L&D_RN_OH

Try collaborating with your pharmacy.

Wow! what interesting stories. I have had one pt lose her uterus, due to uterine atony despite meds and massage. We also lost a pt to AFE last February. She coded, then went into DIC and started bleeding out while we tried to resuscitate her. From SROM to maternal death was a little over an hour. I'm amazed we were able to get the baby out. The horrible thing was, we were sending her home for early labor when she stood up and her water broke. If it had happened at home, they both would have died.

Our OB's do them daily, if the consent is signed by the parents. The CNA's on days assist since they are done after morning rounds. I'm thankful I'm not required to assist as I don't think it is a necessary procedure. Even the AAP says it's not routinely recommended.

I don't tell them it is an off label use, but I do tell them it is an ulcer medication that has been found to ripen the cervix, which I guess is telling them of it's off label use in a round about way. I guess I just meant I don't actually say "This is an off label use, and this drug is not meant for induction of labor."

Cytotec is a pill. Cervidil is impregnated on a thick tampon like string. They are both inserted lady partslly, both used to ripen the cervix, and both can cause hyperstimulation.

Were you told that treatment of PTL is an off label use of Brethine? Many drugs have off label uses that they are effective for. No, I don't tell pts it is an off label use, because I think it is a moot point. I do tell pts what they are being induced with and what possible side effects are, and ask them if they have any questions or concerns.

This sounds like my facility. We're had great results with very few cases of hyperstim. In those cases, if you review the strip and the contraction pattern, generally the last dose shouldn't have been inserted. That is a nurse error, not a med error. Like I said, we use it pretty conservatively. If a pt has made cervical change and/or is having contractions >3 in 10minutes, we don't insert another dose.

I read an article awhile back about that. I believe the possible side effects are the same, but it is not always as effective given po.

Is it possible you were checking for protein in the urine, since she was probably on Mag for PIH? Mag sulfate does help prevent eclamptic seizures but it doesn't necessarily control the spread of the disease. Women can go quickly from PIH to preeclampsia, even on Mag. Proteinuria is a symptom.

Definitely! We have a little more freedom on nights.

Moms with positive UDS get a chemical dependency consult and a SS consult. If baby pops up positive, it is referred to CPS. Where it goes from there depends. If mom has a history with CPS, they baby may go into protective custody, or be sent home with a relative (who the mom tends to live with it seems. ) And we do SS consults on our teen moms.

I read all the horror stories about Cytotec too, and was shocked that anyone would keep using it. However, since I've been working as an L&D nurse, I much prefer it to Cervidil. Our cervidil inductions require continous monitoring while Cytotec does not. While it can't be removed after insertion, which seems to be the big argument, it is used very conservatively and in doses moderated by the pharmacy. Our CNM's prefer it to allow their pts freedonm of movement. Personally, I have seen more hyperstim and kids blown out with Cervidil than with Cytotec, and yet, we continue to use that with no one complaining about it. If I had to be induced for a medical reason, I would choose Cytotec. I couldn't stand being strapped to the monitor for 12 hours, plus, many pts c/o alot of cervical tenderness following Cervidil placement. I think if you're planning on working in OB, you will have a hard time finding a facility that does not use it.

I agree with Deb. If Mom has no urge to push, then by all means let her labor down. If however, she feels the pressure and wants to push, and baby is at +2 station or more, than go ahead and encourage her to push. Some docs will insist pts start pushing as soon as they hit 10 cm, even if baby is still fairly high and Mom is not feeling the urge. With these docs, if they haven't checked the pt themselves, then the pt may be 9 cm for awhile.

I occasionally chart on the strip just as a reminder to chart in the computer. We do save our strips, although if they are not labeled and we cannot id them, they get tossed. They are downloaded every morning onto disc anyway.

Rarely use stirrups. Many of our docs don't break the bed down and those that do still don't use the stirrups. We do 100-125 deliverie/month and rarely see a dystocia. I think the last one we had while I was at work was several months ago.

