there are any issues. Otherwise the CNM may only see the mom/babe once more to discharge them. The bulk of work our CNMs do is in their office with prenatal and postpartum check-ups. If your goal is to become a postpartum RN, a masters level education is overkill. Check out the accelerated BSN programs out there (they typically range 1-1.5 years in length) - these are semi-tailored for folks who already have higher education (BS or MS) in other areas of study. Or there is the ADN-RN route through community colleges (typically 2-year programs) which will also prepare you to become a bedside RN. If you know you want to be an advanced practice nurse (CNM or NP) then you might want to go straight in to a direct-entry MSN program. I would do some more research about what kind of nurse you want to be before applying to programs- maybe you could shadow a postpartum RN and CNM for a day to see the differences?
  9. We mostly have one MD who uses the low-dose pit method but she always orders it along with the foley bulb induction method. It doesn't work every time but I have seen it work pretty well on an unfavorable cervix. The pt. doesn't sleep as well through the night though since we are in the room all the time (q 30min) making sure the foley is still pulled tight with traction on the leg.
  10. RootedRedwood

    fentanyl in labor

    We use IV Fentanyl quite frequently for labor pain where I work. Our providers prefer Fentanyl for labor pain relief over other opiates because it decreases the likelihood of having to give the infant naloxone for respiratory depression after delivery. We rarely have issues with respiratory depression in the infant when using Fentanyl because it is shorter-acting than other opiates such as Morphine and Demerol. This is why Morphine and Demerol are only used in early labor at my facility, while Fentanyl can be given during active labor (but not second stage). We try not to give Fentanyl if we think the mother is within 45 minutes of delivering (which is not always easy to know) so as to reduce the possibility of respiratory depression in the infant after delivery. Usually it is ordered by the MDs/CNMs as 50-100mcg IVP every 30-60 minutes. We also have one MD who almost always orders it to be given in a PCA with a basal rate, which has its pros and cons. In my experience administering Fentanyl, the first dose always seems to work the best and last the longest, with decreasing efficacy in subsequent doses. I have had some laboring moms love it because it was enough to keep them from getting an epidural that they didn't want....and others who hardly felt any relief at all and couldn't wait to get an epidural/intrathecal. The most frequent side effect for the mom that I've noticed is dizziness. As for fetal effects, we often see decreased variability of the FHR for a short time after administration. One other side effect, often reported anecdotally by our RNs, is early breastfeeding difficulties with babies exposed to IV Fentanyl during labor. This usually takes the form of a sleepy babe w/ an uncoordinated suck. I would expect that all IV opiates would have a similar effect on alertness and coordination in the newborn.
  11. RootedRedwood

    Staffing Issue

    Yikes. It does sounds like a disaster waiting to happen. I also work in a small rural hospital- we do 500-600 births a year....so maybe that amount makes the difference. We always have two RNs on at all times trained to do labor and work with sick babies. We also do not have any support staff so we do all the non-nursing stuff too. And no in-house anesthesia on pm/noc shift either. I would not be comfortable being on the unit by myself ever. OB is a pregnant-person ER a lot of the time, and you just don't know what (and how many!) is going to walk in your door. And grabbing a nurse from another unit in an emergency doesn't cut it (although they could help). You need someone with solid OB skills to back you up. I don't think having a ton of experience is the issue- if you had a ton of experience you probably wouldn't even consider working at a place that staffs like that because you would be able to easily imagine all the ways it could go wrong wrong wrong. I don't think it would hurt to talk to the manager- I'd like to hear the justification myself! If I were you, I'd look for a job elsewhere.
  12. RootedRedwood

    Question about "Too narrow of bones" with giving birth

    We have women squatting during labor/pushing/birth with some frequency. The providers where I work are very accommodating to what position the woman wishes to give birth in. Both our Midwives and MDs will get down on the ground on their knees with a flashlight (often the labor rooms are dimly lit per request) to help the baby be born. Often though, people are squatting on the actual labor bed which has a detachable squat bar to help with stability.
  13. RootedRedwood

