jennf83

I am usually good at knowing if a newborn has jaundice of the face, but I'm having a hard time with the body. I'm a home health nurse and now have to use my judgment about drawing bilirubins and I'm not sure when exactly to draw one, anyone have any opinions? If a baby had jaundice down to his belly would you draw one? Is there any tricks either to help with discerning it on the body?? I'm holding the baby in the natural sunlight to help but still having a hard time.

We actually just got a midwife recently that wrote a protocol on nipple stimulation. Of all the inductions I've seen that have used like cervidil/cooks foley balloon, nipple stimulation was enough for them to jump start labor and deliver, no pitocin involved. Just last night we had a delivery that was a post term cervidil induction during the night and then in the morning she started with nipple stim and that was all it took for her! They just did nipple stimulation or breast pumping for so long every 15 minutes. We've had quite the successful stories with that so far!

So even in doubt when you arent sure what kind of decels are going on, or arent sure if you're picking up moms heart rate, its better to turn pit off the same time you are trying position changes? I mean, we were gonna turn the pit off, it wasnt a matter of us not turning it off at all, we just figured we would try a few position changes to see if we could pick it up better to get a true picture. It just happened so fast when we were changing positions that the midwife came in, it was within minutes, and then turned pit off.

Well thats what we thought too, to try position changes first. The docs will get upset if you turn pit off with every decel you see, and we werent even sure if we had a true decel to begin or we were picking up mom until we got the scalp electrode. But my lesson learned with that midwife (she just started working there too), I will just turn the pit off when I see any kind of decel, even earlies, LOL.

Yeah, she did have fluids wide open and a pulse ox on (we always have them on with epi's) and at times it was hard to tell if it was mom or babies. Before all this had happened it was me and another nurse already in the room, so as soon as the other nurses seen what was going on on the monitors in pp, they were back helping pretty rapid. Baby was too close to delivery for an iupc. Fetal scalp electrode wasnt picking up a good reading until towards the end where it started to have longer periods of time where heart rate was in the 60's/70's and only a few seconds of 130's. So what your saying is no matter what, pit should be turned off first instead of trying position changes to see if it improves heart rate?

Yeah, we ended up getting a lot of extra hands, but when it was just me and her, it took both of us to turn her because of her epidural, so in between all of that both of us kinda forgot that she was even on pitocin, prob not the smartest thing, but thankfully she was only at like 4 mu's and ctx were about 3 minutes apart, but still. And honestly, we didnt think it was all that bad because we figured positioning first to see if just a change of position would help baby out. So this all happened prob within not even a couple minutes from the time she deceled to cnm at bedside and pit off.

I am in need of an opinion. I'm sure some people have differnet reasonings/philosophies on this, so I would love to hear it. Pt was on low dose pit, ctx every 3 minutes. After epidural placement (blood pressures fine) baby starts deceling down to 100. Unable to tell what kind really because our monitors werent picking up well, only could go by what we could hear, but they would occassionally pick up hr good. So we flipped her to see if that worked, which it didnt, caused baby to dip down to 90. So we checked her to see if maybe she was ready to push, which she was, baby was literally right there..so we flipped her on her other side again and baby started to drop down to 70's..we were trying to see if it was picking up moms hr becuase our monitors still werent picking up well. We werent sure if it was moms or not because she was runnign around the same pulse. Decided to throw some o2 on her just to be safe and call the midwife to come asap and evaluate. She was there within a minute and put a scalp electrode in and meanwhile said if pit wasnt off (which it wasnt at this time) to get it off. Baby ended up being in the 70's, but eventualy picked up to the 120-130's occasionally. In the end, baby turned out fine, but me and another nurse were to explain the events to the midwife that led up to what happened. So we did and she told us the first thing we should have done was turn off the pit, that we missed that first huge step and could have made things worse than what they were. We didnt think that was really the first thing necessarily to do, we always thought position changes to see if you can get her in a better position, and then if that didnt work to throw on some oxygen and d/c the pit. I understand you need to d/c the pit, but it wasnt like baby was deceling d/t being hyperstimulated. I would love to hear opinions on how you would have handled the situation because I am a new nurse and need some advice, as I have not ran into situations liek this before.

I've seen pitocin used and never cause the baby stress at all, the babies will look perfectly happy (as we call it). Oxygen use is a resuscitative measure. Even if my patient starts having decels, we change positions first, we dont necessarily go for o2 right away because sometimes just changing positions stops the decels.

We only use oxygen when a patient's condition warrants it, regardless if you have pitocin running or not. For example, if a pt is having recurrent late decels we'll give some o2.

We play a lullaby to everytime a baby is born unless we have a mom that lost a baby on our floor or if our fetal loss group is meeting, then we dont play it. Parents seem to really enjoy their baby's lullaby they hear.

Can you explain the variability vs variable deceleration to me, because sometimes what I would think would be a variable, someone said its just variability.

In a previous post, they said not to confuse variability with variable decels, how do you distinguish between them then?

Would you send me this guide? I pm'd you, hopefully it went through.

Hello We had a patient the other day that me and another nurse thought was having late decels. They started out looking like subtle lates and then a few minutes later looked like obvious lates. We questioned the seasoned nurse and she said that since they had good variability that they werent really lates and you didnt have to chart them, that just try changing positions to see if it "fixes them". I always thought a late was a late, no matter if it had good variability or not, but just with minimal to no variability its worse. Any thoughts on this??

Yeah, thats what I thought...or maybe she was 3 cm, I dont remember, I know she was around there!

They started cervidil around 9 pm and she was about 2cm, and then when we checked her in the morning she was 4cm.

Oh. I'll have to look at them more closer next time we check infant warmers. And no, we didnt try ephedrine, never would have thought to try that.

And you can attach an ambu bag to that kind of infant airway? I never took notice.

I had a patient the other night who was a cervidil induction. She was sleeping throughout the night and rang for us in the morning. She had moderate amt of bright red bleeding. In nursing school we were always taught thats s/s of placenta previa, which she did not have according to u/s. What could have caused that to happen? We ended up calling the doc, and he came up and checked her and she expelled an egg size clot. She continued to bleed throughout labor and had PPH, according to her labor nurse. Also, in nursing school they said to never check a lady with bleeding, but the nurses checked her after they looked at the u/s that said where the placenta was. Was that ok to do?

Thanks everyone! And yeah, we were doing interventions for that lady. It all started after she got her epidural, and we tried different positions, oxygen was on, pit d/c, fluids wide open. Our last position tried was her right side and the decels disappeared but baby lost variability and was tachy, so we ended up doing an emergency c-section on her.

Two questions here..I just started a new job in labor and delivery and they were showing me how to check the infant warmers. We were going through all the equipment and came across these little plastic pieces that were infant airways. I was wondering how they are used, noone really explained them to me and during nnrp they never were even brought out. My next question is about decels. Our pt was having decels, I thought they looked like lates, they were occuring after the peak of the ctx, with every contraction. They werent "subtle" like the lates I have seen. My preceptor said they were variables, but to me they didnt really look like the variables I have seen either, so I was wondering if variables can appear as lates or vice versa. They didnt look v-shaped, they kind of looked like a mix between a variable and late, so wasnt sure what it exactly was. Thanks!

Where are you from?

Thanks everyone! So in other words, you dont really want to jump for the narcan right away, you wanna just follow nrp guidelines first?

Quick question for you experienced OB nurses. I have never had to give Narcan to a newborn following birth, but how do you know when you are to do it, I know the "obvious" reason, but how do you know for sure its from mom getting a narcotic close to delivery or something more serious going on in the baby.

Thank you very much!