We use it frequently for cervical ripening. Generally, it is placed every 4 hours. Monitored 30min prior to dose, and 2 hours after. We do not give the next dose if the pt is contracting , 5 min apart and/or there is cervical change. Personally, I prefer it because it offers my pts more freedom of movement. Cervidil requires continous EFM, which really impedes sleep, especially with the nurse coming in every time the pt rolls over to adjust the monitors. Even though Cervidil can be pulled, when it causes hyperstim, the damage is already done. Twice I have seen a pt go from 3 to 10 in less than an hour after hyperstiming with Cervidil, and having it pulled. The only time I have seen hyperstim and/or precipitous labors with Cytotec is when a dose really shouldn't have been placed due to the pt's contraction pattern. We use it pretty conservatively. Sometimes, it works on it's own. But many times, the pts do get Pit in the am.

I agree with the others. What is "unstable"? Some of our PP nurses seem to think if a pt is unable to void during their recovery period, they shouldn't be moved. That is definitely not unstable. Pts with high BPs, on Mag won't be moved. But since preeclampsia can occur days, even weeks after delivery, it's something that a PP nurse should know how to deal with. JMO.

That sounds similar to our setup. Although L&D nurses do keep PP pts if our load allows it. But our PP nurses are not crosstrained to L&D, so if L&D is busy, we give up our PP pts to a PP nurse. We also do not AROM or place IUPC's at my facility.

We have 12 LDRPS, and avg 100-150 births/month. Which is an avg of 3-5 deliveries per day right? Of course some days we have 1, and other days we have 8, but...... I'm not sure where we are this month but I can tell you our record date was March 31. 16 births in 24 hours! With 12 LDRP's, we were definitely shuffling pts.

We allow 4 visitors in L&D. We do have visitors who scam the system somehow and have ended up with 7-8 people in a labor room. It can get ugly when trying to explain the visitor policy over and over to people who insist they must be there. We have allowed more than 4 before but have left that up to the physician or CNM. After delivery, pts can have as many visitors as they want. Personally, I have never understood the people who insist on visiting a new mother at 2 am. Normally, visiting hours don't apply on our unit, but we do point them out postpartum to unnecessary visitors.

Don't know where to point you for statistics. At our facility, we were LDRP's when they created the new unit several years ago, then were LDR's. We are now transitioning back to LDRP's. I think it is consumer driven, and would be interested in seeing statistics. I think our pts who stay in the same room for ldrp are much more satisfied, than those who were being shuffled down the hall following delivery.

Have pts complained? Do you have a breastfeeding policy? I have had a problem with one nurse who has fed my breast babies bottles, without a medical indication. Pts have complained, and since it goes against our breastfeeding policy, incident reports have been completed for these instances. Our policy states breastfed babies are to have no supplements unless medically indicated. I think the only way to change the situation, is to have a set policy in place, and advocate for these pts. Because, unfortunately, some pts don't know they can complain.

In Southwest Ohio, new grads start out at a little over $19/hr, plus shift differentials.

This is how open glottis pushing has worked for my pts. I encourage them to grunt or moan lowly while pushing if that helps them. It's hard to hold your breath and grunt. :) For my pts that have little feeling due to an epidural,who may be more quiet than my unmedicated Moms, I encourage them to blow their air out slowly through pursed lips like they are blowing up a ballon. It seems to work great for me. Some pts still hold their breath while pushing just because that is what feels right to them. And that is fine, I just try to remind them to catch their breath before they turn purple.

I understand that people use their own experiences to make generalizations about situations. I'm sorry that the nurses at your delivery made assumptions about your ability to push. I was merely pointing out that I don't assume anything and I am sure many other L&D nurses do not either, but rather, listen to their pts and their needs. You said "I hear everybody saying...." I just think that was a misinterpretation. For instance, my pt last night, told me, "I feel like a have to take a crap". I did not assume because she had an epidural that she was unable to feel that or when she needed to push.