    Question about "Too narrow of bones" with giving birth

    As I understand it, true CPD is quite rare these days whereas it was more common during times of poor nutrition which caused rickets and other pelvic anomalies. CPD is difficult to diagnose but is often implied when the baby's head does not engage or with "failure to progress" during labor. There are so many other factors that could cause "failure to progress" that have little to do with the adequacy of the pelvis, that I believe that CPD is over-diagnosed. Some of these other factors include: fear, inadequate labor/emotional support, positioning during labor (or lack-there-of), and fetal malposition. Just because you have "narrow hips" does not mean that you will necessarily have trouble birthing a baby. I have seen tiny women (5 feet tall, 100lbs) birth 9 1/2lb babies without problems. You just really can't tell by looking at someone from the outside. Things to know about your pelvis: 1.) it is not a fixed structure. During pregnancy and labor your body produces hormones that allow the ligaments that join your pelvic bones to stretch. 2.) the baby's head (the largest diameter to get through your pelvis) is also not a fixed structure. The baby's head is made up of bones that are separate and able to move in relation to each other - which allows the head to "mould" and reduce it's diameter = better fit through the birth canal. 3.) a squatting position during labor and delivery can increase pelvic measurements considerably. 4.) one of the most important factors of whether a labor and birth with be easy or impossible is the baby's position. If the head is flexed (chin tucked) and baby is OA, you may have an easy time. If the baby has a brow presentation or face presentation, it may be rather difficult/impossible to get the baby out in that position. I think it is really important for women to trust in their body's ability to birth babies. Our thoughts, fears, doubts, and desire for control during labor can really have an effect on progress and outcome . The best advice I can give is to trust that your body has its own innate knowledge on how best to birth a baby, and to just let go of all the other stuff :)
  14. RootedRedwood

    Question about "Too narrow of bones" with giving birth

    As others have said here, the measurement tools used to screen for CPD and macrosomia (a big baby) are often fairly inaccurate and most women should at least be given the chance to labor and try for a vaginal birth. Being induced complicates the matter even more. Inductions often fail when the body is not ready to let the baby out (or baby has not moved into a favorable position). Is your friend being induced for a specific medical reason? It is still within the normal range for pregnancy to go to 42 weeks gestation and often primips naturally go over 40 weeks. Most of our providers won't induce for "post-dates" until the completion of the 41st week (evidence based practice), unless there are other medical complications present (preeclampsia, for example). Hopefully your friend's dates are accurate! Sometimes, we have patients who are just sick and tired of being pregnant and beg for an elective induction before 41 completed weeks....in my experience, these tend to be the inductions that have the highest failure rate, especially with primips. If there is no fetal distress or other complications going on during the induction, sometimes our patients who end up with failed inductions are sent home to try and wait for labor to start on its own for a few days....and if labor does not start on its own, they come back in for another try at induction later in the week before going to a c/section. But not all hospitals have providers that truly try to avoid a c/section like where I work. If your friend does not dilate according to plan, her MD may then diagnose CPD and want to section her. If she does have a c-section due to "failure to progress" or CPD, it will be hard to know if her pelvic outlet was truly inadequate. It is always possible that if labor would have started on its own, without induction, she might have been able to have a successful vaginal delivery. We see this all the time in OB. The best evidence of this occurrence are successful VBACs (vaginal birth after cesarean) that had had a c-section for CPD for the first baby. Often these women are able to deliver a larger baby vaginally than their first baby that came by c-section. Of course, there are many other factors at work here affecting the outcome of each delivery, with fetal malposition being yet another common cause of "failure to progress". Best wishes to your friend
  15. RootedRedwood

    What's The Weirdest Name You've Heard A Patient Name Her Baby?

    In the last month, we have had two uniquely named newborns: "Galaxy Puff" and "Zen Revolution"
  16. RootedRedwood

    Funny OB things people say

    Funny one from a few weeks ago that just popped into my mind and made me laugh again: A very nice woman who had been on bed and pelvic rest for the last few weeks came in to r/o pre-term labor again. I remembered her right away from the last time she was my patient because she was one of those special people who just said whatever they were thinking (no filter whatsoever). So the MD ordered a transvaginal ultrasound to check for funneling. So the US tech is now in the room (along with her boyfriend, the MD, and the patient's mother) and I apologize to the patient in advance for any discomfort that she might have from the procedure. The patient then said, "Oh don't worry! Seriously, bring it ON! This will be the most action I've seen in weeks! This no sex thing is killing me!" Somehow we all managed to keep our composure until after we had left the room. I felt kinda sorry for the US tech- how awkward is that! :imbar